Abstract
BACKGROUND: Although nutritional status is influenced by multidimensional aspects encompassing physical and emotional well-being, there is limited research on this complex relationship. OBJECTIVE: The purpose of this study was to examine the interplay between indicators of physical health (perceived health status and self-care capacity) and emotional well-being (depressive affect and loneliness) on rural older adults' nutritional status. DESIGN: The cross-sectional study was conducted from June 1, 2007, to June 1, 2008. PARTICIPANTS/SETTING: A total of 171 community-dwelling older adults, aged 65 years and older, residing within nonmetro rural communities in the United States participated in this study. MAIN OUTCOME MEASURES: Participants completed validated instruments measuring self-care capacity, perceived health status, loneliness, depressive affect, and nutritional status. STATISTICAL ANALYSES PERFORMED: Structural equation modeling was employed to investigate the complex interplay of physical and emotional health status with nutritional status among rural older adults. The χ(2) test, comparative fit index, root mean square error of approximation, and standardized root mean square residual were used to assess model fit. RESULTS: The χ(2) test and the other model fit indexes showed the hypothesized structural equation model provided a good fit to the data (χ(2) (2)=2.15; P=0.34; comparative fit index=1.00; root mean square error of approximation=0.02; and standardized root mean square residual=0.03). Self-care capacity was significantly related with depressive affect (γ=-0.11; P=0.03), whereas self-care capacity was not significantly related with loneliness. Perceived health status had a significant negative relationship with both loneliness (γ=-0.16; P=0.03) and depressive affect (γ=-0.22; P=0.03). Although loneliness showed no significant direct relationship with nutritional status, it showed a significant direct relationship with depressive affect (β=.4; P<0.01). Finally, the results demonstrated that depressive affect had a significant negative relationship with nutritional status (β=-.30; P<0.01). The results indicated physical health and emotional indicators have significant multidimensional associations with nutritional status among rural older adults. CONCLUSIONS: The present study provides insights into the importance of addressing both physical and emotional well-being together to reduce potential effects of poor emotional well-being on nutritional status, particularly among rural older adults with impaired physical health and self-care capacity.