A federal study could help states better understand and address nutritional needs of older adults.
Over the past decade, a focus has been given to providing federal nutrition assistance programs for children, for good reason, according to the U.S. Government Accountability Office. It has been proven that good nutrition can help children develop, improve their health, improve their minds, strengthen their immune systems and more. But it is unclear whether there has been any focus placed on improving the nutritional benefits of food provided to older adults in programs that serve them, according to a GAO report that looked at nutrition assistance programs.
For more than a year, the GAO - which monitors government spending - conducted a study of federal nutrition requirements for older adults, the relationship between their nutrition and their health outcomes, and the challenges program providers face in trying to meet older adults' nutritional needs.
The agency completed its report in November and, among other things, recommended the U.S. Department of Health and Human Services develop a plan to include nutritional guidelines for older adults, whose needs change and vary as they age, in future publications.
Most recent U.S. Census data show people ages 65 and older make up about 16 percent of the U.S. population. The Census projects that by 2030, one in five Americans will make up that demographic. By 2060, the number of Americans ages 85 and older is expected to triple from 6.4 million today to 19 million.
The majority of older adults have chronic health conditions, such as diabetes or heart disease, according to the report.
"Research shows that such individuals may have different nutritional needs," it states. "As older adults age, they may also face barriers, such as a reduced appetite, impairing their ability to meet their nutritional needs."
DHHS should document a plan for updating its nutritional guidelines to include guidelines specifically for the aging population, the report says, to help ensure to better address the needs of that population.
Federal nutrition programs serving older adults provide meals in congregate settings or in seniors' homes. Supplemental Nutrition Assistance Program benefits allow seniors to buy food in participating food stores. Commodities are available for low-income older adults. Adults with disabilities, who are enrolled in an adult day care program, may receive prepared meals. And older adults may participate in Senior Farmers' Market Nutrition Program, which allows them to purchase fresh produce from farmers markets, roadside stands and community-supported agriculture programs.
But the programs don't have the information necessary to help older adults meet their unique dietary needs.
"According to a study conducted by the Academy of Nutrition and Dietetics, physiological changes that occur with age, such as decreased metabolism and reductions in muscle mass and nutrient absorption, make it difficult for older adults to meet their nutritional needs," the study states. "Research reviewed to develop the dietary guidelines also indicates that older adults experience a decline in calorie or energy needs as they age, due in part to decreased physical activity."
Older adults' taste and smell sensations may also diminish, which also leads to lower food consumption.
Additionally, age-related physical or mental impairments oftentimes affect people's ability to meet their nutritional needs.
"Some older adults' inability to perform daily activities - which can include eating, walking or leaving the home to obtain groceries or meals because of physical or mental impairment - can contribute to inadequate nutrition," the report says. "According to the (Centers for Disease Control and Prevention), age-related declines in cognitive functioning, such as the ability to reason and remember, may affect some older adults' ability to leave their homes and shop for food, hindering their ability to meet their nutritional needs."
Age-related physical impairments, such as mobility or vision, may also affect whether older adults can open, read or use food packaging and may limit their ability to prepare food.
Their medications may affect how they absorb or consume nutrients.
Many older adults experience food insecurity and have limited access to food nutrients
The GAO report presents five recommendations to address nutritional needs of older Americans:
- The first is that the DHHS update its Dietary Guidelines for Americans to not only focus on older adults' needs but also identify existing information gaps on their specific needs.
- Second - states should monitor providers to ensure meals provided to home-bound seniors meet existing federal nutrition requirements.
- Third - improve oversight of meals provided for adult day care centers.
- Fourth - centralize information on promising approaches for making meal accommodations to meet the nutritional meal programs, possibly on the National Resource Center on Nutrition and Aging website. However, content on that site may be out of date. The Administration for Community Living, which backs community-based organizations that support older adults who choose to remain in and participate in their communities as they age, has committed to provide a grant in 2020 for a new site to centralize information.
- Last - the federal Child and Adult Care Food Program provides reimbursements for nutritious meals to eligible adults enrolled at participating adult day care centers. Federal agencies should take steps to better disseminate existing information that could help state and local entities involved in providing CACFP meals meet nutritional needs of older participants. The agencies should also continue to identify additional promising practices to share with the program.
Oversight of nutrition assistance programs is not fully addressing some of the challenges that hinder state and local providers' efforts to meet their clients' nutritional needs, the report says.
Efforts by both DHHS and the U.S. Department of Agriculture to oversee older adult meal programs have limitations that affect information available at the federal level needed to ensure programs are meeting older adults' nutritional needs, it says.
"DHHS and USDA administration and oversight of the nutrition assistance programs are not fully addressing some of the challenges states and local providers indicated hinder their efforts to meet older adults' nutritional needs," the report concludes. "Providers we spoke with faced challenges meeting older adults' needs for certain meal accommodations, and information from DHHS and the USDA regarding promising approaches to meeting those needs is limited or not sufficiently disseminated. Further, both DHHS and USDA's efforts to oversee older adult meal programs have limitations that affect information available at the federal level needed to ensure programs are meeting older adults' nutritional needs."