Nutrition and Healthy Aging in the Community Workshop Summary (2012) / Chapter Skim
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2 Nutrition Issues of Concern in the Community
2 Nutrition Issues of Concern in the Community
Pages 15-48
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From page 15... ...
Sharkey Joseph Sharkey, professor of social and behavioral health at the Texas A&M Health Sciences Center, drew on his research with home-delivered meal participants and providers in North Carolina and Texas to discuss nutrition screening and its role in community-based programs within the Aging Network and potential partners. Screening can be a vital part of reaching the national goal of eliminating nutritional health disparities, preventing and delaying chronic disease and disease-related consequences, and improving postdischarge recovery, daily functioning, and quality of life.
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Who Should Be Screened? In the past, the only people screened were nutrition program participants and those seeking nutrition services.
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• Engagement of nontraditional partners. How can nontraditional partners, such as the Special Supplemental Nutrition Program for Women, Infants, and Children and Federally Qualified Health Cen ters be engaged to assist with screening?
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In closing, Sharkey encouraged people to consider the use of screening as a component of prevention as well as the associated ethics of screening, "How can one determine someone to be at risk for poor nutritional health and do nothing? " TABLE 2-1 Components of Nutrition Screening Component Determinants of Risk Material resources • Adequacy of income and competing demands (other household members and financial demands)
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From page 19... ...
TABLE 2-2 Categories of Food Security Number of Affirmative Category Description of Household Condition Responses to CFSM Fully food secure No reported indications of food access 0 problems or limitations Marginal food One or two reported indications -- typically 1 or more insecurity of anxiety over food sufficiency or shortage of food in the house Food insecurity Reports of reduced quality, variety, or 3 or more desirability of diet Very low food Reports of multiple indications of 8 or more in households security disrupted eating patterns and reduced food with children intake 5 or more in households without children NOTE: CFSM, Core Food Security Module. SOURCE: Ziliak and Gundersen, 2011.
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. Among adults ages 50 years and older whose incomes are below 200 percent of the poverty line,1 about 40 percent are marginally food insecure, 23 percent are food insecure, and 10 percent are very low food secure.
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. Regardless of income level, the added presence of a grandchild greatly increases the predicted risk of food insecurity among food secure and insecure households.
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Health Consequences of Food Insecurity Ziliak and Gundersen reviewed nutrient intake data from the National Health and Nutrition Examination Survey (NHANES) to identify nutrients of concern among adults over 40 years of age.
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Rates are highest among 40–49-year-olds, something that should be considered when developing policies for the Supplemental Nutrition Assistance Program (SNAP) since SNAP participation declines with age.
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Whereas body composition studies have found positive associations between total body fat mass and functional limitations, links between muscle mass and functional limitations have been inconsistent. However, with appropriate adjustment for body size, an association may be detected between relative loss of muscle mass and increased functional limitations (Villareal et al., 2004; Zoico et al., 2004)
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; reductions in coronary heart disease risk factors such as waist circumference, blood pressure, and glucose, triglyceride, C-reactive protein, and interleukin-6 levels (Villareal et al., 2006b) ; reductions in the diagnosis of metabolic syndrome (Villareal et al., 2006b)
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R02158 Figure 2-2 editable vector based on download from original source (Villreal et al., 2011) FIGURE 2-3 Mean percent changes in body weight during intervention.
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. Despite having similar nutrient intakes after adjusting for other factors, only for women were BMI and waist circumference positively associated with intakes of fat and saturated fat and negatively associated with Healthy Eating Index scores and intakes of carbohydrates, fiber, folate, magnesium, iron, and zinc.
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From page 28... ...
Unfortunately, it can be challenging for this population to obtain such a nutrient-dense diet because it involves overcoming barriers such as loss of appetite, changes in taste and smell, oral health decline, mobility constraints, and lower incomes. Inadequate Intake Data from the 2003–2004 NHANES were used by the Institute of Medicine Committee to Review Child and Adult Care Food Program Meal Requirements to identify the prevalence of inadequacy of protein and select nutrients among adults 60 years and older (IOM, 2011a)
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Need for increased protein intake is further supported by the Health, Aging, and Body Composition Study, which found that older adults with the highest intake of protein lost less lean body mass than those with lower protein intakes (Houston et al., 2008)
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Fiber is important for intestinal health and protection against heart disease and metabolic syndrome; however, the median intakes of neither men nor women 60 years and older meet the AI (IOM, 2011a)
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The 2011 IOM report Child and Adult Care Food Programs: Aligning Dietary Guidance for All presented the mean daily food group intakes by adults ages 60 years and older as compared to the 2,000-calorie MyPyramid food group pattern. It showed that older adults are not meeting any of the MyPyramid food group recommendations and are exceeding the recommendations for daily intake of solid fats and added sugar (see Table 2-5)
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From page 32... ...
Jackson Heart Study Using similar methods as the Baltimore Longitudinal Study, this study of African Americans in the southern United States identified different patterns than those listed above. The most common pattern was the "fast food pattern" -- characterized by fast food, salty snacks, soft drinks, and meat -- which was high in energy, fat, trans fat, and saturated fat.
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From page 33... ...
Research on the Effectiveness of the Nutrition Assistance Programs As a part of the report, GAO reviewed the programs' purposes, goals, and the extent to which the goals were being met. While research on these programs is limited, GAO did identify some information on the effectiveness of SNAP and the OAA Nutrition Program.
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(approximate) SNAP 37,645.4 28.4 million people 12.7 million householdsa CACFP 2,394.1 108,000 adults and 3.1 million childrenb OAA Nutrition Program 745.0 More than 2.5 million seniors TEFAP 230.6 Emergency Food and Shelter 140.1 73 million meals served National Board Program CSFP 100.4 440,000 elderly and 31,000 women, infants, and childrena Senior Farmers' Market 20.1 953,000 low-income seniors Nutrition Program NOTES: CACFP, Children and Adult Care Food Program; CSFP, Commodity Supplemental Food Program; FY, fiscal year; OAA, Older Americans Act; SNAP, Supplemental Nutrition Assistance Program; TEFAP, The Emergency Food Assistance Program.
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From page 35... ...
While providers perceive overlap and duplication as beneficial because it provides multiple points of access and increases the chance that those needing services will obtain them, it may also result in increased administrative costs, inefficient use of federal funding, and confusion among participants and providers. GAO Report on the OAA Elderly Nutrition Program GAO analysis of the December Current Population Survey Food Security Supplement shows that among low-income older adult households (age
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From page 36... ...
Larin suggested that older adults may not be participating in the programs because they • have limited awareness of available services; • live in areas with limited available services; • receive informal services through friends, family, or other organizations; • choose not to obtain government assistance; or • receive nutrition assistance through other federal programs, such as SNAP. Increased Demand for OAA Elderly Nutrition Program Services A GAO survey of local agencies conducted in the summer of 2010 reports that requests for home-delivered and congregate meals have increased 79 and 47 percent, respectively, since the start of the economic downturn in late 2007.
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SOURCE: GAO, 2011a. Analysis of December 2008 Current Population Survey Food Security Supplement data.
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Closing Comments Over $90 billion a year is currently spent on nutrition assistance programs, including multiple programs providing services to older adults. Research shows that some of these programs are effectively addressing older adults' nutritional and social needs, yet more updated research is needed to provide additional effectiveness data and to identify services to meet older adults' changing needs.
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From page 39... ...
Role of SNAP Among Older Adults In response to a request from Julie Locher for more information on the role of SNAP in addressing food security among older adults, Larin noted that SNAP is underutilized by older adults. They have the lowest participation rates in SNAP, possibly since they are only eligible for the minimum benefit ($14–$16 per month)
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From page 40... ...
Diets comprising fruits and vegetables, low-fat dairy foods, and lean meats are more expensive, less widely available, and heavier to carry, all of which may prevent low-income older adults from purchasing them. NUTRITION ISSUES RELATED TO AGING IN THE COMMUNITY: PERSPECTIVES AND DISCUSSION Moderator: Gordon Jensen In the final session of the morning, several speakers representing the workshop sponsoring agencies provided perspectives on nutrition issues of concern related to aging in the community.
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In addition to providing meals that meet the current dietary guidelines, the OAA Nutrition Program also includes nutrition education and counseling. The OAA, Lloyd said, provides the opportunity for collaboration among various assistance programs in parallel systems, such as Medicaid waiver programs and the Veterans Administration, in order to develop "comprehensive and coordinated service systems" to meet the nutrition needs of older adults.
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From page 42... ...
She hoped her presentation would help the audience get to know the population being served by giving these older adults a "human face and voice." Older adults needing nutrition services are often overlooked by the community in which they live. She described a trip to a town in Arkansas with a population of 117 that had become a food desert.3 She met an 86-year-old woman that had lived there all her life in the house where she was born.
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2006. Development of food intake patterns for the MyPyramid Food Guidance System.
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2004. Effects of Food Assistance and Nutrition Programs on Nutrition and Health: Volume 3, Literature Review.
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2011a. Child and Adult Care Food Program: Aligning Dietary Guidance for All.
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2002. The Elderly Nutrition Program: An effective national framework for preventive nutrition interventions.
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2006b. Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults.
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