Dietary behavior of home-living older adults: the role of environmental factors

Abstract

While many home-living older adults seem to consume a nutritionally adequate diet, the prevalence of malnutrition in older people living at home remains high and frequently overlooked. Malnutrition in older adults has been recognized as a challenging health concern associated with a decline in health, reduced physical and cognitive function, increased utilization of health services, slower recovery times, premature institutionalization, and increased mortality. The problems that exist in relation to malnutrition, coupled with the increased proportion of older adults in the population, will affect not only the older adults themselves but also has serious implications on health services, public finances, and welfare systems. In response to these growing concerns, effort should be made to help older adults maintain their health. Research evidence increasingly supports the idea that an adequately nutritious sound diet is essential to the health of older adults. It is thus important to understand the dietary behavior of home-living older adults, particularly what factors impact this behavior. The recognition of the importance of understanding dietary behavior has sparked interest in research about these factors. That said, it often focuses solely on the individual-level determinants. Research focusing on environmental determinants of dietary behavior, on the other hand, is growing, but much still remains to be explored. For this reason, this dissertation centered on the environmental determinants of dietary behavior. The main objective of this dissertation is to deepen our understanding of home-living older adults' dietary behavior and advance the current state-of-art literature in this field. This objective is achieved by means of three small interrelated studies. Before proceeding with the studies, I would like to point out the rationale behind them. Many empirical studies in dietary behavior research use in-depth individual interviews as the data collection method. Despite the benefits of in-depth individual interviews as a data collection method, using a single data source to investigate a complex dietary behavior is perhaps insufficient. Additionally, it can result in mono-method bias. To create a good foundation for the studies and improve the overall validity of the findings, I first draw my attention to the data collection method (study 1) before focusing on identifying the environmental factors that impact dietary behavior (study 2). In terms of study 3, the second study's findings guided this study. The paragraphs below describe the three studies. The first study explored the suitability of data collection methods for use with home-living older adults in the context of food choice. The second study investigates environmental factors determining home-living older adults' eating behavior. The third study examines the role of situational factors and the extent to which they lead to the adoption of online grocery shopping. The result of the first study shows that the dyadic interview is a viable method for collecting data from older adults when an alternative interview method is needed. It also indicated that both interview methods generated complementary information. Moreover, using multiple methods has provided greater insights and perspectives about the topic. The findings of study two suggest that a social environment can help encourage healthy eating among home-living older adults. Additionally, participation in a senior center, ensuring access to food (grocery shopping), transportation and mobility aids can support home-living older adults in maintaining their diet and health. The third study found that a combination of poor health, loss of mobility, and distance to the grocery store can create a complex process that hinders older adults' endeavors to obtain healthy food. While some older adults have already adopted online grocery shopping as part of their routines, others are open to the idea as a coping strategy, but some are still hesitant. Taken together, this dissertation contributes to unique insights into data collection methods for use with older adults when exploring food choice, deepens the knowledge of environmental factors associated with eating behavior, and enriches the understanding of situational factors that lead older adults to buy groceries online. The findings carry implications for methodology, theory, and practice within dietary behavior research of home-living older adults.