PRACTICE POINTS

Strengthening the role of nutrition and improving the health of theelderly population

By providing opportunities for social contact and improvednutritional intake, the Elderly Nutrition Program is de-signed to delay the premature institutionalization of the

elderly. Home-delivered meal programs, such as Meals onWheels, greatly contribute to maintaining quality of life in theelderly population and also in delaying costly institutionaliza-tion. As a consultant dietitian and president and owner ofSteffen and Associates, Inc, a company that provides dietaryand nutritional consultation to long-term care facilities, psychi-atric facilities, group homes, and congregate feeding programs,Marolyn Steffen, RD, has a great deal of experience with theelderly patients. The preceding study, “The effects of two mod-els of nutritional intervention on homebound older adults atnutritional risk,” tests the feasibility of a Traditional Meals onWheels program (5 hot meals/week meeting 33% of the DailyReference Intake) and a restorative, comprehensive new Mealson Wheels program (3 meals and 2 snacks/day, 7 days/weekmeeting 100% of the Daily Reference Intake). Steffen finds thisstudy to confirm “that providing adequate nutrition to a home-bound elderly population will improve their health and func-tional status.”

“Improving the health of the elderly population includes pro-viding complete nutrition, rather than providing 33% of dailyrequirements,” says Steffen. Providing complete nutrition careto the elderly, in turn, allows them to “make significant clinicaland functional improvements [in their health].” It also helpsprevent them from becoming malnourished, a major underlyingcondition for admission to long-term care facilities. The ADApublication, Nutrition Management and Restorative Dining

for Older Adults: Practical Interventions for Caregivers,states: “Malnutrition often leads to the need for institutionalcare in the community dwelling elderly. Estimates of the prev-alence of malnutrition or inadequate nutrition among the el-derly range from 10% to 51% of community dwelling olderpeople.” (1) Steffen provides that “over 50% of long-term careresidents are malnourished at admission.”

As stated, Meals on Wheels programs greatly contribute to

maintaining quality of life in the elderly populations, and alsocan delay the need for long-term care in an institutional setting.However, as Steffen points out, there does need to be a certainlevel of functional and cognitive ability of the homebound clientto be able to successfully receive home-delivered meals. Thisalso includes the need for the homebound client to have acertain level of economic status.

Without considering these factors, the client may not be ca-pable of succeeding in the storage, preparation, and therefore,consumption of the home-delivered meals. “The homeboundclient has to be able to handle the storage of at least 14 frozenmeals and 21 refrigerated beverages [per week]. The home-bound client also must be able to prepare the meals by heatingthem in an oven or in a microwave oven,” says Steffen. “Oftenwhen volunteers visit these clients, they find the freezer full offrozen meals. Clients forget to use them, [as they] are not ableto handle ovens. They are not able to do basic meal prepara-tions due to cognition/functional status, or psychiatric statussuch as depression.”

The economic status of clients also plays an important role.Some clients may not have freezers large enough to store 14frozen meals or microwave ovens for heating them. Steffen haslearned that the individuals lacking cognitive abilities and/orproper equipment for preparing food may indeed “benefit morefrom traditional meals, with a hot meal and a cold (supper)meal delivered daily.” Steffen encourages that “clients for eachprogram must be chosen carefully and individually.” Steffenalso suggests including certain medical diagnoses and comor-bidities into the eligibility requirements for participating in theMeals on Wheels programs. Current eligibility factors are re-lated to nutritional risk, food insecurity, and functional limita-tion.

Through programs such as Meals on Wheels and the ElderlyNutrition Program, strengthening the role of nutrition throughimproving the health and well-being of our elderly population,as well as controlling and managing health care and medicalcosts, is possible.

Reference1. Robinson GE, Leif B, eds. Nutrition Management and Restorative Dining forOlder Adults: Practical interventions for caregivers. American Dietetic Asso-ciation; 2001.

This article was written by Melissa Thorpe, an Editor

of the Journal in Chicago, IL.

doi: 10.1053/jada.2003.50077

RESEARCH

Journal of THE AMERICAN DIETETIC ASSOCIATION / 337