Perceived Supports and Barriers to Optimal Nutrition and Physical Activity in a Cohort of Vermont Older Adults: A Convergent Parallel Mixed-Methods Study

Abstract

The purpose of this study was to identify supports and barriers that impacted nutrition status and physical activity in Vermont’s older adults before and during the COVID-19 pandemic. Using a convergent parallel mixed-methods design guided by the socio-ecological model, older Vermonters participated in surveys and focus groups. Quantitative and qualitative strands were analyzed separately and merged during final analysis. Data from 52 participants (70 years + 6.2; 75% female) indicate 31% at risk for falls and malnutrition and 14% food insecure. Thematic analysis revealed Vermont has many food programs, but getting information to those in need is a barrier. Vermont’s rurality supported older adults’ ability to stay active before and during the COVID-19 lockdown; however, they are eager for additional opportunities to be active in their communities. Findings highlight the need to connect older adults with local resources and empower them to advocate for their communities.

Keywords

nutrition physical activity falls community-dwelling COVID-19

Get full access to this article

View all access options for this article.

References

Averill

J. B.

(2012). Priorities for action in a rural older adults study. Family & Community Health, 35(4), 358–372. https://doi.org/10.1097/FCH.0b013e318266686e

Brady

P. J.

Askelson

N. M.

Thompson

Kersten

Hopkins

Ashida

Nothwehr

Janssen

Frisvold

(2023). A qualitative study of factors influencing food choices and food sources among adults aged 50 years and older during the coronavirus disease 2019 pandemic. Journal of the Academy of Nutrition and Dietetics, 123(4), 602.e605–613.e605. https://doi.org/10.1016/j.jand.2022.08.131

Brim

Fromhold

Blaney

(2021). Older adults’ self-reported barriers to aging in place. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 40(12), 1678–1686. https://doi.org/10.1177/0733464820988800

Capalb

D. J.

O’Halloran

Liamputtong

(2014). Why older people engage in physical activity: An exploratory study of participants in a community-based walking program. Australian Journal of Primary Health, 20(1), 74–78. https://doi.org/10.1071/PY12090

Centers for Disease Control and Prevention . (2020a, January 28, 2020). The social-ecological model: A framework for prevention. https://www.cdc.gov/violenceprevention/publichealthissue/social-ecologicalmodel.html

Centers for Disease Control and Prevention . (2020b, October 16, 2020). Steadi - older adult fall prevention. https://www.cdc.gov/steadi/index.html

Chen

Huang

Jiang

Yao

Huang

Xiao

Zhao

(2024). Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis. International Journal of Nursing Sciences, 11(1), 18–30. https://doi.org/10.1016/j.ijnss.2023.12.007

Choi

Y. J.

(2020). Age-friendly features in home and community and the self-reported health and functional limitation of older adults: The role of supportive environments. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 97(4), 471–485. https://doi.org/10.1007/s11524-020-00462-6

Clark

V. L. P.

Creswell

J. W.

Green

D. O. N.

Shope

R. J.

(2008). Mixing quantitative and qualitative approaches. In Handbook of emergent methods (Vol. 363, pp. 363–387). Routledge.

10.

De La Cámara

M. Á.

Jiménez-Fuente

Pardos

A. I.

(2020). Falls in older adults: The new pandemic in the post COVID-19 era? Medical Hypotheses, 145, 110321. https://doi.org/10.1016/j.mehy.2020.110321

11.

Department of Disabilities Aging and Independent Living . (2021). Vermont senior centers: Supporting social connectedness through food, friends and fostering opportunity. https://asd.vermont.gov/services/vermont-senior-centers

12.

Eckert

Gell

N. M.

Wingood

Schollmeyer

Tarleton

E. K.

(2021). Malnutrition risk, rurality, and falls among community-dwelling older adults. The Journal of Nutrition, Health & Aging, 25(5), 624–627. https://doi.org/10.1007/s12603-021-1592-8

13.

Eckert

C. D.

Tarleton

E. K.

Pellerin

Mooney

Gell

N. M.

(2022). Nutrition risk is associated with falls risk in an observational study of community-dwelling, rural, older adults. Journal of Aging and Health, 34(6–8), 1125–1134. https://doi.org/10.1177/08982643221096944

14.

Ellis

Jung

S. E.

Palmer

Shahan

(2022). Individual and interpersonal factors affecting dietary intake of community-dwelling older adults during the COVID-19 pandemic. Public Health Nutrition, 25(6), 1667–1677. https://doi.org/10.1017/S1368980022000696

15.

Food Research & Action Center . (2023, September 2023). Hunger cliff 2023 state fact sheets. https://frac.org/research/resource-library/snap-hunger-cliff-state-fact-sheets

16.

Front Porch Forum . (2023). Helping neighbors connect. https://frontporchforum.com/

17.

Goodyear

Barela

Jewiss

Usinger

(2014). Qualitative inquiry in evaluation: From theory to practice (Vol. 29). John Wiley & Sons.

18.

Goveas

J. S.

Ray

R. M.

Woods

N. F.

Manson

J. E.

Kroenke

C. H.

Michael

Y. L.

Shadyab

A. H.

Meliker

J. R.

Chen

J. C.

Mouton

Saquib

Weitlauf

Wactawski-Wende

Naughton

Shumaker

Anderson

G. L.

Johnson

(2022). Associations between changes in loneliness and social connections, and mental health during the COVID-19 pandemic: The Women’s Health Initiative. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 77(Supplement_1), S31–S41. https://doi.org/10.1093/gerona/glab371

19.

Gundersen

Engelhard

E. E.

Crumbaugh

A. S.

Seligman

H. K.

(2017). Brief assessment of food insecurity accurately identifies high-risk US adults. Public Health Nutrition, 20(8), 1367–1371. https://doi.org/10.1017/S1368980017000180

20.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010

21.

Johnson

A. N.

Clockston

R. L. M.

Fremling

Clark

Lundeberg

Mueller

Graham

D. J.

(2022). Changes in adults’ eating behaviors during the initial months of the COVID-19 pandemic: A narrative review. Journal of the Academy of Nutrition and Dietetics, 123(1), 144–194. https://doi.org/10.1016/j.jand.2022.08.132

22.

Larson

Alexander

Slaughter-Acey

J. C.

Berge

Widome

Neumark-Sztainer

(2021). Barriers to accessing healthy food and food assistance during the COVID-19 pandemic and racial justice uprisings: A mixed-methods investigation of emerging adults’ experiences. Journal of the Academy of Nutrition and Dietetics, 121(9), 1679–1694. https://doi.org/10.1016/j.jand.2021.05.018

23.

LoBuono

D. L.

Milovich

(2023). A scoping review of nutrition health for older adults: Does technology help? Nutrients, 15(20), 4402. https://doi.org/10.3390/nu15204402. https://www.mdpi.com/2072-6643/15/20/4402

24.

Machón Sobrado

Mateo-Abad

Vrotsou

Vergara

(2021). Health status and lifestyle habits of vulnerable, community-dwelling older people during the COVID-19 lockdown. The Journal of Frailty & Aging, 10(3), 286–289. https://doi.org/10.14283/jfa.2021.12

25.

Menec

V. H.

Nowicki

(2014). Examining the relationship between communities’ ‘age-friendliness’ and life satisfaction and self-perceived health in rural Manitoba, Canada. Rural and Remote Health, 14(1), 159–172. https://doi.org/10.22605/rrh2594

26.

Morrison

J. M.

Laur

C. V.

Keller

H. H.

(2019). Screen III: Working towards a condensed screening tool to detect nutrition risk in community-dwelling older adults using CLSA data. European Journal of Clinical Nutrition, 73(9), 1260–1269. https://doi.org/10.1038/s41430-019-0411-3

27.

National Council on Aging . (2020, December, 2020). The impact of COVID-19 on community-based organizations serving older adults. https://d2mkcg26uvg1cz.cloudfront.net/wp-content/uploads/2020-C19-DG22_CBO-COVID-Survey_April-July-October_11-17.pdf

28.

Ory

M. G.

Towne

S. D.

Won

Forjuoh

S. N.

Lee

(2016). Social and environmental predictors of walking among older adults. BMC Geriatrics, 16(1), 155. https://doi.org/10.1186/s12877-016-0327-x

29.

Patton

M. Q.

(2014). Qualitative research & evaluation methods: Integrating theory and practice. Sage Publications.

30.

Payán

D. D.

Rios

L. K. D.

Ramírez

A. S.

Young

M.-E. D. T.

(2021). Structural barriers influencing food insecurity, malnutrition, and health among Latinas during and after COVID-19: Considerations and recommendations. Journal of the Academy of Nutrition and Dietetics, 121(5), 837–843. https://doi.org/10.1016/j.jand.2021.01.005

31.

Roberts

A. W.

Ogunwole

S. U.

Blakeslee

Rabe

M. A.

(2018). The population 65 years and older in the United States: 2016. US Department of Commerce, Economics and Statistics Administration, US.

32.

Shieh

J. A.

Leddy

A. M.

Whittle

H. J.

Ofotokun

Adimora

A. A.

Tien

P. C.

Weiser

S. D.

(2021). Perceived neighborhood-level drivers of food insecurity among aging women in the United States: A qualitative study. Journal of the Academy of Nutrition and Dietetics, 121(5), 844–853. https://doi.org/10.1016/j.jand.2020.12.019

33.

Smith

A. S.

Trevelyan

(2019). The older population in rural America: 2012–2016. In American community survey reports. US Census Bureau.

34.

SocioCultural Research Consultants . (2024). Dedoose version 9.2.5. https://www.dedoose.com/

35.

Stevens

J. A.

Phelan

E. A.

(2013). Development of STEADI: A fall prevention resource for health care providers. Health Promotion Practice, 14(5), 706–714. https://doi.org/10.1177/1524839912463576

36.

Tilley

(2017). Opportunities to improve nutrition for older adults and reduce risk of poor health outcomes. Administration for Community Living, Center for Policy and Evaluation.

37.

United States Census Bureau . (2022). Quick facts. https://www.census.gov/quickfacts/

38.

United States Department of Agriculture Economic Research Service . (2020, August 17, 2020). Rural-urban commuting area codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/

39.

U.S. Department of Health and Human Services Administration for Community Living . (2018). Older American act performance system. https://oaaps.acl.gov/about

40.

Vermont Agency of Human Services . (2022). Vermont state plan on aging FFY 2023-2026. https://asd.vermont.gov/sites/asd/files/documents/Vermont_State_Plan_On_Aging_REVISED_2023_2026.pdf