Senior nutrition programs (SNPs) play an important role in enhancing independence and quality of life. There is sufficient evidence to demonstrate that SNPs improve the nutritional health of the individuals who participate in the programs (Roy & Payette, 2006). Improving or maintaining nutritional health of older individuals is extremely important since poor nutritional status and physical inactivity are considered the second leading cause of death—behind smoking—in the United States.
Meals On Wheels is a generic term often used to describe SNPs. While it is easy to understand how all SNPs came to be lumped into a single category widely recognized by the general public (namely, “Meals On Wheels”), it is important to note that there is more to Meals On Wheels than that name implies. First, SNPs consist of two distinct types of services: firstly, home-delivered meal programs (Meals On Wheels); and secondly, congregate meal programs, that is, those available in facilities, like senior centers, where several seniors assemble and partake of meals together. These two types of nutrition programs are similar in purpose, but there are differences—some obvious, some subtle—between both the program types themselves and the populations each serves. To receive services in both settings, individuals must be age 60 or older. Because demand far outstrips available services, programs are targeted, by law, to those in “greatest economic and social need.”
The Older Americans Act (OAA) is both the principal law governing operation and practices of SNPs, and provides the largest source of federal funding. As mandated by OAA, the primary objective, shared by home-delivered and congregate meal programs, is to furnish hot, nutritious meals to needy seniors at least 5 days per week. Each meal must meet the minimum standard of furnishing at least one third of the Recommended Dietary Allowances (RDA) of key nutrients. Most meals actually exceed this RDA minimum, approximating 40% to 50% of the daily requirement, and typically the meals are “nutrient dense,” that is, their ratios of nutrients to calories are high. As a result, the daily intake of key nutrients is greater for program participants than it is for similar individuals who do not participate in the program.
Providing meals is not the only benefit or service that SNPs provide. Over half of all programs provide nutrition screening and education, and more than a third also include nutrition assessment and counseling.
SNPs provide program participants “more than just a meal.” While it is accomplished in different ways and to a different degree in congregate sites and in the home, socialization—or at least the reduction of social isolation—is a critical benefit that all SNP participants enjoy (Timonen & O'Dwyer, 2010). Those participating in both types of senior meal programs have more social contact than similarly situated nonparticipants. This is true despite the fact that, compared with the general older adult population, individuals who participate in the programs are more than twice as likely to reside alone.
Other than setting, programs differ in the demographic characteristics of program participants. In both cases, program participants are older, predominantly female, more likely to be minority, and are poorer than the overall eligible population (U.S. elders age 60 and older). Home-delivered meal recipients, on average, are older, poorer, and frailer than their counterparts in congregate programs. For example, nearly 59% of home-delivered participants have three or more chronic medical conditions, compared with 41% of the congregate population. Additionally, the majority of homebound participants have some type of functional disability.
Demographic realities foretell that demand for the services of SNPs will increase. Program history demonstrates SNPs can be sensitive and responsive to the changing and growing needs of an ever-burgeoning cohort of aging Americans. But the degree to which SNPs can contribute to the improving health of America's seniors relies on public support—in the form of federal, state, and local funding; financial contributions from individuals, the corporate sector and foundations; and the investment of time and personal resources of volunteers, who prepare, serve and deliver meals. SNPs are one of the most prudent, low cost investments the public sector can make. The cost of providing a senior citizen “Meals On Wheels” for 1 year is roughly equivalent to the cost of one hospital day for a Medicare patient.
What originally may have appropriately functioned primarily as a meal program, the SNP has today truly become “more than a meal” program. SNPs need to be viewed and to view themselves as a national resource, as well-established and cost-effective entities through which to administer a broad-range of nutrition services and interventions. Health promotion and disease prevention are natural and positive consequences of appropriate, and relatively inexpensive, nutrition interventions. The prevention, reduction, and/or postponement of onset of chronic diseases in the elders can enhance quality of life, delay individual institutionalization, and reduce overall national health care costs.
There are approximately 5,000 local SNPs in the United States, providing more than one million meals to seniors each day. Some programs serve meals at congregate locations like senior centers, some programs deliver meals directly to the homes of seniors whose mobility is limited, and many programs provide both services. The National Resource Center on Nutrition and Aging (NRC) is a cooperative initiative of the Administration on Aging and the Meals On Wheels Association of America. It is designed to assist the national aging network to implement the nutrition portions of the OAA.
See also Aging Agencies: City and County Level; Nutritional Assessment; Senior Centers; Senior Hunger. Roy, M. A., & Payette, H. (2006). Meals-On-Wheels improves energy and nutrient intake in a frail free-living elderly population. Journal of Nutrition, Health & Aging, 10, 554–560.