Implementing DASH-aligned Congregate Meals and Self-Measured Blood Pressure in two senior centers: An open label study

Anuradha Hashemi, Kimberly Vasquez, Dozene Guishard, Moufdi Naji, Andrea Ronning, Glenis George-Alexander, Dacia Vasquez, Clewert Sylvester, William Pagano, Chamanara Khalida, Cameron Coffran, Teeto Ezeonu, Kadija Fofana, Dana Bielopolski, Roger Vaughan, Adam Qureshi, Jonathan N Tobin, Rhonda G Kost, Anuradha Hashemi, Kimberly Vasquez, Dozene Guishard, Moufdi Naji, Andrea Ronning, Glenis George-Alexander, Dacia Vasquez, Clewert Sylvester, William Pagano, Chamanara Khalida, Cameron Coffran, Teeto Ezeonu, Kadija Fofana, Dana Bielopolski, Roger Vaughan, Adam Qureshi, Jonathan N Tobin, Rhonda G Kost

Abstract

Background and aims: Cardiovascular Disease (CVD) poses significant health risks for seniors, especially among low-income and minority communities. Senior centers offer multiple services. We tested whether implementing two evidence-based interventions- DASH-aligned meals provided through an existing congregate meal program, and support for home Self-Measured Blood Pressure (SMBP) monitoring-lowers blood pressure among participants at two senior centers serving low-income, racially diverse communities.

Methods and results: Open-label study, enrolling clients aged ≥60, eating ≥4 meals/week at two NYC senior centers. Participants received DASH-aligned congregate meals, and training in nutrition, BP management education, and personal SMBP device. Co-Primary outcomes: a) change in systolic BP measured by independent health professionals, and b) change in percent with "controlled BP" (Eighth Joint National Committee (JNC-8) Guidelines), at Month 1 compared to Baseline.

Secondary outcomes: Changes in BP at Months 3 and 5/6 (last measure). We enrolled 94 participants; COVID closures interrupted implementation mid-study. Mean systolic BP at Month-1 changed by -4.41 mmHg (n = 61 p = 0.07) compared to Baseline. Participants with controlled BP increased (15.7%) at Month 1. Change in mean BP at Month 1 was significantly correlated with BMI (p = 0.02), age (p = 0.04), and baseline BP (p < 0.001). Mean systolic SMBP changed by -6.9 mmHg (p = 0.004) at Months 5/6.

Conclusions: Implementing an evidence-based multi-component BP-lowering intervention within existing congregate meal programs at senior centers serving minority and low-income communities is feasible, and early findings show promising evidence of effectiveness. This approach to cardiovascular risk reduction should be further tested for widespread adoption and impact. Registered on ClinicalTrials.gov NCT03993808 (June 21st, 2019).

Keywords: Cardiovascular risk; Community-based; DASH diet; Hypertension; Implementation research; Nutritional intervention; Self-efficacy; Seniors.

Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to declare.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Figures

Figure 1
Figure 1
Study Procedures Timeline. Schedule of planned intervention components and study assessments for this 6-month study. Weeks are relative to start of interventions at each Site.
Figure 2
Figure 2
CONSORT Diagram of DASH Senior Center Intervention. Consort diagram shows the flow of participants through the study. Site closures due to COVID-19 pandemic-related public health mandates interrupted the delivery of congregate meals and in-person assessments including primary outcome measures; many assessments could be collected remotely.

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