Undernutrition in the elderly has emerged as a problem of unknown proportions and complex etiology. Estimates of prevalence range from 10% to 50%, depending on the sample and diagnostic criteria. The proposed research will draw on the frameworks of the proximate determinants of nutrition and self-management of nutrition to help clarify the causes and experience of undernutrition in community-dwelling rural elderly in three major ethnic groups. The study will focus on African, European, and Native Americans 70 years and older in two rural North Carolina counties. It will use an ethnographic approach with predominantly qualitative methods. Phase 1 will be designed to understand community leaders' knowledge and perception of barriers to adequate nutrition among the elderly and structural features of the communities that limit elders' access to adequate nutrition. Data will be collected through observation, review of existing documents, and key informant interviews. Phase 2 will document the range of variation in nutritional self-management strategies among elders. In-depth interviews will be conducted with a total of 216 elders (36 in each gender/ethnic cell) over 21 months. Up to 4 interviews will be conducted with each elder. Elders will vary in nutritional status, as defined by body mass index and involuntary weight loss of 5% or more in the previous 12 months. The goals of this phase will be (1) to identify the interaction of cultural, social, psychological, biological and ecological factors that influence the development and outcome of undernutrition; (2) to explore the elder's interpretation of and meaning attached to their nutrition and health status; and (3) to examine variation in nutritional self-management strategies by gender and ethnicity. By combining both community and individual perspectives, this research will contribute to understanding who among the elderly is undernourished and how some elders maintain adequate nutritional status and others do not.
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