Home-delivered Meal Programs Research Articles

Home-delivered meals programs for the elderly: distribution of services in New York State.

This study examined the ability of six countywide home-delivered meals programs in upstate New York to meet the challenge of serving the elderly in geographically isolated and impoverished regions. The six counties were divided geographically into county subdivisions. For each subdivision, program client levels were analyzed in relation to two subdivision-level census statistics: poverty rates and population densities for community-residing individuals aged 65 years and older. Client levels were positively correlated with population densities but not with poverty rates. These findings suggest that service delivery was concentrated in densely populated regions. In contrast, impoverished and sparsely populated regions received minimal services.

Home-delivered meals benefit the diabetic elderly

he importance of a regular meal pattern is commonly stressed to elderly diabetic persons and to their caretakers. This recommendation takes forgranted that there are no physical or financial barriers to buying or preparing food. The diabetic elderly who fail to comply with their diets are assumed to lack motivation, intelligence, or both (1-3). By removing these barriers, home-delivered meals (HDMs) may improve the eating patterns of the diabetic elderly and in turn improve control of their diabetes. Because of the increasing incidence of diabetes in the aging population, the number of people who could be helped by HDMs is considerable. For example, in a recent study of HDMs in New York State, 20% of recipients reported that they had diabetes (4). The study reported here, undertaken by the New York State Nutritional Surveillance program, examined the effects of an HDM program on food insecurity, dietary practices, and control of diabetes in an elderly diabetic population.

The Existence and Emotional Closeness of Relationships with Children, Friends, and Spouses

Based on a social support model, the authors analyzed the association between the experience of loneliness and the emotional closeness older persons have in their social relationships with their children, friends, and spouses. The effects on loneliness of age, sex, subjective health status, economic situation, need for attachment, and need for social integration were also examined and controlled. Results are based on 1,071 participants in the congregate and home-delivered meal programs of the Senior Citizens Nutrition and Activities Program in Hillsborough County, Florida. An analysis of covariance showed that the loneliness expressed by these older persons was related, not to variation in age, but to their gender, health status, and economic condition; their needs for affection and security, and desire to be part of a social network; and the existence, but not the emotional commitment, to a set of friends. Whether these persons had children or spouses or not, and if they had either, and were emotionally close or not, made no difference in their assessment of how lonely they felt. Theoretically, the results lend only partial support to the social support perspective.

Nutrient intake of urban and rural elderly receiving home-delivered meals

We evaluated nutrient intake (as measured by a 3-day food record) and nondietary factors that may influence nutrient intake in urban (n = 48) and rural (n = 47) elderly clients in the Title III C home-delivered meal program. Mean nutrient intake did not differ significantly between the two populations; each population met or exceeded 100% of the Recommended Dietary Allowances (RDA) for all nutrients other than energy, vitamin B-6, calcium, magnesium, and zinc. However, 70% of the individuals within each population had intakes below 66% of the RDA for three or more nutrients and were thus classified as having poor diets. Factors such as the need for assistance with shopping and cooking, living situation, vitamin/mineral supplementation, prescription drugs, and dentition did not significantly predict nutritional intake in either the urban or the rural cohorts. However, 50% to 70% of both the rural and the urban homebound elderly needed assistance with cooking and shopping for food. The rural elderly relied on family members for help with shopping and cooking to a greater extent than did their urban counterparts. We conclude that nutrient intake of the homebound elderly is not affected by geographic location. However, both rural and urban clients are at risk for developing nutrient deficiencies.

In-Home Nutritional Assessment of Inner-City Elderly

Aims of this research have been to obtain aggregate data on reported problems in food access that are experienced by homebound, inner-city elderly; to disaggregate the data to show which subgroups of elderly are at highest risk for these types of food insecurity; and to assess whether these elderly differ socioeconomically, medically, or nutritionally from homebound elderly who report that they eat regularly. Instruments were designed to measure population-based food insecurity and to ask respondents to provide information about their socioeconomic status and disabilities as well as the extent to which they have formal or informal assistance in obtaining food. The need to collect this information has been linked to a state-wide effort to target city nutritionally needy elderly for home-delivered meals. Findings have been that food insecurity in the inner-city homebound is linked to loss of mobility as well as to poverty and lack of in-home food assistance. Minority elderly whose questionnaire responses indicate food insecurity include diabetics whose disease control is adversely affected by irregular eating. When methods of home assessment have been used to examine the extent to which a home-delivered meals program meets the nutritional needs of recipients, it has been possible to demonstrate that meals recipients show less food insecurity than a comparison group on waiting lists to receive meals.

The Impact of Community Care on Provision of Informal Care to Homebound Elderly Persons

This study examined the impact of community care on informal care provided by family and friends to homebound elderly persons. Secondary analyses were conducted on data collected from clients at baseline, 9 months (N = 225), and 48 months (N = 76) after acceptance to community care and home-delivered meals programs. Analyses revealed a significant increase in the amount of formal services provided to both groups of clients at 9 months and to community care clients at 48 months. The increase was attributed to the large proportion of "new" or "supplementary" services provided by agencies. No significant decrease in the amount of service provided by informal caregivers was found. In addition, regression analyses demonstrated only a weak impact of formal service on informal care. Analysis of patterns of service provision for each client demonstrated that formal care supplemented rather than substituted for informal care significantly more often in both the 9- and 48-month samples. We conclude that formal care in general supplemented the efforts of informal caregivers, and that informal caregiving remained stable over time.

Home-delivered meals: Food quality, nutrient content, and characteristics of recipients

Meals provided by a home-delivered meal program with the same supplier were evaluated for 5 consecutive days in each of 6 years. In the evaluations, meals were compared with federal guidelines for meal pattern, serving size, and temperature of hot food, and the quality was evaluated. Meal pattern and serving size guidelines were not always met by the meals. Problems included no delivery of milk with the meals and variations in serving sizes for meat or alternate, fruit, vegetable, and dessert. Temperatures of hot foods were often much lower than the 140° or 150°F specified in food safety guidelines. Food quality varied. Protein, iron, phosphorus, vitamin A, and niacin were consistently >33% of the RDA; energy, thiamin, riboflavin, and vitamin C were <33% of the RDA some years, and calcium was consistently <33% of the RDA. Estimated total daily nutrient intakes of 27 recipients followed the same pattern as the nutrient content of the meal s. For many recipients, estimated nutrient intakes from food other than the home-delivered meal was <33% of the RDA. Food preferences were fairly well satisfied. Recall of nutrition-related vocabulary was poor. In this study, home-delivered meals were found to make important contributions to the nutrition needs of the recipients. J Am Diet Assoc 88:55, 1988.

Continuance of elderly on home-delivered meals programs.

Data from 2,002 elderly receiving home-delivered meals in 23 counties of New York State in 1984-85 were analyzed using a baseline survey and a six-month follow-up survey. Survival analysis estimated that 37.4 per cent of the clients left the program by the follow-up. The initial drop-out rate was estimated to be 14.2 per cent per month; by six months the rate fell to 3.3 per cent. Whites left the program at a rate 2.6 times (95% CI = 1.9, 3.8) that of minorities. Recent discharge from hospital was associated with the highest relative probability of program discontinuance (2.7, 95% CI = 2.2, 3.4), followed by having cancer (2.1, 95% CI = 1.6, 2.8), and having a non-hip fracture (2.0, 95% CI = 1.3, 2.9). Many of those with cancer died, while those recently discharged and those with non-hip fractures were more likely to leave the program because they were again able to cook for themselves.