Using GIS to predictively model the risk for undernutrition among the elderly in southeast Minnesota

Alan ArmstrongRA536 – Advanced Research/GrantwritingSaint Mary’s University, MinneapolisSpring Term 2014

The research question

How can GIS be used to assess the risk for

undernutrition among senior citizens in

southeast Minnesota?

How malnutrition begins

• The causes of malnutrition might seem straightforward: too little food or a diet lacking in nutrients. In reality, though, malnutrition is often caused by a combination of physical, social and psychological issues.• Health concerns such as chronic illness, use of

certain medications, difficulty swallowing or absorbing nutrients, or trouble chewing due to dental issues. In other cases, a diminished sense of taste or smell decreases appetite. Dementia also can contribute to malnutrition.

How malnutrition begins

• Limited income. Some older adults might have trouble affording groceries, especially if they're taking expensive medications.

• Restricted diets. Dietary restrictions — such as limits on salt, fat, protein or sugar — can help manage certain medical conditions, but might also contribute to inadequate eating.

How malnutrition begins

• Reduced social contact. Older adults who eat alone might not enjoy meals, causing them to lose interest in cooking and eating.

• Depression. Grief, loneliness, failing health, lack of mobility and other factors might contribute to depression — causing loss of appetite.

• Alcoholism. Too much alcohol can interfere with the digestion and absorption of various nutrients. In addition, nutrients are lacking if alcohol is substituted for meals.

How to spot malnutrition

• Observe your loved one's eating habits. Spend time with your loved one during meals at home, not just on special occasions. If your loved one lives alone, find out who buys his or her food. If your loved one is in a hospital or long term care facility, visit during mealtimes.

• Watch for weight loss. Help your loved one monitor his or her weight at home. You might also watch for other signs of weight loss, such as changes in how clothing fits.

How to spot malnutrition

• Be alert to other red flags. In addition to weight loss, malnutrition can cause poor wound healing, easy bruising and dental difficulties.

• Know your loved one's medications. Many drugs affect appetite, digestion and nutrient absorption.

What you can do about malnutrition• Engage doctors to identify — and address — any contributing

factors. This might include changing medications that affect appetite, suspending any diet restrictions until your loved one is eating more effectively, and working with a dentist to treat oral pain or chewing problems. Request screenings for nutrition problems during routine office visits, and ask about nutritional supplements. You might also ask for a referral to a registered dietitian.

• Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, fresh fruits, and raw vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets. Add cheese to sandwiches, vegetables, soups, rice and noodles.

What you can do about malnutrition• Make meals social events. Drop by during mealtime or invite

your loved one to your home for occasional meals. Encourage your loved one to join programs where he or she can eat with others.

• Encourage regular physical activity. Daily exercise — even if it's light — can stimulate appetite and strengthen bones and muscles.

• Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes.

• Plan between-meal snacks. A piece of fruit or cheese, a spoonful of peanut butter, or a fruit smoothie can provide nutrients and calories.

What you can do about malnutrition• Provide food-savings tips. If your loved one shops for

groceries, encourage him or her to take a shopping list to the grocery store, check store fliers for sales and choose less expensive generic brands. Suggest splitting the cost of bulk goods or meals with a friend or neighbor, or frequenting restaurants that offer discounts for older adults.

• Consider outside help. If necessary, hire a home health aide to shop for groceries or prepare meals. Also consider Meals On Wheels and other community services, including home visits from nurses and registered dietitians.

Impact of malnutrition

Studies have shown that older adults at nutritional risk tend to make more visits to physicians, hospitals and emergency rooms. Malnourished patients have hospital stays nearly twice as long as those of well-nourished patients, and costs of their stays are $2,000 to $10,000 higher. Malnourished older patients are readmitted to hospitals more frequently than those who are well-nourished.

National Resource Center on Nutrition, Physical Activity & Aging

Semcac Senior Dining

http://www.semcac.org/services/senior-services/senior-dining/

Meals On Wheels

http://www.semcac.org/services/senior-services/meals-on-wheels/

Specifics addressed via these programsCauses/factors• Restricted diets• Limited income• Reduced social

contact• Depression (esp.

due to loneliness)

Solutions/tips• Eat foods packed with

nutrients• Restore life to bland food• Make meals social events• Provide food-savings tips• Consider outside help

Scope of analysis

• Eleven counties in southeast Minnesota under authority of the Southeastern Minnesota Area Agency on Aging:• Dodge, Fillmore, Freeborn, Goodhue, Houston,

Mower, Olmsted, Rice, Steele, Wabasha and Winona.

• Senior nutrition dining sites coordinated by Semcac.• Meals on Wheels in 8 of the

counties coordinated by Semcac.

Data Needed

• Basic analysis can be performed using US Census Bureau data.• Broken down by voting precinct – can generally

differentiate those living in cities/towns from those in country.• Age, gender, living status and economic

information.

Data Needed

• Additional data from Southeastern Minnesota Area Agency on Aging and/or Semcac.• Requires establishing a relationship.• Client data would need to be kept in strictest

confidence.• No names, specific addresses, SSNs, or other

personal data.• Might include some medical/health

information.• Could generate much more detailed analysis

Expected deliverables

• Projections to help Agency on Aging and Semcac better prepare for the increasing number of senior citizens expected.• Proactively adjust budgets, shift staffing, or reassign resources.• Provide additional justification for increased funding requests.

• Streamlined route maps for meals on wheels.

• A model that can be easily adapted for use by other Agencies on Aging or Community Action Agencies.

Problems to anticipate

• Agency on aging may not be willing to share client data.• Data may not be in a useful or convenient

format.• Without the additional Agency data, analysis

could be very thin. Alternate layers or data elements may be needed.

Ethical concerns

• Any outside data acquired needs to be scrubbed to ensure no personal information can be extracted.• Results are based on projections and models

with no guarantees or assurances.• Risk factors do not directly equate to incidence.