Capstone Spring 2010

1. Capstone Spring 2010 Leeron Franco

2. Elderly Obesity An interdisciplinary-based plan approach

3. Problem Statement How can the roles retirement facilities play in the obesity of their residents be changed for the better?

4. Relevant Disciplines • Biology: The science of life or living matter in all its forms and phenomena, especially with reference to origin, growth, reproduction, structure, and behavior. • Economics: The study of market forces and their effects on human behavior. • Sociology: The study of society and societal interactions. • Religion: A specific fundamental set of beliefs and practices generally agreed upon by a number of persons/sects.

5. What roles do retirement facilities play in the obesity of their residents? Relevant Disciplines:

7. Justification of Interdisciplinary Approach Elderly obesity in long-term care facilities is a complex question that can only be resolved through an interdisciplinary approach, research, and collaboration. In order to understand this phenomena, I began by identifying the main causes of obesity in the elderly, including social, religious, biological, and sociological factors. I believe that retirement facilities play a significant role in the obesity of the elderly and feel that with the use of an interdisciplinary approach, this would expose these factors contributing to it. Retirement facilities have such a great impact on the eating habits of the elderly. For example, many facilities chose to serve the cheapest food because they are catering to such a large group of people. Elderly people already face enough challenges with less mobility and the feeling of their bodies shutting down. The food that these facilities choose to serve to their residents, is most likely the only food they eat throughout the day. At this point, many of the residents don’t drive, so they spend most of their time in these long-term care facilities. Along with bad eating habits, long-term care don’t always cater to the physical needs of the elderly. At this point in their lives, the elderly try to do whatever they can to elongate their lives as much as possible. By looking at this problem from the interdisciplinary perspective, taking into account the social, economic, biological, and religious influences on elderly eating, I feel able to add new dimension to this area of study. Elderly obesity can only be resolved when all of these factors come together to resolve this social dilemma.

8. Analysis:The Problem With Elderly Obesity Elderly obesity in retirement facilities has become a wide-spread societal problem, affected by economic, biological, economical, and religious factors. Research has shown that genetics play a significant role in a person’s weight throughout their entire life. Geneticists have come up with a theory stating one specific gene can predispose a person to being obese due to its effect on their metabolic components. Economics plays a role in what food is being served in these facilities. Facilities try to find the cheapest food to buy to serve such large amounts of people. Being that pasta is very cheap and easy to prepare makes it a prime candidate for most of the dishes being served. Consuming such high amounts of carbohydrates and not burning off the calories greatly affects the health of the elderly. Social research has shown that elderly living in these types of facilities are more prone to infection and obesity. Long-term care facilities try to cater to the needs of their residents, however they are a business and must make a profit as well. Because of this, they try to feed the residents with the cheapest, not always the healthiest, types of food. This includes foods high in calories, fat, and carbohydrates. Unfortunately having a salad bar is hard to maintain because produce is considered expensive and doesn’t last as long as other food groups. These facilities also don’t always go out of their way to offer physical activities, such as ay to offer physical activities, such as yoga and aerobics because of the costs. These types of decisions make a difference in the lives of the residents living there. Religion plays a slightly smaller role in the foods the elderly consume. There are retirement facilities that cater to elderly of a specific religion. For example, Jewish retirement facilities need to offer a Kosher Menu because the Jewish People follow a strict dietary law, called Kashrut, that prohibits them from consuming certain foods such as shellfish. Also, the actual process of “kosherizing” the food is lengthy and expensive. This is were decisions need to be made so the facility doesn’t end up losing money. Due to these factors affecting the weight of the elderly, the solution has become complex as the problem. All the factor’s in a person’s life (that they have control over) need to change in order to avoid further complications with obesity and other health problems. The solution proposed needs to be an integrated effort of these disciplines so as to be most effective.

9. Biology- Nature As a result of one specific gene, nature makes people more susceptible to being obese later on in life. Apparently, the offspring of two obese parents will inevitably become obese themselves no matter what actions are taken to avoid this. Sociology- Nurture People who are predisposed to being obese because of their parents, may avoid being obese themselves because of certain actions they can take (ie. Eating healthy foods and exercising). People brought up this way tend to remain a normal weight because of outside forces. The environment is a determining factor when it comes to obesity, this may be a good or bad thing. ConflictsStudies have shown that both nature and nurture influence obesity later in life. Many scientists are for one or the other in terms of which has a greater influence on obesity in the elderly. With this in mind, more scientists are leaning towards genetics being the greater factor in obesity because it is based on factual evidence. In other words, some people are predisposed to being obese even before they are born and allow their environment to have any kind of influence on them.

10. Common Ground • The field of epigenetics studies other factors aside from genetics that can affect a person’s genome and phenotype (physical appearance). This gives credibility to the theory of the environment (nurture) having some kind of influence on obesity. • Epigenetics helps bridge hard and soft sciences (objective vs. subjective subjects) such as biology and sociology by unifying them into one theory. It accepts theories and perspectives of these individual disciplines and combines them into a unified theory.

11. Common Ground Vocabulary • Epigenetics- the approximately stepwise process by which genetic information, as modified by environmental influences, is translated into the substance and behavior of an organism. • Hard science- any of the natural or physical sciences, as chemistry, biology, physics, or astronomy, in which aspects of the universe are investigated by means of hypotheses and experiments. • Soft science- any of the specialized fields or disciplines, as psychology, sociology, anthropology, or political science, that interpret human behavior, institutions, society, etc., on the basis of scientific investigations for which it may be difficult to establish strictly measurable criteria. **All definitions courtesy of Dictionary.com**

12. A new approach… • The connection between hard and soft sciences (in relation to elderly obesity) is becoming more evident. An interdisciplinary approach is necessary to handle the convergence of these disciplines to propose a solution. • My experience gained through volunteering at Kinneret has helped shape my proposed solution, hoping to integrate numerous disciplines.

13. An interdisciplinary proposal to address elderly obesity via Kinneret

14. My Observation Volunteering at Kinneret’s dining services has opened my eyes to the foods being offered to the residents. To start off, each resident is giving bread with butter along with a small side of pasta salad. The meal following this appetizer depends on the day, especially if it happens to be a holiday. On one occasion, I happened to volunteer on Chinese Night. The menu included egg drop soup, fried rice, egg foo yong, and chicken with vegetables. To top this off, the residents were given either a cookie or slice of fruit for dessert. The food for that night was high in cholesterol, fat, carbohydrates, and sodium. On another occasion, I happened to have volunteered on the Sabbath. Being that Kinneret is a Jewish retirement facility, this night called for a more festive menu including matzo ball soup, salad, baked chicken or salmon, and mashed potatoes. This is a typical menu for any Jewish family on a Friday night. A great benefit about living at Kinneret is the keeping of Kashrut, also known as the Jewish dietary laws. This puts restrictions on what they can not serve including shellfish and swine. This means only kosher meat is being offered. Kosher meat is prepared in a much cleaner environment then non-kosher meat which is why it is much more expensive. Because of this and budget cuts, the rest of the menu is filled with cheaper, unhealthy dishes. The breads, pastas, and rice being offered are not the best choices for the elderly living there. Eating these types of foods all day everyday puts a strain on their health. I also noticed vending machines offering unhealthy snacks (for example Snickers and Kit Kats) and sodas outside of the main room where the residents spend most of their time. By doing this, the elderly are tempted to purchase these snacks that only hurt them later on.

15. Education • Have nutrition-trained staff to educate the residents on making healthy choices and portion control when it comes to the food options being offered to them. • Offer healthy cooking workshops to show the residents different dishes that are easy to prepare, healthy, and affordable. • Have weekly meetings with a Nutritionist/Dietician to evaluate the residents and explain to them certain foods they should avoid or eat more of so as to live a longer, happier, healthier life. • Have pamphlets filled with healthy eating choices and recipes available

16. Meal Plan • Offer meal plans that provide more options that are low in fat and sodium. • Incorporate fresh fruits and vegetables into every dish being prepared. This makes the plate both colorful and healthy. • Feature heart-smart items such as grilled fish, salads, and nuts. • Offer healthy snacks throughout the day that help with memory and focus, especially in the vending machines. • Emphasize grilled, baked, or raw goods rather than fried.

17. Physical Education • Encourage the residents to get as much exercise as they're capable of doing, even if it's simply walking around the facility. • Providing well-lit sidewalks for them to use throughout the day or night. • Offer exercise classes everyday that help build strength and prevent the residents from becoming weak and frail. Classes that aren’t as intense such as yoga are great and don’t require expensive machines. • Provide incentives for active residents such as cheaper rent or better meal options. • Make the facility vibrant with flowers and trees to add a sense of positive ambiance when walking around. • Take weekly trips to places such as parks and beaches that encourage exercising. • Set up residents with individual exercise programs ran by a hired trainer. • Get involved with the community and participate in Walk-A-Thons that fight different health diseases such as cancer and diabetes. • Have on-site active competitions that involve the residents and their families. This builds strength and memories to last forever!

18. Further Insight Into The Plan • Education: The more we educate the elderly are about their food intake, the better off their personal health will be. Many of the residents at Kinneret come from different backgrounds but if there was someone there to show them how to make healthy food choices, they’d all be on the same page and feel more comfortable. This will also get the seniors excited when it comes to eating. Training the staff can be a cheaper alternative to hiring a dietician. • Meal Plan: Most elderly people want to live long and happy lives. In order to live a long life, they must watch what they eat. Foods high in fat and cholesterol make the elderly prone to infections and sickness. However, by adding more vegetables and fruits to their menu, Kinneret will help build the immunity of their residents at fighting off diseases. By changing the menu weekly to the vegetables that are on sale that week, will help reduce the costs of Kinneret substantially. • Exercise: Physical activity is very important as a person grows older because if not, their body begins to turn frail. By adding exercise programs, this encourages the residents to work out and keep their bodies in shape. This is also a great way for the seniors to get involved with the communittee and socialize with others. They will feel a sense of personal accomplishment and connection towards others. Making these activities fun helps when being associated with food. By exercising with equipment already available (ex. chairs), Kinneret is saving money on buying high-tech gym machines. Also, walk-a-thons are both for a good cause and free.

19. The Bottom Line • Research has shown that genetic predispositions, economical, sociological, and religious factors account for obesity in elderly residents in retirement facilities. • These factors are being studied by disciplinarians who look to find a solution to this problem by incorporating the different disciplines together. • Studies have shown that obesity in elderly is not solely due to their genes but also the environment in which they live in, i.e. theory of Epigenetics. • By applying an interdisciplinary approach to the problem, the solution will be more successful because it integrates numerous disciplines problems into one.

20. The End