Older Americans Act Nutrition Program Research Articles

Increasing Equity and Inclusion in Nutrition Services for Older Adults

The latest version of the Older Americans Act Nutrition Program (OAANP) enacted in 2020 targets those most at risk of nutritional deficiencies, social isolation, and institutionalization. Racial, ethnic, cultural, and sexual minority populations are at high risk for all 3, and yet, these populations are underrepresented in the OAANP. To reach people at risk in neighborhoods with high racial and ethnic diversity, outreach, targeting, and retention are essential. This article synthesizes information obtained through peer-reviewed and gray literature, telephone interviews of nutrition leads/directors of 9 state units on aging, and online review of state plans to present approaches and best practices in increasing equity and inclusion in the OAANP and in other similar programs.

Overhauling Nutrition Assistance Programs to Provide Comprehensive Nutrition Support for Older Adults

Older adults want to “age in place,” but the currently fragmented and inadequate nutrition assistance environment is at odds with this goal. Given the substantial gap between resources needed to make the “Aging in Place” dream a reality and current level of support, investigation into mechanisms of an overhaul to nutrition assistance for older adults is warranted. In this article, we assess the need for comprehensive nutrition support for older adults, review the current federal nutrition support, provide rationales for legislation supporting nutrition support integration and expansion (with an emphasis on home nutrition support for older adults), and introduce operational approaches for an expansion. Older adults face unique challenges to maintaining adequate nutrition. Upwards of 19% of older adults with low incomes (those living in households below 185% of the poverty threshold) were food insecure, and approximately 90% of these individuals did not receive meal services. Fragmentation of federal services across the US Department of Agriculture and Department of Health and Human Services, mobility, technology use, and stigma surrounding assistance programs all but guarantee that older adults do not derive maximal benefit from available services. In light of the complementary nature of different nutrition policies and programs, leading policy experts have called for integrated, multicomponent government strategies that adapt and streamline existing structures and systems. We urge the US Department of Agriculture and the Department of Health and Human Services to conduct pilot studies granting states joint waiver authority for SNAP, Medicaid, Medicare Advantage, and the Older Americans Act Nutrition Program. Leveraging resources and information across parallel programs can allow more older adults to manifest their right to “age in place.”

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.

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.

Characteristics of Older Georgians Receiving Older Americans Act Nutrition Program Services and Other Home- and Community-Based Services: Findings from the Georgia Aging Information Management System (GA AIMS)

This descriptive study examined characteristics of older Georgians receiving Older Americans Act Nutrition Program Services and other home- and community-based services (HCBS) using state aging administrative data (N = 31,341, mean age: 76.6 ± 9.2 y, 71.2% female, 52.3% White). Home-delivered meals (HDM) was used most frequently. The characteristics of older Georgian HCBS participants varied by the type and number of HCBS received. Those receiving HDM and other in-home and caregiving services were more likely to show poorer sociodemographic, economic, and functional characteristics, and food insecurity. Those receiving multiple HCBS were most vulnerable, but showed lower level of food insecurity than those receiving single HCBS, suggesting potential combined benefits of receiving multiple programs. This study underscores the importance of documenting dynamic needs for HCBS, especially HDM, among vulnerable older adults as part of standard administrative process to identify those at high risk of institutionalization, optimize HCBS delivery and coordination, and maximize HCBS benefits.

Older Americans Act Nutrition Programs: A Community-Based Nutrition Program Helping Older Adults Remain at Home

Nutrition interventions are important as the older population, most of whom live in the community, increases in size and diversity. They are key to leading a healthy, functional life and mitigating chronic health conditions. The Older Americans Act Nutrition Program served 86.3 million congregate and 137.4 million home-delivered meals to 1.6 million and 850,000 older adults, respectively (2012). Congregate and home-delivered participants were older, poorer, sicker, more functionally impaired, and at a greater risk of institutionalization than the general U.S. older population. The Nutrition Program is publically and privately funded. About 44% of congregate and 30% of home-delivered expenditures are from federal sources, which dropped from $25 per older adult in 1990 to $12 in 2013. Despite multiple funding sources, funding is insufficient for the expanding older population. Health, nutrition, and social service professionals need to coordinate their community-based services to truly help older adults remain in their homes.

Factors Associated with Inpatient Hospital (Re)admissions in Medicare Beneficiaries in Need of Food Assistance

Little is known about pathways underlying inpatient hospital (re)admissions in older adults unable to meet basic needs. This study examined the factors associated with (re)admissions in a sample of low-income older Medicare beneficiaries in need of food assistance in Georgia in 2008 (N = 892, mean age 75.4 ± 8.8 years, 30.3% Black, 68.5% female). About 35.3% of the sample experienced 1 + hospital (re)admissions. (Re)admissions were significantly more likely in individuals who requested Older Americans Act Nutrition Program Home Delivered Meals services (OR 2.3; 95% CI 1.4, 3.8), had more outpatient emergency room visits (1 visit: OR 2.1; 95% CI 1.4, 3.1; 2+ visits: OR 3.6; 95% CI 2.4, 5.4), and experienced greater multimorbidity (OR 1.6; 95% CI 1.4, 3.1). Support for home and community-based services may be critical in reducing potentially avoidable inpatient hospital (re)admissions.

Persistent Food Insecurity Is Associated With Higher Levels of Cost-Related Medication Nonadherence in Low-Income Older Adults

The purpose of this study was to examine relationships between changes in food insecurity (FI) and cost-related medication nonadherence (CRN) among Older Americans Act Nutrition Program participants and wait-listed individuals in Georgia. This study used data collected from 3 waves of self-administered mail surveys conducted 4 months apart in 2008 and 2009 (n = 664, mean age 74.6 ± 8.9 years, 71.5% female, 31.0% African American). FI was assessed by using a validated 6-item U.S. Household Food Security Survey Module. Practice of 5 CRN behaviors was evaluated. Changes in FI and CRN were determined based on ≥2 repeated measures. Participants with persistent FI and CRN were more likely to be younger, low-income, and in poorer health. After controlling for potential confounders, persistently food insecure individuals and those who became food insecure showed 8.2 (95% CI: 5.4–12.5) times and 5.3 (95% CI: 3.2–8.8) times increased odds of reporting higher levels of CRN than persistently food secure individuals.

Persistent Food Insecurity is Associated with Higher Levels of Cost‐Related Medication Non Adherence in Low‐Income Older Georgians

The purpose of this study was to examine the relationship between changes in food insecurity (FI) and cost‐related medication non‐adherence (CRN) among Older Americans Act Nutrition Program participants and waitlisted people in Georgia. This study used 3 waves of self‐administered mail surveys, conducted 4 months apart between 2008 and 2009 (n = 664, mean age 74.6 ± 8.9, 71.5% women, 31.0% African American). FI was assessed by using a modified version of the nationally validated standard 6‐item US Household Food Security Survey Module. Practice of 5 CRN behaviors (i.e., splitting pills, delaying refills, and skipping doses) was evaluated. Changes in FI and CRN were determined based on ≥ 2 repeated measures. Over the 8‐month period, 35.8% were persistently food insecure, 12.7% became food insecure, 16.7% became food secure, and 34.8% were persistently food secure; 29.2% persistently practiced CRN, 16.7% started practicing CRN, 15.7% stopped practicing CRN, and 38.4% were persistently medication adherent. Participants with persistent FI and CRN were more likely to be younger, low‐income, and in poorer health. After controlling for potential confounders, persistently food insecure and newly food insecure individuals were 8.2 times (95% CI: 5.4, 12.5) and 5.3 times (95% CI: 3.2, 8.8) more likely to report higher levels of CRN than persistently food secure individuals. This study was funded in part by UGA FACS.

The Influence of home‐delivered Dietary Approach to Stop Hypertension (DASH) meals on body mass index and percent of energy needs consumed among older adults with cardiovascular disease

ObjectiveTo examine the impact of a home delivered DASH meal intervention, similar to the Older Americans Act Nutrition Program (OAANP) home delivered meals program, on energy balance and weight.MethodsData for the analysis came from a randomized control trial of home‐delivered DASH meals and medical nutrition therapy conducted from 2003–2005. Study participants (n=298) were over age 60 and had hyperlidemia or hypertension. Difference‐in‐differences (DD) models were used in estimating the effects of the home‐delivered meal intervention on BMI and percent of daily energy needs met.ResultsThe majority of the study participants were white (62.1%), and were women (83.9%), had an income below 165% of the poverty level (71.5%), and were overweight or obese as indicated by a BMI ≥25 kg/m3 (76.7%). The average age was about 72. Receipt of meals did not have a significant effect on BMI or percent of daily energy needs.ConclusionRegistered dietitians and other health care providers are encouraged to assist older adults in obtaining OAANP meals that are therapeutically designed to meet DASH guidelines.This study was funded by the Administration on Aging

Food Security of Older Adults Requesting Older Americans Act Nutrition Program in Georgia Can Be Validly Measured Using a Short Form of the U.S. Household Food Security Survey Module

Food security is a newly recommended outcome measure for the Older Americans Act Nutrition Program (OAANP); however, it is unknown how best to evaluate the need for this program and assess its impact on a large scale. Therefore, we measured food security in all new OAANP participants and waitlisted applicants in Georgia between July and early November, 2008 (n= 4731) with the self-administered mail survey method used in the ongoing Georgia Performance Outcomes Measures project. We used a modified 6-item U.S. Household Food Security Survey Module (HFSSM) with a 30-d reference period and 2 reminder postcards. Approximately 33% of those identified completed the survey (n= 1594, mean age 74.6 ± 9.5 y, 68.6% female, 30.6% black). Most of the respondents (91%) completed all 6 food security questions, whereas 26 did not respond to any question. Infit and outfit statistics for each of the 6 questions were within an acceptable range. Psychometric properties observed in our food security data were generally similar to those in the nationally representative survey conducted by the Census Bureau and suggest that our food security statistics may be meaningfully compared with national food security statistics published by the USDA. Our findings suggest that food security can be reasonably measured by a short form of HFSSM in older adults requesting OAANP. Such methodology also can be used to estimate the extent of food insecurity and help guide program and policy decisions to meet the nutrition assistance needs of vulnerable older adults.

Older Americans Act Nutrition Program Improves Participants' Food Security in Georgia

It is critical to use convincing research methodology to demonstrate the benefits of nutrition assistance programs targeted to vulnerable older adults. We examined the impact of Older Americans Act Nutrition Program (OAANP) participation on food security in participants and waitlisted people in Georgia using two waves of self-administered mail surveys conducted 4 months apart (n = 717, mean age 74.6 ± 9.5, 70.9% female, 33.2% black). At baseline, 54% of the sample was food insecure. Waitlisted people reported higher levels of persistent food insecurity (45.9%) or becoming food insecure (10.0%) than participants (29.3% and 7.1%, respectively) over 4 months. While considering potential confounders, the estimated odds of achieving food security were 1.65 times (95% CI: 1.10–2.48) higher in participants than in waitlisted people over 4 months. Our data suggest the feasibility of using food insecurity measures to detect the benefits of OAANP participation as well as the need to increase the capacity of OAANP.

Impact of Older Americans Act Nutrition Program on Food Security in Vulnerable Older Georgians: Georgia Advanced Performance Outcomes Measures Project (GA Advanced POMP)

Impact of Older Americans Act Nutrition Program on Food Security in Vulnerable Older Georgians: Georgia Advanced Performance Outcomes Measures Project (GA Advanced POMP)

The Validity of Nutrition Screening Initiative DETERMINE Checklist Responses in Older Georgians

The Nutrition Screening Initiative DETERMINE Checklist (NSI) is used throughout the United States to assess nutrition risk of those requesting the services of the Older Americans Act Nutrition Program (OAANP). This study examined the ability of the NSI to evaluate nutrition risk by comparing the responses between NSI and matched comparable survey questions using the self-administered mail survey data that were collected among 924 new OAANP applicants in Georgia (mean age 75.0 ± 9.2 years, 68.8% women, 26.1% Black). Ninety-four percent of our sample provided at least one discordant response (i.e., disagreement between responses to the NSI and matched questions). Questions regarding food intake most frequently yielded discordant responses. Black participants were more likely to provide discordant responses for the meal frequency question. Food insecure individuals were less likely to provide discordant responses for food intake questions. Those who lived alone were less likely to provide discordant responses for the dairy intake question. Some NSI items may have limited ability to reliably assess nutritional risk of older adults. Further efforts are warranted to improve nutritional assessment tools for use in vulnerable older adults.

Unmet Needs for the Older Americans Act Nutrition Program

This study documents the size of unmet needs for Older Americans Act Nutrition Program (OAANP) and characteristics of program participants and waitlisted people based on the data from the Georgia client database systems. About 60% of those who requested the OAANP service between July and early November, 2008 ( n = 4,952) were on waitlists. Waitlisted people, especially those on the Home-Delivered Meals (HDM) waitlist, were more likely to report poorer sociodemographic characteristics, poorer self-reported health status, food insecurity, and nutritional risk. Requesting HDM was the foremost significant factor associated with unmet needs. Other race/not disclosing race information and living alone also increased the odds of being on the waitlists. There is a critical unmet need for the OAANP in Georgia, especially among those targeted by the Older Americans Act and requesting HDM. Federal and state policy makers, administrators, and program providers should better understand and meet the need of nutritionally vulnerable older Georgians.

Recently Hospital-Discharged Older Adults Are Vulnerable and May Be Underserved by the Older Americans Act Nutrition Program

The home-delivered meal (HDM) program of the Older Americans Act Nutrition Program (OAANP) has traditionally served frail homebound older adults; however, due to gaps in the continuum of care, enrollment in this program following hospital discharge remains a challenge. Trained interviewers at 6 HDM sites in 6 U.S. states assigned 566 hospital-discharged individuals, ages 60–96 years, into either early (48 hour) or delayed (2 weeks) enrollment groups and assessed their health and nutrition status. Regardless of elapsed time at enrollment, more than 80% reported at least one limitation in activities and instrumental activities of daily living. About 20% had impaired cognition and more than 40% had depressive symptoms. Also, 40% reported fair or poor appetite. Despite intense recruitment from hospitals, only 30% ofparticipants were referred from hospitals. The recently hospital-discharged older adult population may include a higher prevalence of individuals with poor functional status and at nutritional risk than participants in the OAANP HDM program and yet may be underserved by this program.

Food Insecurity Is Associated with Cost-Related Medication Non-Adherence in Community-Dwelling, Low-Income Older Adults in Georgia

Low-income older adults are at increased risk of cutting back on basic needs, including food and medication. This study examined the relationship between food insecurity and cost-related medication non-adherence (CRN) in low-income Georgian older adults. The study sample includes new Older Americans Act Nutrition Program participants and waitlisted people assessed by a self-administered mail survey (N = 1000, mean age 75.0 ± 9.1 years, 68.4% women, 25.8% African American). About 49.7% of participants were food insecure, while 44.4% reported practicing CRN. Those who were food insecure and/or who practiced CRN were more likely to be African American, low-income, younger, less educated, and to report poorer self-reported health status. Food insecure participants were 2.9 (95% CI 2.2, 4.0) times more likely to practice CRN behaviors than their counterparts after controlling for potential confounders. Improving food security is important inorder to promote adherence to recommended prescription regimens.

The effect of home-delivered Dietary Approach to Stop Hypertension (DASH) meals on the diets of older adults with cardiovascular disease

Many older adults with hyperlipidemia or hypertension participate in the Older Americans Act Nutrition Program, which serves meals in community settings and delivers meals to homes. However, there is little information regarding whether therapeutic meals designed around Dietary Approach to Stop Hypertension (DASH) principles have a beneficial effect on the diets of these older adults. The objective of this study was to determine the degree to which dietary change is influenced by providing 7 home-delivered therapeutic meals weekly to adults aged > or = 60 y. We conducted a 1-y randomized controlled trial in 298 persons with hyperlipidemia or hypertension, in which 50% of participants received 7 therapeutic meals per week for 12 mo. Those in need of dietary change at baseline (n = 210) were examined. Changes in intermediate DASH accordance, DASH accordance, and the nutrients that make up the DASH diet were measured by using 24-h food recalls at baseline, 6 mo, and 12 mo. Chi-square tests, t tests, and multiple regression were used to examine the association between receipt of meals and dietary change over time. Participants who received meals were 20% (P = 0.001) more likely to reach intermediate DASH accordance at 6 mo and were 18% (P = 0.007) more likely to meet saturated fat accordance at 12 mo than were those who did not receive meals. When stratified by race and income, gains were marginally larger for whites and higher-income individuals. Delivery of 7 DASH meals per week was found to increase compliance with dietary recommendations among noncompliant older adults with cardiovascular disease.

Prevalence and predictors of recommendations to lose weight in overweight and obese older adults in Georgia senior centers

Objective To examine the prevalence and predictors of health care professional recommendations to lose weight in Older Americans Act Nutrition Program participants in Georgia senior centers who met professional and/or governmental organization criteria for weight loss recommendation. Methods Demographic, health, and weight loss recommendation information obtained from community-dwelling convenience sample ( n = 793; 2007–2008) of older adults via interviewer administered questionnaires. Results Approximately 70% of participants met weight loss criteria, but only 36% of them received advice to lose weight in the past year. Report of weight loss recommendation was 52.0% for those ‘obese with risks’ and 19.8% for those ‘overweight with risks’. Recommendation to lose weight was significantly ( p < 0.05) associated with body mass index, waist circumference risk, younger age, self-reported disability, and urban residence. When controlled for other health and demographic factors, recommendation to lose weight was significantly associated with heart disease, but not other chronic conditions including diabetes, hypertension, or joint pain. Conclusion Many older adults who may benefit from weight loss are not receiving advice to do so. Health care professionals need to be aware of this problem to assist community-dwelling older adults in better managing their health to help maintain independence and improve their quality of life.

Older Americans Act Nutrition Program Improves Participants' Food Security in Georgia: Georgia Advanced Performance Outcomes Measures Project (GA POMP)

With population aging and the current economic recession, it is critical to use convincing research methodology to demonstrate the benefits of nutrition assistance programs targeted to nutritionally vulnerable older adults. We examined the impact of the Older Americans Act Nutrition Program (OAANP) participation on food security and nutrition risk by using the longitudinal data from the ongoing GA POMP. The sample included 717 older Georgians who began OAANP participation (37.1%) and those added to program waitlists (62.9%) between July and early November, 2008 and completed all study variables in two waves of self‐administered mail surveys conducted 4 months apart (mean age 74.6±9.5, 70.9% female, 33.2% black). At baseline, most of the sample were food insecure (53.8%) and at high nutrition risk (74.9%). Waitlisted people reported higher levels of persistent food insecurity (45.9%) or becoming food insecure (10.0%) than the participants (29.3% and 7.1%, respectively) over the 4 month period. While considering potential confounding factors, the estimated odds of achieving food security were 1.69 times higher in participants than in waitlisted people in the 4 month period. This significant reduction in food insecurity suggests that this easily administered and reliable measure of food security can detect the benefits of OAANP participation in as little as 4 months. This study was funded in part by US AoA and USDA.