Post on 26-Aug-2020
Hunger-Obesity Paradox and the
Community Resources Available to Assist
Nicolle Miller, MS, MPH, RD, LDN
NC Center for Health & Wellness at
UNC Asheville
Senior Nutrition Summit, Charlotte, NC
March 24, 2018
Mission:
Develop equitable opportunities that lead to
healthy North Carolina Communities.
NCCHW works to impact policy, build capacity,
and ignite community initiatives by working through
a web of cross sector relationships organized
around building healthier places throughout the
state.
A profile of North Carolinians:
NC is Aging
#Retirees
#Foreign-born population
(Immigrant and refugees)
#Life expectancy
#Baby boomers
#Lower birth rates
NC Ranks 9th in population age 65+
By 2019, there will be more people 60
and over than ages 0-17 in the state
2019
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
2015 2035
60+
0-17
Source: NC Office of State Budget and Management/demographicsRetrieved 11/1/2016
Counties with more people age 60 and
over than 0-17
2015
(66 counties)
2025
(87 counties)
By 2035, 94 counties will have more people 60 and over than under age 18. The 6 counties with more people 0-17 than 60 and over are Craven, Cumberland, Durham, Harnett, Hoke and Onslow.
Counties with more people ages 60+ than 0-17
Counties with more people ages 0-17 than 60+
Most older adults 65+ years
live in the community
▶Community
33.4 M; 93.5%
▶Nursing Homes
1.5 M; 4.5%
▶Assisted Living
1.0 M; 2.0%
US Census Bureau; Centers for Medicare & Medicaid, Medicare Current Beneficiary Survey
Poverty Rate Increases In Older Age
Source: American Community Survey 2009-2013. Table B17024
7
▪ 83% have at least one chronic disease. 52% have 2 or
more chronic diseases
▪ 68% reported exercising in the past month
▪ 29% reported that their health is fair or poor
▪ 93.5% live in the community
▪ 37% have at least one disability
American Community Survey 2011-2015 five year estimates, Table B18101BRFSS 2015 survey results, NC State Center for Health Statistics
Characteristics of Older Adults in
North Carolina
17%
21%63%
With one type of disability
With 2 or more types of disability
No disability
Seniors may have
unique nutrition
needs and
challengesIn 2015 9.7%
NC older adults
in poverty
Source: American Community Survey 2015 one year estimate. Table S0102 Population 60 years and over in the united states;
USDA - 33 percent of the census tract's population must reside more than one mile from a supermarket or large grocery store (for rural census tracts, the
distance is more than 10 miles).
Food Deserts
– lack access
to healthy food
Chronic
disease and
disability
Seniors’ Nutrition Challenge
• Food Insecurity is the more common, accurate,
and politically acceptable term
• Many reasons for food insecurity
30% of low income older adults choose
between food and medical care
35% of low income older choose between
food and paying for heat/utilities
• Less than half of older adults who are eligible for
SNAP (food stamps) are enrolled in the program
• Food Insecurity leads to Malnutrition = poor
nutrition
Hunger vs Food Insecurity
So What’s the Hunger-Obesity
Paradox?
▶ The common misconception that
obesity results from overeating
▶ Consider the types of foods that are
inexpensive
▶ Consider eating patterns when next
meal is not known
▶ What foods do you donate during
hunger relief efforts?
▶ Someone can be hungry,
malnourished and overweight
Malnourished Patients
Clinical studies have shown that:
• 53% of Medicare admits are suffering
malnutrition;
• 40-60% of patients discharged are
malnourished;
• Discharged patients that are malnourished
have poorer outcomes
Patients with Chronic Conditions -
Highest Risk for Admissions AND
Readmissions
• Congestive heart failure (CHF) patients
• Patients with 2 or more chronic conditions
● 20% of NC adults age 60+ are food insecure
● Malnutrition is often not screened● Over 50% of hospitalized older adults are
malnourished● Hospital stays are longer● Increases health costs● Access to food is one of the quickest
returns on investment among the social determinants of health
● Screening for food insecurity improves care
Identifying Patients Who Require
Nutrition Rx
Ref: UNC Hospital 2014 study; AARP Foundation ISSUE Brief Sept 2016 Addressing Food Insecurity in Primary Care; Defeat Malnutrition Today
NC FNS Statistics June 2017
●NC Participation Rate under 55 years
old: 69%
●NC Participation Rate 55y/o+: 57%
●NC monthly allotment average 55y/o+:
$118
●Robeson Co. 55+ Participation Rate:
63%
●Robeson Co. 55+ monthly allotment
average: $113
●Bladen Co. 55+ Participation Rate: 49%
●Bladen Co. 55+ monthly allotment avg:
$94
Good News!
North Carolina Supports for
Food Insecurity● Senior Nutrition Program
congregate nutrition programhome-delivered meals program
● Supplemental Nutrition Assistance Program SNAP or FNS or food stamps ○ $600,000 NC Pilot Program to increase access
to for dual eligible. The RFA for applications process is underway to partner with a not-for-profit firm.
● Food Banks and food pantries ● Farmers Markets, community gardens● Local food policy councils● Faith-based groups (NCBAM – Serving Hope)
Home Food Delivery for the Elderly
Strengthens Communities
States that invest more on home-delivered meals to seniors have lower rates of seniors in nursing homes.
Meals on Wheels America + AARP Foundation commissioned Brown University’s Center for Gerontology and Healthcare Research: investigate the impact of meal service delivery on the health and well-being of adults 60 years of age and older. 15 week study – waiting list for home delivered meals programs across US Design: Traditional home delivered meal delivery (hot lunch meal with daily visit); Once-weekly frozen meal delivery; or Continuance on the waiting list
The cost of 1 YEAR for a senior to receive
Meals on Wheels is less than 1 DAY in a
hospital.
2018 Malnutrition Quality
Improvement Initiative Academy
of Nutrition and Dietetics
●New quality measures to address
malnutrition in the hospital are being
evaluated
●Will create consistent standards of
practice
●Nutrition care plans are created after
assessment
Nutrition is clinically proven
intervention for many chronic
conditions
● Nutritional Interventions Substantially Improve Patient
Outcomes and Reduce Costs
● Reduction in length of stay 22%
● Reduction in lost hospital revenue per patient 71%
● Reduction in readmission costs 17%
● Reduction in readmission rate 5%
How Much Does the Nutrition Rx
Save?
● Nutrition is low cost versus hospitalization
○($18.95/day vs. $3500 for hospital stay).
● Nutrition is low cost compared to SNF
○($18.95/day vs. $222 – 278/day for SNF)
● Nutrition needs to be measured as a key intervention in reducing readmissions
●How are you making the case for nutrition services?
Gurvey et al., 2013 J. Primary Care and Com. Health 4(4):311
MOWA, ANDA, AARP F, NCOA & You
Call to Action
● Increase funding for the Older Americans Act
Meals and nutrition education
● Strengthen SNAP policies for older adults
Support SNAP-Ed, SNAP Outreach
● Encourage the Centers for Medicare and
Medicaid adopt Malnutrition e Clinical Quality
Measures
Screening and intervention for food insecurity
MOWA, ANDA, AARP F, NCOA & You
Call to Action
● Expand Medicare-covered medical nutrition
therapy/nutrition counseling to include diabetes
and other conditions
● Enhance Medicare Advantage by allowing doctor
to prescribe meals when needed
○implement Improve discharge planning so
health plans provide nutritious meals
● Support community partners
● Massachusetts’s governor signed S.2499, an act
to establish a commission on older adult
malnutrition prevention in 2016
AN INITIATIVE OF THE N.C. CENTER FOR
HEALTH & WELLNESS AT UNC ASHEVILLE
Healthy Aging NC Resource Center
Jeanne Dairaghi,
Chronic Disease
Self-Management
Project Manager
Janice Self,
Data Administrator
Nicolle Miller,
Director of State &
Community
Collaboration
Website:
www.healthyagingnc.com
Katie McDonald
Administrative
Support
Healthy Aging NC at NCCHW
Supports Sustainability of Value-
Based Care and Addresses Social
Determinants of Health
▶ Creating a falls prevention pathway between
an ACO and Evidence-Based Falls
Prevention Programs
▶ Area Agencies on Aging becoming Diabetes
Self-Management Education (DSME)
Medicare Providers
▶ Connecting Community-Based
Organizations with Healthcare
Organizations
Website:
www.healthyagingnc.com
AN INITIATIVE OF THE N.C. CENTER FOR HEALTH &
WELLNESS AT UNC ASHEVILLE
Contact Information
Nicolle Miller
Director of State and Community Collaboration
nmiller2@unca.edu
828-258-7711
Healthy Aging NC Resource Center
HealthyAgingNCInfo@gmail.com
Healthyagingnc.com
AN INITIATIVE OF THE N.C. CENTER FOR HEALTH
& WELLNESS AT UNC ASHEVILLE
Websites
●Meals on Wheels America -www.mealsonwheelsamerica.org/takeaction
●Academy Dietetics and Nutrition -http://www.eatrightpro.org/resources/practice/practice-resources/malnutrition
●National Council on Aging -www.NCOA.org/NutritionTools
●Defeat Malnutrition Today -www.DefeatMalnutrition.Today
●National Foundation to End Senior Hunger -http://www.nfesh.org/
●AARP Foundation - http://www.aarp.org/aarp-foundation/our-work/hunger.html