Assessment of the health and nutrition of elderly in Ypsilanti, MI

Community Nutrition Assessment

Kate McManus
Nutrition 642 Community Nutrition
 As individuals age, their nutritional needs transform as comorbidities and developmental
changes occur, putting them at an increased risk for malnutrition. For these reasons, elderly
adults, defined as age 65 and older, should be paid special attention to when assessing nutrition
and health status in a community. In fact, among community dwelling elderly, the risk of
macronutrient and caloric deficiency is 2-16% and micronutrient deficiency as high as 35% (6).
Malnutrition can be caused by a number of different factors, including somatic, social, and
psychological, and can lead to further health issues, such as decreased functional ability,
decreased bone mass, immune function, and mortality (3,1).
Physical changes that develop with age can affect appetite and the ability to consume and
prepare food. Such changes include dental decaying resulting in inability to chew solid foods,
decreased sense of taste and smell leading to decreased appetite, and having certain dietary
restrictions due to comorbidities such as diabetes, cardiovascular and renal diseases. Adjusting to
these changes can be stressful for the elderly and require an increase in education about what
foods are appropriate. Additionally, dementia and Alzheimers disease decreases the individuals
ability to prepare food (6).
Social factors play a large role in the nutrition status of elderly individuals as well. Many
seniors may require assistance in gathering, preparing, and consuming food. Social isolation is a
high risk factor for malnutrition, as it is shown that eating alone leads to eating less and having
poorer nutritional status. Social isolation is frequently seen in older adults as they are dealing
with retirement, widowhood, and bereavement of those close to them (2). Malnutrition is
commonly seen in those suffering from depression due to social isolation. Depression can be as
high as 10% in the elderly, and for outpatients and those living in nursing homes, can account for
30-36% of unexplained weight loss (1).
The implications of malnutrition in the elderly include increased risk for comorbidities,
increase in hospital admissions, and mortality (2). Decreases in protein and micronutrients
intake, such as vitamin D and calcium, can lead to osteoporosis which is a risk factor for falls
and fractures. Other health problems associated with elderly malnutrition include increased risk
for infection and a decrease in immune function, increase in respiratory and cardiac problems,
and increased risk for operative complications and mortality (4). In fact, in severely
undernourished elderly, hospital complications and death can be anywhere from 2-20 times
greater than in well-nourished individuals. These comorbidities can in turn, increase depression
and decrease quality of life (2).
It is clear that the elderly population is at an increased risk for malnutrition, which can in
turn lead to further health problems. For these reasons, it is particularly important to assess the
health and nutritional status of elderly in the city of Ypsilanti, as it is evident that health status
and nutrition are very closely related.
Ypsilanti is a suburban city within Washtenaw county with a population of 19,945. Of
this, 8.3% of the population is 65 years or older. The median income is $32,148 and 30.6% of the
population is living in poverty. The majority of the population, 61.5%, is white and 29.2% of the
population is African American. The remaining 9.2 percent is described as Asian, American
Indian, or more than one race (7).
Ypsilanti is a suburban city with a population of 19,945 (8). The following will describe in detail
the demographics and features of the community, with special emphasis on the elderly
population.
The distribution of gender is evenly split between 50.3% female and 49.7% male. The
median age is 24.8 and the distribution of age is as follows (8):

Table 1 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/)

As shown in table 1, the largest age group by percentage is 20-24 years old, followed by
15-19 years old. The elderly population (65 years and older) makes up 8.2% of the population
(8).

Demographic of Race by Percentage

90
80
70
60
50
40
30
20
10
0
White Black or African American Indian Asian Hispanic or
American or Alaska Native Latino

Ypsilanti Michigan
Figure 1 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/)
Figure 1 compares the deomgraphic by race between Ypsilanti and the state of Michigan.
In Ypsilanti, the percentage of white alone is smaller than Michigan at 61.5%, while Michigan is
79.7%. Conversely, Ypsilanti has a larger population of black or African American, 29.2% while
the state percentage is 14.2% (8).

Education Level by Percentage

35
30
25
20
15
10
5
0

Ypsilanti Michigan

Figure 2(Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/)

Figure 2 compares the education levels obtained between both the city of Ypsilanti and
the state of Michigan. While Michigan has a higher percentage of residents with a high school
degree or equivalent, 30.2% compared to 18%, Ypsilanti has a higher percentage of residents
with either bachelors or graduate degrees. In Ypsilanti, 19.2% have a bachelors and 16.8%
have a graduate or professional degree, while Michigan has 16.1% and 10.3%, respectively.
Other categories, such as less than 9th grade, 9-12 grade with no degree and associates degree
are more similar between the two regions (8).
The unemployment rate in Ypsilanti is 8.9%, which is slightly higher than the state level
of 7.0%. Related to this is a higher percentage of people living in poverty in Ypsilanti than the
state, a factor that may affect diet and nutritional status. Ypsilanti has 30.6% of residents living
below the poverty level, with Michigan having around half that, at 15.8%. Of this population,
5.3% are above the age of 65 in Ypsilanti, and 8.1% are elderly in Michigan, a population which
as previously discussed, is already at risk for malnutrition. Additionally, the median household
income is higher in Michigan ($49,087) than Ypsilanti ($32.148) (8). Figure 3, below, shows the
occupational distribution of Michigan and Ypsilanti.
 Occupational Distribution by Percentage
40
35
30
25
20
15
10
5
0
Management, Service Sales and office Natural Production,
business, resources, transportation,
science, and arts construction, and material
and moving
maintenance

Ypsilanti Michigan

Figure 3 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/)

For both Ypsilanti and Michigan, the largest distribution of occupations is management,
business, science, and arts, followed by sales and office. The distribution of occupations in
Ypsilanti closely mirrors that of the state of Michigan for all occupations. Looking further into
industries, however, there are some deviations from the state-wide distribution. Jobs in
education, health care, and social assistance in Ypsilanti are higher than Michigan, 31% and
24.1% respectively. This could be in part because of the wider availability of education and
health care jobs at Eastern Michigan University and St. Joseph Mercy hospital, both located in
Ypsilanti, as well as at the University of Michigan, which is located nearby in Ann Arbor.
Conversely, Ypsilanti has a lower distribution of manufacturing jobs (11.8%) than Michigan
(17.4%) (8).

Ypsilanti Michigan
Owner occupied 32.5% 71.5%
Rental occupied 67.4% 28.5%
Table 2 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/)

Table 2, above, highlights the difference in renter and owner occupied housing units.
Ypsilanti has a much greater percentage of rental occupied housing units than the state. The
median rent in Ypsilanti is also lower than the state median, at $730 and $780, respectively.
Similarly, the median home value is lower in Ypsilanti than the state as well ($114,700 and
$120,200) (8). These statistics mirror the trend of decreased income and increased poverty levels
in the city compared to the state.

Health Statistics
Ypsilanti, Michigan and the United States all have similar leading causes of mortality. Table 3,
below, highlights the difference between the regions for mortality for the year 2014.

Number of Deaths and Age-adjusted Mortality Rates for the Ten Leading Causes of Death,
Ypsilanti City and Michigan and United States Residents, 2014

Table 3 (Adapted from Michigan Department of Community Health, Michigan Mortality

Statistic 2014; data available at shttp://www.mdch.state.mi.us/pha/osr/CHI/deaths/frame.asp)

For all three regions, the leading cause of mortality is heart disease, followed by cancer.
For Ypsilanti, however, stroke, which is the third leading cause of death in the state and country
is tied for the sixth leading cause of death, behind unintentional injury, stroke, and kidney
disease. As previously discussed, many of these diseases can be attributed to poor diet and as
seen below, primarily affect older adults (9).

Leading Causes of Death by Age, Washtenaw County, Michigan, 2014

Table 4 (Adapted from Michigan Department of Community Health, Michigan Mortality
Statistic 2014; data available at http://www.mdch.state.mi.us/pha/osr/CHI/deaths/frame.asp)

Table 4 shows the leading causes of death for Washtenaw county adjusted by age. For the
elderly population, 75 years or older in this data, the five leading causes are heart disease, cancer,
stroke, Alzheimers disease, and chronic lower respiratory disease (9). Many of these are
possibly related to a poor diet, and as previously stated, diseases like Alzheimers can affect the
ability to prepare food.
In terms of causes of morbidity for both Washtenaw county and Michigan, several
common conditions include cancer, cardiovascular diseases, chronic lower respiratory diseases,
diabetes, and diseases associated with the kidney. For cancer, both areas have the highest rate of
lung and bronchus cancer (5,843 cases in Michigan and 124 in Washtenaw). For Washtenaw, the
second leading kind of cancer is breast, while in Michigan it is colon and rectum. Common
causes of morbidity that affected older populations specifically include arthritis, hip fractures,
and osteoporosis, conditions that are very closely related to calcium and vitamin D intake.
Together, these accounted for 95,925 hospital discharges in the state and 2,326 in Washtenaw
county for 2012-2014 (9). Furthermore, per the Washtenaw County HIP survey, 12.1% of
residents report fair or poor health. An increased percentage of elderly residents reported
declining health, with 14.3% of residents 65-74 and 23.7% of residents 75 or older reporting so
(10).

Weight Status of Adults

40
35
30
25
20
15
10
5
0
Washtenaw Michigan U.S.

Overweight Obese

Figure 4 (Adapted from Washtenaw County Public Health, 2015 Health Improvement Plan and
Michigan Department of Health and Human Services, 2014 Behavioral Risk Factor Survey; data
available at http://secure.ewashtenaw.org/HIP/HIP.do and
http://www.michigan.gov/documents/mdch/2014_MiBRFS_Annual_Report_Final_Web_504843
_7.pdf)

Adding to this, when looking at obesity and overweight prevalence, as shown in figure 4,
Washtenaw county reports lower percentages than the state of Michigan and the U.S. median.
Obesity is defined as a BMI of 30.0 or greater, while overweight is a BMI of 25.0-29.9. For all
three areas, overweight prevalence is relatively even at 34.4% for Washtenaw, 34.9% for
Michigan, and 35.3% for the U.S. Obesity, however, varies between the areas. Washtenaw has
the lowest prevalence (21.7%), followed by the U.S. (29.6%), and then Michigan (30.7%) (10,
11). For the elderly population in the state, those between the ages of 65-74 have a much higher
rate of obesity, at 38.7%, but a smaller percentage in those aged 75 or older, at 24.6%.
Washtenaw county shows similar results, with those aged 65-74 showing 32.9% obesity, yet for
75 and older the rate is only 16.1% (10,11).
In terms of mental health, Washtenaw county residents reported an average of 3.4 poor
mental health days in a 30-day period, which is lower than the state of Michigan at 4.2.
Similarly, 19.5% of healthy adults in Washtenaw reported ever being told they have depressive
disorder, while the state average is 20.5%. For Michigan, the prevalence of depression was
highest in middle aged groups and lowest in those 75 and older. Only 10.7% of adults 75 and
older reported depression. Washtenaw shows similar results, with the lowest percentage also
being in those 75 and older, at 12.5%(10,11,12). Figure 5, below, highlights some aspects of
social isolation. While many elders feel left out or lack companionship, conversely, it was also
reported that 70% live close to a relative they frequently see and 74% feel connected to others
through the internet. As already stated, social isolation plays a critical role in the nutrition status
of elders, and is very closely related to the amount and quality of food they consume (15).

Social Isolation in older Adults, Washtenaw County

Figure 5(Adapted from the Blueprint for Aging, 60+ survey of Washtenaw County 2014; data
available at http://www.ewashtenaw.org/government/departments/public_health/health-
promotion/hip/2014-chc-meetings/60-survey-presentation)

Nutrition and Physical Activity

Washtenaw county ranks high on the food environment index, which measures factors
that contribute to a healthy food environment. On a scale of 1-10 with 10 being the best,
Washtenaw received a 7.2. The state average is 7.1 and the 90th percentile for the U.S. is 8.3
(13).
 Fruit and Vegetable Consumption
45
40
35
30
25
20
15
10
5
0
Washtenaw Michigan Ypsilanti

Consume <1 fruit per day Consume <1 vegetable per day

Figure 6 (Adapted from Washtenaw County Public Health, 2015 Health Improvement Plan and
Michigan Department of Health and Human Services, 2014 Behavioral Risk Factor Survey; data
available at http://secure.ewashtenaw.org/HIP/HIP.do and
http://www.michigan.gov/documents/mdch/2014_MiBRFS_Annual_Report_Final_Web_504843
_7.pdf)

According to the 2013 Michigan Behavioral Risk Factor Surveillance Survey, only
15.3% of adults consume an adequate amount (5 servings) of fruits and vegetables per day.
Washtenaw county boasts a larger figure, at 22.4%. For adults aged 65 and older this number is
slightly smaller, at 19.7%. Furthermore, as figure 6 shows, 37.7% of Michigan residents
consume less than one fruit per day, and 24.8% consume less than one vegetable per day. Results
for Washtenaw are lower, at 32.3% and 18.8%, respectively. Ypsilanti presents a larger
percentage for both categories, at 40.2% and 26.9% (10,11).

Frequency of Eating Fast Food All Residents Washtenaw County

Table 5 (Adapted from Washtenaw County Public Health, 2015 Health Improvement Plan;
data available at http://secure.ewashtenaw.org/HIP/HIP.do)
 Frequency of Eating Fast Food Older Adults Washtenaw County

Table 6 (Adapted from Washtenaw County Public Health, 2015 Health Improvement Plan;
data available at http://secure.ewashtenaw.org/HIP/HIP.do)

Table 5, above, shows the frequency of eating fast food for all residents of
Washtenaw county. The largest groups reporting 1-3 times per month (31.5%) and never
(29.3%). As shown in table 6, older adults follow a similar pattern, with the highest percentages
in the categories 1-3 times per month and never. For adults 65 and older, a larger percentage
report never eating fast food (10).
Another notable intake assessment is alcohol consumption in terms of binge drinking.
Binge drinking is defined as five or more drinks in one occasion for men and four for women.
The percentage of adults in Ypsilanti who reported binge drinking in the past month is 11.1%.
This is lower than the county total of 14.9%. Older adults represented the lowest proportion of
binge drinkers, at only 4.54%. The overall adult percentage for Ypsilanti is lower than the U.S.
median of 16.3% and increasingly lower for Michigan, at 18.9% (10,11,13).
Food access is a factor that affects fruits and vegetable consumption, and in turn may
affect quality of diet and nutritional status. In Washtenaw county, 7.5% of residents reports
always or usually having fruit and vegetable consumption limited by distance to a grocery store,
while 18.7% report sometimes or rarely and 73.8% reporting never having this issue. In Ypsilanti
specifically, a lower number report always or usually, at 7.2%, but a higher number report
sometimes or rarely, at 21.1%. When broken down by age for Washtenaw, 11.5% of those 65
and older report always or usually, 15.6% sometimes or rarely, and 72.9% never. According to
the community health profile, for low income individuals, 6.9% of Washtenaw county residents
report low food access. This is higher than the U.S. median of 6.2% (10, 13). Figure 7, below,
identifies grocery stores in the area. There are several grocers in the area, including both
specialty stores such as Asian or Latin, and large supermarkets like WalMart and Kroger.
Additionally, most locations allow use of supplemental nutrition assistance programs (SNAP), or
Bridge card, as it is termed in Michigan. Washtenaw county has 8% of the population using this
assistance, which is well under the state total of 15% (14).
 Grocery Stores in Ypsilanti, Mi

Figure 7 (Google maps, Grocery stores in Ypsilanti; data available at maps.google.com)

Similarly, 58.9% of Ypsilanti residents agree that there are stores, restaurants, and other
destinations within walking distance of their home. This is slightly lower than the Washtenaw
county average of 60.5%. These are both higher than the percentage of older adults in
Washtenaw who agree, which is 39.6%, which may be attributed to less mobility or lack of
transportation as one ages (10). Additionally, 7% of Washtenaw county seniors have difficulty
with transportation, including going to grocery stores (15).

Types of Food Stores in Ypsilanti

Figure 8 (Adapted from Washtenaw County Public Health Department, Availability and
Accessibility of Healthy Food in Ypsilanti, Mi, 2007; data available at
http://www.ewashtenaw.org/government/departments/public_health/health-
promotion/hip/pdfs/ypsilanti_report)

Figure 8, above, highlights the types and proportions of different food stores in Ypsilanti.
There is disproportionate amount of convenience stores compared to grocery stores. This may
pose a problem for those with low incomes, as food stamps are more likely to be accepted at
grocery stores than other food stores, and there is a greater selection of healthy and fresh foods at
grocery stores (16).
In terms of physical activity level, 16.1% of Washtenaw county residents reported no
leisure time physical activity, meaning physical activity outside of their job, in the past month.
Washtenaw ranks among the best counties in the country for this factor, with the U.S. median
being 25.9%. The state average is similar to the U.S. at 25.5%. For older adults in Michigan,
however, physical inactivity increases with age. For adults 65-74, the percentage is 29.6% and in
adults 75 and older there is an increased total of 41.0%, yet another factor that may be attributed
to poor nutrition if the individual has comorbidities that impair mobility (11,13).

Percentage of Adults that Meet Physical

Activity Guidelines
50

40

30

20

10

0
Met aerobic Met strengthening Met both guidelines Met neither
guidelines only guidelines only guideline

All Adults Washtenaw All Adults Ypsilanti Older adults Washtenaw

Figure 9 (Adapted from Washtenaw County Public Health, 2015 Health Improvement Plan; data
available at http://secure.ewashtenaw.org/HIP/HIP.do)

Figure 9, above, highlights the percentages of adults that meet certain physical activity
guidelines. The largest category for all three subgroups is meeting neither guideline, and the
lowest for all is meeting strengthening guidelines. Older adults have the lowest percentage of
those meeting strength guidelines, at 5.8% (10). As previously stated, elders have an increased
risk for osteoporosis and decreased bone mass, both of which can be related to frequency of
weight bearing exercise.

Community Assets and Resources

Ypsilanti is a diverse community and as described in detail below, contains abundant

resources and services available to the residents. There are many programs with the goal of
assisting residents in need, which are run by the government, faith-based organizations, and non-
profits. In terms of nutrition-related services, the city contains the following:
Ypsilanti Senior Center
Washtenaw WIC
Meals on Wheels
Growing Hope
Food Gatherers
Ypsilanti Hunger Coalition
 Of significance for older residents is the Ypsilanti Senior Center and Meals on Wheels. The
Ypsilanti Senior Center offers several services, including nutrition, health, education, and
recreation. For example, they offer weekday lunches for a small donation and free exercise
classes open to all seniors (18). Meals on Wheels is a program that offers discounted or free
meals to low-income seniors. Meals are delivered to their residence and can be catered to any
dietary restrictions. Additionally, seniors are provided with companionship from those who
deliver the meals (19).
Food Gatherers is a food bank that serves Ypsilanti, despite being in Ann Arbor. Food
Gatherers is part of a national network of food banks and food programs known as Feeding
America. According to Feeding Americas 2014 annual report, seven million seniors (aged 60
and older) are served by Feeding America. This accounts for 17% of all clients served.
Furthermore, of all client households with at least one senior, 76% report planning to use a food
program associated with Feed America on a regular basis to assist with their monthly food
budget (20)
There are also several farmers markets in the area as well as community gardens. Growing
Hope manages two farmers markets in the city, in addition to a farm stand. They also run a large
community garden. Several other organizations manage community gardens, which allow
residents to rent plots and provide education on gardening and nutrition. Participants of the
Bridge program can use their Bridge cards at farmers markets and receive double up food bucks,
a program that matches the amount of money spent on SNAP eligible foods up to $20 (21).
Additionally, a program funded by the U.S. Department of Agriculture known as Senior Project
FRESH provides coupon books to eligible seniors, those aged 60 and older living in poverty,
with vouchers to purchase Michigan grown, non-processed food from farmers markets and
roadside stands. They also receive nutrition education with the coupons as well (22).
There are also several emergency needs service centers in the city including the
following:
Hope Medical Center
SOS Community Service
Hope America
Friends in Deed
Almost all of the above organizations offer free or discounted meals or groceries. Other
services offered include medical and dental services, SNAP assistance, laundry services,
transportation, and housing and utility assistance.
Aside from nutrition services, there are many organizations that offer health and fitness
support. The area is home to two major hospitals, St. Joseph Mercy and the University of
Michigan Medical Center. Both have clinics or campuses in the city of Ypsilanti. Furthermore,
St. Joseph offers specialized senior programs, including Senior Fit, balance therapy classes,
health education, and support groups (23). Furthermore, located in the adjacent city of Ann
Arbor, is a veterans affairs hospital for those who have served. The VA hospital offers many
physical and mental health services.
Ypsilanti also contains many recreation areas including recreation centers, parks, and
walking and biking paths. The following maps shows many of these areas.
 Recreation Areas in Ypsilanti, Mi

Figure 10 (Google maps, Recreation Areas Ypsilanti; data available at maps.google.com)

Additionally, there are many county and state parks in the area as well. The
Border2Border pathway is a paved path that follows the Huron River and connects several
surrounding cities. Nearby Ann Arbor boasts an extensive list of parks as well. Correspondingly,
according to Community Health Profile, Washtenaw county ranks among the best in the country
in terms of access to parks. Fifty-one percent of individuals living within the county report living
within one half mile of a park. This is well over the U.S. median of just 14% (13).
Complementing the extensive network of facilities available is a comprehensive
transportation system that spans both Ypsilanti and Ann Arbor. The Ann Arbor Area
Transportation Authority (AATA) runs a widespread bus service with routes both within the city
and ones that link to Ann Arbor and other communities. The bus system also provides discounted
fares for seniors, students, those with low income, and those with disabilities. Two AATA
programs unique to seniors is the GoldRide, a shared-ride program for people 65 and older. With
this card, seniors can use shared-ride services and fixed route bus lines free of charge. Another
program is GroceryRide, which provides weekly bus trips from senior housing communities to
grocery stores. This program however, only operates within Ann Arbor (24).
Of note for seniors is the high amount of senior living opportunities available. The
following map shows the variety of facilities available. Several of these places offer subsidized
housing with rent rates just 30% of their gross annual income. Additionally, the Ypsilanti
Housing Commission offers low cost housing based on income (25).
 Senior Living Facilities in Ypsilanti, Mi

Figure 11 (Google maps, senior living facilities Ypsilanti; data available at maps.google.com)

Washtenaw county is also home to the Washtenaw County Food Policy Council, a group
that aims to bring healthy, fair, affordable, and sustainable food sources to all residents. One of
their goals is to increase food access and nutrition throughout the county. Their goals for doing
this include reducing barriers for enrolling in food assistance programs, recommending and
supporting institutions to implement changes that increase food availability and affordability,
increasing transportation services to food access sites, and encouraging school boards to increase
utilization of school nutrition programs (26).
 After completing a thorough analysis of the community of Ypsilanti, it is evident there
are plentiful opportunities and assets for not just seniors, but all citizens. In terms of health
status, Ypsilanti for the most part mirrors that of Washtenaw county and the state. Yet, while
there are many positives to the community, there are definite needs that must be met to further
improve the community and the health of its seniors.
First, the mortality rate for heart disease, the leading cause of death, is well above the
Healthy People 2020 objectives and should be prioritized as an urgent health concern. In
Ypsilanti, heart disease has an age adjusted mortality rate of 223.5. The Healthy People 2020
objective is less than half that at 103.4. Heart disease costs the nation $320 billion annually, yet
is one of the most preventable diseases. Sodium intake greatly affects blood pressure levels, and
in turn heart disease risk. Despite this, 90% of adults in the U.S. exceed the recommended
sodium levels (27). It would be beneficial to find the number of residents who have high blood
pressure and whether it is controlled by medications. The city can then determine the needs in
order to implement programs to decrease this number. As shown earlier, there are many food
programs available in Ypsilanti. Perhaps these organizations could increase awareness of the
harmful effects of high sodium diets and recommend foods and recipes low in sodium.
Additionally, with Ypsilanti being home to large hospitals and universities, a possible solution
would be working with these organizations on education, awareness, and prevention campaigns.
It is widely known that one of the biggest ways to prevent heart disease is through diet
and exercise (27). The following key findings and recommendations relate to increasing physical
activity and nutrition status, which can have profound benefits in not just decreasing heart
disease, but many other diseases, and helping seniors live healthier and satisfying lives. First, in
terms of poor nutrition, a notable finding is the number of residents who consume less than one
fruit or vegetable daily. Per the Washtenaw HIP, 40.2% of Ypsilanti residents consume less than
one fruit and 26.9% consume less than one vegetable per day. Furthermore, only 19.6% of
Washtenaw seniors consume an adequate amount of five servings of each per day. This should
be a very high priority, as low fruit and vegetable intake has a strong correlation with many
diseases, including heart disease and cancer, the two leading causes of death in the area. As
previously discussed, there are many barriers for older adults that prevent them from being able
to purchase, prepare, and consume particular foods, including fruits and vegetables. Possible
barriers include mobility, comorbidities, mental health issues, changes in taste sensation,
socioeconomic status, and changes in ability to chew and digest certain foods (6). Because of
this, when implementing nutrition education and promotion programs, the specific needs of the
elderly should be addressed. Perhaps by educating them on recipes that are easy to make and
foods that are easily digestible.
On the issue of food access, 7% of elderly reported difficulty getting to the grocery store.
As previously mentioned, Ypsilanti is part of the AATA bus system which runs extensively
through the city and neighboring Ann Arbor. While Ypsilanti residents can participate in
GoldRide to receive discounted bus fares, the program GroceryRide is only available to seniors
in Ann Arbor. One possible way to address food access would be to expand this program to
Ypsilanti as well.
As described earlier, Ypsilanti has many food donation programs and farmers market to
help increase fruit and vegetable consumption. While these programs are extremely beneficial,
the effectiveness of these programs should be analyzed. While it is unknown how many seniors
in Ypsilanti participate in SNAP, it is known that participation is low in older adults across the
nation. They have the lowest participation rates of all other demographics. Ways to improve
enrollment may include assistance with application and better understanding of criteria (28).
Community organization such as the senior center, churches, and food organizations may be
places that can implement these services. Additionally, it was noted that Senior Project Fresh
provides coupon books to seniors living in poverty to purchase food from farmers markets.
Perhaps this program can be expanded to those not living in poverty, yet who do not receive
adequate intake for the reasons listed above. Instead of providing the coupons free of charge,
these seniors could receive the books at a discount. This may be a way to incentivize this group
to purchase more healthy foods.
Another noteworthy figure is the percentage of adults not meeting physical activity
guidelines. Approximately 21% of older adults report meeting both strength and aerobic
guidelines. Additionally, only 5.8% meet strengthening guidelines only. This is a concerning
figure, considering older adults are at increased risk for osteoporosis, falls, and bone breaks, all
of which can be prevented by regular, weight bearing exercise. As shown in the analysis, more
older adults reported meeting aerobic guidelines than strengthening. There are many barriers to
exercise that may add to this. First, many adults get exercise simply from walking or bike riding
around their neighborhood, which in Ypsilanti is common to do given the vast number of parks
available. For strength training, however, many adults would have to travel to a gym or
recreation facility. As already stated, transportation is an issue for many adults. Furthermore,
negative attitudes, fear of injury, and not knowing proper exercise form can all hinder the ability
to participate in strength training (29). One suggestion for addressing this issue it to again
encourage participation and education from local hospitals, in addition to senior centers and
community centers. Local personal trainers could come to these organizations and not only
education seniors on the benefits, but show proper form and provide appropriate strength training
programs.
Lastly, an issue that was found to greatly affects older adults in Washtenaw county is
social isolation. A reported 26% of seniors feel isolated from others, while 29% feel left out, and
34% lack companionship. Social isolation affects nearly every aspect of health and should be a
top priority. While it is unknown if social isolation is reported more in men or women in
Ypsilanti, studies have shown that, in general, women are more at risk than men. For example,
the loss of traditional social roles in women, such as taking care of their family, because of
widowhood, contributes to isolation. Additionally, women who are lonely are more concerned
about safety and rely on caregivers. Furthermore, for both genders, the loss of a spouse or family
members adds to social isolation and loneliness. An additional factor to social isolation and
utilization of service programs is whether the individual has children. Having children is
associated with greater use of services, such as healthcare, transportation, and meal deliveries.
Children can act as an enabler and encourager to participate in such programs (30). It would be
beneficial for the community to study and understand the familial situations and genders of the
seniors in order to implement programs and treat the issue properly. Not only will this benefit
seniors, but if the community finds programs, such as volunteerism for example, that match the
strength and talents of the seniors, it can in turn improve the community as well.
The city of Ypsilanti provides many opportunities for seniors to live in a healthy
and safe environment. In fact, many aspects of the community have better rates and statistics
than the state and national findings. Despite this, there are issues that need to be addressed to
continue to provide the best environment possible. The above issues of heart disease, fruit and
vegetable consumption, transportation, physical activity, and social isolation should be top
priorities for community leaders and members
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