Recently Hospital-Discharged Older Adults Are Vulnerable and May Be Underserved by the Older Americans Act Nutrition Program

Abstract

The home-delivered meal (HDM) program of the Older Americans Act Nutrition Program (OAANP) has traditionally served frail homebound older adults; however, due to gaps in the continuum of care, enrollment in this program following hospital discharge remains a challenge. Trained interviewers at 6 HDM sites in 6 U.S. states assigned 566 hospital-discharged individuals, ages 60–96 years, into either early (48 hour) or delayed (2 weeks) enrollment groups and assessed their health and nutrition status. Regardless of elapsed time at enrollment, more than 80% reported at least one limitation in activities and instrumental activities of daily living. About 20% had impaired cognition and more than 40% had depressive symptoms. Also, 40% reported fair or poor appetite. Despite intense recruitment from hospitals, only 30% ofparticipants were referred from hospitals. The recently hospital-discharged older adult population may include a higher prevalence of individuals with poor functional status and at nutritional risk than participants in the OAANP HDM program and yet may be underserved by this program.

KEYWORDS:

• home-delivered meal program
• hospital-discharge
• nutritional risk
• OAANP
• older adults
• transitional care
• vulnerable

This article was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services (DHHS). Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, reflect official DHHS policy.

We wish to acknowledge and thank all individuals who worked on this project. We couldn't have done it without them. These include the staff at Meals On Wheels Association of America, Alexandria, VA; Hawkeye Valley Area Agency, Inc., Waterloo, IA; Cenla Area Agency on Aging, Alexandria, LA; Nutrition Services, Onondaga County Department of Aging & Youth, Syracuse, NY; Meals On Wheels of Stark & Wayne Counties, Massillon, OH; The Lutheran Service Society of Western Pennsylvania, Pittsburgh, PA; Christian Senior Services, Meals On Wheels of San Antonio, TX.

Notes

*2004 Administration on Aging, National Participants Survey (44).

†National Center for Health Statistics. Health, United States, 2007 (45).

‡He et al. (2005) (46).

^§Centers for Medicare & Medicaid Services. Medicare Current Beneficiary Survey, 2002 (47).

*Significantly different from early enrollees (p < 0.01).

†2004 Administration on Aging, National Participants Survey (44).

†Barnes PM et al. (2009) (48).

‡Brault M. (2005) (49).

^§Pratt L, Broody D (2008). Data refers to older adults 60 years and older. Depression status estimated using the Patient Health Questionnaire (PHQ-9), thus it is included here for comparison only (50).

*2004 Administration on Aging, National Participants Survey (44). Data on difficulty shopping is inferred from the question: “Because of a physical or mental health condition, do you have difficulty going outside the home, for example to shop or visit a doctor's office?”

†Brault M. (2005) (49). Data on difficulty shopping is inferred from the question in the Survey of Income and Program Participation (SIPP) “Because of a physical or mental health condition, do you have difficulty going out by yourself?”