Food Insecurity:

Older Adult Nutrition

Jane Hunley, Parkland Geriatrics Program Director

Kara Davis, Geriatrics Clinic and Senior Services Clinical Dietitian

Healthy Living for Older Adults

• Good nutrition (quality and quantity) is important for healthy

aging

Plays a major role in disease prevention and management: diabetes,

hypertension, heart disease, cancer, kidney disease, liver disease

Effects independence: strength, function

Improves quality of life: well-being

• Goal

Remain healthy and independent, in own home for as long as

possible.

• Cost – Impact of poor health and nutrition status

Caregiver burden

Institutionalization

Greater health care utilization

Food Insecurity

Health impact:

• Overnutrition - calorically dense, nutrient poor

• Undernutrition - inadequate intake

• Lower cognitive function

• Poor mental function

Did you know?

• 2 million older adults are among the 14.6% of food insecure

households in America (Chung, 2012)

– Growing senior population

• Strong association between food insecurity and health

– 1 in 3 NTFB clients affected by Diabetes

• 2/3 of NTFB households report having to choose between food and

paying for medical care

Food Insecurity:

Organizational Guidelines & Dietitian Role

Academy of Nutrition and

Dietetics (AND)

Position Papers:

Food and Nutrition Programs for

Community-Residing Older

Adults (2010)

“All older adults should have access to

food and nutrition programs that

ensure the availability of safe,

adequate food to promote optimal

nutritional status.”

Food Insecurity in the United

States (2017)

Healthy People 2020

• Reduce household food insecurity,

and in doing so, reduce hunger

Dietitian’s role:

1. Nutrition assessment and

education

2. Promoting access and utilization of

community services and programs

3. Participate in health outcomes

research

*determine impact of programs

*facilitate program development

4. Advocacy efforts at the local, state,

regional and national levels

Nutrition Assessment and

Education: Can they afford the food they need?

• Limited income

Shopping frequency (quantity)

Types of food purchased

(quality)

• Distribution of finances

Housing

Utilities

Medication/medical bills

Transportation

• Local food prices

Nutrition Assessment and

Education: Can they get the food?

Availability

o Food deserts – access to fresh

produce, traveling distance

o Person shopping not buying

appropriate foods

o Able to store food

Functionality

o Mobility – assistive device

o Cognition

o Vision impairment – food

selection, reading labels and

expiration dates

Transportation

o Driving, vehicle access

o Dependent on others

o Cost – gas, fees

*Like income, transportation can

affect shopping frequency

Nutrition Assessment and

Education: Are they able to prepare their food?

Functional limitations

Physical

• Mobility – pain, assistive device, shortness of breath

• Strength – opening food and beverage packaging

Psychosocial - mental and cognitive impairment

• Depression – social isolation, decreased appetite/intake, loss of

motivation to eat or prepare foods, bereavement

• Memory loss - forgetfulness in when to eat, what to eat, how to

prepare, safety in food prep

Cooking appliances – working/available?

Resources

Social Worker • Screening and referrals to connect

qualified individuals to programs

• Employment (income)

• Housing (cost)

• Transportation assistance

• Meal prep assistance

Community Programs

• SNAP

• CSFP

• Food pantries

North Texas Food Bank

(NTFB)• PAN distribution – 1x/month

• Nourishing Neighbors – 2x/month,

homebound (includes pet food)

• Produce distribution

• Partner/community gardens

• Food 4 Health

Programs

US Department of Health and

Human Services – The Older

Americans Act (OAA)

Nutrition Program

Title IIIC

• 60 and over – eligible for

congregate or home-delivered

meals, nutrition screening,

nutrition education/counseling

• Meals provide 1/3 of DRI and

meet recent dietary guidelines

for Americans

Ryan White Comprehensive

AIDS Resources Emergency

Act

• Older Americans >10% of

HIV/AIDS cases and growing

• Clinical nutrition

education/counseling

• Food assistance (home-

delivered meals, groceries, food

vouchers, liquid nutritional

supplements)

USDA Programs

Commodity Supplemental

Food Program

o </= 130% poverty

o Healthy, shelf stable

Senior Farmer’s Market

Nutrition Program

o </=185% poverty level

o Fresh fruits and vegetables

Supplemental Nutrition

Assistance Program (SNAP)

o </=130% federal poverty level

o Older adults have the lowest

participation rate

The Child and Adult Care

Food Program

o </=130% poverty

o 60 yr +

o Enrolled in adult day center

o Meals must meet federal dietary

guidelines

Barriers to Program Use

Nonparticipation

• Benefit underestimation

• Welfare stigma

• Difficult application process

• Lack of program awareness

• Confusing eligibility

requirements

Language and culture

• Increased diversity

• Less program participation

• Less cultural foods available

Diet restrictions

• Chronic health condition

needs

Program food waste

• Diet restrictions

• Preferences

Nutrition Education Resources

USDA

CSFP – fact sheets, low-

cost recipes

choosemyplate.gov -

smart shopping, meal

planning on a budget,

menus, low-cost recipes

SNAP ed – meal planning,

shopping, budgeting

North Texas Food Bank

Nutrition and culinary ed

Psychosocial Screening in the

community clinics at Parkland

Geriatric Functional Screening

at Parkland

Geriatric Functional Screening

at Parkland

Geriatric Functional Screening

at Parkland

Goals of Care

Efforts/Partnerships

• Past:

• Community Garden at Southeast Dallas Health Center in Pleasant Grove-

partnership with Urban League

• Farm stand vouchers provided to nutrition counseling patients at Hatcher

Station Health Center in south Dallas to use at Baylor Scott and White

Wellness Center

• Numerous food drive efforts

• DASH program

• Present:

• North Texas Food Bank food delivery during holiday season

• Facility and site level canned food drives

Clinical Team Referrals

• Meals on wheels

• Senior centers

• Senior companion program

• Foster grandparent program

• Commodity programs

• Food stamps

Parkland Center for Clinical

Innovation

Past DASH• Robert Wood Johnson funded Data Across

Sector of Health: Food for Health (DASH)

• Collaboration between 3 NFTB food

pantries, PHHS, and PCCI

• Connect PHHS patients who had a diagnosis

of diabetes and/or hypertension and were

identified as being food insecure to

community based organizations

• Screened at PHHS Diabetes education

classes and food pantries

• Participants in the DASH program received

interventions at one of the 3 food pantries:• Nutritional material based on diagnosis, suggested food item list, medical

appointment reminders, follow-up questions on medication compliance,

access to a PHHS social worker if needed, and a personalized shopping

experience at the food pantries

• Patients in the program also had the opportunity to participate in NTFB

cooking and nutrition education classes.

The DASH program wrapped up

November 2017. PCCI and DASH

stakeholders are strategizing on

how to expand the program now

that the funding period has

ended. DASH stake holders saw

the impact the program made in

the populations they serve and

are eager to continue the

expansion of DASH.

8-1-18 CMS Grant--Accountable

Health Communities

National Trends in Care

• Patient Centered Medical Home

certifications

• Population health management

using electronic records to pull data

• Increase in home providers

• Hospital at home

• Focus on frequent flyers/high cost

utilizers

• Transitional care

• Case management

• Care navigation

• Telehealth

• Electronic monitoring

• Electronic patient communications

• Payment Models• New billing codes which often include

multi disciplines and social focus

• Medicare Advantage plans

• Accountable care organizations

• Payment model includes quality

metrics/targets

• Future payment models

• Baby boomers

• NIH Study All of Us

• Focus on all aspects of

neurocognitive functioning

Parkland Focus

• Focus on appropriate

language translation

• Suicide and depression

screening

• Behavioral health

expansion

• Foot care expansion

• Telehealth

• Electronic specialty

consults

• Group visits

• Population health management

using electronic records to pull data

• A1C

• ACE/ARBs

• Obesity

• Chronic kidney disease

Partnerships

Working together…

Helpful links

www.fns.usda.gov/fdd/food-distribution-programs

www.fns.usda.gov/snap/nutrition-education

www.fns.usda.gov/sfmnp/senior-farmers-market-nutrition-program-

sfmnp

AND position papers:

https://www.eatrightpro.org/practice/position-and-practice-

papers/position-papers/food-nutrition-programs-community-

residing-older-adults

https://www.eatrightpro.org/practice/position-and-practice-

papers/position-papers/food-insecurity-in-the-united-states

Helpful links

www.eatright.org

www.choosemyplate.gov/budget

www.whatscooking.fns.usda.gov/fdd/household-material-fact-

sheets

www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-

weight-status/objectives