Literature Review

Jenifer La, Jenny Provo, Julia Whelan, Laurie Terwilliger

3/25/2015
Topic: The Older Americans Act
Research Questions:
1. What is the effectiveness of nutrition programs for Older Americans in terms of:
a. nutrition
b. physical activity
c. social interactions
2. Which is better? Congregate meals vs Home-Delivery Meal Options
Almanza, B., Young, N., Joseph, I., et al. (2007). Clients safe Food Handling Knowledge
and Risk Behavior in a Home-Delivered Meal Program. Journal of the American
Dietetic Association, 107(5), 816-821.
This descriptive study was performed to determine typical handling practices of home
delivered meals, and provide appropriate handling instructions to reduce the risk of food
borne illnesses by improving consumer handling of home delivered meals.
Clients were gathered from 50 home delivered meal preparation sites in six states
selected on geographic dispersion across US, size of the program, and willingness to
participate in the study which involved a total of 869 active MOW men and women.
Surveys were administered to participants via meal delivery rounds that asked them
questions about food handling practices and food safety knowledge. Four scenarios were
given to test the participants knowledge of food safety using strongly agree, agree,
disagree or strongly disagree (Likert Scale). Clients were classified as part of a high risk
group, neutral, or low risk group based on score computation. Another questionnaire was
administered to track the departure time from the meal site, the arrival time of each home
delivered meal at the clients home and the time that the meal was help in the home
before consumption.
Findings from the data concluded that 63% reported that they ate their meals as soon as
they were delivered. Of those clients who did not eat their meals immediately, 234 (82%)
stored the cold food in the refrigerator and 142 (58%) store the hot food in the freezer.
More than one-third of the clients reported that they had leftovers and only 34 (15%) ate
the leftovers within 2 hours. Significant differences among the groups on the basis of a
derived food safety knowledge score were observed in terms of whether or not they ate
their meal immediately (P 0.05). Thirty clients did not report their time of consumption,
and the remaining 839 clients consumed their meals an average of 1.22 hours after
delivery. Conclusions were made that while the majority of MOW participants didnt
have leftovers to become hazardous, there was low scores of knowledge on how to
properly store and cook foods safety. Authors concluded that careful attention should be
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paid to the entire period of time from onsite preparation to offsite consumption and
programs need to provide additional information to educate consumers.
This is strong support for current programs effectiveness at keeping the elder population
healthy. Programs should improve and prioritize education on food safety measures. This
information can be used to emphasize additional funding for MOW programs to
incorporate food safety and that because the sample was from a variety of sites around
the country this data can be used to generalize findings.
Cheong, J.M.K., Johnson, M.A., Lewis, R.D., Fisher, J.G., & Johnson, J.T. (2003).
Reduction in modifiable osteoporosis-related risk factors among adults in the older
Americans nutrition program. Family Economics and Nutrition Review, 15(1), 8391.
The purpose of this study is to determine the effectiveness of providing nutrition and
bone health education intervention for low-income and low-literacy elderly population.
The study was based on questionnaires that were read to participants from four senior
centers with the risk measurements of being a smoker, consuming less than 3 servings of
calcium-rich foods/day, not taking a calcium or vit D supplement, having less than 150
minutes of physical exercise/week or less than 5x/week, and having a high risk of falling
due to physical environment at home. It was found that those who attended the
intervention lessons lowered their risk factors, Caucasian women lowered their risk factor
more than African-American women, and consumption of calcium rich foods and intake
of calcium supplements increased significantly after the intervention. Based upon the
results of this small study, more information is needed to learn about the effectiveness of
nutritional and health risk factors among the elderly participants in nutrition programs
under OAA. This article did not provide enough details about the methodology and there
was no post-test results on heel bone densities. The study was funded by the Area Agency
on Aging, Georgia Department of Human Resources, USDA Food Stamp Nutritional
Education Contracts, and the Georgia Agricultural Experiment Station. This study
answers 1a and 1b of our topic question on how nutrition education can imp act the
effectiveness of nutrition and physical activity of the elderly.
Frongillo, E., Isaacman, T., Horan, C., Wethington, E., & Pillemer, K. (2010). Adequacy of
and Satisfaction with Delivery and Use of Home-Delivered Meals. National Institute
of Health. 29(2), 211-226.
ThisarticlereportsontheresultsofarandomsamplesurveyofNewYorkCityhomedelivered
mealsrecipientsthataimedtoprovideunderstandingabouttheadequacyofandsatisfactionwith
deliveryanduseofhomedeliveredmealsservices.Thefirstrandomtelephonesurveyincluded
1505CityMealsonWheelsrecipientsinNYC.Thesecondrandomtelephonesurveyincluded
500recipientswithhalfofthesampledrawnfromtheoriginalsampleandhalffromanupdated
censusofparticipants.Duringthisstudytworandomtelephonesurveyswereconducted.Thefirst
survey addressed demographic profile, financial status, health status, social networks, use of
formalservices,lengthoftimeenrolledinprogram,typeofmealsreceived,useofmeals,food
preparation,useofkitchenfacilities,nutritionintake,relationshipandinteractionwithdriver,
interaction with agency providing food, and religion and cultural compatibility of food. The
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secondsurveyfocusedonsatisfactionwithfoodpackagingandlabels,foodacquisition,meal
deliveryandmealvariety.
Thestudyfoundthat althoughitisnottheintentofthemealsonwheelsprogram,asizable
proportionoftherecipientsreliedsolelyontheprogramfortheirmeals.Thequalityofrecipients'
overalldietislow,sotheprogrambenefitsthehealthandnutritionofrecipientsbyproviding
fruit,vegetables,andmilkassourcesofessentialnutrients.Educatingrecipientsaboutsafefood
handlingmethodsespeciallywithhotmealswillreduceriskoffoodborneillness.Recipients'high
overallsatisfactionwiththedeliveredmealssuggeststhattheprogramisprovidingimportant
benefitsforthispopulation.Thelimitationoftheprogramwasthatthestudywasconductedover
thephone,informationmaynothavebeenreliable.

Gollub, E. A., & Dian, W. (2014). Improvements in Nutritional Intake and Quality of Life
among Frail Homebound Older Adult Receiving Home-Delivered Breakfast and
Lunch. Journal of the American Dietetic Association, 105, 1227-1235. Received
from: http://www.andjrnl.org/article/S0002-8223(04)00907-1/pdf

This cross sectional field study looked to compare the outcome of the two groups
(breakfast group plus lunch per week and just lunch 5x per week) by examining
differences in participants nutrient intake and aspects of quality of life that might be
affected by home-delivered meal services. Clients were gathered from 5 Elderly Nutrition
Programs that were involved in a Morning Meals on Wheels breakfast service demo
project. There were a total of 381 participants with 167 in the Breakfast group and 214 in
the comparison group and distributed randomly.

Results found the breakfast group had a greater energy nutrient intake (p>0.05), greater
levels of food insecurity (P>0.05) and fewer depressive symptoms (p>0.5). Breakfast
group consumed 300 kcals, 14 g protein, 36 CHO, 12 g fat, and 4g fiber more than the
comparison group, and were statistically significant P<.001. Breakfast group also
consumed more potassium, folate, calcium, iron, magnesium and zinc.
Authors concluded that the addition of a breakfast delivered item from a home delivery
service can improve the lives of frail, homebound elder adults. The breakfast group was
closer at reaching the DRI for key nutrients, which reduce the risk of chronic diseases. A
breakfast program could be marketed as a low cost method of improving food insecurity,
food and nutrient consumption and reducing depressive symptoms. Agencies should
expand their meal programs to include breakfast to their populations.
This strong study will provide evidence for the need of current MOW programs to get
funding for an additional meal delivered. The subjects were from different states,
demographics, age groups and size of facility, which the findings can be extrapolated to
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any need. First study to measure nutritional related quality of life factors that could affect
program participation.
Keller, H. (2006). Meal Programs Improve Nutritional Risk: A Longitudinal Analysis of
Community Living Seniors. Journal of the American Dietetic Association, 106(7),
1042-1048.
Thepurposeofthisstudywastodeterminetheeffectofformalandinformalsupportsformeals
andgroceryshoppingonnutritionalriskinseniors,andtodetermineiffrequencyorchangeinthe
amountofhelpprovidedformealsorshoppingareindependentlyassociatedwiththisnutritional
risk.Forthisstudyvulnerable,communitylivingseniorswererecruitedfromagenciesproviding
servicestotheelderlyinSWOntario,Canada.Vulnerabilitywasdefinedasaseniorwhorequired
informalorformalsupportsforactivitiesofdailylivingtoremaininthecommunity.Tobe
eligibleparticipantshadtorequirehelpforatleastoneactivityofdailyliving,haveadequate
cognitionandspeakEnglish.Atotalof367seniorscompletedthebaselineinterviewand263
seniorscompletedthefinalinterview.ToconductthestudyinterviewersadministeredSCREEN
questionnaires inSeniors homes evaluating eatingand nutritionrisk. A telephone followup
(every3months)wasusedtocollectoutcomedataandseniorsselfreportedchangesinmeal
programuseandhelpwithgroceryshopping.AsecondSCREENquestionnairewastelephone
administered18monthsafterinitialinterview.
Theanalysesindicatedthatformalmealprogramscanpreventfurtherdeclinesinnutritionalrisk
asmeasuredbytheSCREENquestionnaire.However,increaseduseoftheprogramsovertime
suggestsdecliningstatusofthesenioranddiscontinueduseisassociatedwithbetternutrition.
ThelimitationsofthisstudywerethatthefollowupSCREENquestionnairewascompletedover
thetelephonewithoneinterviewer,comparedwiththebaselinewithfiveinterviewers,which
may influence reliability of the instrument. Also, this sample is potentially biased because
participantswerevolunteerswhowerecognitivelywellandhadsurvivedfor18months,despite
beingvulnerable.

Kretser A.J., Voss T., Kerr W.W.., et al. (2003). Effects of two models of nutritional
intervention on homebound older adults at nutritional risk. Journal of the American
Dietetic Association, 103(3), 329-36.
This prospective comparison study looked at testing the feasibility of two models of
home meal delivery with Meals-on-Wheels (MOW) applicants who were identified as
being malnourished or "at-risk" as determined by the validated Mini Nutritional
Assessment (MNA). All 203 men and women participants had to be newly joined on the
program and included if they had a BMI of less than 22. Participant malnutrition level
was randomly yet evenly distributed between invention groups. Two groups included a
Traditional MOW hot meal once a day 5x per week. The New MOW group received a
weekly delivery of 21 meals and 14 snacks, which met 100% of the DRI for the day. Cost
of New plan was $11.00 per day. BMI was reviewed at baseline, 3 mns, and 6 mns.
Surveys were sent home for analysis of perception of health via MNA.

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Results from the study found that the New MOW group gained significantly more weight
between baseline and 3 months than did the Traditional MOW group (2.78 lb vs -1.46 lb,
respectively, P =.0120) and again between baseline and 6 months (4.30 lb vs -1.72 lb,
respectively, P =.0004).
This study strongly supports the MOW programs and its effectiveness at preventing falls
and nutrition related diseases. Its important for programs to assess nutritional risk at the
beginning of these meal programs participation in order to help tailor food preferences
and target needs appropriately.
Lee, J.S., Johnson, M.A., & Brown, A. (2011). Older Americans Act Nutrition Program
Improves Participants Food Security. Journal of Nutrition in Gerontology and
Geriatrics, 30, 122-139.
The purpose of this study is to determine the impact of the OAA on the food security of
participants and nonparticipants in Georgia. It consisted of three self-administered mail
surveys that were administered at 4 month intervals to both participants in the OAA
nutrition programs and those who were waitlisted. Seven different topics were addressed
with questions of health, food security, food and nutrition risk, food group intake, food
acquisition, and medical management. The study focused on answers relevant to food
security during the last 30 days. At baseline, more waitlisted people reported food
insecurity compared to those participating in nutrition programs (58% to 42%
respectively). At the 4-month follow-up, participants had a lowered rate of food
insecurity compared those who were waitlisted. Majority of waitlisted people who were
food insecure at baseline remained insecure at 4 months. Congregate meal participants
were the most food secure at 4-months and the waitlisted home delivered meals people
were the least secure after 4 months. Participants in the nutrition food programs were
more likely to become food secure after 4-months in the program than waited people.
Overall, congregate meal participants and waitlisted had great food security compared to
home delivered meal participants and waitlisted. However, data in the table did not quite
equate to the discussion and some numbers were suspect and not explained in the text.
This was not a rigorous study nor well written. Due to these limitations it was difficult to
draw definitive conclusions. This study was funded by the U.S. Administration on Aging
Advanced Performance Outcomes Measures Project; USDA/ERS/University of Davis
RIDGE program.
This study answers our topic question 2, despite the limitations, the study suggests that
congregate meals have shown to improve food security among the elderly.
Lirette, T., Podovennikoff, J., Wismer, W., et al. (2007). Food preferences and meal
satisfaction on
Meals on Wheels Recipients. Canadian Journal of Dietetic Practice and Research, 68,
214-217.
This descriptive study investigated the Edemondon Meals on Wheels recipients food
preferences and meal satisfaction. A Meal on Wheels employee recruited participants
from selected lunch clubs for the focus groups and questionnaires surveys given to meal

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of wheels participants to mail back. Eleven women and two men from two lunch clubs
participated in the focus groups; 140 meal surveys out of 271 sent were returned.
Findings from the study were that the majority of the hot meal clients were satisfied with
the taste, texture, value, variety, and portion size of their meals. Popular menu items were
barbecued chicken, perogies, and desserts. Up to 25% of participants indicated that meats
were too tough and vegetables were too firm. Vegetables such as broccoli and Brussels
sprouts were the most commonly disliked items. The inability to chew the meat and
certain vegetables made those items less enjoyable and/or the chefs overcooked their
items.
This study will provide information how MOW programs can be innovative by offering
(and advertising) the availability of texture-modified foods and a variety of vegetables.
Meal services for the elderly must continue to monitor meal acceptance, as client needs
change with our aging population.
Millen, B., Ohls, J., Ponza, M., & McCool, A. (2002). The Elderly Nutrition Program: An
effective national framework for preventive nutrition interventions. Perspectives in
Practice, 102(2), 234-240.
ThisstudyexaminedtheinfluenceoftheElderlyNutritionProgram(ENP)onnutritionalhealth
includingtargeting,deliveryandcostsofservices.ItevaluatedENPparticipants'nutrientintake
andsocializationpatternscomparedtononparticipants.InthisstudyENPparticipantsreceiving
either congregate or homedelivered meals were matched with similar nonENP participants.
Nonparticipantswerescreenedforage(60yearsorolder),income,anddisabilitystatus.They
wereofthesamezipcodeastheENPparticipants.Itwasconductedusinginpersoninterviews
withbothgroups,ENPandNonENP.Thesubjectsselfreportedinformationondemographics,
health status, hospital and nursing home admissions, physical functioning, nutrient intake,
socializationpatterns,anduseofENPservices.PhysicalfunctioningwasmeasuredbyActivities
ofDailyLiving(ADL)andInstrumentalActivitiesofDailyLiving(IADL)questionnaires.Their
nutrientintakewasestimatedusing24hourrecallsandanalyzedbytheNutrientDataSystem.
Adequacy of nutrition was determined using DRIs, AIs, and RDAs. Field personnel directly
measuredsubjectsheightsandweightstocalculateBMI.
ThroughthesequestionnairesandanalysistheyfoundthattheENPprogramcurrentlyprovides
congregateandhomedeliveredmealstoabout7%oftheolderpopulationoverall,includingan
estimated 20% of the nation's poor elders. Compared with nonparticipants, ambulatory and
homeboundENPparticipantsarebetternourished(4%to31%highermeandailynutrientintakes)
andachievehigherlevelsofsocialization(17%higheraveragemonthlycontacts).Thelimitations
of this study include the fact that subjects selfreported data on health status, hospital and
nursinghomeadmissions,physicalfunctioning,nutrientintake,socializationmayhavecaused
datatobeunreliable.Also,demographicdataforthenonENPmatchedgroupwasnotnoted.

Porter, K.N., Johnson, M.A. (2011). Obesity is More Strongly Associated With
Inappropriate Eating Behaviors Than With Mental Health in Older Adults
Receiving Congregate Meals. Journal of Nutrition in Gerontology and Geriatrics, 30,
403-415. doi: 10.1080/21551197.2011.623960
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The purpose of this study is to investigate the relationship of eating behaviors,

depression, anxiety, and stress with obesity in older adults participating in congregate
meal programs. Eating behaviors were evaluated with the three-factor eating
questionnaire, mental health was assessed with the Depression Anxiety Stress Scale,
history of depression was assessed with the Behavioral Risk Factor Surveillance Survey
and height and weight were measured to calculate BMI and obesity. Cognitive restraint
and emotional eating were significantly and consistently associated with obesity in all six
regression models, however uncontrolled eating, depression, anxiety, and stress were not
associated with obesity in and of the regression models. This suggests that interventions
in congregate meal participants should evaluate and address cognitive restraint and
emotional eating. Comprehensive programs have the potential to improve obesity
management and psychological well-being in older adults and to address inappropriate
eating behaviors and obesogenic environments in senior centers. Suggestions for such
environments is to provide programs to help with behavior change by incorporating goal
setting accomplishing small meaningful changes, food diaries, problem-solving
techniques, identifying cues associated w/ eating, cognitive restricting, and increasing
physical activities. Accuracy of eating behaviors and mental health were not clinically
diagnosed, thus it is skewed. The population is a very small cross-sectional study and
does now allow causal interferences, however, it is able to suggest a need for further
research for that appropriate obesity prevention and management strategies can be
developed for congregate meal plan participants. This study answers questions 1a and 2
on the effectiveness of congregate meals and the nutritional impact.
Quandt, S.A., Chen, H., Bell, R.A., Savoca, M.R., Anderson, A.M., Leng, X., Kohrman, T.,
Gilbert, G.H., Arcury, T.A. (2009). Food Avoidance and Food Modification Practices
of Older Rural Adults: Association with Oral Health Status and Implications for
Service Provision. The Gerontological Society of America, 50(1), 100-111. doi:
10.1093/geront/gnp096
The purpose of this study is to examine the association between oral health and foods
avoided and modified in a multiethnic rural population of older adults. The crosssectional study focused on two North Carolina counties in a random selection and
screening procedure. Interviewers conducted fact to fact interviews that lasted 1.5-2.5
hours. Foods most commonly avoided due to oral health problems were whole apples
(50%), whole nuts, sticky candy, and raw carrots (~32% each). % of older adults
reporting any time of modification of foods ranged from 23.8% - 67.8%. Examining the
association of any modification of each food with oral health measurers showed that
different types of foods were related to different oral health deficits. Food avoidance and
modification should be made part of assessments for planning for care for older adults.
Interventions such as providing dietary education or helping older adults obtain
appropriate utensils/implements should be developed. Menus should be tailored along
with food preparation techniques. This sample population was observed previously for a
long term study, thus behavioral studies are recorded. This study provided a list of food
options that is far more extensive than previous noted studies and goes more in depth
with food preparations. Limitations include human error in food recall from the subjets
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and the study lacked qualitative data to male causal arguments. This study answers
questions 1a and 2 in terms of the nutritional impact of food avoidance/modifications as
well as interventions to improve congregate meal and home-delivery programs.
Saletti, A., Johansson, L., Yifter-Lindgren, E., Wissing, U., Osterberg, K., & Cederholm, T.
(2004). Nutritional Status and a 3-Year Follow-Up in Elderly Receiving Support at
Home. Gerontology, 51, 192-198.
Thepurposeofthisstudywastoevaluatenutritionalstatus,includingmealpatternsandmeal
relatedproblems,inhomelivingelderlyreceivingmunicipalservices. Itanalyzed 353elderly
(overtheageof65)subjectsreceivinghomecareinfiveSwedishmunicipalitiesfornutritional
status, mortality and quality of life. The participants were interviewed and examined by the
community personnel that usually provided the care. The nutritional status was assessed
accordingtotheMiniNutritionalAssessment(MNA).TheBMIwascalculatedandparticipants
reportedanyrecentweightchange.Participantswereaskedtoassessdietaryintake.Subjects
providedaselfassessmentoftheirnutritionalstatusandoftheirselfperceivedhealthstatus.
SubjectscapabilitiestoperformdailyactivitieswereassessedaccordingtotheADL.Threeyears
after inclusion in the study, a mortality followup was performed by consulting Swedish
populationrecords.Thestudyfoundthatbetween8%and41%oftheelderlyparticipatinginthe
study were assessed as malnourished or at risk of malnutrition. Chewing and swallowing
problemsandreducedappetiteweremoreoftenreportedbythoseatriskofbeingmalnourished
andcouldbeamaincontributingfactor.Themealsonwheelsservicesweregiventoonethirdof
thepopulationwith66%ofthemusedoneportionofthedeliveredmealtospanforseveralmeals.
Thethreeyearmortalitywas50%forthosewhoweremalnourished,40%forthoseatriskof
malnutrition and 28% for the wellnourished group. The limitation of this study was that
observerswereinvolvedinthecareoftheelderlysubjects,mayhaveskewedresults.

Song, H.J., Simon, J.R., & Patel, D.U. (2014). Food preferences of older adults in senior
nutrition programs. Journal of Nutrition in Gerontology and Geriatrics, 33(1), 55-67.
doi: 10.1080/21551197.2013.875502
The purpose of this study is to determine the food preferences of participants in the
Elderly Nutrition Program in Maryland in either congregate meal programs or homedelivered meal programs. This was conducted through surveys which was a joint
partnership between Maryland Department of Aging and local Area Agencies on Aging.
Participants completed the surveys on their own at the program site, where as homedelivered participants were given surveys with their meals. The survey asked
demographic, health and food preference/characteristic questions. 13 food groups were
included in the survey (fresh fruit, chicken, soup, vegetables, salad, potatoes, meat,
sandwiches, pasta, canned fruit, legumes, deli meats, and ethnic foods). The most popular
food preference were fresh fruit (801%), chicken (75.5%), soup (74%), salad (73.5%),
vegetables (72%), and potatoes (67.2%). The least preferred foods were legumes, deli
meats, and ethnic foods. Between 50-58% of the responses to the general taste, variety,
appearance, portion, and temperature of the meals were reported as good or great. Fresh
fruits and salads were preferred more by females whereas males preferred meat, canned
fruit, legumes, deli meats and potatoes. Food preferences varied depending on gender,
race/ethnicity, and how long the older adults were in the program. Males, Caucasians, and
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daily program participants tended to prefer foods typically offered in the senior nutrition
programs compared to females, African-Americans, and people who only occasionally
participated in the programs.. Improvements to nutrition program include a greater
emphasis on good nutrition as even though 85% had chronic diseases, only 17% were
following special diets. There were limitations in this study, most notably the lack of
randomness of the participants. Out of 19 Area Agencies on Aging, only 9 participated in
the study. The results provided a good basis for further studies on preferences and tailored
education through the program.
This study answered our 2nd question on the effectiveness of congregate meals vs home
delivered meals as well as question 1a on the effectiveness of the meals in the nutritional
content. The meals could be more tailored to specific diets and be improved overall based
on the surveys.
Springmeyer, A.N. (2008). Assessing factors that influence participation at senior
congregate nutrition programs (Masters Thesis). California State University of
Sacramento. Master of Public Policy and Administration.
The purpose of this study is to determine the factors that influence attendance and
participation in congregate nutrition programs focusing on why some nutrition programs
are declining while others are increasing, what variables influence attendance in
congregate nutrition programs, and how are congregated nutrition programs adapting to
serve a younger older population. The author sent e-mails to members of the California
Association of Nutrition Directors for the Elderly (CANDE) requesting participation as
as case study volunteer. Seven themes were identified being image,
transportation/location, leadership of the individual program, flexibility of the program,
meal choices, offering cultural/ethnic meals, presentation and ambiance. 8 directors were
interviewed. Social aspect was most important for keeping attendance or increasing.
Flexibility in hours and times meals were served along with menu choices did not seem
to be important factors. Serving healthy foods such as salads and wraps did not increase
attendance and in some cases, caused people to avoid the facility. The older adults
preferred more traditional, high calorie foods. The younger older adults were more
concerned with healthier choices. Site managers have the largest influence over customer
satisfaction and returning participants. Programs in southern CA had food success with
adding physical activities where as in northern CA this had little effect and sometimes the
opposite. Socialization is a very important factor in attendance, choice and flexibility
were not important, and the addition of other activities may be an influential factor. This
study provided an informative thesis while only 8 directors were interviewed, the
responses seemed to provide a lot of information about the difference factors that can
influence participation and attendance in nutrition programs. As the elderly make way for
the younger older adults, nutrition programs will need to adapt to the different needs
and desires of the upcoming generation. This question answered 1c and supporting the
idea of question 2 with how socialization impacts why congregate meals may be a better
alternative for nutrition programs for the elderly.

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Weddle, D., Wilson, F.L., Berkshire, S.D., & Heuberger, R. (2012). Evaluating Nutrition
Risk Factors and Other Determinants of Use of Urban Congregate Meal Program
by Older African Americans. Journal Of Nutrition in Gerontology & Geriatrics, 31(1).
38-58. doi: 10.1080/21551197.2012.647555
The purpose of this study is to explore predisposing, enabling, and need characteristics
that influence congregate meal service and to examine the relationship between
nutritional risk and service use. Surveys were given to congregate meal participants 20
minutes before lunch was served which provided questions on health and lifestyle and
nutrition risk surveys. No statistically significant differences were found relative to the
pre-disposing characteristics of age and gender to congregate meal service use. There is a
significant relationship between chronic illness and congregate service use. 55% of
respondents were not familiar with congregate meals, 16% were non-familiar with homedelivered meals thus awareness of service is needed. Older persons may benefit from
early nutrition intervention to prevent and to have early detection of food insecurity and
poor nutrition. Studies were limited in the fact that the questionnaires were based on selfreporting participants which can lead to confounding answers and bias. Literacy may
have been a difficult task for those and the setting of taking a survey 20 minutes before
lunch may not have been the best time to do so. This answered question 2 that there is
more awareness of congregate meal programs compared to home-delivery meal
programs.
Wellman, N.S., Kamp, B., Kirk-Sanchez, N.J., & Johnson, P. M. (2007). Eat Better & Move
More: A Community-Based Program Designed to Improve Diets and Increase
Physical Activity Among Older Americans. American Journal of Public Health,
97(4), 710-717. doi: 10.2105/AJPH.2006.090522
The purpose of this study is to assess outcomes of an integrated nutrition and exercise
program designed for Older Americans Act Nutrition Program participants. Grants were
awarded to the 10 programs that participated in the study which were based in congregate
dining centers, neighborhood recreation centers, housing complexes in urban-inner city
suburban, rural locations and Native American reservations. Each site coordinator (8
RDs, 1 RN, and 1 Native American Program Manager) followed the Eat Better Move
More Guidebook of 12-week sessions incorporating mini-talks and activities for group
nutrition and physical activity sessions to determine whether or not participation in the
program will lead to improvement in pre and post intervention in nutrition, physical
activity or both. The study showed significant nutrition outcomes in participants through
their stages of change by their increase of fruit/veg/fiber/ca2+ rich foods and fluid intake.
With physical activity, significant improvement has been made in stages of change,
number of days walked, distance of walks, and the ability of timed up and go scores to
prevent fall risk. Completers reported significant exertion levels at post-intervention than
at pre-intervention. However, completion rates of different sights different
significantly according to site. All participants were self-selected volunteers who could
have been motivated for change. Because the program yielded significant outcomes at a
variety of sites involving diverse populations, EBMM can be considered a cost-effect
program. This address our questins 1a and 1b in improving nutritional and physical
activity of older Americans through congregate meal programs.
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Comparison Chart
Authors,
Year
Almanza,
B. et al.,
2007

?s

Purpose

Population

1a

Assess food safety

knowledge and
program temperatures
of MOW deliveries
across the US.

50 sites
across US
with active
MOW
participates

Cheong, J.
et al., 2003

1a,
1b

To determine the
prevalence of low
bone density and
osteoporosis risk
factors

Participant
s in
Northeast
Georgia
Older
Americans
Nutrition
Program
who
receive
Title III-C
or Title IIID services.
Mean age
of 77 years

To determine the
effectiveness of a
nutrition and bone
health education
intervention for lowincome, low-literacy
elderly population.

Research
Methods
Surveyed
MOW men and
women age
60+

Questionnaires
were read to
participants
and answers
analyzed.

Results

Limitations

Findings from the data concluded that

63% reported that they ate their meals
as soon as they were delivered. Of
those clients who did not eat their
meals immediately, 234 (82%) stored
the cold food in the refrigerator and
142 (58%) store the hot food in the
freezer.
52% lowered at least one risk factor.

Small sample size

Consumption of calcium-rich foods

and calcium supplements increased
significantly in those who participated
in the educational intervention
compared with those who did not
participate.

Only 36% of participants

attended all 3 lessons.
More women than men bias.
Participants were selfselected, not random.
Small sample size.

63 females
7 males
n = 70
initial, 59
final
42
Caucasian
women
page 11

21 AfricanAmerican
women

Frongillo,
E. et al.,
2010

1a,
2

This article reports on

the results of a
random-sample survey
of New York City
home- delivered meals
recipients that aimed
to provide
understanding about
the adequacy of and
satisfaction with
delivery and use of
home-delivered meals
services

The first
random
telephone
survey
included
1505 City
Meals-onWheels
recipients
in NYC.
The second
random
telephone
survey
included
500
recipients
with half
of the
sample
drawn
from the
original
sample and
half from
an updated
census of
participant
s.

Two random
telephone
surveys were
conducted. The
first survey
addressed
demographic
profile,
financial status,
health status,
social
networks, use
of formal
services, length
of time
enrolled in
program, type
of meals
received, use of
meals, food
preparation,
use of kitchen
facilities,
nutrition
intake,
relationship
and interaction
with driver,
interaction with
agency
providing food,
and religion

Although it is not the intent of the

program, a sizable proportion of the
recipients relied solely on the program
for their meals. The quality of
recipients' overall diet is low, so the
program benefits the health and
nutrition of recipients by providing
fruit, vegetables, and milk as sources of
essential nutrients. Educating
recipients about safe food handling
methods especially with hot meals will
reduce risk of foodborne illness.
Recipients' high overall satisfaction
with the delivered meals suggests that
the program is providing important
benefits for this population.

The study was conducted

over the phone,
information may not
have been reliable.

page 12

Gollub, E.
et al., 2014

1a,
2

To assess two MOW

groups (a breakfast
plus lunch group and
just lunch group) and
their nutritional risk
and lab values

MOW
participant
s from 5
pilot
breakfast
programs
in US

Keller, H.,
2006

1a

To determine the effect

of formal and informal
supports for meals and
shopping on
nutritional risk in
seniors, and to
determine if frequency
or change in the
amount of help
provided for meals or
shopping are

Vulnerable,
community
-living
seniors.Vul
nerability
was
defined as
a senior
who
required
informal or

and cultural
compatibility
of food. The
second survey
focused on
satisfaction
with food
packaging and
labels, food
acquisition,
meal delivery
and meal
variety.
Intervention
groups: B+L
and just L
group over 6
months.

Interviewers
administered
SCREEN
questionnaires
in Seniors
homes
evaluating
eating and
nutrition risk.
Telephone
follow-up

Breakfast group had a greater energy

nutrient intake (p>0.5), greater levels
of food insecurity (P>0.5) and fewer
depressive symptoms (p>0.5).
Breakfast group consumed 300 kcals,
14 g protein, 36 CHO, 12 g fat, and 4g
fiber more than the comparison group,
and were statistically significant
P<.001. Breakfast group also
consumed more potassium, folate,
calcium, iron, magnesium and zinc.
Our analyses indicate that
formal meal programs can
prevent further declines in
nutritional risk as measured by
the SCREEN questionnaire.
However, increased use of the
programs over time suggests
declining status of the senior
and discontinued use is
associated with better

The follow-up SCREEN

questionnaire was
completed over the
telephone with one
interviewer, compared
with the baseline with
five interviewers, which
may influence reliability
of the instrument.
This sample is
page 13

independently
associated with this
nutritional risk.

formal
supports
for
activities
of daily
living to
remain in
the
community
. Seniors
were
recruited
from
agencies
providing
services to
the the
elderly in
SW
Ontario,.
Canada. To
be eligible
participant
s had to
require
help for at
least one
activity of
daily
living,
have
adequate
cognition
and speak
english.
367 seniors
completed

(every 3
months) was
used to collect
outcome data
and seniors
self-reported
changes in
meal program
use and help
with grocery
shopping. A
second
SCREEN
questionnaire
was telephone
administered
18 months after
initial
interview.

nutrition.
Meal program use: Meals On
Wheels 28.1%; Meals with
socialization 42.2%; No meal
program 29.7%

potentially biased
because participants were
volunteers who were
cognitively well and had
survived for 18 months,
despite being vulnerable.

Baseline nutritional risk: High

risk 41.4%; Moderate risk
25.5%; Low risk 33.1%
Perceived health: Fair/poor
43%; Good/excellent 57%
Life satisfaction: Neutral/very
dissatisfied 16.3%;
Satisfied/very satisfied 83.7%

page 14

Kretser. A.,
et al 2003

1a, To assess a new MOW

1b, model of 21 meals per
2
week vs a traditional
MOW program and
the outcomes of
nutritional status.

Lee, J.S., et 2
al, 2011

To determine the
impact of the Older
Americans Act
Nutrition Program on
the food security of
program participants
and nonparticipants in
Georgia.

the
baseline
interview;
263
completed
the final
interview.
New to the
program
MOW
participant
s in VA

N= 4,952
(77%
female
23% male)
Mean age
74.6 years
33%
AfricanAmerican,
65%
Caucasian
62% at
poverty;
50% less
than high
school
education;
74% selfreported

New MOW
with 21 meals
per week
versus 5 meals
per week.

Surveys sent to
participants at
initial time and
at 4-month
follow up.
Participants
filled them out
and returned
them.

The New MOW group gained

significantly more weight between
baseline and 3 months than did the
Traditional MOW group (2.78 lb vs
-1.46 lb, respectively, P =.0120) and
again between baseline and 6 months
(4.30 lb vs -1.72 lb, respectively, P
=.0004).
People who did not participate in the
nutrition program remained food
insecure after 4 months. People who
participated lowered their food
insecurity from 42% to 29%.
Comparative data from nonparticipants: 58% insecure at baseline
to 46% after 4 months.

Sample was only

attributed to participants
in VA.

N= 4,731 surveys mailed

successfully
1,594 survey returns for
baseline; 954 returned at
4-months
Survey results may not
reflect the actual
population. Biased
toward those who tend to
fill forms out, were
literate, women over
men, had help from
family/friends to fill out
survey.

page 15

poor
health;
53%
living
alone

Lirette T.,
et al, 2007

1a,
2

To assess meal
preferences and meal
satisfaction among
MOW participants.

Active
MOW
participant

Focus group
and mailed
surveys

The majority (72% to 88%) of the hot

meal clients were satisfied with the
taste, texture, value, variety, and
portion size of their meals. The texture
and toughness of the meats and
vegetables were hard to chew due to
dental issues and digestive issues.

Millen, B.,
(2002)

1a,
1c,
2

To examine the
influence of the
Elderly Nutrition
Program (ENP) on
nutritional health
including targeting,
delivery and costs of
services. ENP
participants' nutrient
intake and
socialization patterns
were compared to nonparticipants.

ENP
participant
s receiving
either
congregate
or homedelivered
meals were
matched
with
similar
non-ENP
participant

In-person
interviews with
both groups.
The subjects
self-reported
information on
demographics,
health status,
hospital and
nursing home
admissions,
physical
functioning,

The ENP program currently

provides congregate and
home-delivered meals to about
7% of the older population
overall, including an estimated
20% of the nation's poor elders
Compared with nonparticipants, ambulatory and
homebound ENP participants
are better nourished (4% to
31% higher mean daily
nutrient intakes) and achieve

One limitation of this

research is that the focus
group participants were
recruited by a MOW
staff member. Clients
may have felt obliged to
participate, although it
did not prevent them
from identifying
concerns and making
suggestions. In addition,
the hot meal survey was
not validated in this
population.
Subjects self-reported
data on health status,
hospital and nursing
home admissions,
physical functioning,
nutrient intake,
socialization may have
caused data to be
unreliable.
Demographic data for the
non-ENP matched group
page 16

s. Nonparticipant
s were
screened
for age (60
years or
older),
income,
and
disability
status.
They were
of the same
zip code as
the ENP
participant
s.

Porter, K.,
et al., 2011

1a,
2

Investigates the
relationship of eating

N = 120,
participatin

nutrient intake,
socialization
patterns, and
use of ENP
services.
Physical
functioning
was measured
by Activities of
Daily Living
(ADL) and
Instrumental
Activities of
Daily Living
(IADL).
Nutrient intake
was estimated
using 24-hour
recalls and
analyzed by
Nutrient Data
System.
Adequacy of
nutrition was
determined
using DRIs,
AIs, and
RDAs. Field
personnel
directly
measured
subjects
heights and
weights to
calculate BMI.
Eating
behaviors were

higher levels of socialization

(17% higher average monthly
contacts)

Based on median split of each eating

behavior obese participants had higher

was not noted

Limitations with this

page 17

behaviors, depression,
anxiety, and stress with
obesity in older adults
participating in
congregate meal
programs.

g in 4
senior
centers in
northeast
Georgias
Area
Aging w/
informed
consent
forms

evaluated with
the three-factor
eating
questionnaire,
mental health
was assessed
with the
Depression
Anxiety Stress
Scale, history
of depression
was assessed
with the
Behavioral
Risk Factor
Surveillance
Survey, and ht
and wt were
measured to
calculate BMI
and obesity.

cognitive restraint p < 0.0001,

uncontrolled eating p < 0.05, and
emotional eating p < 0.05 compared to
non-obese participants.

study are that eating

behaviors and mental
health were self-reported
and not clinically
diagnosed, thus accuracy
Cognitive restraint and emotional
is skewed. The
eating were significantly and
population studied is also
consistently associated with obesity in
a very small sample for a
all six regression models, however,
uncontrolled eating, depression anxiety, cross-sectional study and
does not allow casual
and stress were not associated with
obesity in any of the regression models. inferences to be made.
Stress summary score was significantly
correlated with BMI but was not
associated with obesity, there were no
associations of depression or anxiety
with BMI or with obesity.

With DASS
(mental health
questionnaire)
scores were
ranked as
follows: 0= low
symptoms, 1=
had symptoms
that were mild,
moderate, or
severe
Eating
behaviors were
scored with 1=
never, 2=
page 18

Quandt, S.,
et al.,
(2009)

1a,
2

To examine the
association between
oral health and foods
avoided or modified in
a multiethnic rural
population of older
adults

N = 635
[344 F,
21M] in
two North
Carolina
counties
that was
chosen in
1996 for a
long term
study of
rural aging
due to high
proportion
of minority
older
adults and
older
adults
living in

rarely, 3=
sometimes, 4=
always. Topics
assessed were
cognitive
restraint,
uncontrolled
eating, and
emotional
eating. Each
eating behavior
score was
recoded to low
(=0) and high
(=1) according
to the median
split
: Participants
were located
using a random
dwelling
selection and
screening
procedure
based on a
multistage
cluster
sampling
design in which
the primary
sampling units
were stratified
and sleeved
with
probability
proportionate
to their sizes.

Foods most commonly avoided due to

oral health problems was whole apples
(50%). Whole nuts, sticky candy, and
raw carrots were the foods next most
frequently reported (~32%). Corn,
popcorn, and grilled or fried meats
were avoided by about 14%.
% of older adults reporting any type of
modification of foods ranged from
23.8% (for beans) to 67.8% (for
apples). The most common
modification was usually slicing thin or
chopping the food into small pieces.
More than half of the participants
reported modifying apples and meats in
this way. For all foods, including
apples, cooking a long time to soften
was reported. More than a third
reported using this technique for meats
due to the condition of their teeth,

Limitations includes that

the food avoidances and
modification data were
obtained through selfreports which are subject
to human error (i.e. fail
to recall). Questionnaire
was asked if foods were
avoided/modified due to
specific oral health
problems, however, other
factors may have caused
avoidance/modifications.
Sample consisted of only
older adults in a rural
region of southern U.S.
Less than 20 foods were
included. The crosssectional design and lack
page 19

poverty
compared
to the
remainder
of the
state.

859 individuals
were eligible to
participate. 635
out of 859
individuals
conducted the
face-to-face
home
interviewers
lasting from
1.5-2.5 hours
(response rate
73.9%).
Interviewers
attempted to
recruit
participants
who met the
inclusion
criteria by
visiting each
randomly
selected
dwelling in a
cluster. If the
individual was
not home, the
interviewer
would make a
point to set an
appointment to
return. The
interviewer
made at least
three additional
attempts to
contact the

mouth, or dentures. Other foods were

of qualitative data
avoided by about 10% or fewer (i.e.
prevents it from making
lettuce, berries, fried chicken,
causal arguments.
tomatoes, seafood, ground/stewed
meats). Examining the association of
any modification of each food with oral
health measurers showed that different
types of foods were related to different
oral health deficits.

page 20

Saletti, A.,
et al.,
(2004)

1a,
2

To evaluate nutritional
status, including meal
patterns and mealrelated problems, in
home-living elderly
receiving municipal
services.

353 elderly
(over the
age of 65)
subjects
receiving
home care
in five
Swedish
municipalit
ies

selected
individuals. All
interviewers
completed 1
day didactic
training and
recorded
practice
interviews
The
participants
were
interviewed
and examined
by the
community
personnel that
usually
provided the
care. The
nutritional
status was
assessed
according to
the Mini
Nutritional
Assessment
(MNA). The
BMI was
calculated. A
recent weight
change was
reported by
participants.
Participants
were asked to
assess dietary

8% and 41% of the elderly

were assessed as
malnourished or at risk of
malnutrition; Chewing and
swallowing problems and
reduced appetite were more
often reported by those at risk
of being malnourished; Mealson-wheels services were
given to one-third, 66% of
them used one portion for
several meals; The threeyear mortality was 50% for
those who were malnourished,
40% for those at risk of
malnutrition and 28% for the
well-nourished group

Observers were involved

in the care of the elderly
subjects, may have
skewed results.

page 21

intake. Subjects
provided a selfassessment of
their nutritional
status and of
their selfperceived
health status.
Subjects
capabilities to
perform daily
activities were
assessed
according to
the ADL. Three
years after
inclusion in the
study, a
mortality
follow-up was
performed by
consulting
Swedish
population
records.

page 22

Song, H.,
et al.,
(2014)

1a,
2

To determine the food

preferences of
participants in the
Elderly Nutrition
Program in Maryland.

Seniors
and their
spouses
participatin
g in either
congregate
meal
programs
or homedelivered
meal
programs
in
Maryland.

Surveys filled
out by
participants onsite at senior
facility.
Surveys were
turned in and
evaluated.

Participants filled out surveys asking

about their preferences for 13 different
food groupings.
The most popular food preferences
were fresh fruit (80.1%), chicken
(75.5%), soup (74.0%), salad (73.5%),
vegetables (72.0%), and potatoes
(67.2%). The least preferred foods
were legumes (39.2%), deli meats
(36.0%), and ethnic foods (22.5%).
Fresh fruit and salads were preferred
more by females than males.

n = 2,024
76%
female

Out of 19 Area Agencies

on Aging, only 9
participated in the study.
Biased toward women.
Only representative of
certain areas of
Maryland.
Other factors may have
influenced preferences
such as method of
cooking, over/under
cooked, loss of
taste/disease factors
influencing preferences.

Overall, Caucasians liked the food

choices better compared to AfricanAmericans.

Mean of
76.9 years
60.9%
Caucasian
and 39.1%
AfricanAmerican

Springmey
er, A., et
al., (2008)

1c,
2

Looked at factors that

influence attendance
and participation in
congregate nutrition
programs focusing on
three questions:
1. Why are some

58% had 12 chronic

diseases
Adults
over the
age of 60;
mix of
ethnicities:
African
American,
Hispanic,

8 directors
interviewed, 7
in person and
one over the
phone.
Answers to
questions were
evaluated and

Eight directors of Elderly Nutrition

Programs throughout California were
interviewed on seven themes related to
their facility.

Self-selected directors they agreed to an email

request for interviews.
Not random.

Results: Social aspect was most

important for keeping attendance or
increasing. Flexibility in hours and

Small sample size for

such a large and varied
population.
page 23

nutrition programs
declining while others
are increasing?

Asian
living in
California

compared.

N = 151
[113 F,
38M]
attending a
congregate
meal in 1
of 10
churches
were
identified
using the
Directory
of
Churches
2010 that
were
predominat
ely African
American

Lunch was
served to entice
participants to
do the survey.
Church leaders
were required
to submit a site
authorization/c
ooperation
letter. It was
emphasized
with pastors the
importance of
individuals
right to refuse
participation.
The survey was
open to all
members of the
community
aged 60 and
older
regardless of
whether they

2. What variables
influence attendance in
congregate nutrition
programs?

Weddle,
D.,Wilson,
F.L.,
Berkshire,
S. D., &
Heuberger,
R.. (2012)

3. How are
congregated nutrition
programs adapting to
serve a younger
older population?
To explore
predisposing, enabling,
and need
characteristics that
influence use of
congregate meal
service and to examine
the relationship
between nutritional
risk and service use.

times meals were served along with

menu choices did not seem to be
important factors.
Serving healthy foods such as salads
and wraps did not increase attendance
and in some cases, caused people to
avoid the facility. The older adults
preferred more traditional, high calorie
foods. The younger older adults were
more concerned with healthier choices.
Salad bars did not seem to increase
attendance and increased waste.
No statically significant differences
were found relative to the predisposing characteristics age p=0.62
and gender p=0.88 to congregate meal
service use. Living arrangements were
statistically significant as they were
less likely to use congregate meal
services. Examination of need
characteristics indicated a significant
relationship between chronic illness
and service use P < 0.5, however there
is no significant relationship between
number of hospitalizations and
congregate meal service use.
33% of respondents reported high
nutrition risk and of those, 88% had
never used congregate meal services.
18% of the respondents who were
congregate meal participants were at
higher nutrition risk than their
nonparticipant counter parts.
55% of respondents were not familiar
with congregate meals, 16% were non
familiar with home-delivered meals.

Possibility for leading

questions due to
interview style. Hard to
quantify and compare
answers due to subjective
nature of interview.

Participants was selfreporting the

questionnaires and risk,
thus leading to
confounding answers or
bias. Nonparticipants
may have problems or
concerns that made them
not want to participate.
Literacy may have been a
difficult task for those.
Lunch may not have
been the best time to
provide the survey as
participants were waiting
for their meal.

page 24

were familiar
with, or had
previously used
the congregate
meal service.
Respondents
were not
required to be
members of the
church to
complete the
survey.
Approximately
20 minutes
before lunch
was served, the
10-item NSI
checklist and a
22-item health
and lifestyle
survey
instruments
were explained
to participants.
The survey
answers were
anonymous.
After all
participants
indicated that
they had
completed the
nutritional risk
survey,
instructions
were given for
the 22-item

Awareness of service is highly

correlated with the level of service use
of both programs. 23% of those who
knew of the congregate meal service
reported to have used it. Of the 83% of
those who were aware of homedelivered meal service only 9.7% had
actually used the service.

page 25

Wellman,
N.S.,
Kamp, B.,
KirkSanchez,
N.J., &
Johnson, P.
M. (2007).

1a,
1b

To assess outcomes of
an integrated nutrition
and exercise program
designed for Older
Americans Act
Nutrition Program
participants.

N = 620,
participant
s in 10
congregate
meal
programs,
neighborho
od rec
centers,
and
housing
complexes
in urban
inner-city
suburban,

health and
lifestyle survey
and were
encouraged to
be truthful.
Questions
could be
skipped if it
made the
participant feel
uncomfortable
and for those
who did not
wish to
participate,
their choice
was honored
and no
influence was
put on them to
change their
minds.
Multisite
Nutrition Outcomes
applied
Significant movement of
intervention
participants through nutrition
study- the lead
stages of change
person at each

31% increased number of

site (8 RD, 1
serving of fruit by consuming 1
RN, 1 Native
or more serving (18%
American
decreased number of serving)
Program
37% increased vegetable
Manager)
consumption by 1 or more
participated in
serving (13% decreased number
an 1.5-day
of serving)
workshop on
33% increased fiber
protocol
consumption by 1 or more
implementation

Limitations included that

completion rates differed
significantly according to
site, influential factors
may have included
differences in staff and
facilities. All participants
were self-selected
volunteers who may have
been motivated for
change, there were no
control groups in the
project. Extensive and
time-consuming data
collection and process
page 26

and rural
locations
and Native
American
reservation
s

, incorporated
changes in data
collection tools
suggested by
site leaders and
providing
technical
assistance
throughout the
study via biweekly
conference
calls and a
dedicated list
serv.

serving (16% decreased number

of serving)
42% increased Ca-rich food
consumption by 1 or more
serving (14% decreased)
31% increased fluid intake by
1-3 glasses (18% decreased
their intake by the same
amount)
P < .001

associated with the

project are not
representative within the
10 study sites in the
program costs.

Physical Activity Outcomes

Of 42% who were not at

maintenance stage of regular
physical activity, 75% made a
significant advance of 1 or
more stages toward
maintaenance
At post intervention number of
blocks walked per day
increased significantly from 10
to 14.5 (45% increase) and
flights of stairs climbed from
4.6 to 5.7 (24% increase)
Number of days walked
increased 9% 5.7 to 6.2 days
Timed Up and Go scores
measured by trained program
staff improved from 11.7
seconds to 10.6 seconds (norm
is 7-10 second, individuals
needed more than 10 seconds
are considered to have limited
physical mobility and at
increased risk of falling)
Completers reported significant
page 27

exertion level at postintervention (5.4) than at preintervention (4.9) on modified 1

(none) to 9 (very, very strong)
P < .008
99% of participants indicated
that they would recommend the
program to others
93% reported that it helped
them eat better
90% reported that it helped them
move more

page 28

Discussion and Conclusion:

The purpose of the Older Americans Act was in response to a concern by policymakers about a
lack of community social services for older persons. The OAA funds critical services that keep
older adults healthy and independent services like meals, health promotion, and more. With
meals, the OAA provides congregate and home delivered meals to the elderly especially for
those that are food insecure. However, continue awareness of these programs are needed
(Weddle, 2012) as these opportunities are feeding a limited amount of the older Americans.
Food handling practices need to be improved within the nutrition programs through the OAA.
This includes food preparation techniques, temperature readings, diet textures, and tailored menu
for chronic illness. With food handling practices, education must be provided to the participants
on re-heating food to prevent food borne illnesses (Almanza, 2007). Food handling practices
should also be taught to staff to improve consistent portion sizing and nutrient dense foods to
participants as participants tend to consume 1 meal per day (Frongillo, 2010).
As the elderly continue to age, oral health begin to diminish. This directly impacts food
consumption as participants are no longer interested in eating which can lead to malnutrition.
Diet modification techniques and tailored menus need to be taught to staff to provide foods that
allow eating without modification to be an easier task for the elderly (Liurette, 2007& Quandt,
2009). Along with tailored menu diet textures, further reinforcement need to develop menus
catered to diets for those that are chronically ill. Of 85% participants who have chronic illness
(i.e. T2DM, HTN), only 17% of the participants were given a diet-modified option (Weddle,
2012). Tailored menu may increase promotion of meal programs, along with improve overall
satisfaction for the participants (Krester 2003 & Song 2014).
Programs that provided physical activity and socialization has also shown to be effective to
participants. These programs are typically held in congregate meal sites over home-delivery
meals. Further research need to be done to determine the mental/emotional well-being of homedelivery meal participants. For participants who attend congregate meals and were given the
opportunity to attend nutrition education and physical activity programs has shown statistically
significant improvement in stages of change. Participants were increasing fruit, veg, Ca2+-rich
foods and water/fluid consumption as well as increasing length of physical activity in time and
distance. Overall improvement has been seen in timed up and go exercises as preventive
measures for at risk to fall participants (Wellman, 2007). Socialization is also a factor in overall
satisfaction in participating in meal services and nutrition programs (Springmeyer, 2008).
Conclusion: Nutrition programs for the elderly has shown to be effective for participants. Studies
has shown improved p.o. intake of food was apparent for participants attending the programs
versus those that do not (Lee, 2011). Programs that offered physical activity and nutrition
education has also shown improvement in endurance of the elderly and improved food/diet
choices. However, continued improvement with the awareness of the programs need to be made
to reach out to participants who do not have access to these opportunities. Overall improvement
in food handling and diet textures need to be made to cater the population to decrease the risk of
malnutrition and ingestion of food borne illnesses along with providing nutrition and health
promotion education has shown to be beneficial for this population.
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