Impact of home-delivered meal programs on diet and nutrition among older adults

Abstract

Background:

Poor diet quality and insufficient nutrient intake is of particular concern among older adults. The Older Americans Act of 1965 authorizes home-delivered meal services to homebound individuals aged 60 years and older.

Objective:

The purpose of this study was to review scientific evidence on the impact of home-delivered meal services on diet and nutrition among recipients.

Methods:

Keyword and reference searches were conducted in Cochrane Library, Google Scholar, PubMed and Web of Science. Inclusion criteria included: study design (randomized controlled trials, cohort studies, pre-post studies, or cross-sectional studies); main outcome (food and nutrient intakes); population (home-delivered meal program participants); country (US); language (articles written in English); and article type (peer-reviewed publications or theses).

Results:

Eight studies met the inclusion criteria, including two randomized controlled trial studies (from the same intervention), one cohort study, two pre-post studies, and three cross-sectional studies. All but two studies found home-delivered meal programs to significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Other beneficial outcomes include increased socialization opportunities, improvement in dietary adherence, and higher quality of life.

Conclusions:

Home-delivered meal programs improve diet quality and increase nutrient intakes among participants. These programs are also aligned with the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults maintain independence and remain in their homes and communities as their health and functioning decline.

Keywords

Home-delivered meal meals on wheels diet nutrition systematic review

Introduction

Food and nutrient intake adequate to one’s health and wellbeing is recognized as a human right (United Nations, 2007). Using the Mini Nutritional Assessment, the estimated overall prevalence of malnutrition among older adults is about 23% among 11 developed countries and South Africa (Kaiser et al.,2010). Poor diet quality among older adults is linked to various adverse health problems, such as anemia, immune dysfunction, decreased bone mass, impaired muscle function, reduced cognitive function, poor wound healing, delayed recovery from surgery, and increased mortality (Ahmed and Haboubi, 2010). The joint position statement of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education stresses that “all older adults should have access to food and nutrition programs that ensure the availability of safe, adequate food to promote optimal nutritional status” (Kamp et al., 2010).

The Older Americans Act (OAA) of 1965 was the first federal-level legislation aimed at providing comprehensive services for older adults (House of Representatives, 1965). The OAA Nutrition Program is the largest national food and nutrition program specifically for the older population (Kamp et al., 2010). Title III C2 of the OAA authorizes home-delivered meals (also known as meals on wheels) and related nutrition services to homebound individuals aged 60 years and over, the spouse of the beneficiary, and cohabitating people with disability (Administration on Aging, 2010). Services are also available to individuals who are under the age of 60 years with disabilities if they reside with the homebound older individual. Often, home-delivered meals are the first in-home service that older adults receive, serving as a primary access point for other home- and community-based services such as nutrition screening, education, and counseling. In 2010, 145,454,444 home-delivered meals (about 60% of all meals including both home-delivered and congregate meals) were served to 868,076 older adults (about 33% of all OAA Nutrition Program participants). Home-delivered meal programs are typically required to offer at least one meal per day, five or more days per week (less frequently in rural areas). Each meal should provide a minimum of one-third of the daily recommended dietary allowances established by the Food and Nutrition Board of the National Academy of Sciences and comply with applicable safety, sanitation, and delivery provisions of state and local laws. Local nutrition providers (such as the Meals On Wheels Association of America that currently runs approximately 5,000 local senior nutrition programs nationwide) are afforded the flexibility to design meals that are appealing to program participants.

Mounting health care costs necessitate federal cost-containment policy to rebalance long-term care away from more expensive nursing homes to less expensive home and community-based services (Kamp et al., 2010). The average cost of a one-month nursing home stay is equivalent to providing home-delivered meals five days a week for approximately seven years (MetLife Mature Market Institute, 2008). Each additional $25 states spent on home-delivered meals per year, per person aged 65 years and over is found to be associated with a reduction in the low-care nursing-home population by 1% (Thomas and Mor, 2013). Home-delivered meal program participants are among the most vulnerable older population in the US (Barrett and Schimmel, 2010a). About 91% reported they would have entered nursing home were it not for receiving home-delivered meals as well as other services (e.g. case management and homemaker services) (Altshuler and Schimmel, 2010). Despite home-delivered meal programs’ potential contribution to cost containment by promoting independent living, the OAA Nutrition Program remains sparse in scale and is negatively affected by federal budget cuts. In 2008, the home-delivered and congregate meals reached less than 5% of eligible older Americans, and those served averaged less than three meals per week (Administration on Aging, 2011). From 1990–2010, total appropriations for OAA nutrition services shrank by 10.4%, and consequently total meals served declined by 3.9 million.

As noted in the editorial of the American Journal of Clinical Nutrition:

[T]he sparseness of outcomes research on the OAA Nutrition Program is one of the reasons why federal funding has grown only 6-fold since its inception in the 1970s, whereas the plethora of research on the Supplemental Food Program for Women, Infants, and Children (WIC) has helped WIC grow its federal funding 332-fold in the same time period (Wellman, 2010).

About 40 million US residents (13% of US population) are 65 years and older. This number is expected to more than double by 2050 (Federal Interagency Forum on Aging-Related Statistics, 2012). In the midst of this societal transition, home-delivered meal programs’ capacity to address challenges posed by tightening global financial environments, dependence on volunteers, and increasing social isolation among the aging population has been questioned (Winterton et al., 2013). This calls for a comprehensive overview of the scientific literature examining the impact of home-delivered meal programs’ ability to serve the dietary and nutritional needs of the older population in the US. Despite individual studies on home-delivered meal programs over time, to our knowledge, the current work presents the first systematic review on the effectiveness of these programs in improving diet quality and increasing nutrient intakes among program participants.

Methods

Study selection criteria

Studies which met all of the following criteria were included in the review (Figure 1) – study design: randomized controlled trials (RCTs), cohort studies, pre-post studies, or cross-sectional studies; main outcome: food and nutrient intakes; population: home-delivered meal program participants; country: US; language: articles written in English; and article type: peer-reviewed publications or theses.

Search strategy

We searched four electronic bibliographic databases – Cochrane Library, Google Scholar, PubMed, and Web of Science, using various combinations of the following keywords: “home-delivered meals,” “meals on wheels,” “meal program,” “Elderly Nutrition Program,” “Older Americans Act,” “Administration on Aging” and “Aging Services Network.” Titles and abstracts of the articles identified through keyword search were screened against the study selection criteria. Potentially relevant articles were retrieved for evaluation of the full text.

We also conducted a reference list search (i.e. backward search) and cited reference search (i.e. forward search) from full-text articles meeting the study selection criteria. Articles identified through this process were further screened and evaluated using the same criteria. We repeated reference searches on all newly-identified articles until no additional relevant article was found. The two authors of this review jointly determined the inclusion/exclusion of all articles retrieved in full text and discrepancies were resolved through discussion.

Data extraction and synthesis

A standardized data extraction form was used to collect the following methodological and outcome variables from each included study: publication year, intervention duration, targeted population, sample size, study design, outcome measure, study result, and intervention effectiveness.

Formal meta-analysis could not be conducted due to the dissimilar nature of study design and outcome measure. Analysis was limited to a narrative review of the included studies with general themes summarized.

Study quality assessment

Following Wu et al. (2011) and An (2013), the quality of each study included in the review was assessed by the presence or absence of eight dichotomous criteria: (a) a control group was included; (b) baseline characteristics between control and intervention groups were similar; (c) the intervention period was at least four weeks; (d) the measurement tools for food and nutrient intakes were shown to be reliable and valid in previously published studies; (e) participants were randomly recruited from a well-defined population; (f) attrition was analyzed and determined not to significantly differ by respondents’ baseline characteristics between control and experiment groups; (g) potential confounders were properly controlled in the analysis; and (h) study procedures were documented in detail in the article. A total study quality score ranging from 0–8 was obtained for each study by summing up these criteria. Quality score helped measure the strength of the study evidence and was not used to determine the inclusion of studies.

Results

Study selection

A total of 396 articles were identified in the keyword and reference search, among which 363 were excluded in title/abstract screening. The remaining 33 articles were further evaluated in full text against the study selection criteria. Among them, eight articles evaluated the nutrition status of home-delivered meal program participants but without pre-post or cross-sectional comparisons (Coulston et al., 1996; Herndon, 1995; Lipschitz et al., 1985; Lo et al., 1989; Sharkey, 2002, 2004; Sharkey and Schoenberg, 2002; Vailas et al., 1998), seven articles evaluated the nutritional value of home-delivered meals but without measuring participants’ food or nutrient intakes (Barić et al., 2006; Beck et al., 2010; Bunker et al., 1986; Galea et al., 2013; Gatherer, 1971; Maclellan, 1997; O’Dwyer et al., 2009), five articles compared the effectiveness of different modes of home-delivered meal programs in increasing nutrient intakes and satisfaction among participants (the study designs were mode-to-mode rather than treated-to-untreated comparison) (Charlton et al., 2013; Gollub and Weddle 2004; Kretser et al., 2003; Osteraas et al., 1983; Silver et al., 2008), one article identified the nutritional needs (rather than food or nutrient intakes) of home-delivered meal program participants (Krassie et al., 2000), one article evaluated the impact of nutrition education and counseling (rather than the meals) on nutritional risk among home-delivered meal program participants (Wunderlich et al., 2011), and three articles examined home-delivered meal programs in other countries including Canada (Keller, 2006; Roy and Payette, 2006) and Belgium (Goeminne et al., 2012). Excluding the above articles yielded a final pool of eight studies (Edwards et al., 1993; Frongillo and Wolfe, 2010; Gleason et al., 2002; Marceaux, 2012; Ponza et al., 1996; Racine et al., 2012; Steele and Bryan, 1985; Troyer et al., 2010).

Basic characteristics of the included studies

Table 1 summarizes the eight studies included in the review, including two RCTs (from the same intervention) (Racine et al., 2012; Troyer et al., 2010), one cohort study (Frongillo and Wolfe, 2010), two pre-post studies (Gleason et al., 2002; Marceaux, 2012), and three cross-sectional studies (Edwards et al., 1993; Ponza et al., 1996a, 1996b; Steele and Bryan, 1985). The difference between pre-post and cohort studies is that the latter not only had an intervention group as in the former but also a control group which was followed before and during the intervention. All studies targeted homebound older adults in the US. Among the five studies with longitudinal quasi-experimental or experimental design (i.e. RCTs, cohort studies, and pre-post studies), the intervention duration lasted for 8–52 weeks. All but one study had relatively small sample sizes ranging from 35–298. Only one cross-sectional study had a relatively large sample size of 1659, approximately evenly split between home-delivered meal program participants (experimental group) and program-eligible nonparticipants (control group) (Ponza et al., 1996a, 1996b). Most studies represent recent work: four studies published in or after 2010, one study after 2000, and two studies after 1990. The earliest work included in the review is a cross-sectional study published in 1986. Besides food and nutrient intakes, other outcome measures include food insecurity (Edwards et al., 1993; Frongillo and Wolfe, 2010), dietary accordance (Troyer et al., 2010), energy intake (Frongillo and Wolfe, 2010; Gleason et al., 2002; Ponza et al., 1996a, 1996b; Racine et al., 2012), nutritional risk (Marceaux, 2012), diabetic control (Edwards et al., 1993), anthropometry (Gleason et al., 2002; Racine et al., 2012), quality of life (Gleason et al., 2002), and social contacts (Ponza et al., 1996a, 1996b).

Table 1.

Basic characteristics of the studies on the impact of home-delivered meal programs on diet and nutrition.

Author(s), year	Intervention duration (week)	Targeted population	Sample size	Study design	Outcome measure
Steele and Bryan, 1985	Not applicable	Homebound elderly	54	Cross- sectional	Food and nutrient intakes measured by 24-h dietary recall and diet history
Edwards et al., 1993	Not applicable	Homebound elderly with diabetes	154	Cross-sectional	Dietary patterns, food insecurity, and diabetic control
Ponza et al., 1996a, 1996b	Not applicable	Homebound elderly	1659	Cross-sectional	Food and nutrient intakes measured by 24-h dietary recall; total number of social contacts
Gleason et al., 2002	8	Homebound elderly with coronary heart disease	35	Pre-post	Food and nutrient intakes measured by three-day diet records and fasting serum lipid profiles; diet quality; anthropometry; quality of life
Frongillo and Wolfe, 2010	52	Homebound elderly	101	Cohort	Food and nutrient intakes measured by 24-hour dietary recall
Troyer et al., 2010	52	Homebound elderly with hypertension or hyperlipidemia	298	RCT	Dietary approach to stop hypotension accordance rate
Marceaux, 2012	12	Homebound elderly	40	Pre-post	Food and nutrient intakes measured by food frequency question; nutritional risk measured by nutrition screening initiative checklist and mini nutritional assessment-short form
Racine et al., 2012	52	Homebound elderly with hypertension or hyperlipidemia	298	RCT	BMI; total energy intake; percent of daily energy needs consumed calculated from 24-h dietary recall and FFQ

BMI: body mass index; RCT: randomized controlled trial.

Effectiveness of home-delivered meal programs

Table 2 reports the results and conclusions of the eight studies included in the review. All but two studies found home-delivered meal programs to noticeably improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Significantly increased micronutrients include vitamin A, vitamin C, vitamin B₁, vitamin B₂, vitamin B₆, vitamin B₉, vitamin B₁₂, beta-carotene, calcium, magnesium, phosphorus, potassium, iron, and zinc. Also identified were: significantly increased macronutrients carbohydrate and fiber; significantly decreased micronutrient sodium; significantly decreased macronutrients total fat, saturated fat, monounsaturated fat, polyunsaturated fat, and dietary cholesterol. Besides the impact of home-delivered meal programs on diet and nutrition, other reported beneficial outcomes include increased socialization opportunities and improvement in dietary adherence and quality of life.

Table 2.

Results and conclusions of the studies on the impact of home-delivered meal programs on diet and nutrition.

Author(s), year	Study result	Program effectiveness
Steele and Bryan, 1985	Nonparticipants had significantly higher intakes of carbohydrate, vitamin B₁, and iron than home-delivered meal program participants	No evidence is found on the effectiveness of home-delivered meal programs in improving diet quality or increasing nutrient intakes
Edwards et al., 1993	Home-delivered meal program participants reported fewer days without eating, more regular eating patterns, and greater diversity in diets than nonparticipants. Prevalence of food insecurity and hospitalization due to hyperglycemia or hypoglycemia were lower among home-delivered meal program participants than nonparticipants	Home-delivered meal programs are effective in improving regularity of diet patterns and reducing food insecurity, and helps with diabetic control
Ponza et al., 1996a, 1996b	All nutrient intakes under examination were higher among home-delivered meal program participants than nonparticipants. The increases were statistically significant for protein, vitamin A, vitamin C, vitamin D, vitamin B₂, vitamin B₆, vitamin B₉, vitamin B₁₂, calcium, phosphorus, potassium, magnesium, and zinc, and total food energy. Home-delivered meal program participants reported more social contacts than nonparticipants	Home-delivered meal programs are effective in increasing nutrient intakes and socialization opportunities
Gleason et al., 2002	Significant reductions in daily intakes of total energy, total fat, saturated, monounsaturated, and polyunsaturated fats, protein, dietary cholesterol, and sodium, and significant increases in carbohydrate and fiber were found following home-delivered meal program participation at post-test. Significant reductions in weight, waist circumferences, hip circumferences, and BMI were found without significant changes in high density lipoprotien or triglycerides. Significant improvements in quality of life and diet quality were found	Home-delivered meal programs are effective in improving dietary adherence and helps with weight control among elderly with coronary heart disease
Frongillo and Wolfe, 2010	Fruit/vegetable and milk consumption, protein and total energy consumption, and intake of vitamin A, vitamin B₁, vitamin B₂, vitamin B₆, vitamin B₁₂, calcium, and zinc increased among home-delivered meal program participants relative to nonparticipants at post-test	Home-delivered meal programs are effective in improving diet quality, increasing nutrient intakes, and reducing the risk of food insecurity
Troyer et al., 2010	Home-delivered meal program participants were significantly more likely to reach Dietary Approach to Stop Hypotension accordance and saturated fat accordance than nonparticipants at post-test	Home-delivered meal programs are effective in increasing compliance with dietary recommendations among overweight/obese elderly with hypertension or hyperlipidemia
Marceaux, 2012	Statistically significant decreases in food/nutrient intakes were found at post-test for vitamin D, total fat, saturated fat, monounsaturated fat, percent calories from fat, and percent calories from sweets/desserts. Significant increases were found for intake of beta-carotene and percent calories from protein. Nutritional risk decreased after home-delivered meal program participation at post-test	Home-delivered meal programs are effective in improving diet quality, increasing nutrient intakes, and reducing the risk of nutritional risk
Racine et al., 2012	No significant difference in the change of BMI, total energy intake, and percent of daily energy needs consumed were found between home-delivered meal program participants (i.e., experimental group) and nonparticipants (i.e. control group) before and after experiment	No evidence is found on the effectiveness of home-delivered meal programs in reducing weight, total energy intake, and percent of daily energy needs consumed among overweight/obese elderly with hypertension or hyperlipidemia

BMI: body mass index

The two studies with null findings on the impact of home-delivered meal programs are Steele and Bryan (1986) and Racine et al. (2012). The former is a cross-sectional study conducted in the 1980s, comparing nutrient intakes between 32 homebound program participants and 22 nonparticipants. Its reliability is of concern due to the lack of experimental design and no adjustment for potential confounders (i.e. differences in characteristics between program participants and nonparticipants which could correlate with food and nutrient intakes). The outcome measures in Racine et al. (2012) include body mass index (BMI), total energy intake, and percentage of daily energy needs consumed, with the conclusion that participation in home-delivered meal programs did not cause weight gain or weight loss in a sample of overweight/obese older adults with hypertension/hyperlipidemia.

Results are mixed on home-delivered meal programs’ impact on vitamin D and protein intake. Ponza et al. (1996a, 1996b) reported higher daily intakes of Vitamin D among program participants relative to matched nonparticipants, whereas Marceaux (2012) found decreases in Vitamin D intake at post-test. Ponza et al. (1996a, 1996b) and Frongillo and Wolfe (2010) found positive association between protein consumption and home-delivered meal program participation, whereas Gleason et al. (2002) reported reductions in daily protein intake.

The role of home-delivered meal programs in energy intake and weight control remains less clear. Ponza et al. (1996a, 1996b) and Frongillo and Wolfe (2010) reported program participation to be associated with significant increase in total energy intake. In contrast, Racine et al. (2012) did not find difference in the change of BMI, total energy intake, and percentage of daily energy needs consumed between the randomized home-delivered meal program participants and non-participants with hypertension/hyperlipidemia before and after program participation. Moreover, Gleason et al. (2002) even found reductions in total energy intake as well as weight, waist circumferences, hip circumferences, and BMI following program participation.

Study quality

Table 3 reports the results of study quality assessment. Studies included in the review on average met five out of eight quality criteria, but the distribution of qualification differed substantially across criteria. All eight studies included measurement tools for food and nutrient intakes that have been shown to be valid and reliable in existing literature, seven of them controlled individual demographics and other potential confounders in the analysis and documented research procedures in some detail, and six of them had a control group. In contrast, only one study randomly recruited participants from a pre-defined population, and only in three studies was attrition examined and determined not to significantly differ by respondents’ baseline characteristics between control and experiment groups.

Table 3.

Quality assessment of studies on the impact of home-delivered meal programs on diet and nutrition.

Item^a	Criterion of study quality	Mean (standard deviation)
1	A control group was included	75%
1	A control group was included	(46%)
2	Baseline characteristics between control and intervention groups were similar	38%
2		(52%)
3	The intervention period was at least four weeks	63%
3	The intervention period was at least four weeks	(52%)
4	The measurement tools for food and nutrient intakes were shown to be reliable and valid in previously published studies	100%
4		(0%)
5	Participants were randomly recruited from a well-defined population	13%
5		(35%)
6	Attrition was analyzed and determined not to significantly differ by respondents’ baseline characteristics between control and experiment groups	38%
6		(52%)
7	Potential confounders were properly controlled in the analysis	88%
7		(35%)
8	Study procedures were documented in detail in the article	88%
8	Study procedures were documented in detail in the article	(35%)
9	Total study quality score by summing up items 1–8	5.0
9	Total study quality score by summing up items 1–8	(1.5)

^aItems 1–8 are all dichotomous variables.

Discussion

Poor diet quality and insufficient nutrient intakes are among major health risk factors in today’s aging population. We reviewed scientific evidence on the impact of home-delivered meal programs on diet and nutrition among homebound older adults. Six out of eight studies included in the review found the programs to meaningfully improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Evidence appears less consistent on the role of home-delivered meal programs in intakes of vitamin D, protein, and total energy, and weight management.

The inconsistencies in results across studies included in the review could partially be due to the differences in meals served and sample characteristics. Despite the general guidelines on program eligibility, meal delivery, and nutritional standard of meals, Title III C2 of the OAA offers local programs the flexibility to manage their own menu and meal delivery plans to best meet the specific needs of the population they serve (Administration on Aging,2010). Moreover, interventions across studies targeted individuals with different health conditions (e.g. inpatients with respiratory disease, homebound older adults with diabetes, coronary heart disease, or hypertension/hyperlipidemia), which required meals with specific nutritional compositions. For instance, a high-calorie meal plan may not be appropriate for obese adults but could be desired for frail older people with unintentional weight loss.

A few limitations of the reviewed studies should be noted. Almost all studies included in this review had a relatively small size and were implemented in specific settings (e.g. homebound older adults served by one or a few local sites), which limits the generalizability of study outcomes. The intervention durations (only pertaining to longitudinal studies) were typically limited to 2-4 months, so that the long-term trends and impact of home-delivered meal programs on weight change and chronic condition prevention/management may not be evaluated. Separating the effects of home-delivered meal programs from those of other intervention elements (e.g. nutrition education and counseling, case management, homemaker services, and family caregiver support) was often infeasible as most OAA Title III program participants use multiple services at the same time (Barrett and Schimmel, 2010b). Studies included in the review differed by study population, intervention setting, experimental design, and outcome measure, which precluded meta-analysis. We exclusively focused on the impact of home-delivered meal programs on diet and nutrition, whereas other relevant research questions were beyond the scope of this review, such as nutritional value of meals, innovations on menu design, means of delivery, and site logistics, identification of nutritional needs of existing or eligible consumers, targeted advertisement of home-delivered meal programs to people in need, and nutrition education and consulting. Readers interested in the above topics may refer to the articles excluded after full-text review.

The potential benefit of home-delivered meal programs to participants may be beyond diet and nutrition. Volunteer drivers who are in charge of daily meal delivery usually serve as a “safety check” and report health conditions or needs of homebound older adults, and unanswered deliveries are investigated (Thomas and Mor, 2013). Many of those who deliver meal also provide companionship to home-delivered meal program participants and thus reduce the social isolation of older adults. Ponza et al. (1996a, 1996b) found that home-delivered meal program participants on average had 16 more social contacts per month than did eligible nonparticipants. Fifty-nine percent of program participants reported they enjoyed the communication with the meal delivery person, and 98% reported the delivery person was pleasant. Besides the older adults themselves, meals are also served to their family caregivers who live with them, which partially releases the burden and stress associated with long-term care (Foster and Kleinman, 2011).

Home-delivered meal programs help those individuals to maintain independence and remain in their homes and communities even as their health and functioning decline (Altshuler and Schimmel,2010). Home-delivered meal programs target the most vulnerable older population who are highly likely to enter nursing homes (Altshuler and Schimmel,2010). Compared to the general population aged 60 years and over, home-delivered meal program participants are on average much older, of lower income, and associated with worse physical and mental health conditions (e.g. hypertension, diabetes, cancer, a history of fall or stroke, and cognitive impairment) and more difficulties in performing activities of daily living (e.g. bathing and showering, dressing, and functional mobility) (Barrett and Schimmel, 2010b; Kleinman and Foster, 2011). As the US health care system becomes increasingly unsustainable, reducing the financial burden of nursing homes by promoting independent living of vulnerable adults through OAA Title III services including home-delivered meal programs could be a feasible option (Kamp et al., 2010). However, OAA nutrition programs have been negatively affected by the nation’s recent financial crisis. Largely due to federal, state and local budget cuts and sequestration, the OAA nutrition programs served 14 million fewer meals and 88,000 fewer seniors across the nation in 2011 as compared to 2010 (Meals on Wheels Association of America, 2013). Compared to other national nutrition programs such as WIC and Supplemental Nutrition Assistance Program, OAA Title III services are substantially sparser and much slower in growth (Kamp et al., 2010).

Conclusions

Adequate food and nutrition are instrumental for older Americans’ health and well-being. Home-delivered meal programs are found to improve diet quality and increase nutrient intakes among participants. These programs are also aligned with the federal cost-containment strategy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults “age in place” and maintain an acceptable quality of life within their own homes and communities.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of interest

None declared.

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