Background: Food insecurity (FI), the unpredictable availability of nutritionally balanced food to maintain health, is a growing public health issue. This study aims to elicit perspectives of older adults at risk for FI and evaluate the potential impact of a fresh food Rx (FFRx) program.

Methods: Five focus groups (n=26) were conducted in February-March, 2020, with Hispanic, Spanish-speaking and African-American, English-speaking older adults. Existing fresh food infrastructure, relevant nutritional support programs, facilitators and barriers to accessing and cooking healthy food, and perceptions of a FFRx program were evaluated. Focus groups were recorded and transcribed with a thematic analysis performed by a professional qualitative research team, using Atlas.ti version 8.4 to inductively identify emerging themes.

Results: Four themes emerged: 1) Factors that influenced food access; 2) factors affecting cooking behavior: time constraints, participants’ level of enjoyment with cooking, familiarity with produce preparation, and cultural and communal role of cooking and eating; 3) factors affecting healthy eating patterns: food likeability, knowledge of sustainable diets, support for behavior change, and recognition of cultural dietary patterns; and 4) feedback on FFRx, including produce boxes and cooking classes, was positive. Participants preferred local, farm-fresh food and were interested in learning ways to prepare vegetables. Concerns about the stigma of receiving community aid and previous low participation in health coaching programs were voiced.

Conclusions: Overall, participants were interested in receiving and learning about healthy foods and ways to prepare them. A FFRx program that includes the distribution of produce and healthy lifestyle education would meet this interest. Social, cultural, and financial barriers to healthy eating may not be immediately resolved, but these barriers can be addressed over time with consistent, sustainable programs.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Purpose: The primary aim of this study was to assess NPs’ ability to identify depression as a risk factor for cardiovascular disease (CVD) and CVD as a risk factor for depression in older adults.

Rationale: Heart disease is the leading cause of death for those aged 65 and older, and NPs routinely incorporate CVD risk reduction into patient care. A large body of evidence supports depression, prevalent in older adults, as a significant and independent risk factor for, as well as a comorbidity of, CVD.

Supporting literature: Numerous studies support the association between depression in seemingly healthy individuals and future development of CVD. Depression can also exacerbate classic CVD risk factors (e.g., smoking). A meta-analysis of studies of older adults identified depression as an independent risk factor for the onset of CVD and concluded clinically diagnosed MDD to be the most important risk factor for developing CVD. Effective treatment of depression reduces disability, improves outcomes, and quality of life. Yet, older adults are less likely to be diagnosed or receive help for depression compared to younger adults.

Methods: NPs recruited from the AANP membership developed a risk profile using a standardized checklist of potential health risks after reviewing a series of four older adult vignettes.

Results: A national sample of practicing NPs participated (N=111). Risk for CVD in the presence of diagnosed MDD or depression symptoms (DS) was identified by 60-66% of subjects. Risk for depression in the presence of diagnosed CVD was identified among 56-62%. Suicide risk in the presence of MDD or DS was identified by 39-56%.

Implications: Rooted in the biopsychosocial model, NPs are well-suited to integrate physical and mental health in care. Many, however, do not recognize the bi-directional risk of depression and CVD, potentially missing valuable opportunities to implement screening and preventive services to reduce risk, promote early identification, diagnosis, and management in an overall effort to reduce disability, improve outcomes, and quality of life.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

The purpose of this study was to perform a secondary data analysis by applying a researcher-derived frailty index to hospitalized patients with clostridium difficile (CDI) ages 55 and older with an aim of investigating frailty index score and prediction of in-hospital mortality and re-admission for non-related CDI occurrences within one year of initial presentation.

Hospitalized frail older adults are at increased risk for mortality and acuity of care (Hatheway et al., 2017). The frailty index for CDI (FI-CDI) allows frailty recognition for interventions. Guided by the accumulation of deficits approach (Rockwood and Mitniski, 2011), the FI-CDI was created per standard guidelines (Searle et al., 2008). All admissions (24 hours or greater) were included for patients 55 and older hospitalized with CDI, indicated by ICD-9 and 10 codes.

The FI-CDI estimated frailty for adults ≥ 55 years hospitalized for CDI between December 2013 through December 2015. FI-CDI variables included laboratory abnormalities, diseases, functional status, and psychosocial indicators. Binary form was used to code deficits, with “1” identifying deficit presence and “0” identifying deficit absence. The FI-CDI was calculated by dividing number of deficits present in an individual by total number of deficits measured (39), with frailty defined as ≥ 0.25. The FI-CDI was applied to 454 patients who had complete admission data for the 39 deficits.

The average age of the 871 study patients with CDI was 73.6 years (SD=10.7) and 59% were female with 70% white. The average frailty score of 0.42 (SD=0.11), where prevalence (those with a score ≥ 0.25) of frailty on admission was 92.1% of the CDI patients. Preliminary modeling shows that FI-CDI 39 frailty scores were significantly higher in those with first CDI admission in-hospital mortality (M = 0.412 alive vs. M = 0.462 died; p = 0.018), but not significantly higher in those with non-CDI readmission within 1 year (M = 0.438 with readmission vs. M = 0.415 not readmitted; p = 0.331).

Timely frailty assessment to decrease mortality risk is imperative in older adults with CDI. Clinical data from the FI-CDI leads to targeted, multidisciplinary approaches with goal of decreasing morbidity and mortality risk.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.