Meals-on-wheels Research Articles

Multiple imputation Procedure for Record Linkage and Causal Inference to Estimate the Effects of home-delivered meals

To assess the impact of home-delivered meals programs offered by Meals on Wheels (MOW) a dataset that includes enrollment into MOW and healthcare utilization is required. Because of confidentiality restrictions this data is dispersed over MOW programs internal systems and Medicare claims. In the absence of unique identifying identifiers, MOW beneficiaries are linked to Medicare beneficiaries using probabilistic linking algorithm. However, this procedure may erroneously link individuals across the two datasets, which may result in biased treatment effect estimates and suboptimal interval estimates. We propose a two-stage multiple imputation framework to estimate causal effects when the covariates and outcome information are stored in Medicare claims and the treatment assignment is MOW program data. In the first stage, we create multiple datasets in which MOW beneficiaries are linked to Medicare beneficiaries using a Bayesian record linkage technique. In the second stage, we match Medicare beneficiaries that were not enrolled in MOW programs to those that did. Using these matches we multiply imputed for each MOW beneficiary their unobserved healthcare utilization if they did not receive MOW. This procedure propagates the errors in the linking process and the matching process, and can be used to estimate effects of interventions in other linked datasets when there are no unique identifiers.

A Bayesian Record Linkage Approach that Adjusts for Variables in One File

In many healthcare and social science applications, information about units is dispersed across multiple data files. Linking records across files is necessary to estimate associations between variables exclusive to each of the files. Common record linkage algorithms only rely on similarities between linking variables common to all the files. Moreover, analysis of linked files often ignores errors that may arise from incorrect or missed links. Bayesian record linking methods allow for natural propagation of linkage errors, by jointly sampling the linkage structure and the model parameters. We extend an existing Bayesian record linkage approach to integrate associations between variables exclusive to each file being linked. We show analytically, and using simulations, that the proposed method improves the linkage process, and results in accurate statistical inferences. We apply the proposed method to link Meals on Wheels (MOW) recipients to Medicare Enrollment records, and examine the relationship between activities of daily living and healthcare utilization among MOW recipients.

Home-Delivered Meals and Nursing Home Placement Among People With Self-Reported Dementia

Home-delivered meals promote food security and independence among homebound older adults. However, it is unclear which of the 2 predominant modes of meal delivery, daily-delivered vs mailed (or drop-shipped) frozen meals, promotes community living for homebound older adults with dementia. To assess the risk of nursing home admission within 6 months between homebound individuals receiving daily-delivered vs drop-shipped frozen meals. This pilot, multisite, 2-arm, pragmatic clinical trial included older adults with self-reported dementia on waiting lists for meals at 3 Meals on Wheels (MOW) programs in Texas and Florida between April 7 and October 8, 2021, to assess time to nursing home placement. Participants were randomized to receive either meals delivered by an MOW driver or frozen meals that were mailed to participants' homes every 2 weeks. Participants received their assigned intervention for up to 6 months. The primary study outcome was days from randomization to a Minimum Data Set nursing home admission assessment within 6 months. Feasibility of conducting this type of study was examined by tracking enrollment, examining baseline characteristics, monitoring participants' intervention fidelity, measuring the proportion of participants linked with Centers for Medicare & Medicaid Services (CMS) data, and analyzing the primary study outcome. Among 325 eligible participants who were randomized, 243 enrolled in the study (mean [SD] age, 81 [8.0] years; 152 (62.6%) were female): 128 to the daily-delivered meals group and 115 to the drop-shipped frozen meals group; 119 participants (49.0%) lived alone. Among the total participants enrolled, 227 (93.4%) were linked deterministically to their CMS data; probabilistic methods were used to link the remaining 16 participants (6.6%). At 6 months from randomization, 160 participants (65.8%) were still receiving meals, and 25 (10.1%; 95% CI, 6.3%-14.0%) were admitted to a nursing home. After adjusting for sex, race and ethnicity, age, program, and living arrangement and the use of death as a censoring event, the adjusted log hazard ratio of nursing home placement between daily-delivered and drop-shipped frozen meals was -0.67 (95% CI, -1.52 to 0.19). This pilot randomized clinical trial demonstrated the feasibility of enrolling participants with self-reported dementia on waiting lists at MOW programs, linking their data, and evaluating outcomes. While this pilot study was not powered to detect meaningful, statistically significant differences in nursing home placement, its feasibility and initial results warrant exploration in a follow-on, adequately powered trial. ClinicalTrials.gov Identifier: NCT04850781.

An intergenerational service-learning approach to improve hand function in older adults

ABSTRACT Homebound older adults are at greater risk for functional impairments, social isolation, and loss of independence. Adequate hand function is needed to perform many daily activities, yet is understudied, particularly in the homebound population. The purpose of this study was to pilot test an intergenerational program in which pre-health college students were trained to deliver hand exercises to homebound older adults receiving Meals on Wheels (MOW) services. Eight MOW clients (mean age: 80.1 ± 12.9y) and 17 students completed the program. Students visited clients 2×/week for 6 weeks and engaged in hand exercises and meaningful conversations. Measures of hand strength, dexterity, self-reported function, self-efficacy, depression, and social isolation were taken before and after the program. Clients and students also completed a post-program experience survey. Significant improvements in pinch strength were observed, and 75% of clients reported better upper limb mobility after training. Survey feedback was positive with clients saying they enjoyed interacting with college students, while students praised the hands-on nature of the program and engagement with older adults. Results from this pilot study demonstrate an intergenerational approach to deliver hand training is feasible and underscores the value of using such models to increase access to care for homebound older adults.

Pilot Program to Assess Effectiveness of a Meal Supplementation Program in Addressing Food Insecurity in Pregnancy [ID: 1376240

INTRODUCTION: Food insecurity (FI) has been associated with adverse pregnancy outcomes including hypertension, decreased birth weight, and increased prenatal depression, and can be reduced by meal supplementation programs. However, screening for FI is not universal during pregnancy, and few studies address the feasibility of screening and implementation of interventions such as meal supplementation programs within prenatal clinics. METHODS: A novel pilot program was designed in collaboration with Meals on Wheels (MoW) to provide meal supplementation to positively screened pregnant individuals and their households. Universal FI screening for all patients occurred during their obstetrical intake visit using the “Hunger Vital Sign.” Those screening positive were offered enrollment in the program. To address the feasibility of incorporating enrollment into routine obstetric care, clinic practitioners were surveyed anonymously on the program and its potential effect on clinic workflow. RESULTS: In the first 3 months of the program, one in five (42/211 [20%]) of new prenatal patients screened positive for FI; of these, more than half (23/42 [55%]) of those with FI desired enrollment in the program. Nearly all clinic practitioners (35/36 [97%]) felt the program was beneficial to patients and 91% (32/35) agreed the program “does not significantly interfere” with their work. 97% (35/36) felt the program should continue. CONCLUSION: Food insecurity is prevalent among pregnant patients, but more than half of eligible patients declined meal supplementation program enrollment. Although incorporating such a program into a prenatal clinic is feasible from a provider perspective, feedback on the program from eligible participants is urgently needed to increase uptake rates.

Meals on wheels services and the food security of older people.

In recent years, Meals on Wheels (MoW) services have been in a state of decline as austerity policies have become entrenched. However, this decline is occurring with little knowledge of the impact withdrawal of MoW services has on the health and well-being of those who use them. The pandemic has raised awareness of precarity and vulnerability in relation to food that affects many people in the UK and other Westernised countries and this provides further context for the analysis presented. This paper presents findings of a mixed methods ethnographic study drawing on qualitative interviews and visual methods underpinned by social practice theory to explore the household food practices of older people receiving MoW services. Interviews were conducted with 14 older people receiving MoW, eight MoW staff delivering MoW services in the east of England and one expert. The Covid-19 pandemic interrupted the study, and once the first lockdown began visits to the homes of older people were terminated and the remaining interviews were undertaken by telephone. The study found that a number of threats accumulated to change food practices and moved people towards vulnerability to food insecurity. Threats included difficulty accessing food and cooking due to sensory and physical challenges. The MoW service increased participants' coping capacity. As well as benefiting from the food provided, the relational aspect of the service was important. Brief encounters between MoW staff built caring relationships that developed over time to ensure older people felt valued and cared for. The study demonstrates how MoW services make a positive contribution to food practices, supporting vulnerable adults to continue living well in their own homes and protecting them from food insecurity and ill-being. Local authorities looking to make cost savings through ending MoW services should consider the impact this would have on the well-being of older residents.

The value of the Physical Internet on the meals-on-wheels delivery system

Driven by innovative technologies such as the Internet of Things, blockchain, and mobile applications, meals-on-wheels (MOW) delivery services have shifted from a self-delivery (SD) model to outsourcing-delivery (OD) and volunteer-delivery (VD) models. The OD model is implemented by for-profit on-demand food-delivery platforms, and the VD model is implemented by non-profit service-sharing time banks designed for older adults. This work explored the concept of the Physical Internet (PI) to MOW delivery. First, we integrated recyclable PI-containers, smart lockers, and a PI-management system into SD, VD, and OD models to develop PI-enabled models. Second, we proposed simplified novel multi-objective mixed-integer linear programming models combined with a hierarchical clustering algorithm for the MOW delivery problem. The optimal planning decision minimizes the service providers’ costs while maximizes customer satisfaction. Third, we compared different PI-enabled models in terms of service cost and customer satisfaction and conduct sensitivity analyses of key parameters, such as objective-related parameters (i.e., cost of traveling and dispatching) and constraint-related parameters (i.e., number of parking sites and geographical distributions of demand). Finally, we verified the proposed solution through a real-life case. Our results indicate that the VD model exhibited strong adaptability to PI. The OD model is more sensitive to the marginal traveling cost, the VD model is more sensitive to the fixed dispatching cost, and both the SD and VD models are sensitive to the geographical demand distribution and number of clusters. PI in the VD model improves meal quality in almost all situations. This study can guide IHC centers on the adoption of PI and MOW models.

Social Connectedness, Meals on Wheels Services and Healthcare Utilization Among High-Need Older Adults

Homebound vulnerable adults 65+ are at an increased risk for social isolation and loneliness. The adverse consequences of loneliness are profound – including increased health care utilization, burden of dementia, chronic diseases, and mortality. Meals on Wheels (MOW) is a familiar source of nutritional support for homebound individuals who wish to stay in their homes and has additional important benefits. A growing body of evidence demonstrates that MOW provides mental and social health benefits beyond nutrition, but less is known about the interplay between MOW, social cohesion, and health services use. This project will address this gap in the literature using data from the 2013-2020 National Health and Aging Trends Study (NHATS), a nationally-representative panel study of 65+ Medicare enrollees. Using matching and longitudinal multivariate techniques, the risks of hospitalization and permanent nursing home entry are compared between MOW users and non-users. Our longitudinal dataset includes 11,266 observations. Of those, 12.8% rely on MOW or other food assistance (N= 1,488) and 16.6% experience low social cohesion (N= 1,936). Some 6.6% of participants are nursing home residents (N= 748) and the 39.1% report an overnight hospital stay in the prior year (N= 4,560). MOW is a comparatively low-cost intervention to help homebound older adults retain their independence and limit costlier healthcare utilization. This work extends our understanding of MOW services beyond simple nutrition benefits to its potential impact on social health.

Engaging Stakeholders in a Pragmatic Trial of Home-Delivered Meals for Persons with Dementia

Gathering stakeholder feedback is essential to designing and implementing relevant and actionable research. Additionally, stakeholders, particularly those directly impacted by an intervention, bring unique insights and experiences. This paper presents the process and findings of a research endeavor to co-design a pragmatic clinical trial with a Stakeholder Advisory Panel (SAP) in an effort to understand facilitators and barriers to conducting the research and implementing study findings. The proposed trial compares the impact of frozen, drop-shipped meals versus daily home-delivered meals provided by Meals on Wheels (MOW) programs on the ability of individuals living with dementia to age in place. We recruited nine SAP members, who were compensated for their time. The SAP is composed of a) MOW clients with dementia, b) family members of MOW clients with dementia, c) paid or volunteer MOW drivers, and d) MOW staff. A research team member facilitated two 90-minute meetings with the SAP members via Zoom. The topics of the meetings included potential benefits and challenges with each mode of meal delivery, the importance of the primary outcome (time to nursing home placement), topics of interest to include in interviews with clients and caregivers, and how participants would explain the study to a friend. Audio of the Zoom meetings was transcribed, and meeting summaries were shared with the SAP. Benefits of forming and engaging a SAP, as well as key lessons learned from SAP members and how recommendations were reflected in changes to the study protocol will be discussed.

Nutritional risk and dietary intake among newly enrolled meals on wheels participants

This study aimed to gain a better understanding of the nutritional risk (NR) and nutritional needs of newly enrolled Meals on Wheels (MOW) participants. This cross-sectional study in a Midwest state assessed the NR and dietary intake frequencies (DIF) of 167 newly enrolled MOW participants ages 60 years and older using the Dietary Screening Tool. Participants were primarily female (62.9%) and enrolled in MOW during the winter (85%). Over half (53.9%) classified “at NR,” 43.7% “at possible NR,” and 2.4% “not at NR.” “Low” DIF of dairy, lean protein, and processed meat were detected. “Moderate” DIFs of vegetable, total and whole grains, whole fruit and juice, and added fats, sugars, and sweets were also found. Male participants experienced higher NR (p < 0.0005) and consumed lower fruit and vegetable DIFs (p < 0.030) than females. Lean protein DIFs were lower in the winter than in the summer (p = 0.04). Early identification of NR and factors influencing NR can help community food programs better address OA nutrition concerns.

The views, experiences and expectations of Australian Meals on Wheels customers: A national survey.

To investigate views and expectations of Australian Meals on Wheels (MOW) customers to inform the development of National Meal Guidelines and improve current services. A survey was designed through literature review and consultations with key stakeholders. National convenience sampling returned 337 surveys. Descriptive statistics and chi-squared analyses were applied to the survey data. Meals on Wheels customers reported satisfaction with their current service, with the meal itself found to be the most valuable aspect. People living in small country towns were more likely to value the social contact provided by MOW than those in major cities (P=.001). Delivery of pantry items was the most popular additional option for future services. Valuable information for inclusion in the development of the National Meal Guidelines was provided: nutritional content of meals, meal variety, packaging and presentation, opportunities for nourishing snacks and pantry items, and social contact.

Malnutrition Intervention in Low Socioeconomic Senior Populations

This study aims to identify the effectiveness of malnutrition intervention programs within senior populations. Government subsidized nutrition intervention programs, such as Meals on Wheels, play a vital role in the prevention of malnutrition in lower socioeconomic senior populations in the United States (Roy, 2006). For many older adults, meals received via nutrition programs serve as a lifeline, meeting essential nutritional needs and preventing premature institutionalized care (Lepore, 2019). Sixty-three Meals on Wheels (MOW) participants residing in Southern California were assessed, comparing nutritional status upon program intake against nutritional status after three to six months to identify improvement or decline. This study relied on self-reporting on the part of senior participants to explore the characteristics related to socioeconomic status and nutritional risk, and collect quantitative data. Further, it aimed to highlight whether nutritional risk was decreased through program usage. Access to the MOW nutrition program was found to correlate with a reduction in malnutrition risk among the participants in the study. Through the use of nutrition programs and their evaluations, malnutrition and malnutrition risk may be detected earlier, and subsequent measures for prevention can be employed.

An innovative rehabilitating meals-on-wheels service for frail old people - a controlled feasibility study.

Rationale: The current uniform meals-on-wheels (MOW) service provided to frail old community-dwelling people have a negative impact on nutritional status, physical function and quality of life, which suggest the need for a more targeted and situation-adapted service.

Frailty and Nutrition Risk Screening in Home-Delivered Meal Clients

Community service providers, such as Meals on Wheels (MOW) programs, help older adults remain in their homes despite advanced care needs. The purpose of this study was to determine if a frailty index (FI) could be calculated from self-reported health, function, and nutrition information already collected by MOW providers to provide additional information for care planning and risk stratification. Data from 258 MOW clients at one provider were used to calculate the FI from 40 possible health and age-related variables collected during routine health assessments. The average FI was 0.29 ± 0.13(SD), range 0.05–0.68. Frailty was categorized as non-frail, vulnerable, frail, and most frail; nutrition risk increased incrementally with these categories; however, they appear to assess risk from differing angles and etiologies. The addition of the FI can provide a more holistic picture of MOW client health than nutrition risk alone and the FI can be calculated from routinely-collected data.

Tracking and treating malnutrition: a retrospective observational study of the nutritional status of vulnerable people accessing a meals-on-wheels (MOW) service.

The aims of the study were to describe the characteristics of meals-on-wheels (MOW) recipients, including prevalence of malnutrition amongst those who have received input from the Nutrition and Wellbeing Service (NWS) and to explore whether the NWS had an impact on the nutritional status (malnutrition risk) of recipients over time. Support services, for example, MOW, play an important role in the prevention and treatment of malnutrition in the community. In the UK, MOW services are under threat. However, little is known about how they support the health and well-being of older people. This study reports on the characteristics of MOW recipients and investigates change in nutritional status over time. A retrospective study of MOW recipients of nutritional concern who were offered a check through the NWS was conducted. Demographic, social and health information were gathered at the initial visit. Nutritional status (risk of malnutrition) was obtained using the validated Malnutrition Universal Screening Tool (MUST), at the initial and subsequent visits. Changes over time were investigated for recipients receiving at least two follow-up visits. An initial visit was made to 399 MOW recipients, and 148 recipients had two or more follow-up visits. At initial screening, 177 (44%) of recipients were at medium or high risk of malnutrition. Frailty was significantly related to malnutrition risk (P = 0.049). At follow-up, there was a reduction in malnutrition risk. The MOW service was associated with a reduction in malnutrition risk. By offering well-being visits within a MOW service, malnutrition can be identified early. Future studies into how MOW services might delay or prevent the need for support from acute health services and social care are warranted.

Aging in America and Meals on Wheels: Exploring Impacts on Food Insecurity, Health Outcomes, and Hospitalizations

In the U.S., the 65 and older demographic is expected to double in size by 2050 and with older adults accounting for more than a third of hospital stays, it can be expected that the portion of hospital stays by older adults will increase accordingly. One program that has been linked to reducing hospitalizations and improving health outcomes is Meals on Wheels (MOW). Secondary analysis of existing data from the Eighth National Survey of OAA Participants was conducted to explore the impact of MOW service on health outcomes, hospitalizations, and food insecurity while focusing on the following research question: does MOW service reduce the number of hospitalizations and improve health outcomes, and if so, how does the length of service influence these relationships? This research showed that respondents to the survey have high levels of self-reported health improvement (76.1 to 91.5%) and low levels of food insecurity (9.4 to 29.7%) after MOW participation.

VIDEODINING IN OLDER ADULTS AGING IN PLACE: A FEASIBILITY AND ACCEPTABILITY STUDY

Loneliness and a loss of commensality contribute to the decline in nutritional status observed in older adults. The use of video chatting while dining, i.e. “VideoDining”, provides an opportunity for older adults to eat with another person virtually while dining at home. We tested the acceptability and feasibility of VideoDining in older adults receiving Meals on Wheels (MOW) and explored whether it changed meal intake. Participants were recruited from a rural county in NY and ate their MOW meal while VideoDining with a companion diner at a different location. To assess acceptability, we conducted semi-structured qualitative interviews with each participant and companion diners completed a written survey. The amount of the VideoDining meal consumed was compared to usual intake from three days of food records. 140 MOW clients were contacted,13 agreed to participate and 10 completed the VideoDining experience. Barriers to participation included being uncomfortable with the technology, lack of internet service and illness. Participants were 80% female, 100% white, and all lived alone. Average meal length was 39 minutes and 40% ate more than usual, 30% ate the same, and 30% ate less. Reasons for eating less included being nervous and eating when not their usual mealtime. All participants reported they would VideoDine again and companion diners rated the overall experience a 9.2 out of 10. Older adults are able to VideoDine with a new acquaintance and have a positive experience. Further study is needed to determine if VideoDining can increase dietary intake and decrease loneliness in older adults.

An innovative rehabilitating meals-on-wheels service for frail old people

Abstract Background Preparing meals are part of ordinary activities of daily living. However, frail old people receiving meals-on-wheels (MOW) may lose their functional abilities in relation to such preparation. No studies have investigated, whether it is possible for frail old people, receiving MOW to learn or relearn to manage own meals. The aim of this intervention is to investigate if a rehabilitating MOW service including an innovative food basket could have a positive effect on functional abilities in relation to the preparation of meals and thereby improve health-related quality of life in frail old people. Methods An 8-week randomized controlled trial. 76 old people (65+ years old) who receive MOW are randomized to either a control group receiving usual MOW service or an intervention group additionally receiving one of four different food baskets consisting of four different food ingredients and recipes with graduation in degree of complexity delivered twice a week. The recipes is chosen in accordance with level of function, assessed by means of AMPS and the old adult practice cooking skills under supervision of an experienced occupational therapist. Primary outcome is health-related quality of life measured by EuroQol-5D-5L, secondary outcomes are physical function (30 seconds chair-stand), Satisfaction with food-related quality of life questionnaire, Food related functional ability questionnaire, Meal quality questionnaire, dietary intake and body weight. Results The intervention is ongoing and planned to end July 2019. Data will undergo statistical analyses and presented in November 2019. Conclusions The study will contribute with new knowledge about whether a rehabilitating MOW service including an innovative food basket could have a positive effect on functional abilities in relation to the preparation of meals and thereby improve health-related quality of life in frail old people.

An Innovative Rehabilitating Meals-on-wheels Service for Frail Old People

An Innovative Rehabilitating Meals-on-wheels Service for Frail Old People

A New Data Resource to Examine Meals on Wheels Clients' Health Care Utilization and Costs.

Access to social services (eg, nutrition) can impact older adults' health care utilization and health outcomes. However, data documenting the relationship between receiving services and objective measures of health care utilization remain limited. To link Meals on Wheels (MOW) program data to Medicare claims to enable examination of clients' health and health care utilization and to highlight the utility of this linked dataset. Using probabilistic linking techniques, we matched MOW client data to Medicare enrollment and claims data. Descriptive information is presented on clients' health and health care utilization before and after receiving services from MOW. In total, 29,501 clients were from 13 MOW programs. Clients' demographics, chronic conditions, and hospitalization, emergency department (ED), and nursing home (NH) utilization rates. We obtained a one-to-one link for 25,279 clients. Among these, 14,019 were Medicare fee-for-service (FFS) beneficiaries and met inclusion criteria for additional analyses. MOW clients had high rates of chronic conditions (eg, almost 90% of FFS clients were diagnosed with hypertension, compared with 63% of FFS beneficiaries in their communities). In the 6 months before receiving MOW services, 31.6% of clients were hospitalized, 24.9% were admitted to the ED and 13% received care in a NH. In the 6 months after receiving meals, 24.2% were hospitalized, 19.3% were admitted to the ED, and 9.5% received care in a NH. Linking MOW data to Medicare claims has the potential to shed additional light on the relationships among social services, health status, health care use, and benefits to clients' well-being.