Rural Aging Study (Geisinger)

Goals / Objectives
1: Continue to validate the recently developed Diet Quality Screening Questionnaire (DQSQ) in relation to longitudinal health outcomes and mortality among the 4,009 remaining participants. 1A: Test criterion validity: a. Ascertain whether low DQSQ scores place persons of advanced age at risk for adverse health outcomes. b. Ascertain whether low DQSQ scores place persons of advanced age at risk for increased mortality. 2: Conduct comprehensive dietary assessments of a representative subset of 200 community-dwelling participants from the cohort to include 24 hour dietary recalls, food security, DQSQ, functional limitations, and quality of life measures. 2A: Extend criterion validity testing of the DQSQ in a sample of very advanced age by contrasting the associations of dietary patterns, HEI, and DQSQ, with the health and life quality outcomes of interest with those from the original dataset of the younger sample that was evaluated in 2004 with the same comprehensive assessment and that was used to originally develop and validate the DQSQ.

Project Methods
The Geisinger Rural Aging Study (GRAS) was initiated from 1994 to 1999 as a longitudinal study of health outcomes in relation to nutritional status among 21,645 community-dwelling older persons. Participants have been rescreened at 3-4 year intervals with a battery of questionnaires that encompass multiple domains of nutrition risk. The remaining GRAS cohort now has 4,009 respondents with a mean age of 81 years. Recent follow up investigations reveal that unhealthy dietary patterns are significantly associated with high blood pressure and that among women such patterns significantly increase their odds of experiencing weight loss. Results from additional testing of our Diet Quality Screening Questionnaire (DQSQ) indicate that lower scores are significantly associated with low body mass index (BMI). Those with higher, more favorable DQSQ scores were significantly more likely to be food sufficient, report eating breakfast, have no chewing difficulties, and report no decline in intake in the previous 6-months. Health and Activity Limitation Index (HALex) scores were significantly lower for subjects with DQSQ scores categorized as unhealthy or borderline compared with healthy scores. HALex scores were also significant lower for those with low BMI and for those with severe obesity. Our findings suggest that the DQSQ is able to identify potential targets for improving diet quality that may positively influence health-related outcomes and quality of life. Key knowledge gaps remain, especially in our understanding of those =80 years of age. Dietary patterns and diet quality are poorly characterized, the longitudinal relationships between diet, nutrient intake, and health outcomes are largely unknown, and the relationships between overweight and obesity, and health outcomes are poorly understood. Further investigation of this aging cohort will afford unique opportunities that strongly align with National Program Action Plan priorities focused on life stage nutrition to capture longitudinal data on persons of advanced age in the context of diet, nutrient intake, and health outcomes. Our proposed first objective includes continued testing of the DQSQ in relation to longitudinal health outcomes, healthcare resource use among remaining GRAS participants, and mortality. A sub-objective is to ascertain whether low DQSQ scores place persons of advanced age at risk for adverse health outcomes and mortality. We will also conduct comprehensive dietary assessments of a representative subset of 200 community-dwelling participants who are =80 years of age to include 24 hour dietary recalls, food security, DQSQ, functional limitations, and quality of life measures. The primary anticipated product is further testing and dissemination of the innovative DQSQ instrument for assessment of diet quality among older persons. Our research seeks to provide new knowledge to inform evidence-based recommendations for improved health and life quality of aging persons.