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Papadaki A, Ali B, Cameron A, Armstrong MEG, Isaacs P, Thomas KS, Gadbois EA, Willis P. 'It's not just about the dinner; it's about everything else that we do': A qualitative study exploring how Meals on Wheels meet the needs of self-isolating adults during COVID-19. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2012-e2021. [PMID: 34766667 PMCID: PMC8652984 DOI: 10.1111/hsc.13634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
Meals on Wheels (MoWs), a service offered by local authorities in England, deliver meals to older, housebound and/or vulnerable adults, who might otherwise not be able to acquire and prepare their own meals. Research suggests that MoWs provide benefits beyond nutrition. Little is known about the actual interactions between service providers and clients, particularly during the COVID-19 pandemic. The aim of this small-scale, formative study was to explore MoWs service providers' experiences and their perceptions around the benefits and challenges faced by the service, and understand how these experiences changed during the first UK national lockdown. Semi-structured interviews were conducted in September 2020 with 18 service providers of MoWs (drivers who deliver the meals, service coordinators and managers) in two local authorities in England, and analysed thematically. Participants indicated that benefits of the service encompassed those to clients (e.g. welfare checks, encouraging independence and identifying and addressing isolation and loneliness), employees (e.g. sense of pride, rewarding relationships with clients) and the wider community (e.g. reducing pressures on families), and described MoWs as the 'fourth emergency service' (e.g. being the first responders to emergency situations). Participants identified several challenges faced by the MoWs service, including organisational challenges (e.g. funding cuts and closures, lack of appropriate publicity to raise awareness of the service) and restrictions on time spent with clients. The pandemic and lockdown resulted in increased demand on resources, concerns about client and staff wellbeing and uncertainty about how the service will cope if lockdowns continue. These findings provide important insights regarding the wide benefits of MoWs and the challenges the service faces, which can be used as the formative research base to guide future interventions and policies to protect vulnerable adults, not only during the COVID-19 pandemic, but beyond.
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Affiliation(s)
- Angeliki Papadaki
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Becky Ali
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
| | - Ailsa Cameron
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Paul Isaacs
- Centre for Exercise, Nutrition and Health SciencesSchool for Policy StudiesUniversity of BristolBristolUK
| | - Kali S. Thomas
- U.S. Department of Veterans Affairs Medical CenterProvidenceRhode IslandUSA
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Emily A. Gadbois
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Paul Willis
- Centre for Research in Health and Social CareSchool for Policy StudiesUniversity of BristolBristolUK
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Brady PJ, Askelson NM, Thompson H, Kersten S, Hopkins H. Meeting Older Adults' Food Needs: Interviews with Area Agency on Aging Staff, Food Bank Staff, and Older Adults. J Nutr Gerontol Geriatr 2022; 41:235-255. [PMID: 36016490 PMCID: PMC9679729 DOI: 10.1080/21551197.2022.2114569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Area Agencies on Aging (AAAs) and food banks provide nutritious food for in-need older adults. The objective of this study was to identify successes, challenges, and opportunities associated with meeting the food needs of older adults. We used semi-structured telephone interviews with AAA nutrition staff (n = 5), food bank program coordinators (n = 5) and executives (n = 6), and older adults (n = 60) in Iowa. AAAs and food banks identified providing healthy food and client satisfaction as successes and funding and staff/volunteer capacity as challenges. Before the pandemic, the relationships between these organizations were limited, but both saw opportunities for collaboration. Older adults described coordination between AAAs and food banks during the COVID-19 crisis. AAAs and food banks play an important role in meeting older adults' food needs, but their effectiveness is limited by challenges related to funding and capacity. There is a need to identify feasible and sustainable strategies for collaboration past this crisis.
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Affiliation(s)
- Patrick J. Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2 Street Suite 300, Minneapolis, MN, 55455
| | - Natoshia M. Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA 52246
- University of Iowa Public Policy Center, 310 S Grand Ave, Iowa City, IA 52242
| | - Helaina Thompson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA 52246
| | - Sarah Kersten
- Department of Community and Behavioral Health, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA 52246
| | - Haley Hopkins
- Iowa Department of Public Health, 321 E. 12 Street, Des Moines, IA, 50319
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Shieh JA, Leddy AM, Whittle HJ, Ofotokun I, Adimora AA, Tien PC, Weiser SD. Perceived Neighborhood-Level Drivers of Food Insecurity Among Aging Women in the United States: A Qualitative Study. J Acad Nutr Diet 2021; 121:844-853. [PMID: 33547033 PMCID: PMC8084897 DOI: 10.1016/j.jand.2020.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/16/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aging populations in the United States exhibit high rates of food insecurity and chronic illness. Few studies have explored the neighborhood-level drivers of food insecurity among such populations, and how they intersect with experiences of aging. OBJECTIVE The aim of this study was to explore how aging women experience food insecurity in the United States, and the neighborhood-level factors that influence these experiences. DESIGN Semistructured qualitative interviews were conducted to elicit participants' perceptions of how their neighborhood influenced their experiences with food security and aging. PARTICIPANTS/SETTING Thirty-eight food-insecure women aged 50 years and older were purposively sampled from the Northern California, Georgia, and North Carolina sites of the Women's Interagency Human Immunodeficiency Virus Study. Interviews were conducted between November 2017 and July 2018 at the three Women's Interagency Human Immunodeficiency Virus Study sites. STATISTICAL ANALYSIS Three researchers thematically analyzed the data using an inductive-deductive approach. RESULTS Participants described neighborhood-level drivers of food insecurity that centered around three themes: accessibility of food from traditional food stores, the role of food aid institutions, and the intersection of aging with the food environment. Participants explained that food insecurity was related to limited access to food stores largely due to long distances and poor public transportation in Georgia and North Carolina, and high food prices in Northern California. Most participants described being dependent on food aid programs, but found this difficult due to poor quality food and long wait times. Aging-related issues emerged as a cross-cutting theme, with fatigue, poor strength, and chronic illness amplifying barriers to accessing food. CONCLUSIONS Findings from this study reveal the structural barriers that aging women face in accessing healthy food within their neighborhoods, and how experiences with aging and chronic illnesses exacerbate these barriers. Although future programs should address common neighborhood-level barriers such as the accessibility and affordability of healthy foods, they should also be tailored to aging women and the local context.
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Affiliation(s)
- Jacqueline A Shieh
- (1)Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA.
| | - Anna M Leddy
- (2)Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Henry J Whittle
- (3)Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Ighovwerha Ofotokun
- (4)School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA
| | - Adaora A Adimora
- (5)School of Medicine, and Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Phyllis C Tien
- (6)Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sheri D Weiser
- (6)Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Sinnett S, Bengle R, Brown A, Glass AP, Johnson MA, Lee JS. The validity of Nutrition Screening Initiative DETERMINE Checklist responses in older Georgians. ACTA ACUST UNITED AC 2011; 29:393-409. [PMID: 21104511 DOI: 10.1080/01639366.2010.521031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Nutrition Screening Initiative DETERMINE Checklist (NSI) is used throughout the United States to assess nutrition risk of those requesting the services of the Older Americans Act Nutrition Program (OAANP). This study examined the ability of the NSI to evaluate nutrition risk by comparing the responses between NSI and matched comparable survey questions using the self-administered mail survey data that were collected among 924 new OAANP applicants in Georgia (mean age 75.0 ± 9.2 years, 68.8% women, 26.1% Black). Ninety-four percent of our sample provided at least one discordant response (i.e., disagreement between responses to the NSI and matched questions). Questions regarding food intake most frequently yielded discordant responses. Black participants were more likely to provide discordant responses for the meal frequency question. Food insecure individuals were less likely to provide discordant responses for food intake questions. Those who lived alone were less likely to provide discordant responses for the dairy intake question. Some NSI items may have limited ability to reliably assess nutritional risk of older adults. Further efforts are warranted to improve nutritional assessment tools for use in vulnerable older adults.
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Affiliation(s)
- Stephanie Sinnett
- Department of Foods and Nutrition, University of Georgia, Athens, Georgia 30602, USA
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Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria. Public Health Nutr 2011; 14:1017-23. [DOI: 10.1017/s136898001000385x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.DesignMultilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.SettingRandom selection of households from fifty small areas in Melbourne, Australia, in 2003.SubjectsThe main food shoppers in each household (n 2564).ResultsA lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.ConclusionsIn Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.
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Lee AH, Jancey J, Howat P, Burke L, Kerr DA, Shilton T. Effectiveness of a home-based postal and telephone physical activity and nutrition pilot program for seniors. J Obes 2011; 2011:786827. [PMID: 20847889 PMCID: PMC2931427 DOI: 10.1155/2011/786827] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 05/05/2010] [Indexed: 12/01/2022] Open
Abstract
Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.
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Affiliation(s)
- Andy H. Lee
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
- *Andy H. Lee:
| | - Jonine Jancey
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
| | - Peter Howat
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
| | - Linda Burke
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
| | - Deborah A. Kerr
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
| | - Trevor Shilton
- Western Australia Division, National Heart Foundation, Perth, WA 6008, Australia
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Lee JS, Sinnett S, Bengle R, Johnson MA, Brown A. Unmet Needs for the Older Americans Act Nutrition Program. J Appl Gerontol 2010. [DOI: 10.1177/0733464810376512] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study documents the size of unmet needs for Older Americans Act Nutrition Program (OAANP) and characteristics of program participants and waitlisted people based on the data from the Georgia client database systems. About 60% of those who requested the OAANP service between July and early November, 2008 ( n = 4,952) were on waitlists. Waitlisted people, especially those on the Home-Delivered Meals (HDM) waitlist, were more likely to report poorer sociodemographic characteristics, poorer self-reported health status, food insecurity, and nutritional risk. Requesting HDM was the foremost significant factor associated with unmet needs. Other race/not disclosing race information and living alone also increased the odds of being on the waitlists. There is a critical unmet need for the OAANP in Georgia, especially among those targeted by the Older Americans Act and requesting HDM. Federal and state policy makers, administrators, and program providers should better understand and meet the need of nutritionally vulnerable older Georgians.
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Affiliation(s)
| | | | | | | | - Arvine Brown
- Georgia Department of Human Services Division of Aging Services, Atlanta, GA, USA
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Hamelin AM, Mercier C, Bédard A. Discrepancies in households and other stakeholders viewpoints on the food security experience: a gap to address. HEALTH EDUCATION RESEARCH 2010; 25:401-412. [PMID: 19564176 DOI: 10.1093/her/cyp033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper reports results from a case study on household food insecurity needs and the interventions that address them. It aimed at comparing households' perceptions on food insecurity experience and vulnerability to those of other stakeholders: community workers, programme managers and representatives from donor agencies. Semi-structured interviews with 55 households and 59 other stakeholders were conducted. Content analysis was performed, using a framework encompassing food sufficiency, characterization of household food insecurity and vulnerability of households to food insecurity. Overall, the results draw attention to a gap between households and the other stakeholders, where the later do not seem always able to assess the realities of food-insecure households. Other areas of divergences include: characteristics of food insecurity, relative importance of various risk factors related to food insecurity and the effectiveness of the community assistance to enhance the households' ability to face food insecurity. These divergent perceptions may jeopardize the implementation of sustainable solutions to food insecurity. Training of stakeholders for a better assessment of households' experience and needs, and systematic evaluation of interventions, appear urgent and highly relevant for an adequate response to households' needs. Collaboration between all stakeholders should lead to knowledge sharing and advocacy for policies dedicated to poverty reduction.
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Affiliation(s)
- Anne-Marie Hamelin
- 1Department of Food Sciences.utrition, Pavillon Paul-Comtois, Université Laval, 2425 rue de l'Agriculture, Québec, QC, Canada G1V 0A6.
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Abstract
Prevention of premature chronic diseases is an important component of healthy aging. Nutrition education can help to reduce the risk of premature chronic diseases in some older adults. Home delivered meals and congregate dining services assist vulnerable elderly persons by providing opportunities for nutritional and social support. Screening and assessment tools identify factors affecting nutritional health and can also provide specific directions for planning, implementation, and evaluation of tailored interventions. Dietitians and allied health professionals are well positioned to assist a heterogeneous population of older adults in securing nutritional adequacy.
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Affiliation(s)
- Magdalena Krondl
- Department of Nutritional Sciences, Faculty of Medicine, Institute for Human Development, Life Courses and Aging, University of Toronto, Ontario, Canada.
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Perception of needs and responses in food security: divergence between households and stakeholders. Public Health Nutr 2008; 11:1389-96. [DOI: 10.1017/s1368980008003406] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectivesThe aim of the study was (i) to describe the needs of food-insecure households and their assessment of community programmes, as expressed by households and perceived by stakeholders; and (ii) to examine the similarities and differences between households’ and stakeholders’ perceptions in Quebec City area.Design/setting/subjectsA semi-structured interview and sociodemographic questionnaire with fifty-five households and fifty-nine stakeholders (community workers, managers, donor agencies). The transcriptions were subjected to content analysis and inter-coder reliability measurement.ResultsThe respondents’ perceptions converge towards three main categories of needs: needs specific to food security, conditions necessary for achieving food security and related needs. There was agreement on the necessity of better financial resources, although the impact of financial resources alone may be uncertain in the opinion of some stakeholders. Different perceptions of needs and of their fulfilment by community programmes emerge between both groups. Despite households found positive aspects, they complained that quality of food and access were major needs neglected. Their account suggests overall a partial fit between the programmes and food security needs; even a combination of programmes (e.g. collective kitchens, purchasing groups, community gardens) was insufficient to adequately meet these needs. In contrast, most stakeholders perceived that the household’s primary need was a basic amount of food and that the households were satisfied with programmes.ConclusionsIt is urgent to evaluate the overall effect of community programmes on specific aspects of household food insecurity. The results emphasise that community programmes alone cannot bring about social change needed to prevent food insecurity.
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Keller HH, Dwyer JJM, Edwards V, Senson C, Gayle Edward H. Food security in older adults: community service provider perceptions of their roles. Can J Aging 2008; 26:317-28. [PMID: 18304920 DOI: 10.3138/cja.26.4.317] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as "the need for personalization of service". Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.
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Affiliation(s)
- Heather H Keller
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.
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