Delivering More than a Meal to our Community

Kim Jeffery, RD

Dietitian / Client Service Manager

Learning Objectives:

1. How CMOW is positioned to play a pivotal role in community food actions to address food security.

2. Key factors impacting nutrition and food security as we age.

3. How can we as a community effectively support the nutritional health of seniors?

Our New Home

Cook-Chill Kitchen

Cook-Chill Production Kitchen

• Optimal kitchen design and workflow

• Ingredient Control Room

• Increased time for recipe & menu development

• Improved food safety & handling

• Enhanced food quality

• Ability to triple production capacity

214,241 Lunch & Supper Meals18,789 Frozen Entrée Meals4,741 Chopsticks Meals14,697 Group Meals52,722 Sandwiches

45,760 Servings of Hot Soup

Quick Facts 2013

Total Meals: 388,137

What does Meals on Wheels do?

Lunch & Supper Program: Lunch Tray & Supper Meal (meal unit)

Delivered Mon – Fri (weekends available)

Frozen Program: Variety of entrées, meals, soups, baked goods

Delivered on Tuesdays or Pick-Up

Chopsticks Program: Authentic Chinese cuisine

Delivered Monday - Friday

Group Meals:Meals prepared for groups to enjoy together

Delivery available Mon – Fri during lunch hour

Working Homeless Program:Sandwiches provided daily

Delivered Monday – Friday

Hot Soup Program:11 elementary schools currently

Delivered Tuesdays & Thursdays

Who are our typical clients?

21% of our clients are <65

49% of our clients are between 66-85

30% of our clients are >85

Seniors Too-busy-to-Cook

Persons with Disabilities Group Functions

Patients Recovering School Children

Caregiver Relief Working Homeless

Length of Time on Service

23%

17%

11%7%

42%

0 - 3 Months

4 - 6 Months

7 - 9 Months

10 - 12 Months

Over 12 Months

Standard Diets & Modifications

Vegetarian

Renal

Gluten Free

Special Diet (CHF/GI)

No Milk Products

No Pork/Beef

Cut Up

Minced

Pureed

37% of our clients receive a special diet or texture modified meal

Where do we deliver?

What else do we deliver?

More than meal . . .

We are part of your community safety net.

Friendly Visits Greeting Cards

Kudos for Flowers Special Guest Volunteers

Smoke Detectors Secret Santa

Community Engagement

• Elder Service Corp Project

• Older Adult Service Providers of Calgary

• Age Friendly Calgary

• Partnerships and Collaborations

Elder Service Corp Project

• Partnership with Calgary Family Services

• Team of 3 active older adults

• Connect with seniors in community

• Identify need & develop action plan

• Improving nutritional intake

• Reducing isolation

• Timeline: April – December 2014

Vulnerable Older Adults are:

• 65+ years

• living alone

• living on a low income

• single and/or bereaved

• in poor health

• experiencing language/cultural barriers

• having transportation difficulties

Household Composition

Clients live alone

Income Levels

Clients’ individual income

at or below $20,400

Low Income Cutoff (LICO)

for individual is $19,597

Statistics Canada 2012

Cost of Eating in Alberta

“A monthly household food cost of not more than 15% of household

net income is considered affordable.”

Cost of Eating in Alberta: Dietitians of Canada, AB Public Health & AHS. 2008

Food Security

In general, food security may be understood as the flow of healthy and desired food throughout a system of:

Evaluating Outcomes of Community Food Actions: A Guide; Public Health Agency of Canada, 2012.

• Production and Supply • Availability and Distribution• Affordability• Access• Consumption

Why Use Meals on Wheels?

It’s about preventative health!

• Increased consumption of nutritious food

• Improved feelings of social connectedness

• Improved or maintained independence

• Decreased family stress

• Improved health & wellbeing

Behind each door is a story of compassion, dignity, and community.

“You know, it’s food for the soul too! The

volunteers give me a lift every time they visit.”

Successful Aging

“Healthy eating is believed to be linked to a higher quality of life.”

Good nutrition can influence:

• personal health

• types and severity of disease

• maintenance of body functions

• improved physical ability

Keller HH, Ostbye T, Goy R. Nutritional Risk Predicts Quality of Life in Elderly Community-Living Canadians. J of Gerontology: Medical Sciences. 2004; Vol. 59A, No. 1: 68-74.

Individual Determinants of Healthy Eating

• Age

• Gender

• Education Level

• Socio-economic factors

• Health and physiological factors

• Lifestyle and behaviors

• Beliefs

Aging process itself effects alterations in

both food selection and food intake.

Collective Determinants of Healthy Eating

• Accessible food labels

• Appropriate food shopping environment

• Marketing & promotion of healthy eating message

• Adequate social supports

• Provision of effective community-based

meal delivery services

Payette H, Shatenstein B. Determinants of Healthy Eating in Community-dwelling Elderly People.Can J Pub Health 2005

Changes to Food Intake & Appetite

• Compromised or impaired senses

• Medications

• Swallowing Function

• Dentition

• Co-morbidities

Malnutrition

Malnutrition is a process that includes both the deficiency and excess (or imbalance) of energy, protein and other nutrients.

Characterized by:

• Poor appetite

• Inadequate dietary intake

• Inadequate nutritional status

• Weight loss and muscle wasting

Ultimately influences body functioning and over all health!

Adapted from AW McKinlay: Malnutrition: the spectre at the feast. J R Coll Physicians Edinb 2008:38317–21.

Prevalence of Malnutrition

Declining health & functional capabilities

Increased prevalence of malnutrition

Social supports, living arrangements and access to community food services affects both dietary quantity and quality.

www.phac-aspc.gc.ca/seniors 2002

Older Adults & Sarcopenia

Sarcopenia is a loss of muscle mass

and strength.

Prevalence:

~15% in people over 65

~50% in people over 80

Why does this matter?

Tyler Churchward-Venne MSc PhD. McMaster University. Oct 2013

Effects of Sarcopenia

• Compromised Mobility

• Increased risk of falls and broken bones

• Decrease in grip-strength affecting ADL

• Increased insulin resistance

FRAILTY

FRAILTY

Tyler Churchward-Venne MSc PhD. McMaster University. Oct 2013

Nutrition Exercise

• Adequate, daily, high quality protein

• Consumption of protein at bedtime

• Possible Omega-3 FA supplementation

• Possible whey protein supplementation

• Resistance exercise (low load / high freq)

“Physical activity increases the sensitivity

of muscle to nutrient intake.” ¹

¹Churchward-Venne T. (2013)Houston et al. Am J Clin Nutr (2008)

Nutrition Risk

“Nutrition is one of the few modifiable risk factors for health in old age.”

It will impact:

• institutionalization

• quality of life

• survival

Keller HH. Applied Physiology, Nutrition & Metabolism (2007)

Estimate community-dwelling Canadians over 65 are at nutritional risk

Statistics Canada (2013)

Nutrition Risk Factors in Older Adults

• Reduced mobility affecting shopping & cooking

• Financial limitations to purchase healthier food

• Poor support network

• Limited convenient and accessible transportation to the grocery store

• Living alone - isolation

Why Screen for Nutrition Risk?

• Important for healthy aging and quality of life

• Promote an independent lifestyle

• Raise personal awareness

• Early identification of eating problems

Bringing Nutrition Screening to Seniors in Canada

Dietitians of Canada & Heather Keller, RD., PhD. 2003

SCREEN © Tool

Seniors in the

Community

Risk

Evaluation for

Eating and

Nutrition

www.flintbox.com/public/project/2750

• Valid & reliable tool

• Community-living older adults

• Community agencies & health providers

SCREEN © Tool• Appetite

• Frequency of eating

• Chewing & swallowing

• Digestion

• Weight Changes

• Motivation to cook

• Ability to shop & prepare food

• Isolation and loneliness

• Food restrictions due to health conditions

www.flintbox.com/public/project/2750

Nutri-eSCREEN®

Eating habits questionnaire that seniors can complete to help them assess how they are doing with their daily food choices.

http://www.nutritionscreen.ca/escreen

“Dependency on others for food purchasing and preparation is

associated with poorer nutrient intake”

Keller, H. H. (2005). Reliance on others for food related activities of daily living. Journal of Nutrition for the Elderly, 25(1), 43‐59.

required some

support with food-

related activities of

daily living (FADL)

Keller, H. H. (2005). Reliance on others for food related activities of daily living. Journal of Nutrition for the Elderly, 25(1), 43‐59.

Supporting Healthy Eating

• Senior-friendly grocery stores

• Accessible and economical transportation

• Nutrition Education classes:

• Cooking for One or Two

• Shopping Effectively

• Cooking Clubs

• Community Gardens

Keller et al. Jrnl of Hunger & Envirn Nutrn Vol 1(3) , 2006

Supporting Healthy Eating

• Congregate Meal Programs

Incorporation of:

· healthy eating education

· exercise programs

· entertainment and social activities

• Ethical nutrition screening initiatives

• Other ??

Keller et al. Jrnl of Hunger & Envirn Nutrn Vol 1(3) , 2006

Senior Friendly Grocery Store

• wider aisles

• anti-slip floors

• better lighting

• larger price labels

• smaller packages

• magnify lenses

• seats on carts

• steps below shelves

• rest areas

• emergency call buttons

Health Promotion

“We need to adapt public health messages on current knowledge of

energy and nutrient needs, as well as food choices, attitude and consumption

practices of seniors.”

Nutrition and Healthy Aging, Pub Health Agency (2001)

“Aunt Dotty always enjoyed her meals on wheels!”

Thank you

Calgary Meals on Wheels is partially funded by