Home-delivered Meals Research Articles

Effective elements of home-delivered meal services to improve energy and protein intake: A systematic review.

Home-delivered meal services are an example of a nutritional intervention in the home setting developed to enhance dietary intake and contribute to the independence of especially older adults. There is a lack of evidence about the contribution of specific elements of any home-delivered meal service on the improved outcomes. Therefore, a systematic review was performed to evaluate which elements of home-delivered meal services are effective to improve energy and protein intake, nutritional status, functional outcomes and satisfaction in adults. Pubmed, Embase and Web of Science databases were searched for studies assessing energy and protein intake, nutritional or functional status, or satisfaction of these services. The quality of the studies was assessed using the Quality Criteria Checklist for Primary Research. Of 138 studies meeting the search criteria, 19 were included, none of which met the criteria to be rated as high quality. These studies show that various elements of home-delivered meal services such as Meals on Wheels providing protein-enriched bread or snacks in addition to meals or providing meals and snacks for whole days can improve outcomes such as energy and protein intake and satisfaction. A distinction can be made between services focusing on supporting homebound, essentially healthy, older adults and services aiming at the optimal, nutritional, transmural care for patients at risk for malnutrition. This review shows that various elements of these meal services can improve key outcomes. Following the rising interest and importance of these interventions, there is an urgent need to optimize such services to improve nutritional care at home regarding the increasingly limited time frame of admission in hospitals.

P83 Nutrition Education in Congregate and Home Delivered Meal Sites: What Do We Know?

Background By 2030, nearly 21% of the population will be 65 years and older. Those who reach 65 will live, on average, an additional 19 years. Adequate nutrition is essential to health and quality of life for older adults. Congregate and home-delivered meal programs are an ideal setting to provide nutrition education to promote successful aging. Objective This study described the content of nutrition education delivered at congregate and home-delivered meal programs and the extent to which education sessions were being evaluated for effectiveness. Study Design, Settings, Participants This cross-sectional study collected data through a novel, national, online survey for nutrition educators working with congregate and home-delivered meal programs. Survey participants were recruited via multiple listservs and contact information from agencies and organizations who work with congregate and home delivered meal participants (n = 236). Forty five states in the US were represented. Measurable Outcome/Analysis Descriptive statistics were conducted for the full sample and compared between dietetic (n = 116) and non-dietetic professionals (n = 120). Results Almost 70% of nutrition educators worked in the profession for 10+ years and more than half worked with older adults for 10+ years. The most common topics delivered at congregate and home-delivered meal programs were: food safety (62%), healthy eating (57%), and diabetes (56%); the most common delivery method was handouts (71%). Only 29% choose materials that focus specifically on behavior change. Nutrition educators were somewhat satisfied with available materials yet reported not knowing about, nor using, freely available, evaluated programs for older adults. Nutrition educators reported malnutrition as a major issue but that they lacked tools to screen for and address malnutrition. Dietetics professionals were more likely to conduct evaluations for their sessions (2.13 vs.1.67, 4-point scale) compared to non-dietetic professionals. Conclusion Nutrition educators working with congregate and home-delivered meal participants need training on how to conduct evaluations, especially non-dietetic professionals. Training is needed for addressing malnutrition and using screening tools. Resource-sharing hubs at both local and national levels are warranted. Funding None.

P156 Current State of Utilization of Theory Based, Behaviorally Focused Nutrition Education in Congregate and Home Delivered Meal Sites and Factors Contributing to its Use

Background By 2030, nearly 21% of the population will consist of older adults, 65 years and older, making adequate nutrition essential for health and quality of life. Congregate and home-delivered meal programs are an ideal setting to provide nutrition education for older adults that can promote successful aging. Objective To determine if nutrition educators working at congregate and home delivered meal sites were conducting theory-based and behaviorally focused nutrition education (TB-BF-NE) and whether dietetic professionals differ from non-dietetic professionals in their degree of conducting TB-BF-NE. Additionally, this study determined what educator factors influenced the degree to which TB-BF-NE was used. Study Design, Settings, Participants This cross-sectional study involved a national online survey for nutrition educators working with congregate and home-delivered meal programs. The questions that asked about TB-BF-NE had four scales related to the degree to which they: enhanced motivation, facilitated action, created supportive environments, and considered delivery methods. Participants were recruited via multiple listservs and a variety of agencies and organizations. Forty five states in the U.S. (n = 211) were represented. Measurable Outcome/Analysis Independent t-tests compared dietetic professionals (n = 102) versus non-dietetic professionals (n = 109) for each TB-BF-NE scale and total score. Multiple linear regression analysis determined if educator factors explained the variance in TB-BF-NE score. Results Dietetic professionals scored higher than non-dietetic professionals on all TB-BF-NE scales and total score (all P Conclusion For non-dietetic professionals, more training on TB-BF-NE—what it is, why it matters, and how to incorporate it into nutrition lessons—is needed. Additionally, having smaller groups, longer sessions, and conducting evaluation support TB-BF-NE and should be encouraged. Funding None.

O6 Meals on Wings: A Food Recovery Meal Program to Improve the Nutritional Health and Well-Being of Seniors

Background For the older adult, maintenance of good nutritional health is essential to functioning, the prevention or management of chronic disease, and quality of life. Compounding this problem is the increasing numbers of seniors that are food insecure. Studies show approximately half of community-dwelling elders are at nutrition risk which leads to increased risk for additional health problems, functional decline, reduced quality of life and hospitalization. The Meals on Wings program offers a solution for some of those seniors in need by recovering unused food that would normally be wasted from area hospitals and repackaging it into healthful meals. The meals are delivered to home-bound seniors using student volunteers to recover food, prepare the meals and deliver to the seniors. This program not only fights hunger in the community but also helps decrease food waste. Objective Investigate the impact of a food recovery and meal delivery program on the nutritional health, social well-being, and isolation of home-bound seniors. Evaluate the impact of volunteering on student volunteers' empathy and perception of social responsibility. Study Design, Setting, Participants This study utilizes a within-group, pretest-posttest design. There are two study groups: home-bound seniors on the waitlist for Meals on Wheels and students enrolled at the University of North Florida. Measurable Outcome/Analysis Seniors’ nutritional health and social well-being are measured using a pre-post methodology. Surveys are given at enrollment, three months, and six months, and include the following measures: MNA-SF, 24-hour food recall, USDA 6-Item Food Security Survey, WHO-5 Well-Being Index, and the 3-Item Loneliness Scale. Student volunteers are surveyed at program start and at 90 days using the Toronto Empathy Questionnaire-Public Service Motivation Scale. Results After six months, the program has: delivered 2,048 meals; seen significant improvements in senior's nutritional health parameters; and seen a significant improvement in students' public service motivation. Conclusion Receiving home-delivered meals for a short duration significantly improves recipients' nutritional health and well-being, improves student public service motivation, and reduces food waste. Funding None.

Diet Quality of Congregate and Home-delivered Meal Recipients in the United States (P04-076-19)

Objectives1) Examine diet quality of OAANSP meals, 2) examine diet quality of complementary food consumed in addition to the CM/HDM meal, and 3) examine diet quality of daily intake by individuals who did versus did not consume a CM/HDM meal.Background: Older adults are becoming a larger proportion of the US population, a phenomenon that will continue over the next few decades. Congregate (CM) and home-delivered meals (HDM) of the Older Americans Act Nutrition Program (OAANP) have beneficial effects on the lives of older adults. Yet, data demonstrating value remains relatively limited, arguably leading to underfunding. MethodsData from the Administration for Community Living (ACL) Outcomes Evaluation Study was collected using a multistage clustered sample design. Data collection tools comprised a survey (including information on respondent’s sociodemographics, health status, self-reported weight and height, social relationships, dietary self-reliance, participation in other nutrition assistance programs, and food security) and two 24-hour recalls. HEI-2010 was used to calculate individual and mean scores using the simple HEI scoring algorithm and the population ratio method, respectively. Radar plots were used to visualize HEI comparisons, and multiple logistic regression models were built to examine associations between diet quality and OAANSP. ResultsOAANSP participation was associated with HEI (P < 0.0001 and P = 0.04 for CM and HDM, respectively) and so was number of meals/day (P = 0.007 and P = 0.03 for CM and HDM, respectively). Compared to the complementary diet, OAANSP meals had better scores for total vegetables (P < 0.0001), and greens and beans (P < 0.001). The complementing diet quality for CM participants had better scores than the meal for total fruit, whole grains, seafood and plant proteins; and whole grains for HDM participant. Meals and complementing foods exceeded the dietary guidelines for sodium, refined grains, saturated fat, added sugar and total protein. HDM participants’ mean HEI score was lower on no meal-day compared to meal-day (P < 0.0001). ConclusionsCM/HDM meals may need to be revised, especially for sodium, added sugar and refined grains. Adding another meal daily and expanding nutrition education may be important for a healthier diet. Funding SourcesNone.

Low-income homebound older adults receiving home-delivered meals: Physical and mental health conditions, incidence of falls and hospitalisations.

Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low-income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self-reported falls and hospitalisations among largely low-income and racial/ethnic minority adults age 50+ (N=2,224), clients from a home-delivered meals programme in Central Texas. Data came from comprehensive, in-home assessments done in 2017 by these older adults' case managers. We used bivariate analyses to compare those with and without incidence of self-reported past-year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past-year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.

Design and rationale of a randomized-controlled trial of home-delivered meals for the management of symptomatic ascites: the SALTYFOOD trial.

BackgroundWhen patients with cirrhosis develop ascites, it is associated with sharply increased mortality and healthcare utilization with decreased quality of life. Dietary salt restriction is first-line therapy for ascites but it is limited by poor adherence.MethodsWe will recruit 40 patients with cirrhosis and ascites who have received a recent paracentesis or hospitalization for a 1:1 randomized trial of standard care (education on salt restriction) versus home-delivered meals. Our primary outcome is the number of paracenteses needed over 12 weeks. Secondary outcomes include hospital-bed days, health-related quality of life (HRQOL, Ascites Symptom Inventory-7 and Visual Analogue Scale) and performance on batteries of physical function including hand grip (kg) and walk speed (m/s). All subjects follow up through a series of calls where any paracenteses, hospital readmissions, weight changes and diuretic dosage changes are recorded. In a final Week 12 visit, knowledge of dietary sodium intake, quality of life and frailty are reassessed, and satisfaction with the meal-delivery program is evaluated. Paired comparison testing will be conducted between the two arms.DiscussionA nutritionally standardized meal-delivery program for patients with cirrhosis and ascites post discharge has a variety of potential patient-based benefits, including the effective management of ascites, reduction of healthcare utilization and improvement of HRQOL. We have three core hypotheses. First, patients will report interest in and satisfaction with a home-delivered meals program. Second, subjects on a salt-restricted (2 g sodium) meal-delivery program will have fewer therapeutic paracenteses and all-cause readmissions than subjects receiving standard of care. Third, subjects on a salt-restricted (2 g sodium) meal-delivery program will report increased HRQOL compared to subjects receiving standard of care.

TELE-BEHAVIORAL ACTIVATION FOR SOCIAL ISOLATION IN OLDER HOME-DELIVERED MEALS RECIPIENTS: PRELIMINARY RESULTS FROM AN ONGOING RANDOMIZED CONTROLLED TRIAL

Introduction Homebound older adults are often unable to participate in social interactions and activities that require leaving the home, resulting in a high prevalence of isolation among this population. Isolation is associated morbidity, disability, and mortality. Technology has been explored as a potential avenue for meaningful social interaction for homebound seniors. We present preliminary results of an ongoing randomized controlled trial evaluating the acceptability, feasibility and comparative effectiveness of delivering two interventions by video-conferencing technology to promote social connectedness among homebound older adults receiving home-delivered meals: 1. Behavioral activation (tele-BA) vs. 2. Friendly visitors (tele-FV). To our knowledge, this is the first randomized controlled trial to leverage local Meals on Wheels (MoWs) agencies to engage homebound, socially isolated older adults in a telehealth intervention for social isolation. Methods Older adults in New Hampshire and central Texas were recruited for our study by local MoWs agencies during the routine annual evaluation of their home-delivered meals clients. After a brief eligibility screening by their MoWs case workers and indicated interest, MoWs clients were referred to our study team and contacted by telephone for a full eligibility assessment. Eligible participants endorsed social isolation (6 or greater on the 3-item UCLA Loneliness Scale), but did not report symptoms of moderate to severe depression (PHQ-9 Results In the first year of our study, 50 socially isolated older adults (age M±SD73.5±9.2 years; range 51 to 90 years) participated in either the tele-BA intervention (n=28) or tele-FV comparison condition (n=22). Participants were predominantly non-Hispanic white (70%), female (65%), of lower SES (56% less than $20,000 annual income) and living alone (68%). When asked, all participants indicated they would recommend this tele-program to family and friends (Net Promotor Scale 0-10: M±SD 9.7±0.9; range 6-10). Most participants (92%) found these tele-sessions moderately to very acceptable for their social isolation and 95% indicated somewhat positive to very positive general reaction to the program. Preliminary data at 12-week follow-up showed reduction on the 8-item Social Isolation measure and the PHQ-9, with a trend towards greater improvement in participants who participated in the tele-BA group. Conclusions Overall, participants found tele-Behavioral Activation and tele-Friendly Visits to be positive experiences and acceptable for their social isolation, and would recommend the program to their friends and family. Preliminary data showed improvement in isolation and depressive symptoms for both groups, which is sustained through 12 weeks of post-intervention follow-up. Our preliminary results suggest the feasibility, acceptability and potential effectiveness of using tele-technology to deliver interventions for homebound older adults who report social isolation. We also found potential evidence of the effectiveness of modified tele-behavioral activation program, compared to friendly visitors, in reducing social isolation and subclinical depressive symptoms in this population. Finally, we demonstrated the feasibility of working in collaboration with community-based Meals on Wheels agencies to identify socially isolated clients and refer them to this program. This research was funded by AARP-Foundation

Nutritional Risk of the Elderly Receiving a Home-Delivered Meal Service Program and the Factors for Nutritional Risk

Nutritional Risk of the Elderly Receiving a Home-Delivered Meal Service Program and the Factors for Nutritional Risk

"It's Not Just a Simple Meal. It's So Much More": Interactions Between Meals on Wheels Clients and Drivers.

Background and Objectives: Meals on Wheels (MOW) programs provide home-delivered meals to over 1.5 million older adults; yet, very little is known about the drivers who make meal deliveries possible. Specifically, we do not have clear insight into their interaction with clients or the benefits that they may receive through their service. The objective of this article is to describe the characteristics of MOW drivers, the interactions among drivers and clients, and the benefits of the program to both. Research Design and Method: This qualitative research study reports on interviews with 84 MOW staff (leadership, case managers/client assessors, volunteer coordinators) and drivers at six geographically and operationally distinct programs across the United States. Results: Qualitative analysis of the interviews with MOW staff and drivers revealed the following key themes: (a) clients have multiple vulnerabilities; (b) clients appear to derive social, as well as nutritional benefit from receiving meals; (c) drivers report they provide additional support to their clients beyond delivering the meal; (d) social bonds between drivers and clients were reported to strengthen over time; (e) drivers claim that they, too, derive validation and personal benefit through their meal delivery. Discussion and Implications: This research highlights the significant contributions that meal delivery drivers made in the lives of MOW clients beyond the actual meal itself. This research also spotlights the perceived benefits experienced by the drivers and points to the importance of conducting further research to determine the effects of meal delivery on client and drivers' outcomes, more broadly.

THE IMPACT OF NUTRITION-COUNSELING PROGRAM ON THE USE OF HOSPITAL SERVICES FOR MEALS ON WHEELS CLIENTS

AbstractHome-delivered meals program has shown great promises in overcoming nutritional challenges for homebound adults facing food insecurity and/or at risk of diabetes. Nutrition-counseling provides knowledge and skills for diabetes management. The purpose of this study was to identify the impact of a nutrition-counseling program with home-delivered meals (HDM), on use of hospital services, before and after receiving services for 6 months. This study includes 2,440 clients, at risk of diabetes, enrolled in either HDM service only (n=1,099) or HDM and nutrition-counseling program (n=1,341) at a Meals on Wheels organization in Fort-Worth, Texas. Hospital service data was extracted from a regional claims database. Analysis of covariance and generalized estimating equations with Poisson distribution were performed to compare program effectiveness on utilization of hospital services between two groups. The average number of emergency room (ER) visits decreased from 1.15 to .75 and from .83 to .62 for HDM group and HDM and counseling group, respectively (F=20.67, p<.001). The average number of hospitalizations decreased from .52 to .26 and from .46 to .30 for HDM group and HDM and counseling group, respectively (F=29.05, p<.001). At completion of 6 months service, both groups were less likely to experience ER visits and hospitalizations after adjusting age, sex, race/ethnicity, and weekly number of meals. However, HDM and counseling group showed significantly less ER visits than HDM group. The findings of this study indicate that a structured nutritional-counseling program with HDM may contribute to reducing healthcare utilization for older adults with challenges of diabetes and food insecurity.

MEALS ON WHEELS: PERSPECTIVES FROM TODAY’S AGING ADULT

Low cost home-delivered meal (HDM) programs, like Meals on Wheels (MOW) provide nutritional and social support for older adults; however, there is a wide gap between those in need of HDM programs and participation rates. This study explored factors influencing aging adults’ interest in participating in a HDM program, like MOW. Awareness, perceptions, motivators and barriers toward participation, and preferred program attributes were examined. Four focus groups were held with 31 older adults not enrolled in MOW in a Midwest state. All completed a sociodemographic questionnaire. Focus groups were audio-recorded, transcribed, and analyzed for themes; questionnaires were analyzed using descriptive statistics. Participants were primarily retired (80.6%), white (87%), “food secure” (71%), females (77.4%) between ages 65–84 years. Over half (54.8%) received congregate meals. Many reported being responsible for their transportation (80.6%), food purchases (87.1%), and meal preparation (77.4%). Many were aware of the MOW program but lacked awareness of other HDM programs. Participants associated MOW with loss of independence and poor food quality. MOW was positively viewed as a source of companionship. Key HDM program use motivators included affordable cost, choices/variety, nutritionist or dietitian involvement, and clientele testimonies. Common barriers were cost, skepticism of advertisement claims, food safety concerns, and limited meal storage space. Preferred program attributes were convenience and quality menu options. Preferred promotional strategies included brochures and group presentations with free meal samples. These findings will better enable MOW to restructure program components and implement marketing techniques that appeal to today’s aging adult.

FUNCTIONAL AND COGNITIVE IMPAIRMENTS AMONG OLDER ADULTS RECEIVING HOME-DELIVERED MEALS

The overall purpose of the Older Americans Act (OAA) programs is to help older adults remain in their homes through the provision of long-term services and supports. The OAA Nutrition Program (both congregate and home-delivered nutrition services) specifically targets older adults who are in poor health and functionally impaired. For example, 3% of the general population age 60 and over have difficulties with 3 or more activities of daily living, compared to 10% of congregate participants and 31% of home-delivered participants. In addition, 24% of congregate participants and 49% of home-delivered participants report their health as poor or fair; 40% of congregate and 67% of home-delivered participants take over five medications daily, and 19% of congregate and 32% of home-delivered participants have been in the hospital in the past year. Little is known, however, about the specific functional limitations and cognitive impairments that contribute to older adults being homebound and receiving home-delivered meals. Data from the 2017 National Survey of Older Americans Act Participants suggest that while age and mobility limitations are significant predictors of an older adult receiving home-delivered meals, the presence of cognitive impairment increases the likelihood that an older adult will have difficulty eating, using the toilet, bathing, preparing meals, taking medications, dressing, walking, getting around inside the home, and going outside of the home. Specifically, among adults age 60–64 receiving home-delivered meals, there is a large difference in functional limitations among those with cognitive impairments as compared to those without.

SOCIAL COHESION AMONG COMMUNITY-DWELLING OLDER ADULTS WHO ARE HOMEBOUND OR WHO RECEIVE MEALS ON WHEELS SERVICES

Social cohesion is a characteristic of communities rooted in norms of trust and reciprocity. Sometimes described as what holds us together, social cohesion is linked to a variety of health outcomes for older adults, including self-rated health status and overall mortality. Data from the National Health and Aging Trends Study (NHATS) were used to test the hypothesis that perceived social cohesion would be lower for certain vulnerable sub-groups of older adults: (1) the homebound and semi-homebound, and (2) recipients of Meals on Wheels services. NHATS uses a nationally representative sample of Medicare beneficiaries ages 65 and older. The 7,070 included in this analysis represent 38,834,686 community-dwelling older adults across the US, of whom 6,982,672 were homebound or semi-homebound and 379,865 reported receiving Meals on Wheels services. Social cohesion was calculated as the average level of agreement with three NHATS items: people in this community… know each other, are willing to help each other, and can be trusted. Homebound and semi-homebound individuals reported low social cohesion significantly more often than community-dwelling older adults who were not homebound. However, the prevalence of low social cohesion was not significantly different for respondents who reported receiving help from Meals on Wheels relative to those who did not receive services. This result may be an artifact of underreporting of Meals on Wheels in the NHATS dataset or it may suggest that home-delivered meal programs like Meals on Wheels are protective against low social cohesion – further research is warranted to ascertain which.

Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis

BackgroundMedicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS.MethodsWe used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures.ResultsBlack HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest.ConclusionsFindings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.

Food insecurity and hunger safety net use among single-room occupancy tenants in San Francisco, CA

ABSTRACTWe used a cross-sectional survey to explore the prevalence of food insecurity and use of hunger safety net programs, as well as the extent that they are associated, among 595 single-room occupancy tenants living within high-poverty neighborhoods in San Francisco, CA. The population was primarily male (73%) and over 55 years old (59%). 84% were classified as food insecure. 46% used free grocery programs, 44% used free dining rooms, and 34% used free home-delivered meals. Adjusted regressions estimated an inverse relationship (OR 0.91, 95% CI: 0.8, 1.0) between free home-delivered meals and food insecurity, suggesting a potential protective association.

Introduction to the Special Issue: Applications of Internet of Things

This editorial introduces the special issue, entitled “Applications of Internet of Things”, of Symmetry. The topics covered in this issue fall under four main parts: (I) communication techniques and applications, (II) data science techniques and applications, (III) smart transportation, and (IV) smart homes. Four papers on sensing techniques and applications are included as follows: (1) “Reliability of improved cooperative communication over wireless sensor networks”, by Chen et al.; (2) “User classification in crowdsourcing-based cooperative spectrum sensing”, by Zhai and Wang; (3) “IoT’s tiny steps towards 5G: Telco’s perspective”, by Cero et al.; and (4) “An Internet of things area coverage analyzer (ITHACA) for complex topographical scenarios”, by Parada et al. One paper on data science techniques and applications is as follows: “Internet of things: a scientometric review”, by Ruiz-Rosero et al. Two papers on smart transportation are as follows: (1) “An Internet of things approach for extracting featured data using an AIS database: an application based on the viewpoint of connected ships”, by He et al.; and (2) “The development of key technologies in applications of vessels connected to the Internet”, by Tian et al. Two papers on smart home are as follows: (1) “A novel approach based on time cluster for activity recognition of daily living in smart homes”, by Liu et al.; and (2) “IoT-based image recognition system for smart home-delivered meal services”, by Tseng et al.

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas.

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months. This study used a pre-posttest study design, with data collected before and after 3 months of HDM services. Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas. Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months. The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month. After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk. Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

Home Delivered Meals to Older Adults: A Critical Review of the Literature.

The United States is witnessing a growing aging population stemming in part from medical advancements allowing people to live decades longer than previous generations. Simultaneously, food insecurity among older adults has increased, and is projected to get worse as the Baby Boomer generation ages. This review focuses on an assistance program for older adults: home-delivered meals. Specifically, we focus on the effects of Meals on Wheels (MOW) on the physical and emotional well-being of older adults, and the wide variety of procedural and operational issues that various MOW programs around the country experience. Findings from the literature highlight the positive outcomes these programs have on their clients. Although there have been recent budget cut threats from the federal government, evidence suggests that more funding should be allocated so these programs can provide services to everyone in need, and even expand what they are able to offer to older adults.

DISEASE-SPECIFIC QUALITY OF LIFE IMPROVEMENTS DO NOT PREDICT OVERALL QUALITY OF LIFE IN OLDER ADULTS FOLLOWING DISCHARGE FROM HEART FAILURE HOSPITALIZATION

Older patients hospitalized for heart failure (HF) often have poor disease-specific quality of life (QOL), but less is known about their general QOL. The GOURMET-HF study randomized older adults to usual care or home-delivered meals for 4 weeks following HF hospitalization. Disease-specific QOL was