Chapter 2 Community-Based Nutrition Services

a primary care delivery platform that the nation can rely on for accessible, affordable, and high-quality health care will require significant workforce develop- ment and fundamental payment reform (50,51).

Outpatient Clinics and

Interdisciplinary Assessment Clinics Ambulatory care centers are becoming multiple service providers, offering services such as physician and spe- cialist care, outpatient surgery, wound care, diabetes education, wellness classes, rehabilitation, mental health care, and even fitness services. These centers provide assessment, treatment, counseling, and educa- tion. Clients come from homes, nursing homes, group homes, adult-care centers, or assisted-living facilities to receive treatment or preventive care.

Because older adults have special needs, they may have difficulty understanding education provided under stressful situations and will need more assistance in their homes after procedures than do younger individu- als. To ensure comprehension, nutrition professionals need to provide older adults with additional follow-up on educational sessions. Older adults may have special nutritional considerations if fasting for tests make them too weak to prepare their own meals when they return home. The nutrition professional should make appro- priate referrals to improve the nutritional outcomes of the outpatient clinics for older adults.

SUMMARY

Practice opportunities for RDNs and NDTRs have increased, bringing specialized expertise and collabora- tion to an interdisciplinary community-based service system to plan and deliver an array of nutritional and social services and health and wellness activities. The services offered should be built around community population demographics to reduce risk factors and enable older persons to maintain health and remain in their communities. RDNs and NDTRs may serve as consultants or include this population within their com- munity-based private practice. Positions are often available in senior centers, community health centers, medical homes, congregate and home-delivered nutri- tion programs, adult daycare centers, food pantries, state and local governments, Area Agencies on Aging, faith communities, nonprofits, physician offices, and medical clinics. The nutrition professional will need to understand how economics, social issues, and the polit- ical environment affect the health of the older adult. Given the federal cost-containment policy to shift long-term care away from nursing homes and toward home- and community-based services, it is imperative that the RDN and NDTR understand the availability of

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programs so that all older adults have access to food and nutrition programs that ensure the availability of safe, adequate food and nutrition services to promote optimal nutritional status. Providing information on food assistance and meal programs, nutrition educa- tion, screening, assessment, counseling, therapy, moni- toring, evaluation, and outcomes documentation to ensure more healthful aging for those remaining in their home will continue to be essential as health care focuses on prevention rather than the traditional medical model of health care delivery.

REFERENCES 1. Administration on Aging, Administration for Community Living, US Department of Health and Human Services. Profile of Older Americans: 2014. Washington, DC: Administration on Aging; 2013. http://www.aoa.acl.gov/Aging_Statistics/Profile/Index. aspx. Accessed December 13, 2015.

2. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. June 2012. www.agingstats.gov/agingstatsdotnet/Main_ Site/Data/2012_Documents/docs/EntireChartbook.pdf. Accessed December 13, 2015.

3. Knickman JR, Snell EK. The 2030 problem: caring for aging baby boomers. Health Serv Res. 2002;37(4):849-884. www.ncbi.nlm.nih.gov/pmc/ articles/PMC1464018/. Accessed December 13, 2015.

4. Day T. About the National Aging Network. www.longtermcarelink.net/eldercare/area_agencies_on_ aging.htm. Accessed November 24, 2014.

5. Bernstein M, Munoz N. Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness. J Acad Nutr Diet. 2012;112:1255-1277.

6. Lawson DL, Fitzgerald N, Morgan KT. Position of the Academy of Nutrition and Dietetics: the role of nutri- tion in health promotion and chronic disease preven- tion. J Acad Nutr Diet. 2013;113:972-979. doi:10.1016/j.jand.2013.05.005.

7. Fitzgerald N, Morgan KT, Slawson DL. Practice paper of the Academy of Nutrition and Dietetics: the role of nutrition in health promotion and chronic disease pre- vention. J Acad Nutr Diet. 2013;113(7):983. doi:10.1016/j.jand.2013.05.007.

8. Kamp B, Wellman N, Russell, C. American Dietetic Association; American Society for Nutrition; Society for Nutrition Education. Position of the American Die- tetic Association, American Society for Nutrition, and Society for Nutrition Education: food and nutrition pro- grams for community residing older adults. J Am Diet Assoc. 2010;110:463-472. doi:10.1016/j.jada.2009.12 .009.