EXPLORING CHALLENGES AND STRATEGIES RELATED TO PLANT-BASED DIETARY PATTERNS IN COMMUNITY-DWELLING OLDER ADULTS WITH HYPERTENSION

Abstract

Some of the most pressing global crises faced by society are the rise in chronic diseases and climate change. Plant-based diets (PBDs) have become an important part of the sustainability discussion affecting all four 4 domains: nutrition and health, environment, economics, and society. Due to this, it has been offered as one possible solution to the burden of noncommunicable diseases, environmental concerns, and potential economic stressors. Additionally, the growing older adult population presents further challenges. Although research on PBDs and health has grown in recent decades, studies on older adults, particularly those with chronic conditions, remain scarce despite the potential impact. Broadly, this research focuses on PBDs in hypertensive older adults as a substudy under the Dietary Approaches to Stop Hypertension-Plus (DASH-Plus) initiative. The DASH-Plus was developed in partnership with the University of Maryland Extension (UME) system and is a community-based program to help hypertensive, community-dwelling, older adults manage their blood pressure (BP). Using a quasi-experimental design, eight intervention senior centers and eight corresponding control sites were recruited in Maryland and participated in the study. Data was collected at three time points: baseline (week 0), intermediate (week 9), and final (week 24) at participating sites. A total of 212 participants were enrolled in the study.

First, baseline data from the DASH-Plus study was used to examine psychosocial factors and demographic characteristics associated with a healthy PBD consumption among hypertensive older adults (≥60 y), and factors that potentially influence the likelihood of adopting a plant-based dietary pattern in the future were identified. This was followed by assessing readiness to consume a PBD. Using longitudinal data collected at three time points, we evaluated the DASH-Plus program’s impact on participants’ readiness levels and associated psychosocial factors. We focused particularly on perceived barriers and benefits, as these factors serve as critical variables affecting an individual’s decisional balance within the Transtheoretical model (TTM) and represent key constructs in the Health Belief Model (HBM) when discussing dietary behavior changes. In addition, specific perceived benefits and barriers pertaining to this population were identified. Finally, the changes in consumption of healthy plant-based foods were evaluated to assess the effectiveness of the DASH-Plus program in shifting older adults toward a healthy PBD.

Through these investigations, our cross-sectional analysis of baseline data revealed that older adults who lived with family members (spouse/partner and/or children), were in a higher stage of change (action/maintenance stages) to consume a PBD, had fewer perceived barriers, maintained better hypertensive, self-care practices (medication adherence, low-salt diet, physical activity, and smoking), and had fewer chronic conditions were more likely to consume a PBD. When readiness to consume a PBD was more closely examined to understand behavior changes resulting from the DASH-Plus program, perceived barriers and perceived benefits to consuming a PBD were found to be key determinants. The DASH-Plus program effectively elevated PBD readiness at 9 weeks, but these effects diminished at 24 weeks. Similarly, when changes in PBD intake were examined, there were significant increases in plant-based food consumption at 9 weeks, but these were also not sustained at 24 weeks. Increased self-care, higher education levels, lower number of medical conditions, and less PBD barriers were found to be key predictors influencing PBD consumption.

While the DASH-Plus program effectively increased both PBD readiness and consumption in the short term, these effects declined by the 24-week follow-up. The intervention demonstrated the potential to influence dietary shifts toward more plant-based eating patterns among older adults; however, these findings underscore the need for further research to explore strategies for maintaining these changes over the long term. Possible strategies could involve increasing the duration of the intervention, the frequency of sessions, total didactic hours, adding booster sessions, and other supportive measures. Future studies should also consider targeting key factors related to PBD adoption, including reducing perceived barriers, providing education tailored to various educational levels, and offering additional social support for older adults living alone or with non-family members. These approaches may help older adults with chronic diseases successfully incorporate more healthy plant-based foods into their diets.