Together in Care: An Enhanced Meals on Wheels Intervention Designed to Reduce Rehospitalizations among Older Adults with Cardiopulmonary Disease—Preliminary Findings

Rehospitalizations in the Medicare population may be influenced by many diverse social factors, such as, but not limited to, access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12 months, and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3 months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital expenditure. In regard to the results, 84 participants were included in the pilot cohort, with the majority (54) having COPD. Mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p < 0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as its generalizability across diverse geographic regions.

Engaging Stakeholders in a Pragmatic Trial of Home-Delivered Meals for Persons with Dementia

Gathering stakeholder feedback is essential to designing and implementing relevant and actionable research. Additionally, stakeholders, particularly those directly impacted by an intervention, bring unique insights and experiences. This paper presents the process and findings of a research endeavor to co-design a pragmatic clinical trial with a Stakeholder Advisory Panel (SAP) in an effort to understand facilitators and barriers to conducting the research and implementing study findings. The proposed trial compares the impact of frozen, drop-shipped meals versus daily home-delivered meals provided by Meals on Wheels (MOW) programs on the ability of individuals living with dementia to age in place. We recruited nine SAP members, who were compensated for their time. The SAP is composed of a) MOW clients with dementia, b) family members of MOW clients with dementia, c) paid or volunteer MOW drivers, and d) MOW staff. A research team member facilitated two 90-minute meetings with the SAP members via Zoom. The topics of the meetings included potential benefits and challenges with each mode of meal delivery, the importance of the primary outcome (time to nursing home placement), topics of interest to include in interviews with clients and caregivers, and how participants would explain the study to a friend. Audio of the Zoom meetings was transcribed, and meeting summaries were shared with the SAP. Benefits of forming and engaging a SAP, as well as key lessons learned from SAP members and how recommendations were reflected in changes to the study protocol will be discussed.

Food Insecurity in Older Adults: Gerontology Students and RSVP a Partnership that Works

A gerontology course related to policies /programs each year researches, develops and designs a service-learning project related to an issue/concern for older adults and their quality of life. Students wanted to work with vulnerable older adults and after research and discussion decided on tackling the issue of food insecurity in older adults. Food insecurity is a growing issue for older adults which has been exasperated by COVID-19. According to Meals on Wheels America (2020) there has been a 22% increase in the number of older adults needing food assistance. In addition, while the need for food banks has increased donations have declined (Next Avenue, 2020). Students partnered with RSVP, which had previously conducted a food donation project.. Students took on the responsibility for advertising, soliciting grocery stores to allow us to set up and engage shoppers in purchasing items for the project. In addition, they reached out to the university community and set up food donation stations. RSVP sent out emails to their constituents to encourage them to volunteer and do their shopping on the date of the project. Students were paired with RSVP volunteers at two stores and provided shopping lists and information about food insecurity in older adults to shoppers. Students collected 566 pounds of food. The food was distributed equally between Catholic Charities, which has a senior shopping program and the Somali Elder Community. Students sorted the food by categories and removed any foods with pork/gelatin products for the Somali Community.

Social Connectedness, Meals on Wheels Services and Healthcare Utilization Among High-Need Older Adults

Homebound vulnerable adults 65+ are at an increased risk for social isolation and loneliness. The adverse consequences of loneliness are profound – including increased health care utilization, burden of dementia, chronic diseases, and mortality. Meals on Wheels (MOW) is a familiar source of nutritional support for homebound individuals who wish to stay in their homes and has additional important benefits. A growing body of evidence demonstrates that MOW provides mental and social health benefits beyond nutrition, but less is known about the interplay between MOW, social cohesion, and health services use. This project will address this gap in the literature using data from the 2013-2020 National Health and Aging Trends Study (NHATS), a nationally-representative panel study of 65+ Medicare enrollees. Using matching and longitudinal multivariate techniques, the risks of hospitalization and permanent nursing home entry are compared between MOW users and non-users. Our longitudinal dataset includes 11,266 observations. Of those, 12.8% rely on MOW or other food assistance (N= 1,488) and 16.6% experience low social cohesion (N= 1,936). Some 6.6% of participants are nursing home residents (N= 748) and the 39.1% report an overnight hospital stay in the prior year (N= 4,560). MOW is a comparatively low-cost intervention to help homebound older adults retain their independence and limit costlier healthcare utilization. This work extends our understanding of MOW services beyond simple nutrition benefits to its potential impact on social health.

How Has COVID-19 Impacted Older Adults and Their Needs for Services?

COVID-19 has had profound effects on older adults and will have lasting impacts on their preferences and needs for services, including those offered by Meals on Wheels and other community organizations. Organizations serving older adults would benefit from insights about how to prioritize resources and services to address older adults’ needs during the pandemic and beyond. On behalf of Meals on Wheels America, NORC at the University of Chicago conducted a study to explore COVID-19’s impacts on older adults and older adults’ needs during the pandemic. We conducted two data collection activities with adults age 60 and older: a nationally representative survey with 1,535 respondents and 24 interviews. Results indicated that COVID-19 has affected older adults’ physical and mental health, social connectedness, employment, and use of services and technology. Informal networks of family members and friends are a source of assistance for 50% of older adults during the pandemic. Impacts of COVID-19 differed by income, rurality, disability status, and living situation. Findings documented the extent to which older adults had unmet needs during the pandemic, such as activities to help keep busy at home and affordable food to meet dietary needs. Survey respondents who have a lower income, are 75 and older, live alone, and who are Black were more likely to have unmet needs. Findings suggested a need to strengthen partnerships among organizations that serve older adults to address diverse needs, conduct ongoing assessments of older adults’ needs and preferences, and enhance assistance for informal support networks.

Dementia Care Management: Social Capital for Persons with Dementia that Live Alone

Social connections are critical for healthy aging (Ahn et al., 2020). Consistent findings in research for persons with dementia that live alone show that a natural support network is the gold-standard for success, as social capital enhances well-being. Therefore a community-based intervention was piloted as part of a national 'special populations grant' in partnership with the local Meals-on-Wheels program. Dementia care management provided by graduate social work interns sought to provide weekly supportive contacts. Quantitative data was collected at baseline and following the program through administration of standardized measurement tools for “thriving” and for “dementia quality of life.” The sample to date (N=33) consists of a majority being white females (82.4%), with additional participants expected as the remaining enrolled complete the program. These early “completers” do not show significant changes in their specific “surviving to thriving” domains, yet they do report greater perceptions of quality in their life as a whole following the dementia care management intervention when comparing post data to their baseline (Chi Square 18.95, p=0.004). To date this intervention continues to be studied and suggests a positive impact is likely for older adults with dementia that live alone, as well as for the communities where they reside.

Self-Reported Utilization of Nutrition-Related Resources in Veterans Compared to Non-Veterans

As they age, Veterans are at elevated risk for developing nutrition-associated chronic diseases compared to their Non-Veteran counterparts. This is despite Veterans often being eligible for a variety of nutrition-related resources. This project compared self-reported utilization of community and government nutrition-related resources in male Veterans compared to Non-Veterans participating in the 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys. Veterans (mean: age: 59 years; BMI: 29 kg/m2; N=135) self-reported “yes” and Non-Veterans (age: 61 years; BMI: 30 kg/m2; N=230) self-reported “no to “ever having served on active duty in the U.S. Armed Forces.” A similar percentage of Veterans (3%) and Non-Veterans (4%) reported utilizing meal delivery programs (i.e., “Meals on Wheels) and eating at community or senior centers (both 7%) in the past year. Veterans were less likely than Non-Veterans to report receiving emergency food (i.e. from church or food bank) in the past year (7% vs. 12%; P&lt;0.01) and tended to be less likely to report ever having received benefits from a nutrition assistance program (NAP; i.e., Food Stamps) (27% vs. 32%; P=0.08). Veteran also reported their household receiving more financial assistance the last time they received support from a NAP ($281 vs. $188; P=0.02). These data suggest that Veterans have less reliance on NAP than Non-Veterans; however, when they do receive assistance, Veterans appear to receive greater financial support. Future studies are needed to identifying ways to improve access to nutrition-related resources in those at risk for food insecurity.

Together In Care: An Enhanced Meals on Wheels Intervention Designed To Reduce Rehospitalizations Among Older Adults – Preliminary Findings

Rehospitalizations in the Medicare population may be influenced by many social factors, such as access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12-months and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3-months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital utilization. In regards to the results, 84 participants comprised the pilot cohort. Their mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p<0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as the generalizability across diverse geographic regions.

Meals on Wheels central Texas: addressing loneliness and isolation through client-volunteer interaction

Purpose Meals on Wheel Central Texas (MOWCTX) provides meals to more than 5,000 home-bound older adults in the Austin area every weekday. The purpose of this paper is to examine the impact of client-volunteer interactions to assess the social benefits clients receive and ascertain if and how loneliness and social isolation are addressed. Design/methodology/approach Observations of volunteer-client interactions, interviews with clients and surveys of clients were conducted to gain insight into clients’ experiences with MOWCTX services. Findings Qualitative analysis of observation and interview data revealed four non-tangible benefits clients received from MOWCTX: reduced physical risks when mobility issues are present, a daily safety check, opportunities for social contact and increased ability to maintain independence. Survey results supported these conclusions. Originality/value This research examines the impact of volunteer-client relationships on the experience of loneliness and social isolation.