CHAPTER Note: Chapter 2 is adapted from: 2

Community-Based Nutrition Services

Adams K. Moving Toward Culture Change: Defining Skilled Nursing Facility Residents’ Dining Style Prefer- ences [dissertation]. Logan: Utah State University; 2012. http://digitalcommons.usu.edu/cgi/viewcontent. cgi?article=1186&context=gradreports

The population of community-residing older adults aged 65 years and over continues to grow, and as of 2011, includes the first of the baby boomers (1,2). This increasingly heterogeneous group continues to reflect racial, ethnic, health, and socioeconomic diversity, negating a “one size fits all” approach to provision of food and nutrition services and programs. An increase in demand for community-based nutrition services has resulted from this population’s desire to remain inde- pendent, living in their own homes (3). Changes in the health care system and in public policy have also resulted in earlier discharge from hospitals to home- and community-based care, increasing the need for these nutrition services for older adults. These changes are also reflected in a shift from congregate meals to larger numbers of home-delivered meals (1,4). Unfortunately, senior hunger is frequently hidden; older adults do not always admit need or seek services without encouragement from family, friends, physi- cians, or other health care professionals. With this knowledge, it is imperative that the nutrition profes- sional take an active role in community assessment, policy development, and public health assurance to ensure nutrition needs of older adults are addressed. Poor nutrition impacts physical and mental health, quality of life, and in some cases longevity. The Academy of Nutrition and Dietetics position and practice papers on nutrition for older adults and chronic disease prevention demonstrate the need for registered dietitian nutritionists (RDNs) and nutrition and dietetic technicians, registered (NDTRs) to expand

their practice to include prevention, treatment, and maintenance of health and well-being for all community-residing older persons, especially those who are vulnerable and at risk (5-10) (Table 2.1, see pages 18–19).

FOOD INSUFFICIENCY

Older adults who report food insufficiency (defined as an inadequate amount of food intake due to lack of resources or access) experience lower mean intake of several nutrients, lower intake of the vegetable and meat groups, lower dietary variety, lower mean serum levels of certain nutrients, and higher risk of being underweight. In addition, they are generally in poor or fair health (11,12). Being marginally food insecure is roughly equivalent to being 14 years older than the chronological age . Vitamin and mineral deficiencies can weaken immune systems and may increase the risk of cognitive dysfunctions. Even being marginally food insecure strongly affects quality of health in seniors (13,14).

In the National Center for Health Statistics (part of the Centers for Disease Control and Prevention) NHANES III survey, 79% of those surveyed with food insufficiency had an income below the cutoff for sup- plemental nutrition assistance program eligibility (130% of poverty level). Other causes of food insuffi- ciency among older adults may include food deserts (food access), poor transportation, decreased mobility, lack of ability for self-care, and limited availability of help with daily activities. These contribute to the in - ability to buy and prepare food, resulting in possible food insufficiency (13,15).