Nutrition Services Program Research Articles

REASONS OLDER ADULTS START ATTENDING CONGREGATE MEAL PROGRAMS AND WHO ATTENDS FOR SOCIALIZATION

Abstract The Older Americans Act Nutrition Services Program’s congregate meals support food security and nutrition, promote socialization, and improve quality of life. Understanding what drives people to first attend a congregate meal program may support efforts to increase involvement. This study used the 2019 National Survey of Older Americans Act Participants to analyze the open-ended survey responses of congregate meal participants (N=1,072) on why they started attending the program. The top three reasons were that they sought socialization (36.3%), had a medical or age-related need (18.7%), or accompanied or were referred by a friend or relative (12.3%). We conducted descriptive analyses on differences in the demographic, socioeconomic, and health characteristics of those attending for socialization compared to others. Results indicated a relationship between attending congregate meals for socialization and several characteristics: these individuals are more often non-Hispanic white (p< 0.05), widowed (p< 0.05), aged 75 to 84 (p< 0.05), and have at least a high school education (p< 0.01). People who attend for socialization are also less likely to be lower income (p< 0.01), living in cities (p< 0.001), have food insecurity (p< 0.01), and living with three or more ADLs (p< 0.01). Findings suggest two subpopulations of congregate meal attendees: those who have the choice to attend and do so for socialization, and those who attend because of unmet needs (e.g., food insecurity or disability). Identification of different categories of participants and what drives them to attend congregate meal sites has implications for improvements to advertising congregate meal services, targeting of certain populations, and ultimately to increasing participation.

Food Insecurity is Directly Associated with the Use of Health Services for Adverse Health Events among Older Adults

In 2018, 14.3 million US households experienced food insecurity, which has been linked to negative health outcomes such as depression and anxiety, diabetes, and hypertension. This connection is particularly important for older adults, who are at greater risk than younger adults for developing certain health conditions. We estimated the association between food insecurity and the use of health services for adverse health events over a 12-mo observation period following survey interview for a nationally representative group of older adults participating in the congregate meal (CM) and home-delivered meal (HDM) programs. We analyzed data from the Nutrition Services Program (NSP) Outcomes Survey matched to Medicare claims and enrollment data in 2015-2016 for a nationally representative sample of 626 CM or HDM recipients ages 67 y and older. We used logistic regression analysis controlling for demographic characteristics, prior health events, and geography to estimate the association between food insecurity and use of health services, including emergency department visits, inpatient stays, skilled nursing facility stays, and home healthcare episodes. We used ordinary least squares regression analysis to estimate the association between food insecurity and Medicare spending. Food insecurity was associated with an average increased likelihood of using health services for adverse health events of 16% (95% CI: 1%, 32%) for HDM participants. Food insecurity was associated with an average increased likelihood of emergency department visits of 24% (95% CI: 6%, 41%) for CM participants and 20% (95% CI: 5%, 36%) for HDM participants. There was no observed increase in likelihood of using the other health services. Food-insecure participants were less likely to have a skilled nursing facility stay. Food insecurity is associated with an increased likelihood of use of health services for adverse health events in older adult participants in meal service programs.

Continued Participation in Congregate Meal Programs: The Role of Geographic Access to Food

The Nutrition Services Program is the largest program that provides prepared meals to older adults in need. However, little is known about the factors associated with participants’ continued receipt of meals. This study uses longitudinal nationally representative survey data and residential location information to examine the factors associated with continuing to receive congregate meals (N = 383). 71.6% of participants in a given month continued to receive program meals in all of the next 12 months. Participants with geographic access to food proximate to their home were significantly more likely to stop receiving meals than those with more limited access (OR = 0.37, CI 0.16, 0.85); this was true among participants who lived alone, were older, had lower income, or lived in an urban area. Understanding the factors associated with continuing to receive congregate meals will ensure that older adults can meet their food needs and have a primary access point for community services.

Determinants of Food Insecurity Among Congregate Meal Participants: A Cross-Sectional Study Using Participant Information Matched to Geographic and Service Provider Data.

As people age, they are more likely to face financial, medical, and mobility related challenges that can put them at risk of food insecurity. This is a serious public health concern that has been associated with many adverse health outcomes. This study examined factors associated with food insecurity among older adults who receive congregate meals from the Administration on Aging's Nutrition Services Program. Combining participant, geographic, and provider data allowed for a more detailed assessment of older adult food insecurity than is typically possible using other national surveys. A cross-sectional study. We conducted a cross-sectional data analysis using national survey data from the Administration on Aging's Nutrition Services Program Outcomes Survey, conducted from 2015 to 2016. The data were linked to provider data from the meal site where participants ate. Logistic regression analysis was conducted to estimate the associations between food insecurity and demographic, household, geographic, and provider-level characteristics and circumstances. Interviews with congregate meal participants were conducted in person at congregate meal sites or another preferred place. A total of 520 older adults were included as study participants. All older adults were participating in the Nutrition Services Program and receiving congregate meals at the time of the survey interview. All participants were at least 67 years old. This study used a 6-item food security measure as the dependent variable. Older adults who answered at least 3 of the 6 questions affirmatively were considered food insecure. Food security was assessed over a 30-day recall period. 18% of congregate meal participants lived in food insecure households. Among congregate meal participants, having low income, difficulty reaching family and friends, past military service, and mobility challenges, and attending a site that provided nutrition counseling were associated with increased food insecurity (most odds ratios ranged from 1.1 to 2.6). Older age, geographic access to food, certain chronic health conditions, and provider-offered nutrition screening and social activities reduced the odds of experiencing food insecurity (most odds ratios ranged from 0.2 to 0.4). Although the Nutrition Services Program helps to alleviate food insecurity, a nontrivial percentage of participants remain food insecure. Nutrition programs can help address clients' food access limitations by broadening nutrition screenings at meal sites to include more comprehensive assessments based on non-traditional risk factors for food insecurity.

PARTNERING WITH NUTRITION SERVICES PROGRAM PROVIDERS TO DISSEMINATE EVIDENCE-BASED PROGRAMS USING TELE-HEALTH

Among adults ≥ age 65, 48% have prediabetes and are eligible to participate in the Medicare-covered Diabetes Prevention Program (DPP). We conducted a six-week pilot study to evaluate the feasibility and acceptability of a telehealth-adapted DPP for Nutrition Services Program (NSP) older adult meal program recipients. We enrolled NSP recipients (n=16) from a New York City senior center. These DPP participants attended weekly interactive DPP webinars and completed questionnaires covering lifestyle, physical activity, quality of life, and food records, and wore physical activity trackers. Retention was 75%; attendance averaged 80%; and weight loss was 2.9% (p=0.001). Our six-week pilot data suggest that a tele-adapted DPP intervention can achieve the Medicare reimbursement goals for attendance and 5% weight loss. We are surveying NSP recipients, who receive home-delivered meals, to evaluate the acceptability and feasibility of conducting a larger scale tele-adapted DPP intervention trial among NSP participants.

INCREASING VULNERABILITY AMONG OLDER AMERICANS ACT HOME-DELIVERED NUTRITION SERVICE CLIENTS

Older Americans Act (OAA) programs are designed to help frail and vulnerable older adults remain in their homes through the provision of long-term services and supports. Administrative data from the Administration for Community Living (ACL) show that older adults receiving OAA services are three times more likely to live below the poverty level (33.0%) as compared with all older adults (9.2%). In addition, they are almost twice as likely to be living alone (45%) as compared with the general population (28%). Using data from the recently released 2018 National Survey of Older Americans Act Participants, we examine the largest program administered by ACL, the OAA Nutrition Program, to see if the economic vulnerability of home-delivered nutrition service clients has changed over the past 10 years. Results from this study show that recipients of home-delivered nutrition services are more in need of low-cost or free meals in 2018 than they were in 2008 due to a 24% increase in Medicaid eligibility, 41% increase in those who report not having enough money or food stamps to buy food, and 101% increase in those who report receiving food stamps. This increase in economic need may be due to a demographic shift in the marital status and living arrangements of older adults, specifically the 75-84 age group. The increase in the percentage of older adults who are divorced, live alone, and have low income has made the home-delivered nutrition services program even more important today than it was a decade ago.

Facilitating Fresh: State Laws Supporting School Gardens Are Associated With Use of Garden-Grown Produce in School Nutrition Services Programs

ObjectiveTo examine whether state laws are associated with the presence of school gardens and the use of garden-grown produce in school nutrition services programs. DesignNationally representative data from the School Health Policies and Practices Study 2014 were combined with objectively coded state law data regarding school gardens. Main Outcome MeasuresOutcomes were: (1) the presence of a school garden at each school (n = 419 schools), and (2) the use of garden-grown items in the school nutrition services program. AnalysisMultivariate logistic regression was used to examine each outcome. Contextual covariates included school level, size, locale, US Census region, student race/ethnic composition, and percentage of students eligible for free and reduced-priced meals. ResultsState law was not significantly associated with whether schools had a garden, but it was associated with whether schools used garden-grown items in nutrition services programs (odds ratio, 4.21; P < .05). Adjusted prevalence of using garden-grown items in nutrition services programs was 15.4% among schools in states with a supportive law, vs 4.4% among schools in states with no law. Conclusions and ImplicationsState laws that support school gardens may facilitate the use of garden-grown items in school nutrition service programs. Additional research is needed regarding the types of messaging that might be most effective for motivating school administrators to appreciate the value of school gardens. In addition, another area for further research pertains to scaling garden programs for broader reach.

Culturally tailored postsecondary nutrition and health education curricula for indigenous populations

BackgroundIn preparation for the initial offering of the University of Alaska Fairbanks (UAF), Interior–Aleutians Campus Rural Nutrition Services (RNS) program, a literature review was conducted to establish the need for the proposed program and to substantiate the methodology for delivering integrated, culturally tailored postsecondary education and extension to Alaska Natives and rural Alaskans. There was a striking absence of peer-reviewed journal articles describing culturally tailored postsecondary health curricula for indigenous populations.ObjectiveTo complete and discuss a current (November 2012) literature review for culturally tailored postsecondary health curricula designed and delivered for indigenous populations.Methods/DesignThe author conducted an expanded online search that employed multiple configurations of key terms using Google and Google Scholar, as well as pertinent sources. The author located archived reports in person and contacted authors by email.ResultsThe expanded search produced a modest amount of additional literature for review. A disappointing number of publications describing or evaluating culturally tailored postsecondary health curricula in mainstream institutions are available. Related resources on culturally tailored extension and resources for the development and delivery of culturally tailored nutrition and health curricula were identified.ConclusionsThe present results demonstrate a significant absence of literature on the topic, which may or may not indicate the absence of sufficient culturally tailored postsecondary health curricula for indigenous populations. There are indications that culturally tailored postsecondary health curricula for indigenous populations have the potential to effectively address certain issues of health literacy and health disparities.

Nutrition Services and Foods and Beverages Available at School: Results From the School Health Policies and Programs Study 2006

Schools are in a unique position to promote healthy dietary behaviors and help ensure appropriate nutrient intake. This article describes the characteristics of both school nutrition services and the foods and beverages sold outside of the school meals program in the United States, including state- and district-level policies and school practices. The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=944). Few states required schools to restrict the availability of deep-fried foods, to prohibit the sale of foods that have low nutrient density in certain venues, or to make healthful beverages available when beverages were offered. While many schools sold healthful foods and beverages outside of the school nutrition services program, many also sold items high in fat, sodium, and added sugars. Nutrition services program practices in many schools continue to need improvement. Districts and schools should implement more food preparation practices that reduce the total fat, saturated fat, sodium, and added sugar content of school meals. In addition, opportunities to eat and drink at school should be used to encourage greater daily consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products.

Role of Cooperative Extension in Congregate Nutrition Programs for the Elderly

We explored the nature of programming between the Cooperative Extension Service and the Congregate Nutrition Services Program at the national level. Our findings indicate that home economics extension staff carry out many diverse roles with respect to congregate nutrition programs and that topics covered in instruction by extension staff cover a wide range of areas. Only about 20% of respondents viewed programming for congregate nutrition programs as a priority area in their states, but 66% viewed it as important. The discussion focuses on the value of interagency coordination and the development of a comprehensive program package as ways of enhancing extension's role in congregate nutrition service programs.

The community health nurse's nutrition guidelines: a trimester approach for expectant mothers.

1The currently a nutritionist for the Nutrition Services Program of the Allegheny County Health Department and is adjunct assistant professor for the Clinical Dietetics and Nutrition Program at the University of Pittsburgh in Pennsylvania 2The currently the curriculum advisor at St. Francis Hospital School of Nursing in Pittsburgh, Pennsylvania. Both authors were formerly with the Maternity and Infant Care Project at the Allegheny County Health Department