Older Americans Act Research Articles

Malnutrition Risk Among Older Americans Act (OAA) Nutrition Program Participants in 2022

Malnutrition Risk Among Older Americans Act (OAA) Nutrition Program Participants in 2022

Increases in loneliness among Older Americans Act participants during COVID-19.

Loneliness is increasingly understood as a public health crisis, and older adults are experiencing particularly severe impacts. Social distancing efforts during the COVID-19 pandemic may have increased loneliness among older adults. Guided by the Social Ecological Model, this study uses two cross-sectional waves of the National Survey of Older Americans Act Participants (NSOAAP) from 2019 and 2021 to expand understanding and identify possible points of intervention to increase social support for vulnerable older adults. Results reveal that while home-delivered meal participants have higher levels of loneliness than congregate meal participants, levels of loneliness did not increase during the COVID-19 pandemic and their loneliness levels did not differ significantly by age, geographic location, or living arrangement. Congregate meal participants' loneliness increased during the first year of the pandemic, particularly for participants aged 65-74, those living in suburban or rural areas, and those living alone. These findings suggest opportunities for policymakers and aging services providers who seek to increase social engagement among older adults who participate in Older Americans Act (OAA) nutrition programs. The evidence suggests a need for increased social engagement initiatives through OAA programs that prioritize social support for groups who are disproportionately burdened by loneliness.

POLICY SERIES: STRATEGIES TO FRAME OUR PUBLIC POLICY WORK

Abstract Our words and the way we harness the power of them when advocating for age inclusive policies, like the Older Americans Act (OAA), matters. Since 1965 the OAA has supported our nation with funds to strengthen community social services. It currently authorizes a wide array of service programs through a national network of 56 state agencies on aging, 618 area agencies on aging, nearly 20,000 service providers, 281 Tribal organizations, and 1 Native Hawaiian organization representing 400 Tribes. In 2024, the OAA will be considered for reauthorization. We all have a stake in ensuring it is passed so we all have the infrastructure we require as we age. Join The National Center to Reframe Aging and the National Center on Elder Abuse, the leading organizations for effective framing, in this session to discuss the OAA as an example of how we can apply communication strategies in supporting reauthorization, review framing strategies to advance a more equitable story of aging in America and learn how to apply framing tools to your advocacy communications.

STRATEGIES TO FRAME OUR PUBLIC POLICY WORK

Abstract Our words and the way we harness the power of them when advocating for age inclusive policies, like the Older Americans Act (OAA), matters. Since 1965 the OAA has supported our nation with funds to strengthen community social services. It currently authorizes a wide array of service programs through a national network of 56 state agencies on aging, 618 area agencies on aging, nearly 20,000 service providers, 281 Tribal organizations, and 1 Native Hawaiian organization representing 400 Tribes. In 2024, the OAA will be considered for reauthorization. We all have a stake in ensuring it is passed so we all have the infrastructure we require as we age. Join The National Center to Reframe Aging and the National Center on Elder Abuse, the leading organizations for effective framing, in this session to discuss the OAA as an example of how we can apply communication strategies in supporting reauthorization, review framing strategies to advance a more equitable story of aging in America and learn how to apply framing tools to your advocacy communications.

THE AGING NETWORK AS A CATALYST FOR COMMUNITY GERONTOLOGY AND APPLIED RESEARCH

Abstract The Older Americans Act (OAA) established Area Agencies on Aging (AAAs) fifty years ago as local community-based organizations responsible for planning, coordinating, funding, and delivering nutrition and other supportive services which allow older adults to remain living in their homes and communities. Local control and decision-making, mandated by the OAA, has allowed AAAs to adapt to the evolving needs and demands of their communities The centrality of their role was never more apparent than during the COVID-19 pandemic. As national and societal circumstances have resulted in increased social isolation, housing insecurity, and public health concerns for older adults, AAAs have adapted and expanded beyond traditional OAA services to address the social and health needs of an increasingly diverse older adult population. The Community Gerontology framework provides a useful structure to understand the evolution and impact of AAAs and the broader Aging Network on the health of older adults. Using data from the 2022 National Survey of AAAs and a new qualitative study on Community Care Hubs, academic and Aging Network-based researchers will illustrate the many partnerships and pathways of mutual influence between AAAs and the micro and macro levels to describe how Aging Network services are expanding provision of services for health care partners, public health initiatives, and new housing and homelessness services and partnerships to address emerging needs. The symposium will conclude with an illustration of how applied researchers and Aging Network organizations partnered on research-informed practice to innovate and strengthen services for at-risk older adults.

STATE GENEROSITY IN HOME- AND COMMUNITY-BASED SERVICES (HCBS): VARIATIONS AND IMPACT ON DEMENTIA OUTCOMES

Abstract To meet the needs of community-living older adults and reduce overall medical spending, home- and community-based services (HCBS) provide assistance and care for persons with significant physical and cognitive limitations. Together, Medicaid long-term services and supports (LTSS) coverage and the Title III program under the Older Americans Act (OAA) of 1965 support the majority of the HCBS for older adults living in the U.S. with low-income and/or disabilities. We evaluated state variations in generosity of supporting HCBS in recent years and how these variations affect the healthcare outcomes of community-living older adults and socio-economic and racial disparities in dementia outcomes. State HCBS generosity from the perspectives of program participation and intensity of services was defined by the exploratory and the confirmatory factor analysis with data from multiple sources, including state reports from the National Association of State Budget Officers. State data was linked to a nationally representative sample of older adults who enrolled in the Health and Retirement Study in 2020. Analyses revealed that overall state supports for HCBS increased over time in recent years while state Medicaid expenditures for institutional long-term care remained largely stable. State supports through both Medicaid and the OAA programs for HCBS varied substantially and persisted in recent years. Discussion will focus on instrumental variable analyses that determine the causal impact of state variations in HCBS generosity on health outcomes (i.e., unmet need; hospitalization) for persons living with dementia persons.

POSTPANDEMIC SUCCESSES AND CHALLENGES IN REOPENING OLDER AMERICANS ACT CONGREGATE MEALS

Abstract The COVID-19 pandemic required Older Americans Act (OAA) congregate nutrition programs to shut down in-person dining but continue serving meals in innovative ways. Re-opening provided a unique opportunity for congregate nutrition programs to continue these innovative changes and/or reinvent how they serve meals. These changes will be crucial for OAA nutrition programs to maintain their relevance, as all adults over age 60 qualify for OAA meals, yet fewer than that attend. To identify successful practices that could be adopted nationally and describe continuing challenges, we conducted surveys, focus groups, and interviews of congregate nutrition programs. Overall, 523 completed the entire survey, nine participated in focus groups, and three were interviewed. Responses came from across 47 states with most (94%) reporting permanently adopting service delivery methods implemented during the COVID-19 pandemic. Overall, nutrition programs described grab-and-go meals having attracted new participants during the pandemic and programs pairing other services with meals to appeal to and retain a wide range of participants. These include medically tailored meals, culturally relevant meals, partnerships with other organizations, and entertainment. These results can be used to strengthen congregate nutrition programs.

HOME-DELIVERED MEAL DELIVERIES AND FEELINGS OF SAFETY FOR OLDER AMERICANS ACT PARTICIPANTS

Abstract Home-delivered meals supported by the Older Americans Act (OAA) serve a dual purpose of improving nutritional intake and providing regular social contact for older adults. This regular contact can increase feelings of safety experienced by meal recipients. The benefits of home-delivered meal services may vary between meal recipients based on sociodemographic characteristics. Variation in home-delivered meal clients’ reports of feeling safer at home because of regular meal delivery visits was examined to support ongoing efforts to increase social engagement and equity through the delivery of OAA services. Using data from the 2019 National Survey of Older Americans Act Participants (NSOAAP) home-delivered meal module, descriptive statistics and logistic regression were conducted to identify the characteristics associated with feeling safer at home because of meal delivery visits. The majority (85%) of meal recipients report feeling safer because of meal delivery visits, and rates were especially high for rural recipients (92%), those with a high school education or less (89%),racial/ethnic minorities (94%), and those with three or more ADL limitations (90%). Logistic regression found that rural residence (OR=3.3), lower educational attainment (OR=2.0), racial/ethnic minority status (OR=4.7), living alone (OR=1.6), and having 3+ ADLs (OR=1.9) were significantly associated with higher odds of feeling safer at home because of meal delivery visits; however, age, gender, and suburban residence were not significant. Findings suggest that benefits of home-delivered meal programs are supporting the needs of traditionally disadvantaged groups and broadly increasing meal recipients’ sense of safety in their homes.

Leveraging the Contribution of Volunteers: The Critical Role and Economic Value of Volunteers in Older Americans Act Programs

ABSTRACT The United States is facing a surge in the aging population, which will increase the demand for services and supports that allow older adults to age independently. This study assessed the size and value of the volunteer labor force in two home- and community-based programs funded under the Older Americans Act (OAA). Using publicly available program data for fiscal years 2015–2019, we calculated the annual contribution of volunteers, based on the total number of volunteer hours and share of labor effort, and estimated the economic value of volunteers in these OAA programs. In fiscal year 2019, volunteers contributed a total value of $1.7 billion in the OAA Title III program and $14.0 million in the Title VII long-term care ombudsman program. These results highlight the value of volunteers in OAA programs and the need for policies to support volunteers in the aging services network.

Malnutrition-related conditions and interventions in US state/territorial Older Americans Act aging plans

BackgroundFactors that decrease independence and increase morbidity must be reduced to improve the nutrition, health, and other challenges confronting older adults. In the United States (US), the Older Americans Act (OAA) requires each state/territory develop multi-year aging plans for spending federal funds that foster healthy aging (including support of congregate/home delivered meals programs) and separately requires grant applications for nutrition service programs supporting older Native Americans. Malnutrition (particularly protein-energy undernutrition), sarcopenia, frailty, and obesity can all result in disability but are potentially changeable. The study goal was to collect baseline information on mentions of these malnutrition-related conditions and interventions that address them in US state/territorial OAA program multi-year aging plans.MethodsOAA program multi-year aging plans available on the ADvancing States website in February 2021 (n = 52) were searched for number of mentions of defined nutrition terms including malnutrition, sarcopenia, frailty, obesity, and whether terms were included in plans’ goals/objectives, strategies/actions, or solely in the narrative.ResultsMalnutrition, sarcopenia, frailty, and obesity were mentioned infrequently in US state/territorial OAA program multi-year aging plans. 33% of plans mentioned malnutrition but only 8% as goals/objectives and 15% as strategies/actions. 62% mentioned frailty; 6% (goals/objectives), 15% (strategies/actions). None mentioned sarcopenia whereas in contrast, 21% mentioned obesity; 2% (goals/objectives), 2% (strategies/actions). Nutrition intervention mentions were nearly nil. There were no significant differences in frequency of term mentions by US region or by states with higher percentages of older adults or obese adults.ConclusionsClearly specifying definitions of malnutrition-related conditions and incorporating them into measurable goals/objectives, defined strategies/actions, and outcomes may help improve future state/territorial OAA program multi-year aging plans to better support healthy aging.

Approaches to Serving Rural Older Adults in State Plans on Aging: A Policy Content Evaluation.

Every state is required to submit a State Plan on Aging describing how it will use resources from the Older Americans Act (OAA), including a section specific to serving rural older adults. This paper describes a policy content evaluation of all 50 State Plans on Aging, focusing on Section 307(a)(10), which describes how states will serve rural older adults. We identified the most common and innovative approaches to using OAA funds to serve rural older adults across states. The most common information included about using OAA funds to serve rural older adults was describing the funding formula used to allocate resources. However, states varied in their definition of rural and in the details of their funding formulas. A minority of states also described additional approaches to serving rural older adults, including prioritizing Black, Indigenous, or rural residents of color; outreach; and targeted service delivery.

The effects of aging services and the supplemental nutrition assistance program on food insecurity among older Georgians: 2018–2020

AbstractUsing administrative data from Georgia covering January 2018–August 2020, we estimated the effect of services provided through the Older Americans Act (OAA) and the Supplemental Nutrition Assistance Program (SNAP) on food insecurity among older Georgians. Our sample included those who received services prior to and during the coronavirus disease 2019 (COVID‐19) pandemic. For the entire sample period, we found home‐delivered meals and other OAA services reduced food insecurity by 3% and 4%, respectively. During COVID‐19, the effect of SNAP on reducing food insecurity significantly increased from 2.1% to 4.7%, while the loss of “traditional” congregate meals services increased food insecurity by 7%.

Do State Agency on Aging Strategic Plans Include Terms Related to Malnutrition?

Demand for federal nutrition assistance programs is increasing as the older population grows and further accelerated with the COVID-19 pandemic. Older adult nutrition programs are based on federal nutrition guidelines that have traditionally focused on healthy populations, yet many older adults have multiple chronic conditions/advanced age. Some guidelines are changing; the 2020 Dietary Guidelines for Americans recognize older adults’ risk for malnutrition and also need for adequate protein to prevent lean muscle loss with age. The 2020 Older Americans Act (OAA) reauthorization included reduction of malnutrition in OAA’s official purpose and added program participant screening for malnutrition. The OAA requires State Agencies on Aging submit multiyear strategic plans to receive program funding, but it is unknown how the plans address risks for malnutrition, including overweight, underweight, and muscle loss (sarcopenia/frailty). We searched 51 State Agency on Aging strategic plans posted at advancingstates.org to determine their frequency of mentioning nutrition, malnutrition/underweight/undernutrition, obesity/overweight, frail/frailty, sarcopenia, and dietary supplements/oral nutrition supplements (DS/ONS)/meal replacements. Every state plan included nutrition but less than a third included malnutrition. There was wide variability in how nutrition and malnutrition were incorporated into state goals and strategies. Very few plans included obesity, frailty, and DS/ONS terms; none included sarcopenia. Although there has been some movement, there is need for many State Agencies on Aging plans to address all aspects of malnutrition including overweight, underweight/other factors related to muscle loss (sarcopenia/frailty) that adversely impact healthy aging. Wide disparities in plan structure/use of terms create opportunities for more common approaches/definitions.

Policy Series: The Older Americans Act, the Aging Network, and the Pandemic

This session provides insights into how the pandemic challenged the capabilities and ingenuity of the Older Americans Act (OAA) programs and the aging network and what it means for in-home and community aging services now and in the future. Speakers will include key aging network stakeholders, who will discuss the overnight evolution of programs serving often isolated older adults.

Older Americans Act Meals Programs: Responding to the Pandemic

This session provides insights into how the pandemic challenged the capabilities and ingenuity of the Older Americans Act (OAA) programs and the aging network. Speakers will include key aging network stakeholders, who will discuss the overnight evolution of programs serving often isolated older adults.

Older Americans Act Supports and Services: Adapting to the Pandemic

This session provides insights into how the pandemic challenged the capabilities and ingenuity of the Older Americans Act (OAA) programs and the aging network. Speakers will include key aging network stakeholders, who will discuss the overnight evolution of programs serving often isolated older adults.

Nutrition‐Related Policy Fundamentals for Supporting Older Adults in the Community during a Pandemic: Lessons from COVID‐19

AbstractNutrition is a key factor supporting healthy aging. Yet during the global COVID‐19 pandemic, issuances of shelter‐in‐place orders, closures of senior centers and other congregate dining locations, losses of income, increases in grocery prices, and other changes have left many older adults struggling to maintain good nutrition. However, there are available solutions to improve the nutrition of millions of older adults who may be challenged to put food on the table. This commentary outlines the problems of older adult malnutrition and food insecurity and their strong correlation with COVID‐19. It summarizes existing federal nutrition programs for older adults, including the U.S. Department of Health and Human Services' Older Americans Act (OAA) nutrition programs and the U.S. Department of Agriculture's means‐tested nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP). The commentary also contains lessons from community‐based OAA nutrition programs that refocused some of their nutrition services and other supportive services during the COVID‐19 pandemic to better serve socially distancing, newly homebound older adults. It explores pre‐ and post‐COVID‐19 policy actions and opportunities for improving the nutrition, health, and well‐being of community‐dwelling older Americans during the current pandemic and beyond, including the need for more federal funding and flexibility for older adult nutrition programs, the need for improvements to older adult access to these programs, and the need for more older adult nutrition screening and intervention.

Transforming Aging Services: Area Agencies on Aging and the COVID-19 Response.

For over four decades, Area Agencies on Aging (AAAs) have served as focal points to help older adults remain in their homes and communities. AAAs partner with other organizations to administer services authorized under the Older Americans Act (OAA). AAAs represent loosely coupled systems; they are responsive to guidelines established by the OAA while maintaining flexibility to leverage limited resources, establish partnerships, and create innovative programs to meet community needs. As stay-at-home orders and concern for safety have kept many older adults homebound during the COVID-19 pandemic, an important question is how the Aging Network, including the over 600 AAAs, has responded to these rapidly changing needs. Although time and more systematic assessments are required, available information suggests that the loosely coupled network of AAAs has been a key, adaptable resource. This article begins with a description of the Aging Network and its history before turning to how the community-specific, collaborative, and evolving nature of AAAs places them at a unique position to respond to the challenges that arise with COVID-19. It concludes with how AAAs can continue to adapt to meet the needs of older adults and the people who care for them.

Something Old, Something New: The Modernization of the Older Americans Act

The Older Americans Act (OAA) is the foremost federal law focused on the wellbeing of aging adults in the US. Since its conception 1965, the OAA has sought to optimize the lives of aging Americans, with emphasis on low-income adults, through programs that promote nutrition, transportation, support caregivers, offer employment, and combat elder abuse. This symposium will explore the modernization of the 2020 OAA, which was last reauthorized in 2016. Presentations 1 and 2 will focus on important updates to the definitions used throughout OAA (Title I). Presentation 3 will cover several noteworthy changes to improving grants for states and community programs on aging’s (Title II). Presentation 4 will provide additional context to amendments made to modernize activities for health, independence, and longevity (Title III) prioritize senior Community Service Employment Programs (Title IV) and enhance grants for Native Americans (Title V). Presentation 5 explores the modernizing allotments for vulnerable elder rights protection activities and other programs (Title IV) included changes in funding and home and community-based best practices and elder justice activities. Collectively, these presentations will provide an overview of the key changes in the reauthorization of the OAA. This work will allow GSA attendees to understand the specific efforts to modernization this critical legislation to better serve the aging US population.

Policy Series: The Older Americans Act Reauthorization: Major Successes and Shortcomings

This session provides an update on the2020 Older Americans Act (OAA) reauthorization process and passage of the new law “Supporting Older Americans Act of2020.” Presenters will provide insights on both the content of the new law and the process that led to the bicameral, bipartisan legislation. Speakers will include representatives of the aging network and other stakeholders, who will discuss key changes to the OAA and how they may be implemented over the next five years.