Assessing Intake of Food and Dietary Supplements in Older Adults Proceedings of a Workshop Series (2023) / Chapter Skim
Currently Skimming:
5 Nutritional Policies, Practices, and Challenges That Affect Older Adults
5 Nutritional Policies, Practices, and Challenges That Affect Older Adults
Pages 69-90
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 69... ...
Despite these technological advances, older adults still desire the high-touch, in-person, in-home services that are at the heart of the Older Americans Act signature programs, such as Meals on Wheels. Responsive, safe, person centered access to services can be ensured by expanding and scaling effec tive policy approaches, connecting community-based senior nutrition programs to other service sectors, such as health care, and prioritizing nutrition security.
|
From page 70... ...
Increasing funding and accessibility of older adult nutrition programs is key, as is increased flexibility for congre gate meal programs so that they can adapt to the effects of the pandemic. (Blancato)
|
From page 71... ...
he shared the example that the Biden-Harris administration announced the White House Conference on Hunger, Nutrition, and Health for September 2022.1 This is only the second-ever White House conference on these topics since 1969, and it will release a national strategy for ending hunger and improving nutrition and physical activity by 2030 so that fewer Americans experience diet-related chronic diseases. EDUCATION POLICY: TEACHING ABOUT FOOD AND NUTRITION IN MEDICINE Timothy Harlan, George Washington University, discussed nutrition education for health care professionals beyond registered dietitians (e.g., physicians, residents, medical and nursing students)
|
From page 72... ...
Harlan mentioned a nonprofit organization, the Culinary Medicine Specialist Board, a group of several dozen medical schools and partner sites with a vision to "empower healthier lifestyles and reshape the course of chronic disease in America by integrating the science of medicine into culinary tradition" (Stauber et al., 2022, pp.
|
From page 73... ...
In addition, programming is available for practicing health care professionals, such as continuing medical education courses, a 60-credit-hour Certified Culinary Medicine Specialist program, and an annual Culinary Medicine Conference. Standardized policies on integrating these topics in medical education do not exist, but he recommended this.
|
From page 74... ...
This helps ensure that services align with their personal lifestyle and culture and any medical needs. Screening is conducted by generalist staff and volunteers, but more specialized nutrition education, counseling, and dietary supplements are provided by registered dietitians.
|
From page 75... ...
3 aims to reduce hunger, food insecurity, and malnutrition; promote socialization; and improve the health and well-being of older adults by helping them access nutrition and other disease prevention and health promotion services, delaying the onset of adverse outcomes. Since OAA's establishment in 1972, it had three reauthorizations that changed its focus and funding priorities in response to evolving social, demographic, and economic conditions.
|
From page 76... ...
About half of them tapped local partnerships to help fill gaps and provide emergency meals, and a similar proportion served congregate meal clients in alternative formats, such as grab-and-go, drive-thru, or curbside pick-up. She added that more than half developed opportunities to address social isolation.
|
From page 77... ...
Third is to prioritize nutrition security to mitigate the risk of malnutrition among older adults. HEALTH CARE PAYMENT POLICY: NEW OPPORTUNITIES TO USE MEDICARE DOLLARS TO ADDRESS NUTRITION AND SOCIAL DETERMINANTS OF HEALTH Marshall Chin, University of Chicago, discussed new opportunities to use health care payment policy levers to address nutrition and social determinants of health.
|
From page 78... ...
He urged attendees to understand how these and other payment policy levers could affect food and added that the levers also interact with each other and should not be viewed in isolation. Chin provided context for his presentation's frame of health equity and social determinants of health.
|
From page 79... ...
Chin referenced his work with the Robert Wood Johnson Foundation's Advancing Health Equity program, which works with state Medicaid agencies, Medicaid managed care organizations, and health care organizations to achieve health equity. The program has a Health Care Payment Learning & Action Network, an active group of several hundred public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate the U.S.
|
From page 80... ...
80 FIGURE 5-3 Framework for advancing health equity. SOURCE: Presented by Marshall Chin on May 6, 2022 (Chin, 2020)
|
From page 81... ...
Chin elaborated on the differences between prospective and retrospective payment models, noting that the latter reward and incentivize reducing disparities and advancing health equity. An example is pay-forperformance, which rewards the outcome rather than providing payment up front (prospective payment)
|
From page 82... ...
The purpose is to improve health care for people with Medicare through "better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved."7 They needed to adjust certain health equity benchmarks to better support care delivery and coordination for those in underserved communities, which has required collecting beneficiary-reported demographic and social needs data. Chin cited another example of alternative payment models, state Medicaid plans, explaining that each state has contracting arrangements with Medicaid managed care organizations.
|
From page 83... ...
Local initiatives to improve population health and advance equity through partnerships with community organizations must be viewed within the context of the wider policy challenges, Chin advised, which involve overall health care financing policies and global payment models. He ended with a quote about caring for diverse populations in current society: "Clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy.
|
From page 84... ...
. The OAA nutrition programs are more than just a meal -- they are a source of social and community connection; provide screenings that can help identify malnutrition, food insecurity, fall risk, isolation, and mental health issues; and promote evidence-based disease prevention and health promotion programs to help improve health and well-being and reduce disease and injury.
|
From page 85... ...
According to the legislation that paved the way for the conference (H.R.5724) , its purpose is to develop a road map to end hunger and improve nutrition by 2030 and to review existing and crossdepartmental strategies and consider new approaches to improve health by eliminating hunger, reducing prevalence of chronic diseases, and improving access to and consumption of nutritious foods in accordance with the Dietary Guidelines for Americans.
|
From page 86... ...
. The article suggested that prioritizing nutrition security could address a gap in clinical and public health screening tools for food insecurity: a lack of assessment of diet quality or nutrition.
|
From page 87... ...
A challenge of promoting cross-sector collaboration is the need to establish commonly aligned metrics and incentives, which he characterized as a relatively uncharted space but also a "huge frontier" for advancing health equity. Meeting the Nutrition Needs of Frail Adults of Advanced Age The Meals on Wheels network takes pride in providing meals that are responsive to its population's needs, Akobundu said; older adults receive an initial nutrition screening and have access to more in-depth opportunities for evaluation of their lifestyle, religious, medical, and cultural needs.
|
From page 88... ...
Key Takeaways for Health Care Providers In DiMaria-Ghalili's view, the take-home message is the importance of training all health care providers across the care continuum to screen older adults for nutrition risk, including during office and home care visits. Screening should also occur at both hospital admission and discharge, and the latter is important for indicating what services a patient might need at home.
|
From page 89... ...
It is a purposeful shift for those who were trained in the medication-oriented model of addressing health, toward more opportunities and funding for educating providers about nutrition and providing nutrition services in the community. DiMaria-Ghalili added that training on social determinants of health is being integrated into health care provider curricula, which is a major shift but one that sets the stage for better equipping providers to address food and nutrition insecurity and malnutrition.
|
From page 90... ...
2021. Prioritizing nutrition security in the U.S.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.