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Food Insecurity:
Older Adult Nutrition
Jane Hunley, Parkland Geriatrics Program Director
Kara Davis, Geriatrics Clinic and Senior Services Clinical Dietitian
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Healthy Living for Older Adults
• Good nutrition (quality and quantity) is important for healthy
aging
Plays a major role in disease prevention and management: diabetes,
hypertension, heart disease, cancer, kidney disease, liver disease
Effects independence: strength, function
Improves quality of life: well-being
• Goal
Remain healthy and independent, in own home for as long as
possible.
• Cost – Impact of poor health and nutrition status
Caregiver burden
Institutionalization
Greater health care utilization
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Food Insecurity
Health impact:
• Overnutrition - calorically dense, nutrient poor
• Undernutrition - inadequate intake
• Lower cognitive function
• Poor mental function
Did you know?
• 2 million older adults are among the 14.6% of food insecure
households in America (Chung, 2012)
– Growing senior population
• Strong association between food insecurity and health
– 1 in 3 NTFB clients affected by Diabetes
• 2/3 of NTFB households report having to choose between food and
paying for medical care
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Food Insecurity:
Organizational Guidelines & Dietitian Role
Academy of Nutrition and
Dietetics (AND)
Position Papers:
Food and Nutrition Programs for
Community-Residing Older
Adults (2010)
“All older adults should have access to
food and nutrition programs that
ensure the availability of safe,
adequate food to promote optimal
nutritional status.”
Food Insecurity in the United
States (2017)
Healthy People 2020
• Reduce household food insecurity,
and in doing so, reduce hunger
Dietitian’s role:
1. Nutrition assessment and
education
2. Promoting access and utilization of
community services and programs
3. Participate in health outcomes
research
*determine impact of programs
*facilitate program development
4. Advocacy efforts at the local, state,
regional and national levels
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Nutrition Assessment and
Education: Can they afford the food they need?
• Limited income
Shopping frequency (quantity)
Types of food purchased
(quality)
• Distribution of finances
Housing
Utilities
Medication/medical bills
Transportation
• Local food prices
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Nutrition Assessment and
Education: Can they get the food?
Availability
o Food deserts – access to fresh
produce, traveling distance
o Person shopping not buying
appropriate foods
o Able to store food
Functionality
o Mobility – assistive device
o Cognition
o Vision impairment – food
selection, reading labels and
expiration dates
Transportation
o Driving, vehicle access
o Dependent on others
o Cost – gas, fees
*Like income, transportation can
affect shopping frequency
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Nutrition Assessment and
Education: Are they able to prepare their food?
Functional limitations
Physical
• Mobility – pain, assistive device, shortness of breath
• Strength – opening food and beverage packaging
Psychosocial - mental and cognitive impairment
• Depression – social isolation, decreased appetite/intake, loss of
motivation to eat or prepare foods, bereavement
• Memory loss - forgetfulness in when to eat, what to eat, how to
prepare, safety in food prep
Cooking appliances – working/available?
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Resources
Social Worker • Screening and referrals to connect
qualified individuals to programs
• Employment (income)
• Housing (cost)
• Transportation assistance
• Meal prep assistance
Community Programs
• SNAP
• CSFP
• Food pantries
North Texas Food Bank
(NTFB)• PAN distribution – 1x/month
• Nourishing Neighbors – 2x/month,
homebound (includes pet food)
• Produce distribution
• Partner/community gardens
• Food 4 Health
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Programs
US Department of Health and
Human Services – The Older
Americans Act (OAA)
Nutrition Program
Title IIIC
• 60 and over – eligible for
congregate or home-delivered
meals, nutrition screening,
nutrition education/counseling
• Meals provide 1/3 of DRI and
meet recent dietary guidelines
for Americans
Ryan White Comprehensive
AIDS Resources Emergency
Act
• Older Americans >10% of
HIV/AIDS cases and growing
• Clinical nutrition
education/counseling
• Food assistance (home-
delivered meals, groceries, food
vouchers, liquid nutritional
supplements)
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USDA Programs
Commodity Supplemental
Food Program
o </= 130% poverty
o Healthy, shelf stable
Senior Farmer’s Market
Nutrition Program
o </=185% poverty level
o Fresh fruits and vegetables
Supplemental Nutrition
Assistance Program (SNAP)
o </=130% federal poverty level
o Older adults have the lowest
participation rate
The Child and Adult Care
Food Program
o </=130% poverty
o 60 yr +
o Enrolled in adult day center
o Meals must meet federal dietary
guidelines
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Barriers to Program Use
Nonparticipation
• Benefit underestimation
• Welfare stigma
• Difficult application process
• Lack of program awareness
• Confusing eligibility
requirements
Language and culture
• Increased diversity
• Less program participation
• Less cultural foods available
Diet restrictions
• Chronic health condition
needs
Program food waste
• Diet restrictions
• Preferences
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Nutrition Education Resources
USDA
CSFP – fact sheets, low-
cost recipes
choosemyplate.gov -
smart shopping, meal
planning on a budget,
menus, low-cost recipes
SNAP ed – meal planning,
shopping, budgeting
North Texas Food Bank
Nutrition and culinary ed
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Psychosocial Screening in the
community clinics at Parkland
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Geriatric Functional Screening
at Parkland
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Geriatric Functional Screening
at Parkland
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Geriatric Functional Screening
at Parkland
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Goals of Care
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Efforts/Partnerships
• Past:
• Community Garden at Southeast Dallas Health Center in Pleasant Grove-
partnership with Urban League
• Farm stand vouchers provided to nutrition counseling patients at Hatcher
Station Health Center in south Dallas to use at Baylor Scott and White
Wellness Center
• Numerous food drive efforts
• DASH program
• Present:
• North Texas Food Bank food delivery during holiday season
• Facility and site level canned food drives
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Clinical Team Referrals
• Meals on wheels
• Senior centers
• Senior companion program
• Foster grandparent program
• Commodity programs
• Food stamps
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Parkland Center for Clinical
Innovation
Past DASH• Robert Wood Johnson funded Data Across
Sector of Health: Food for Health (DASH)
• Collaboration between 3 NFTB food
pantries, PHHS, and PCCI
• Connect PHHS patients who had a diagnosis
of diabetes and/or hypertension and were
identified as being food insecure to
community based organizations
• Screened at PHHS Diabetes education
classes and food pantries
• Participants in the DASH program received
interventions at one of the 3 food pantries:• Nutritional material based on diagnosis, suggested food item list, medical
appointment reminders, follow-up questions on medication compliance,
access to a PHHS social worker if needed, and a personalized shopping
experience at the food pantries
• Patients in the program also had the opportunity to participate in NTFB
cooking and nutrition education classes.
The DASH program wrapped up
November 2017. PCCI and DASH
stakeholders are strategizing on
how to expand the program now
that the funding period has
ended. DASH stake holders saw
the impact the program made in
the populations they serve and
are eager to continue the
expansion of DASH.
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8-1-18 CMS Grant--Accountable
Health Communities
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National Trends in Care
• Patient Centered Medical Home
certifications
• Population health management
using electronic records to pull data
• Increase in home providers
• Hospital at home
• Focus on frequent flyers/high cost
utilizers
• Transitional care
• Case management
• Care navigation
• Telehealth
• Electronic monitoring
• Electronic patient communications
• Payment Models• New billing codes which often include
multi disciplines and social focus
• Medicare Advantage plans
• Accountable care organizations
• Payment model includes quality
metrics/targets
• Future payment models
• Baby boomers
• NIH Study All of Us
• Focus on all aspects of
neurocognitive functioning
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Parkland Focus
• Focus on appropriate
language translation
• Suicide and depression
screening
• Behavioral health
expansion
• Foot care expansion
• Telehealth
• Electronic specialty
consults
• Group visits
• Population health management
using electronic records to pull data
• A1C
• ACE/ARBs
• Obesity
• Chronic kidney disease
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Partnerships
Working together…
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Helpful links
www.fns.usda.gov/fdd/food-distribution-programs
www.fns.usda.gov/snap/nutrition-education
www.fns.usda.gov/sfmnp/senior-farmers-market-nutrition-program-
sfmnp
AND position papers:
https://www.eatrightpro.org/practice/position-and-practice-
papers/position-papers/food-nutrition-programs-community-
residing-older-adults
https://www.eatrightpro.org/practice/position-and-practice-
papers/position-papers/food-insecurity-in-the-united-states
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Helpful links
www.eatright.org
www.choosemyplate.gov/budget
www.whatscooking.fns.usda.gov/fdd/household-material-fact-
sheets
www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-
weight-status/objectives