[Senate Report 117-196]
[From the U.S. Government Publishing Office]


117th Congress}                                           { Report
                                 SENATE
  2d Session  }                                           { 117-196

======================================================================
              RECOGNIZING 50 YEARS OF THE NATION'S FIRST 
               NUTRITION PROGRAM FOR OLDER ADULTS

                               __________

                              R E P O R T

                                 OF THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


               November 15, 2022.--Ordered to be printed
               
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
39-010                           WASHINGTON : 2022                     
          
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                       SPECIAL COMMITTEE ON AGING

              ROBERT P. CASEY, JR., Pennsylvania, Chairman
KIRSTEN E. GILLIBRAND, New York      TIM SCOTT, South Carolina
RICHARD BLUMENTHAL, Connecticut      SUSAN M. COLLINS, Maine
ELIZABETH WARREN, Massachusetts      RICHARD BURR, North Carolina
JACKY ROSEN, Nevada                  MARCO RUBIO, Florida
MARK KELLY, Arizona                  MIKE BRAUN, Indiana
RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                     MIKE LEE, Utah
                Stacy Sanders, Majority Staff Director 
                Neri Martinez, Minority Staff Director 
                         
                         LETTER OF TRANSMITTAL

                              ----------                              

                                       U.S. Senate,
                                Special Committee on Aging,
                                 Washington, DC, November 14, 2022.
Hon. Kamala Harris,
President, U.S. Senate,
Washington DC.
    Dear Madam President: Under authority of Senate Resolution 
70 agreed to on February 24, 2021, I am submitting to you a 
report of the U.S. Senate Special Committee on Aging entitled: 
Recognizing 50 Years of the Nation's First Nutrition Program 
for Older Adults.
    Senate Resolution 4, The Committee Systems Reorganization 
Amendments of 1977, authorizes the Special Committee on Aging 
``to conduct a continuing study of any and all matters 
pertaining to problems and opportunities of older people, 
including but not limited to, problems and opportunities of 
maintaining health, of assuring adequate income, of finding 
employment, of engaging in productive and rewarding activity, 
of securing proper housing and, when necessary, of obtaining 
care and assistance.'' Senate Resolution 4 also requires that 
the result of these studies and recommendations be reported to 
the Senate annually.
    I am pleased to transmit this report to you.
            Sincerely,
                                      Robert P. Casey, Jr.,
                                                          Chairman.
                                                          
                                                
117th Congress}                                           { Report
                                 SENATE
  2d Session  }                                           { 117-196

======================================================================
 
              RECOGNIZING 50 YEARS OF THE NATION'S FIRST 
               NUTRITION PROGRAM FOR OLDER ADULTS
                                                          
                                 _______
                                

               November 15, 2022.--Ordered to be printed

                                _______
                                

            Mr. Casey, from the Special Committee on Aging, 
                        submitted the following

                              R E P O R T

                              ----------                              


                           EXECUTIVE SUMMARY

    There are more than 77 million adults ages 60 years or 
older living in the United States, representing over 23 percent 
of the total population, and the Nation's aging population is 
expected to grow exponentially in the coming 
years.i}ii Older adults are an asset to American 
communities though many face barriers to living independently 
as they age. To help address these barriers, the Older 
Americans Act (OAA) of 1965 (P.L. 116-131, as amended) 
authorized comprehensive services designed to support older 
adults living in their communities.iii In 1972, the 
OAA was amended (P.L. 92-258) to establish the Nutrition 
Program, which now funds community-based nutrition programs, 
including home-delivered and congregate meal 
services.iv In the 50 years that have followed, the 
OAA Nutrition Program has increased access to healthy and 
affordable food for older adults, helping to combat hunger, 
foster social connectedness, promote healthy aging, and prevent 
adverse health outcomes, as demonstrated in this report.
    In 2020, an estimated 5.2 million, or 6.8 percent, of older 
adults in the United States ages 60 and older were food 
insecure.v The home-delivered and congregate meal 
programs supported by the OAA Nutrition Program provide 
critical lifelines for older adults and bolster their dietary 
intake. The 2021 National Survey of OAA Participants conducted 
by the Administration for Community Living (ACL) found that 70 
percent of people who participate in meals programs at senior 
centers or other authorized group settings indicated that they 
eat healthier foods as a result of the program.vi 
Seventy-six percent of the people who receive home-delivered 
meals indicated the same.vii The OAA Nutrition 
Program ensures that older adults across the country have 
consistent access to food.
    The OAA Nutrition Program often provides more than a meal 
to participants and can foster connection among socially 
isolated or lonely older adults. Older adults are at an 
increased risk of loneliness and social isolation because they 
are more likely to experience risk factors such as living 
alone, loss of family or friends, chronic illness, and hearing 
loss.viii A report from the National Academies of 
Sciences, Engineering, and Medicine (NASEM) found that nearly 
one-fourth of community-dwelling adults ages 65 years and older 
are socially isolated.ix Social isolation has been 
found to have the same adverse impact on health as smoking 15 
cigarettes a day.x Nutrition programs can serve as a 
critical source of connection for older adults who are socially 
isolated or feeling lonely and congregate meal program 
participants often report more satisfaction with their 
socialization opportunities than nonparticipants.xi
    Additionally, the OAA Nutrition Program often becomes an 
entry way to additional programs and services that support 
older adults.xii Participants in both home-delivered 
and congregate meal programs can receive nutrition education as 
well as screening and counseling in addition to their meal 
which can lead to further referrals to aging services. This 
connection to broader aging services helps to ensure that older 
adults remain in their homes as they age.
    A core priority of the OAA Nutrition Program is to delay 
adverse health outcomes among older adults.xiii 
Enhanced health outcomes may enable older adults to stay in 
their homes and communities and delay or avoid 
institutionalization. Many older adults who participate in the 
OAA Nutrition Program are low-income and living with multiple 
chronic conditions that place them at increased risk of adverse 
health outcomes.xiv
    The United States Senate Special Committee on Aging 
(Committee) recognizes the positive impact of 50 years of the 
OAA Nutrition Program on older Americans. This report provides 
a broad overview of OAA funding for nutritional services, the 
role of the aging network and ACL in supporting older adult 
nutrition, and the importance of community volunteers and 
public-private partnerships in meeting the needs of each 
community. Through this report, the Committee seeks to 
encourage people, communities, and governments to work together 
to strengthen food security, foster social connections, and 
promote health and well-being among older adults.

                              INTRODUCTION

    Over the past 50 years, the OAA Nutrition Program has 
improved the lives of millions of older adults.xv 
Its success in providing nutritious meals, wellness and safety 
checks, and social visits is a testament to the dedicated 
commitment made by the staff and volunteers of local nutrition 
programs throughout the United States.
    The OAA Nutrition Program works to meet the following 
purposes, as stated in the law:
          1. Reduce hunger, food insecurity, and malnutrition;
          2. Promote socialization of older individuals; and
          3. Promote the health and well-being of older 
        individuals
                  a. by assisting such individuals to gain 
                access to nutrition and other disease 
                prevention and health promotion services
                  b. to delay the onset of adverse health 
                conditions resulting from poor nutritional 
                health or sedentary behavior.xvi
    The OAA established the Administration on Aging (AoA), an 
agency within ACL under the United States Department of Health 
and Human Services (HHS), as the primary federal agency for 
administering most OAA programs.xvii The OAA also 
established the aging network, which consists of State Units on 
Aging, Area Agencies on Aging (AAA), Title VI Native Americans 
aging programs, and community-based organizations. This network 
develops, coordinates, and delivers OAA-sponsored services and 
supports, including the OAA Nutrition Program.xviii
    AoA coordinates with the 56 State Units on Aging 
representing the 50 states, District of Columbia, and five 
United States territories as well as with American Indian 
tribes, Alaska Native villages, and Native Hawaiian 
organizations.xix}xx AoA provides funding for the 
implementation of local nutrition programs through the form of 
state, tribal, and territory formula grants.xxi 
These grants finance both home-delivered and congregate meals 
as well as other services such as nutrition screenings, 
education, and health promotion.xxii States and 
territories receive their funding through Title III of the OAA 
and are required to provide a funding match of 15 percent, 
which expands the impact of federal funding.xxiii 
American Indian tribes, Alaska Native villages, and Native 
Hawaiian organizations receive their funding through Title VI, 
which does not require a match.xxiv Title III of the 
OAA also includes the Nutrition Services Incentive Program, 
which incentivizes states, territories, and eligible tribal 
organizations to serve more meals through the provision of 
additional grants.xxv State Units on Aging develop 
implementation guidelines and rely on more than 600 AAAs and 
thousands of local service providers and volunteers to deliver 
services.xxvi}xxvii
    The population eligible for the OAA Title III Nutrition 
Program are adults ages 60 and older and the program strives to 
reach populations with the greatest social and economic need, 
including those who are low-income, live in rural communities, 
have limited English proficiency, or are at risk of 
institutional care.xxviii Through Title VI Native 
Americans aging programs, American Indian tribes, Alaska Native 
villages, and Native Hawaiian organizations can establish their 
own eligibility guidelines and often provide services to those 
who are under 60.xxix Successive updates to the OAA 
Nutrition Program expanded eligibility to include the spouse of 
an older adult, regardless of age. These updates also give 
states and territories the option to create programs that offer 
meals to certain qualifying people, such as people with 
disabilities who live with eligible older adults.xxx
    The OAA Nutrition Program provides participants with 
services through home-delivered and congregate meal programs. 
Congregate meals are served in group settings, such as in a 
community center, local religious institution, or adult day 
center. Congregate meals provide older Americans the 
opportunity to eat a nutritious meal while having a chance to 
connect with peers and volunteers. These meals also give older 
Americans the opportunity to ask questions or share concerns 
with local organizations that can provide information on 
healthy eating habits and healthy aging. In 2020, 48.8 million 
meals were provided to more than 1.3 million older adults in 
congregate meal settings.xxxi
    Home-delivered meals are provided to older adults who are 
unable to leave their home and their spouses, if applicable. 
Forty-one percent of those who have a meal delivered at home 
have trouble going outside of their home, which may include for 
shopping for their own groceries or visiting the 
doctor.xxxii Home-delivered meals provide older 
Americans with social contact through their interactions with 
local staff and volunteers. These social interactions have 
proven to be exceedingly important for the well-being of 
homebound older adults, especially during the COVID-19 pandemic 
when many faced increased social isolation and loneliness. An 
estimated 198.6 million meals were provided to more than 1.4 
million older adults in 2020, representing an increase of 
nearly 50 million meals compared to 
2019.xxxiii}xxxiv
    For most program participants, their source of social 
connectedness comes from volunteers. Volunteers prepare and 
serve meals in senior centers or other congregate meal sites as 
well as deliver meals to those participating in the home-
delivered program. In 2019, volunteers contributed over 62.4 
million hours to all OAA Title III AAAs, which includes the OAA 
Nutrition Program and other home and community-based services. 
The economic value of their contributions was approximately 
$1.7 billion. This return on investment by the volunteers 
exceeded the total amount of federal funding provided for all 
OAA Title III programs in fiscal year 2019, which was $1.49 
billion.xxxv
    COVID-19 Pandemic and Congressional Action: During the 
early stages of the COVID-19 pandemic, stay-at-home orders and 
social distancing guidelines caused local nutrition programs to 
change how they provided their services. To ensure older adults 
were served, Congress provided funding and flexibilities that 
allowed for service delivery changes. Over the course of the 
pandemic, about $1.7 billion in additional funding was 
provided.xxxvi These funds expanded drive-through 
and grab-n-go meal options for congregate meal participants, 
enhanced services and other supportive services provided 
through the Native Americans aging programs.
    This funding and flexibility allowed the Florida Department 
of Elder Affairs, for example, to provide congregate meals in a 
drive-through format so that older Americans who relied on the 
program were still provided a meal while also maintaining 
social distancing guidelines.xxxvii AAAs were also 
supported as they adapted to changing requirements and utilized 
the flexibilities offered to provide congregate meals in nearby 
parks, helping to reduce social isolation, as was done in 
Lackawanna County, Pennsylvania by the Lackawanna County AAA.
    In 2022, communities across the country are celebrating the 
50th Anniversary of the OAA Nutrition Program. The United 
States Senate also recognized this milestone in March 2022 with 
the passage of Senate Resolution 550, led by Chairman Casey and 
Ranking Member Scott, which highlighted the value of the OAA 
Nutrition Program in addressing hunger, malnutrition, food 
insecurity, and social isolation among older adults while 
improving their overall health and well-
being.xxxviii

Section 1: Reducing Food Insecurity Among Older Adults

    Adequate nutrition serves as a preventive measure against 
chronic illness and is integral to maintaining good health, 
functional ability, and quality of life across the 
lifespan.xxxix Yet, over 5 million adults ages 60 
and older experienced food insecurity in 2020 and the pandemic 
exacerbated the challenges older adults may face in accessing 
healthy foods.xl}xli Food insecurity, as defined by 
the U.S. Department of Agriculture (USDA), is the ``limited or 
uncertain availability of nutritionally adequate and safe 
foods, or limited or uncertain ability to acquire acceptable 
foods in socially acceptable ways.''xlii Older 
adults who are lower income, have a disability, reside in 
southern states, or are living with grandchildren are more 
likely to be food insecure.xliii In addition, many 
older adults are malnourished or at risk of 
malnutrition.xliv According to ACL, malnutrition is 
a ``nutrition imbalance that affects both overweight and 
underweight individuals'' and occurs over time.xlv 
Other unique barriers that affect older adults' ability to meet 
their nutritional need may include transportation obstacles, 
functional limitations, language accessibility, and social 
isolation.xlvi}xlvii}xlviii
    Both food insecurity and malnutrition threaten an older 
adult's ability to remain healthy and independent and may lead 
to an increased need for long-term care services and 
supports.xlix Food insecurity among older adults has 
increased by nearly 30 percent since 2001 and 
disproportionately affects older adults who are racial and 
ethnic minorities.l Black older adults experience 
food insecurity rates that are nearly four times that of white 
older adults and Hispanic older adults experience food 
insecurity rates that are over two times that of non-Hispanic 
white older adults.li Similarly, food insecurity is 
more prevalent among Asian American, Pacific Islander, and 
Native American older adults and older adults who identify as 
multi-racial than white older adults.lii
    Food insecure older adults often have an overall lower diet 
quality, which puts them at higher risk for developing chronic 
conditions, such as diabetes, heart disease, and 
hypertension.liii}liv Food insecure older adults are 
74 percent more likely to have diabetes and nearly three times 
more likely to have depression than their food secure 
counterparts.lv This ultimately results in adverse 
health outcomes, increased medical needs and health care 
utilization, and higher health care costs.lvi
            Older Americans Act: Meeting the Needs of Food Insecure 
                    Older Adults
    The OAA Nutrition Program is an effective intervention 
aimed at ameliorating limited food access for older adults. In 
most communities, the OAA home-delivered and congregate meal 
programs serve a minimum of one meal a day, at least five days 
a week.lvii More than 900,000 meals are provided 
each day through 5,000 participating local service providers 
across the country.lviii The OAA Nutrition Program 
maintains high satisfaction rates amongst participants, with 
nearly 75 percent reporting that the programs improved their 
health.lix Further, 61 percent of home-delivered 
meal participants and 42 percent of congregate meal 
participants indicated that without access to the programs, 
they would have to reduce their daily food intake.lx
    Additionally, over half of all program participants 
indicate the meals provided through the OAA Nutrition Program 
account for 50 percent or more of their daily food 
consumption.lxi States and local agencies are 
required to prioritize addressing the needs of marginalized 
populations, including low-income people and those of racial 
and ethnic minorities.lxii In 2018, a national 
survey of OAA Nutrition Program participants found that 
approximately 19 percent of home-delivered meal participants 
and 11 percent of congregate meal participants reported annual 
household incomes of $10,000 or less.lxiii
    Many older adults have limited incomes and face difficult 
financial decisions, such as choosing between purchasing their 
medication, paying their utilities, or buying 
groceries.lxiv In 2019, almost one in ten adults 
ages 65 and older lived below the federal poverty level, with 
older women of color, especially those living alone, 
experiencing the highest rates of poverty.lxv The 
meals provided through the OAA Nutrition Program can help those 
with limited incomes bridge financial gaps in order to reduce 
their risk of food insecurity and remain independent.
    Serving Native American Communities: In 1978, the OAA 
established support for Native Americans aging programs with 
the inclusion of Title VI, which authorized grants to Tribal 
organizations to deliver supportive services, including 
nutrition services, to older adults. Recent reauthorizations of 
the OAA continue to build upon dedicated funding for Native 
Americans nutrition services. Over time, these reauthorizations 
have provided additional pathways for American Indian, Alaska 
Native, and Native Hawaiian communities to expand their reach 
and meet the needs of all older adults, while allowing the 
flexibility to maintain culturally relevant meals and 
practices.lxvi This is particularly important as 
this population of older adults is expected to increase by 67 
percent by 2040.lxvii
    As an example, the Moenkopi Senior Center, located in the 
Hopi Upper Village of Moenkopi in northern Arizona, serves 
older adults in Moenkopi Village and the Hopi Reservation. The 
center provides traditional home-delivered and congregate meals 
like hominy and vegetable stew, socialization, recreational 
activities such as Yucca basketweaving and quilting, and health 
and wellness services. While the center had to close for two 
years during the COVID-19 pandemic to ensure the health and 
safety of all participants, they serve as a vital community 
center for Hopi Elders. As their facility remained unoccupied 
during that time, when the Moenkopi Senior Center decided to 
reopen, several updates were required in order to resume 
operations, including new kitchen equipment. Funding from the 
OAA and community-based organizations as well as technical 
assistance from the Inter-Tribal Council of Arizona AAA and the 
Hopi Office of Aging and Adult Services enabled the Moenkopi 
Senior Center to reopen successfully and expand capacity. The 
resources provided by the OAA to support Native Americans 
nutrition services are essential to addressing food insecurity 
and improving the health of Native American older adults, who 
continue to be one of the most marginalized and economically 
disadvantaged communities in the Nation.lxviii

Section 2: Promoting Socialization and Reducing Isolation

    The benefits of the OAA Nutrition Program go well beyond 
the meals provided, as one of the statutory purposes is to 
promote the socialization of older people.lxix 
Whether in congregate meal sites or home-delivery services, 
these programs enhance socialization and reduce social 
isolation among older Americans.
    Social isolation refers to the objective absence or 
limitation in the quantity of social 
interactions.lxx Conversely, loneliness is 
subjective and occurs when there is a perceived discrepancy 
between an individual's desired and achieved level of social 
interactions.lxxi Compared to younger adults, older 
adults are more likely to experience isolation.lxxii 
Many homebound older adults may be isolated due to physical or 
mental health conditions, living alone, or lack of access to 
consistent and reliable transportation.lxxiii
    The negative impacts of isolation are especially salient 
for older adults. Studies have found that late-life isolation 
or loneliness is associated with a 50 percent increased risk of 
developing dementia, a 30 percent increased risk of developing 
incident coronary artery disease or experiencing a stroke, and 
a 26 percent increased risk of all-cause 
mortality.lxxiv The OAA Nutrition Program addresses 
late life social isolation and loneliness by promoting positive 
social experiences.
            Older Americans Act: Fostering Connections
    Congregate meal programs provide meals in senior centers, 
schools, faith-based settings, churches, farmers' markets, and 
other community locations. Bringing older adults together to 
share a meal fosters opportunities for recreation and social 
interaction. Participants in these programs have routine 
contact with other older adults, OAA Nutrition Program staff, 
and volunteers, cultivating a space to tell stories, ask 
questions, and share their lived experiences.lxxv An 
evaluation of the OAA Nutrition Program found that 93 percent 
of congregate meal participants were satisfied with their 
opportunities to spend time with other people.lxxvi 
Benefits from these interactions may include improvements in 
mood, opportunities for friendship, and a sense of belonging to 
the community.lxxvii
    In some cases, congregate meal programs also offer a 
pathway to additional social activities such as exercise 
classes, arts and crafts, cooking classes, discussion groups, 
and off-site trips. Participants who attended congregate meal 
sites that offered social activities reported higher levels of 
satisfaction with socialization opportunities than participants 
who attended sites that did not offer these 
activities.lxxviii These findings underscore the 
value of congregate meal programs in enhancing socialization 
among participants and the importance of staying connected in 
late life.
    Older adults in the community who receive home-delivered 
nutrition services similarly benefit from social contact and 
support from staff members and volunteers. Research has found 
that, compared to older adults who were on a waiting list to 
receive home-delivered meals, those receiving daily delivered 
meals were more likely to report reductions in 
loneliness.lxxix Moreover, older adults receiving 
daily delivered meals were three times more likely than those 
receiving frozen, once-weekly delivered meals to indicate that 
the services received from the home-delivered meal program 
helped them feel less lonely.lxxx As one program 
provider shared ``I feel that socialization is just as 
important as the hot nutritious meal they receive. Without the 
sites, they might go all day without leaving their apartment or 
seeing anyone.''lxxxi
    Combating Worsening Isolation Amidst a Global Pandemic: 
While addressing social isolation has been a long-standing goal 
of the OAA Nutrition Program, this objective was of heightened 
urgency during the COVID-19 pandemic. Throughout the pandemic, 
older adults had a higher risk of experiencing complications 
from the virus. Shelter-in-place restrictions and stay-at-home 
orders led to increased isolation and loneliness among older 
adults.lxxxii As a result of Congressional action, 
the OAA Nutrition Program had additional flexibilities to offer 
grab-n-go services or lunches in the park to safely connect 
with participants. Some programs also adapted by expanding 
services that provided regular and trusted human interactions 
via telephone.
    Mr. Rocky Duff from South Carolina, for example, became a 
volunteer with the Meals on Wheels Telephone Reassurance 
Program during the pandemic. He made daily calls with multiple 
home-delivered program participants, including a couple from 
Charleston County who expressed appreciation for their daily 
interaction with the volunteer, noting that they felt special 
because someone calls to check on them.
    The innovative models adopted by local programs during the 
COVID-19 pandemic allowed older adults to maintain social 
connections to their community, while also adhering to public 
health guidelines. In particular, volunteers were central to 
ensuring continued socialization among older adults and strived 
to keep consistent and meaningful interactions. As highlighted 
by the COVID-19 pandemic, human connection is a hallmark of the 
home-delivered and congregate meal programs and helps to combat 
social isolation among older adults.

Section 3: Promoting Healthy Aging

    Adequate nutrition is critical to good health, physical 
ability, and quality of life across the lifespan and 
contributes to healthy aging.lxxxiii According to 
the Pan American Health Organization, healthy aging is ``the 
continuous process of optimizing opportunities to maintain and 
improve physical and mental health, independence, and quality 
of life throughout the life course.''lxxxiv Eating 
well supports older adults in maintaining a healthy weight and 
having the nutrients their bodies need to stay active and 
engaged. Healthy eating can also reduce the risk of certain 
chronic conditions or lessen their symptoms. Further, eating 
nutritious foods protects bones, joints, and muscles. As adults 
age, their caloric needs will likely shift to account for 
changes in metabolism, the impact of chronic conditions, and 
medication interactions.lxxxv
    It is important that older adults receive nutritional 
counseling and support to follow recommended dietary guidelines 
that promote health. Yet, many older adults face barriers, such 
as lacking transportation, fragmented systems of care, limited 
access to nutritional services and counseling, and financial 
insecurity that inhibit their ability to eat well. 
Additionally, the United States Government Accountability 
Office (GAO) found that federal nutrition guidelines do not 
address the varying nutritional needs of older adults of 
different ages and with different health 
conditions.lxxxvi HHS plans to address the unique 
nutritional needs of older adults in the 2025-2030 Dietary 
Guidelines which will equip federal programs with the guidance 
necessary to better promote healthy aging through nutritional 
services. The nutrition needs of older adults can be wide-
ranging and person-centered dietary recommendations can help 
promote healthy aging.
            Older Americans Act: Supporting Health and Independence
    The OAA Nutrition Program promotes healthy aging among 
older adults by recognizing that adequate nutrition is a core 
component of overall health and by serving as a bridge to 
broader aging services. ACL's 2021 National Survey of Older 
Americans Act Participants found that 90 percent of home-
delivered meal participants and 80 percent of congregate meal 
participants reported the programs help them to live 
independently.lxxxvii
    The OAA Nutrition Program helps older Americans access a 
wide array of other services, such as nutrition screenings, 
transportation, respite care, and evidence-based health 
programs, all of which help support healthy aging. It is 
estimated that at least 43 percent of older adults receiving 
congregate meals receive one or more additional service, like 
transportation or chronic disease self-management classes. 
Additionally, nearly 60 percent of older adults who receive 
home-delivered meals receive one or more supportive 
service.lxxxviii
    Delivering More than a Meal: The home-delivered meals 
program is especially critical in promoting healthy aging, as 
it serves homebound older adults who are often more socially 
isolated, in poorer health with greater functional limitations, 
experience more falls, and are more likely to be underweight 
than congregate meal participants.lxxxix The program 
ensures that homebound older adults are better able to meet 
their dietary needs, while providing them with social 
interaction and a wellness check so they can safely remain at 
home and independent. In addition, home-delivered meal drivers 
often provide a report on the well-being of program 
participants so a care manager can follow up with additional 
support, if needed.
    In Somerset County, Pennsylvania, Phil, an 82-year-old 
driver, delivers nearly 300 meals a week to program 
participants and conducts a wellness check with each delivery. 
During his regular route, Phil encountered a program 
participant that had fallen. He contacted a Somerset County AAA 
care manager, and with her assistance, stayed with the 
participant for several hours until they were able to locate 
her family. Phil returned for an additional meal delivery and 
found that the participant had fallen again. He was able to 
connect her to emergency services where she was treated in the 
hospital and ultimately connected to more supportive services. 
Without Phil and the support of the Somerset County AAA, the 
participant may not have received the timely help she needed to 
remain healthy. The OAA Nutrition Program is often the first 
entry point to aging services for older adults and provides 
critical support and referrals to additional services.

Section 4: Delaying Adverse Outcomes Among Older Adults

    An important part of the statutory purpose of the OAA 
Nutrition Program in promoting the health and well-being of 
older adults in gaining access to nutrition is to ``delay the 
onset of adverse health conditions resulting from poor 
nutritional health . . .''xc This purpose is central 
to the program as older adults, particularly the oldest 
segments of the United States population, are more likely to be 
diagnosed with one or more chronic conditions and to experience 
adverse health outcomes as a result, such as falls. In 2017, 
the average age for a congregate meal participant was 77, and 
the average age for a home-delivered meal participant was 
82.xci
    Many OAA Nutrition Program participants are at increased 
risk for weight-related diseases and other health problems. In 
2017, six percent of home-delivered meal participants were 
underweight, compared to less than one percent of congregate 
meal participants. Moreover, 72 percent of congregate meal 
participants and 57 percent of home-delivered meal participants 
had a Body Mass Index (BMI) greater than 25, indicating they 
are overweight or obese and at-risk for additional health 
problems.xcii
    Poor nutrition can lead to muscle loss among older adults, 
which may increase the risk of falling. Falls can result in 
serious injury, such as broken bones or head injuries and may 
lead to higher rates of hospitalization. In 2018, three million 
older adults were treated for falls-related injuries in the 
emergency department (ED), causing more than 950,000 
hospitalizations or transfers to another 
facility.xciii That same year, nearly 36 million 
falls were reported among older adults in the past year, 
resulting in approximately 32,000 deaths.xciv
            Older Americans Act: Reducing Barriers to Health and Well-
                    being
    Growing bodies of research indicate the OAA Nutrition 
Program can delay adverse health outcomes. In general, 
congregate meal participants were less likely than 
nonparticipants to have a nursing home admission.xcv 
The OAA Nutrition Program serves as both a primary prevention 
strategy and treatment intervention for older adults who may be 
at risk of or who are currently navigating chronic health 
conditions.xcvi A randomized-control trial, for 
example, assigned eligible older Americans on a waiting list to 
a home-delivered meal program. The study suggests that those 
receiving daily delivered meals may experience a reduction in 
their risk of falls but, according to the authors, further 
research is warranted to fully understand the effect of meals 
on falls.xcvii Overall, the vast majority of OAA 
Nutrition Program participants reported that the program helped 
them eat more nutritious meals and control their 
weight.xcviii These responses indicate the program's 
positive impact on the health of participants.
    Long-term trends in adverse health experiences may also 
illustrate better outcomes for congregate meal members. 
According to a recent evaluation, participation in the 
congregate meal program may also be associated with a reduction 
in hospital readmissions three years into the program. The 
study found that about two percent of participants had a 
readmission, compared with eight percent of program-eligible 
nonparticipants. Among low-income participants and non-
participants, the relative improvement was even starker: one 
percent versus 13 percent.xcix American Indian, 
Alaska Native, and Native Hawaiian elders who participated in 
the OAA Nutrition Program also experienced significantly fewer 
hospitalizations and falls per year in comparison with non-
participating elders.civ
            Strengthening Partnerships to Support Healthy Aging
    The health care system increasingly recognizes nutrition as 
a social determinant of health, defined as the conditions in 
the places where people live, learn, work, and play that affect 
a wide range of health risks and outcomes.ci As 
such, many AAAs are developing partnerships with health care 
providers and broader community stakeholders to more 
comprehensively address the nutritional needs of older adults.
    One potential example can be seen in the work of the 
Central Midlands Council of Governments AAA in Columbia, South 
Carolina. The Central Midlands Council of Governments AAA 
partnered with Prisma Health and UnitedHealthcare to provide 
older adults recently discharged from the hospital with 
nutritionally-balanced meals to help prevent readmission and 
support long-term health goals.xcii After one year, 
only 10 percent of discharged patients who participated in the 
program were readmitted to the hospital, whereas 28 percent of 
patients who declined to participate were 
readmitted.ciii
    In some cases, AAAs and their volunteers are critical 
lifelines to health care. Dave, a regular volunteer driver for 
SeniorsPlus in Western Maine, found a woman in her 80s who had 
fallen in her home. She had been on the floor without food or 
water for three days when Dave delivered her meal. Dave 
immediately called 911 and stayed with her until the EMTs 
arrived and took her to the hospital. SeniorsPlus received a 
call from the local fire chief commending Dave for saving her 
life.civ

                             LOOKING AHEAD

    In the 50 years since the OAA Nutrition Program was signed 
into law, it has made substantial progress toward reducing 
hunger, creating meaningful opportunities for engagement and 
social interaction, connecting older Americans to services to 
promote healthy aging, and decreasing adverse health outcomes 
among older adults. This landmark anniversary provided the 
Committee the opportunity to reflect on the significant impact 
these policies and programs have made on the lives of older 
Americans.
    As the Nation's population continues to age, addressing 
health and nutrition will remain an important tool for ensuring 
greater independence and enhanced well-being among older 
adults. The COVID-19 pandemic exacerbated the painful realities 
of social isolation and loneliness among many older Americans. 
The OAA Nutrition Program provides regular opportunities for 
older adults to gather with one another and to be connected 
with additional resources. As a result of the pandemic, many 
programs adopted new methods to allow older adults to gather 
safely. As the Committee considers the effects of the Nation's 
changing demographics on the OAA Nutrition Program, innovative 
approaches to foster new connections and promote health offer a 
blueprint for the future.
    The Committee's examination of these programs underscores 
the critical importance of measuring outcomes and gathering 
data to inform best practices in the field. The 2020 
reauthorization of the Older Americans Act established a 
Research, Demonstration, and Evaluation Center for the Aging 
Network which would examine the effectiveness of OAA programs, 
such as the Nutrition Program, and assess innovative models 
conducted on the state and local level. Additional research and 
evaluation will equip the aging network as well as policymakers 
with needed information to address food insecurity among older 
adults.
    As the Nation prepares for a rapidly aging population, 
older adult hunger and food insecurity will remain a challenge. 
The Committee recognizes the importance of leveraging 
partnerships among all stakeholders to ensure all older adults 
have access to healthy and affordable food. This report 
demonstrates the Committee's commitment to combating hunger 
among older adults and preserving essential nutrition programs.

                               END NOTES

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(2020). Retrieved from https://data.census.gov/cedsci/
table?q=american%20community%20survey. Note that 60+ data was 
determined through the addition of 60 to 64 data and 65 and 
over data.
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