DASH Diet Intervention at Senior Centers
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      The Carter Burden Network (CBN) is an New York City senior services agency, providing vital
      meal programs for low-income, minority seniors, age 60 and over. In 2016, CBN formed a
      community-academic partnership with The Rockefeller University (RU) and Clinical Directors
      Network (CDN) to conduct a Healthy Aging pilot study and found that 84% of participants had
      high blood pressure, with up to 27% "uncontrolled" using age-adjusted criteria. High blood
      pressure is a modifiable risk for cardiovascular disease, and has been readily improved in
      controlled trials by replacement of a typical Western diet with the Dietary Approaches to
      Stop Hypertension (DASH) diet. The DASH diet has been proven to meaningfully reduce blood
      pressure in as little as 14 days. However, the DASH diet has not been tested in seniors, in
      the setting of senior centers. Many seniors attending CBN centers receive close to 40% of
      their daily nutrition through congregate meals served there. This study tests the
      effectiveness of implementing the DASH-diet through modification of congregate meals at CBN
      senior centers to align with DASH, while providing educational and behavioral support,
      including home self-monitoring of blood pressure, to improve self-efficacy related to blood
      pressure management. The primary outcome is the change in systolic blood pressure.
    

Detailed description: 
      The Carter Burden Network (CBN) is an New York City senior services agency, providing vital
      meal programs for low-income, minority seniors, age 60 and over. Its four senior centers
      serve 300,000 meals annually through congregate breakfasts and lunches, and home-delivered
      meals. In 2016, CBN formed a community-academic partnership with The Rockefeller University
      (RU) and Clinical Directors Network (CDN) to conduct a Healthy Aging pilot study at two of
      its East Harlem sites, finding that 84% of participants had high blood pressure, with up to
      27% "uncontrolled" by age-adjusted criteria. Hypertension continues to be a significant,
      modifiable, but poorly-controlled contributor to morbidity and mortality from cardiovascular
      disease (CVD), contributing to stroke, heart attack, renal failure, and cognitive decline,
      increasing healthcare costs and causing loss of function, independence, and quality of life.
      Replacement of a typical Western diet with the Dietary Approaches to Stop Hypertension (DASH)
      diet has been proven to reduce blood pressure in i hypertensive individuals, and individuals
      with normal blood pressure in as little as 14 days. However, approaches to effective
      implementation of the DASH diet are untested in community-living seniors.

      To address the high cardiovascular risk of uncontrolled hypertension among seniors and
      introduce innovation into its nutritional program, CBN, RU and CDN designed this two year
      project to test a DASH-diet-based multi-component intervention to lower blood pressure in two
      of its senior centers, serving low-income and/or minority seniors. The intervention includes
      health education, participant input into menu design, redesign of current congregate meals
      menus to make them with DASH-aligned menus, and home-self monitoring of blood pressure with
      educational and social support. The primary outcome will be the change in mean systolic blood
      pressure, measured by health professionals one month after full DASH implementation, compared
      to baseline. Secondary outcomes include the change in the percentage of seniors with blood
      pressure in the range of "controlled" by Joint National Committee 8 (JNC-8) guidelines, and
      the change in blood pressure at three months and at six months.

      To optimize acceptance of the changes to menu and recipes, clients will be engaged and
      provide feedback during the design, implementation and conduct phases of the study. Dietary
      changes will be planned to incorporate client preferences. Clients will provide feedback
      weekly on menu acceptability referencing a simple smiley face Likert scale. Educational
      programs will consist of a series of sessions covering nutritional education including
      recipes and cooking demonstrations, blood pressure information and training in home
      self-monitoring with a study-provided blue-tooth enabled Omron 10 device, and information to
      enhance medication adherence. Participants will have pulse, blood pressure, weight, and
      behavioral aspects of self-efficacy assessed at baseline, and at Months 1, 3, and 6 of after
      DASH implementation. Surveys to assess quality of life, food frequency (for compliance with
      DASH-aligned eating outside of congregate meals), menu satisfaction, medication adherence,
      and other risks relevant to blood pressure management will be assessed at the same Month
      0,1,3,6 time points).
    

Intervention name(s): Revision of congregate meal menus and recipes to align with parameters of DASH eating plan; On-site blood pressure monitoring; Home self blood pressure monitoring; Medical adherence education; Nutrition Education
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): On a programmatic level, congregate meal menus and recipes have been adapted to align with DASH eating. The changes, which include the introduction of additional servings of fruits, vegetables, seeds, grains, replacement of simple or processed carbohydrates with healthier alternatives, introduction of more fish, reduction in added salt, and replacement of animal fats and butter with olive oil, will be phased-in in stages over 6 weeks, concurrent with the start up the study's educational programs addressing nutrition, BP, and medication adherence. The fully DASH-aligned menus will begin by week 7. The dietary intervention affects all seniors eating congregate meals at the center, not only those enrolled in this protocol to study the impact of DASH implementation.; At baseline (Month 0), and at Months 1, 3, and 6 after the full implementation of the DASH aligned congregate meals, participants will have blood pressure measured by professionals, on-site at the senior center, following established standard procedures. They will receive verbal and written information about their blood pressure results, and encouragement to share the results with their providers.; Provision of personal Omron 10 home blood pressure monitoring device, training in proper use, and schedule for home self monitoring of BP over the course of the study.; One required educational session with the community pharmacist to learn about medication adherence strategies; One required educational session to review the elements of the DASH eating plan, how to overcome barriers to healthy eating, recipes, cooking demonstrations and materials for household members.
Other intervention name(s): DASH diet; self-measured blood pressure monitoring (SMBP)
Intervention model: Single Group Assignment
Intervention model description: This is an implementation study, testing whether provision of the evidence-based DASH diet for to community-living seniors as a portion of their daily intake, in the setting of congregate meals at senior centers, coupled with evidence-based home self-blood pressure monitoring, can lead to effective blood pressure lowering.
Masking: None (Open Label)
Primary purpose: Other
Keywords: Nutrition, micro-nutrients, implementation, food insecurity