Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries

Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants’ health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70–97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review

Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.

Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch

OBJECTIVE

This study evaluated the influence that expanding a home-delivered meals service to include breakfast and lunch would have on the nutritional status and quality of life of at-risk older adults.

DESIGN

This cross-sectional field study compared two groups. The breakfast group (n=167) received a home-delivered breakfast and lunch, 5 days per week. The comparison group (n=214) received a home-delivered lunch 5 days per week. Participants' 24-hour food recall, demographics, malnutrition risk, functional status, and surveys of quality of life as health, loneliness, food enjoyment, food security, and depression were obtained.

PARTICIPANTS

Study participants were recruited from five Elderly Nutrition Programs involved in the Morning Meals on Wheels breakfast service demonstration project. They formed a geographically and racially/ethnically diverse sample. Participants ranged in age from 60 to 100 years, were functionally limited, and at high nutritional risk. Most were low income, lived alone, and had difficulty shopping or preparing food.

STATISTICAL ANALYSIS

Descriptive statistics were used to assess group comparability. Independent sample t tests were used to examine group differences, with Bonferroni's method used to control for familywise Type I error.

RESULTS

Breakfast group participants had greater energy/nutrient intakes (P<.05), greater levels of food security (P<.05), and fewer depressive symptoms (P<.05) than comparison group participants.

CONCLUSIONS

The addition of a breakfast service to traditional home-delivered meals services can improve the lives of frail, homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service to a targeted population.

Differences in Preferences of Entrees by Elderly Congregate Meal Participants According to Age, Gender, Ethnicity and Education and a Factor Analysis Approach to Group Entrée Preferences

Congregate meal participants (n = 381), ages 60-100, provided preference ratings of 43 entrees utilizing a modified Food Rating Scale (FACT). Differences in preferences of entrees associated with age, gender, ethnicity and educational level were analyzed using X2 analysis. Factor analysis was used to group entrees which were associated according to preferences. Both males and females agreed with the top five preferred entrees. For other entrees, females had a higher acceptance level. Both age groups preferred the same top five entrees; for other entrees, the younger group was more accepting of these. Few differences were noted among the various ethnic groups (91% white and 7% African-American). Education level of respondents had a varying association with entree preference, depending upon the specific entree.

The feasibility of using a telephone-administered survey for determining nutritional service needs of noninstitutionalized older adults in rural areas: time and costs

PURPOSE

This study examined response, participation, time, and costs for a telephone-administered survey to obtain comprehensive information on general health, eating habits, living environment, and functional status from a sample of older persons in a rural North Carolina county.

DESIGN AND METHODS

A probability sample of persons aged 60 years and older from the most recent electoral rolls were mailed a personalized letter, which was followed by telephone contact to recruit them into a contemporaneous survey that used a modified version of the Nutrition Screening Initiative's Level I and II screens. Time requirements and costs associated with the completion of surveys were calculated.

RESULTS

Seventy-six percent of the persons contacted by telephone (residents of 96% of county precincts) completed the survey. Because minority elders were more likely to lack a working telephone, they were underrepresented in the sample. With 555 calling attempts (58% of surveys completed on first attempt), we estimated a cost of $10.65 per completed survey.

IMPLICATIONS

Telephone-administered surveying of older adults may be considered as an appropriate component of an overall community-based service strategy. The estimation of the constituents of nutritional risk, by geographic area, economic status, or ethnicity, may aid in providing estimates of service needs and procuring and allocating resources. Additional methods of data collection are necessary in order to target older persons without telephone service.