ACL recently awarded six grantees funding for innovative projects that will enhance the quality, effectiveness, and outcomes of nutrition services programs provided by the national aging services network. The grants total $742,872 for this year with a two-year project period. Through this grant program, ACL aims to identify innovative and promising practices that can be scaled across the country and to increase use of evidence-informed practices within the nutrition programs.
The six organizations receiving grants and their projects are:
Iowa Department on Aging: Aims to improve health outcomes of participants in the Linn County Innovations in Nutrition Program by promoting higher service quality. Objectives include collaborating with community health partners to increase referrals to the congregate meal sites; increasing the availability and variety of evidence-based health promotion programs at the sites; and providing chronic disease-specific nutrition education.
LiveOn NY (formerly the Council of Senior Centers and Services), New York, New York: Will use an existing city-wide data collection system to address oral disease and ability to eat among homebound older adults. Objectives include developing and delivering modified meals appropriate for reduced oral/dental function; and testing the utility of oral health items included in the Senior Tracking Analysis and Reporting System to identify clients in need of modified meals.
Health Promotion Council of Southeastern Pennsylvania: Will use the program “Taking Charge of Diabetes” to increase knowledge about healthy eating and diabetes management. The Taking Charge program aims to help people self-manage their Type-2 diabetes to decrease their diabetes-related hospitalizations and emergency room visits.
Maryland Department of Aging: Will introduce evidence-based practices, cost-cutting measures, innovative meal products, and efficient service delivery methods to address the epidemic of older adult malnutrition. Objectives include improving quality within the statewide delivery system by creating new medically tailored meal packages and meal delivery mechanisms for patients transitioning from hospital to home. The project also will establish an evidence-based framework for a new malnutrition education program.
University of Utah: Will develop a high-quality malnutrition home visitation pilot program for home-delivered meal recipients. Objectives include providing community-focused malnutrition training from a person- and family-centered perspective; identifying nutrition indices related to functionality, quality of life, ability to age-in-place, and hospital readmission; and creating personalized nutrition care plans.
Missouri Alliance of Area Agencies on Aging:
Will use an advanced data-card technology to improve the service, delivery, and cost-effectiveness of congregate nutrition programming for older people at high risk of malnutrition. The technology will track member participation, and offer interactive feedback, personal nutrition information, and health management advice.
For home delivered meals, the program will use in-home, artificial intelligence-enabled “smart” speakers to improve the service, delivery, and cost-effectiveness of the in-home nutrition program for older people at high risk of malnutrition. The speakers will reduce access barriers to good nutrition by opening up numerous nutrition choices. They are also highly programmable, and community partners will install code that facilitates communication and food ordering through local food pantries, all through simple voice commands by the client. Creating grocery lists, browsing and ordering food items, and arranging for delivery to the home are examples of services. After the client communicates the food order to the pantry, the volunteer network or contract delivery service transports the food items to the home.
Iowa Department of Aging, Linn County Innovations: According to your short program discription of the use of funds awarded your organization agreed to: "Iowa Department on Aging: Aims to improve health outcomes of participants in the Linn County Innovations in Nutrition Program by promoting higher service quality. etc" To my reading of the results posted today, 8/13/19 the outcomes are not being reported. Only the value of services provided and the numbers served. These are not HEALTH OUTCOMES. These are factors which may contribute to HEALTH OUTCOMES. Where is your proof of value? On the email received today, there are several measurement of increased donations and participation, but not a single health outcome i.e. lower blood pressure, weight loss, lower cholesterol levels, reduced LDLs increased HDLs, etc. Looks like you spent all your money on delivery with no measurements of real HEALTH OUTCOMES. Were there any to report? Are they reported elsewhere? Please show me the value of the cost of services provided. Respectfully, Thank you.
Thank you for your interest in nutrition innovations and your question about Iowa’s project. ACL collects and reviews data that measure several widely accepted markers that indicate a successful nutrition and education program.
But first, some background on the situation facing Iowa’s Heritage Area on Aging (referred to as “Heritage”). Heritage serves the people of Linn County and Cedar Rapids. Since 2011, the area had a 74% decrease in participation at its senior meal program, compared to a statewide decline of 46%. This steep decline reflected the trend in rural counties across the country, but intensified by flooding in 2008 that destroyed the area’s senior center. Losing the place where seniors gathered for meals and other health-related activities directly translated to lost meals and interactions about healthy behavior and risk reduction, including diabetes and falls prevention programs.
Linking seniors to food and services is critical to maintaining and improving health. Seniors who face food insecurity often also face housing problems, social isolation, and multiple chronic conditions. Therefore, providing someone access to food is not necessarily enough to improve their health. Iowa’s innovation uses a multiple-pronged approach.
Outcomes Evaluation Findings
In July 2019, we published the results of a major evaluation project on all senior nutrition programs funded by title III-C of the Older Americans Act. That evaluation showed that most participants report that the nutrition program had helped them to eat healthier foods, and two-thirds of the participants indicated the program had improved their health and helped them to achieve or maintain a healthy weight.
Although the majority of participants were food secure, we know that:
- 16 percent of congregate meal participants and 23 percent of home-delivered meal participants had experienced food access limitations during the past month due to lack of money or other resources.
- 54% of participants say a congregate meal supplies 50% or more of total food for the day.
- 71% of congregate and 90% of home-delivered meal participants felt the program helps them live independently and remain in their home.
- Participants have fewer hospitalizations, fewer ER visits leading up to a hospital readmission, and fewer nursing home admissions.
Food insecure older adults who are 50 years of age or older are at an increased risk of having a chronic health condition, including conditions that could be mitigated by healthy food options, for example diabetes and high blood pressure.
Additionally, food insecure individuals may skip meals, eat smaller meals, or water down drinks, all of which compromise basic nutrition. These actions can make chronic health conditions worse, and contribute to poorer health and possible functional decline.
(Source, and info on how the data was collected: https://acl.gov/programs/program-evaluations-and-reports.)
Data from Iowa’s Innovation Grant program:
Knowing these findings, Iowa’s approach links seniors to evidence-based programs that help address with chronic conditions. A health needs assessment by Linn County needs identified diabetes and falls as significant issues (among others). Therefore, Heritage included two evidence-based programs to their model: Matter of Balance and Stepping on. These two evidence-based programs have the following health outcomes.
After completing A Matter of Balance:
- 97% of participants are more comfortable talking about fear of falling
- 97% feel comfortable increasing activity
- 99% plan to continue exercising
- 98% would recommend MOB
After completing Stepping On, participants had a 31% reduction in falls. This demonstration concluded that the program helps older adults who live at home prevent falls.
The Heritage Area Agency on Agency is working with Iowa State University to measure nutrition risk and awareness of the program. These results will be finalized at the end of the grant period.
We hope this background information and data is useful.