Project:
Impact of Home-Delivered Meals on the Nutritional Status and Food Security of the Elderly in New York State

Year: 2002

Research Center: Department of Nutrition at the University of California, Davis

Investigator: Frongillo, Edward A., and Wendy S. Wolfe

Institution: Cornell University

Project Contact:
Edward A. Frongillo, Associate Professor and Director
Cornell University
Division of Nutritional Sciences
Program in International Nutrition
B17 Savage Hall
Ithaca, NY 14853
Phone: 607-255-3153
eaf1@cornell.edu

The Home-Delivered Meals (HDM) component of the Nutrition Services Incentive Program provides meals to noninstitutionalized frail elderly persons who are no longer able to obtain an adequate diet without assistance. This study examined whether participation in the HDM program improves nutritional outcomes, characterized elders who are most likely to benefit from the program, and identified a number of nutritional indicators that can be used in program evaluation.

Several studies have found benefits associated with HDM. For example, a recent national evaluation found that participants in both HDM and Congregate Meals had a higher average daily intake of nutrients than a matched comparison group of nonparticipants. However, due to methodological limitations, these studies could not determine whether participation in the HDM program was responsible for the improved outcomes. The authors addressed the methodological limitations of previous studies by comparing those who received HDM with a nonrandomized control group and by using longitudinal data on the nutritional outcomes of both the control and treatment group members. The authors also examined outcomes other than nutrient intakes, such as food security and dietary patterns, and information on measured, rather than self-reported, height and weight.

This collaborative study analyzed data collected by the New York State Office for the Aging in 1999 in three counties representative of Upstate New York. All elders referred for aging services over a 5-month period received a standard assessment and were asked to participate in the study. Of the 212 people who agreed to participate, 171 began receiving HDM and 41 began receiving other services but not HDM. Both the HDM recipients and nonrecipients completed a baseline survey and two followup surveys, at 6 months and 12 months after the baseline survey. The surveys contained a 24-hour dietary recall and questions used to construct the Federal measure of food security. A number of elders in the initial sample did not complete the followup surveys, primarily because they stopped participating in HDM because they no longer needed it, moved, or died. A total of 99 elders completed the 6-month followup survey, and 67 elders completed the 12-month followup survey. The authors used estimation techniques that suggest that the bias resulting from the loss of sample members is minimal.

The study found that respondents’ dietary intakes before receipt of HDM were lower than recommended for many nutrients and food groups. After receipt of meals through the HDM program, however, participants reported eating more vegetables, a greater variety of fruits and vegetables, and more beta carotene, vitamin E, and magnesium. In addition, the prevalence of food insecurity among elders in the sample decreased from 23 percent to 13 percent. The analysis shows that the positive effects of the HDM are greater among males and elders who live alone. Participants with poorer initial nutritional status also show greater improvement, regardless of demographic characteristics.

The analysis compared HDM participants whose diets were assessed in the followup surveys on days that they had eaten an HDM meal with participants whose diets were assessed on days that they had not eaten an HDM meal. Participants who had eaten an HDM meal on assessment day showed greater improvement over time in 25 of 27 indicators of nutrient intake and dietary patterns compared with participants who had not eaten an HDM meal on assessment. The authors found similar results when they examined nutrient density rather than total nutrient intake.

These results provide evidence that the HDM program improves the nutritional well-being of the elderly. The fact that some applicants are placed on a waiting list shows there is unmet interest in participating in the HDM program. The positive effects of the program are an important consideration in the decision to allocate limited resources to social programs. Information on those who are likely to benefit most from the program can be used to target program resources more effectively. In addition, the new nutritional indicators identified in the study can be used to measure the effect of the HDM and other food assistance and nutrition programs.