[Senate Report 117-196]
[From the U.S. Government Publishing Office]
117th Congress} { Report
SENATE
2d Session } { 117-196
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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
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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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iiU.S. Census Bureau, American Community Survey.
(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.
iiiThe Older Americans Act of 1965 (P.L. 89-73,
as amended through P.L. 116-141, the Supporting Older Americans
Act of 2020). (2020, April 10). https://acl.gov/sites/default/
files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20a
s%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf.
ivP.L. 92-258, An Act to Amend The Older
Americans Act of 1965. https://www.congress.gov/92/statute/
STATUTE-86/STATUTE-86-Pg88.pdf.
vGunderson, C., Ziliak, J. (2022, May 11). The
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viiId.
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xiiId.
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