Hungry Seniors in Washington: An Update Washington Food Coalition Annual Conference Martha Peppones MS, RDN, CSG, CD Nutrition Director Senior Services of Snohomish County Hungry Seniors in Washington: An Update 2013

Overview Demographics Nutritional needs of older adults Senior hunger Impacts of hunger Solutions Food assistance programs Other types of assistance Resources

Number of Older Americans Age Wave, Silver Tsunami, Graying of America Hungry Seniors in Washington: An Update 2013

Older Americans in Poverty 8.7% live below FPL 15% are below the Supplemental Poverty Measure Considers regional variations of housing costs, non-discretionary expenditures, medical out-of- pocket expenses SPM new measure released by Census bureau in 2011 – shows significantly higher number than the official poverty level For those age 65+, MOOP is the major source of differences between these measures Source: Administration on Aging. A Profile of Older Americans: 2012 http://www.aoa.gov/aoaroot/aging_statistics/Profile/2012/Index.aspx Hungry Seniors in Washington: An Update 2013

Older Americans in Poverty Racial/ethnic 6.7% of elderly whites 17.3% of elderly African Americans 11.7% of elderly Asians 18.7% of elderly Hispanics Gender 10.7% women 6.2% men Source: Administration on Aging. A Profile of Older Americans: 2012 http://www.aoa.gov/aoaroot/aging_statistics/Profile/2012/Index.aspx Hungry Seniors in Washington: An Update 2013

Older Americans in Poverty Living arrangements 5 % living with families 16.5% living alone Location 11.7% in principal cities 10.1% South Highest poverty rates Hispanic women who live alone (38.8%) African American women living alone (32.2%) Source: Administration on Aging. A Profile of Older Americans: 2012 http://www.aoa.gov/aoaroot/aging_statistics/Profile/2012/Index.aspx

Nutrition & Health Health Functionality Independence Quality of life Adequate nutrition is essential for Health Functionality Independence Quality of life Hungry Seniors in Washington: An Update 2013

Nutrients of concern in older adults Energy needs Vitamins and minerals or Fluid Protein Energy needs decrease multifactoral but primarily due to decreased physical activity V/M needs constant or even increased – it’s a challenge to get the nutrient requirements without exceeding kcal limits Limits discretionary intake Fluid – goal is to prevent dehydration (a form of malnutrition). Lots of influences – reduced ability of kidneys to concentrate urine, decreased thirst, changes in cognition, medications, mobility disorders, incontinence Protein – big challenge especially with limited resources. Concern here is preserving lean body mass. Low LBM, leads to frailty, decreased immune function, impaired wound healing. Sarcopenia (loss of muscle mass and associated strength) has very negative impacts on functionality and ability to live independently. Some of the current research says 30 gm protein each meal. Hungry Seniors in Washington: An Update 2013

Nutrient Concerns – con’t Fiber Vitamin D and Calcium Vitamins B12, folic acid, and B6 Antioxidants Fiber – national surveys indicate lower than recommended intakes in older adults. Gastric motility, glycemic control, reduced cholesterol. F/V/ whole grains. But have to be careful with those with poor appetite and anorexia – high fiber can lead to early satiety. Need to consider fluid intake. D and Calcium – decreased sun exposure, less able to produce D, decreased ability to absorb Ca. best known role is bone health; may help with other conditions – cancer, diabetes, immunity, heart disease. Current recommendations based on evidence around bone health – not other conditions. B12 and B6 – 20% older adults may have marginal status of B12 – deficiency is anemia and neurological changes. Reversible if treated in time. If FA too high (fort foods and supplements), it can mask B12 def. B6 needs increase Antioxidants – (carotenoids – esp lutein and zeaxanthin) whole f/v………may have some relationship age-related macular degeneration . There is no evidence that antioxidants have effect for treating diagnosed cognitive impairment/Alzheimers Hungry Seniors in Washington: An Update 2013

Factors Affecting Nutritional Well Being of Older Adults Medical Problems Exercise & Recreation Friends Diet Modifications Shopping Skills Medications Housing Religion Cooking Skills Physiological Changes Dental Chewing/ Swallowing Skills Mental Disorders, Dementia Transportation Neighborhood Crime/ Abuse Family Money Food essential in everyday life If diet consistent with current guidelines (incr f/v, wh grains, poultry, fish, low fat dairy) – assoc with better nutr status, QOL, survival. Point of this …. Hunger can be affected by many factors. Ex: live in a rural area with no transportation and no friends or family support, has dementia, never cooked a meal in their lives ‘just lost my wife of 60 years, I’m at total loss of what to do’ When food security is evaluated, commonly asked questions ‘not enough money to buy food I need’, skipped meals because I didn’t have money’, etc – all about finances Older adults have many other issues that affect food security. Hungry Seniors in Washington: An Update 2013

Washington Report Card for Health 42.7% report having a disability 60% are not eating recommended 2 servings of fruit per day 70% not eating 3 servings of vegetables per day One in four older adults are obese 32% older adults have lost ≥ 5 natural teeth Source: The State of Aging and Health in America 2013 CDC http://nccd.cdc.gov/DPH_Aging/default.aspx Hungry Seniors in Washington: An Update 2013

Senior hunger – the 2011 numbers National 4,800,000 at risk of hunger (8.4%) Washington State 7.6% at risk of hunger Keep in mind, these numbers only reflect those who had financial constraints about hunger – does not include the isolated elderly woman who can’t get to the store and can’t stand long enough to prepare a good meal…… SOURCE: Ziliak, J. & Gundersen, C. (2013). Spotlight on Food Insecurity among Senior Americans 2011. University of Kentucky and University of Illinois. Hungry Seniors in Washington: An Update 2013

Hunger will continue to increase The senior food insecurity rate has more than doubled since 2001 10,000 adults will turn 65 every day until 2030 Hunger numbers will increase by 50 % when the youngest boomers reach age 60 in 2025 For seniors, protecting oneself from hunger is more difficult – sometimes have enough $ but no resources or access to prepare food due to lack of transportation, functional limitations, health problems Hungry Seniors in Washington: An Update 2013

Hunger is increasing….

Surprising truth about younger seniors Hungry Seniors in Washington: An Update 2013

Living above the poverty line does not mean exemption from hunger Hungry Seniors in Washington: An Update 2013

Who’s more likely to be hungry? Poor, near poor (up to 200% FPL) African American (17%), Hispanic (18%) Single – widowed, divorced Unemployed Younger than 74 – especially 60-64 Disabled Female Living with grandkids Lives in southern US Those who are hungry have lower intakes of energy & V/M, more likely to be in poor or fair health, higher rates of chronic conditions (depression, DM), more socially isolated, more hospitalizations, have ADL limitations Younger group – speculate it’s because older cohort lived through depression and have better coping mechanisms, positive effect of OAA programs Being food insecure is like being functionally 14 years older. Ziliak et al. Causes, Consequences & Future of Senior Hunger in America, Meals on Wheels Foundation. March 2008. www.mowaa.org/ Hungry Seniors in Washington: An Update 2013

Chronic illness and food insecurity 80% of older adults have one chronic condition 50% have at least two Increased number of chronic conditions related to higher level of food insecurity Additional health care costs Limited ability to manage with scarce resources Tarasuk V, et al. Chronic Physical and Mental Health Conditions Among Adults May Increase Vulnerability to Household Food Insecurity. J Nutr. Doi:10.3945/jn.113.178483. 2013 Hungry Seniors in Washington: An Update 2013

Impacts of food and nutrition on health POOR DIETS CHRONIC DISEASES (Heart Disease; Hypertension; Diabetes; Osteoporosis; Some Cancers: colon and breast; Arthritis; COPD; Renal Disease) ACUTE CONDITIONS (Dehydration; Pressure Ulcers; Infections; Pneumonia; Influenza; Fractures; Tooth Abscesses; Gum Disease) AGE-RELATED CONDITIONS / DISEASES (Hearing Loss; Macular Degeneration; Destructive Joint Disease: knees and hips; Loss of Muscle Mass: Sarcopenia; Cognition / Mental Health) WITHOUT ADEQUATE HEALTHY, SAFE FOOD AND NUTRITION SERVICES Low stamina Slower recovery Longer hospital stays Sleep disturbance Hospital readmission Premature institutionali-zation Depression & anxiety Increased morbidity & mortality Poor appetite Hungry Seniors in Washington: An Update 2013

IMPACT OF MALNUTRITION ON FUNCTIONALITY Underweight Obesity Limits Muscle Strength Reduces Stamina Prevents Physical Activity Decreases ability to: Perform ADLs & IADLs: Eat, Walk, Grocery Shop, Prepare Meals Grip Items & Lift Heavy Objects Increases Dependency Increases Need for Caregiver Assistance Increases Risk for Falls & Fractures Threatens Independence Reduces Quality of Life Increases Healthcare Costs 20 Hungry Seniors in Washington: An Update 2013

Solutions? Access to coordinated, comprehensive food and nutrition services Federal food and nutrition programs SNAP OAA CSFP CACFP SFMNP TEFAP - Local food banks and pantries

SNAP and older adults Nationally, overall participation rate is 75%; >82% in WA state Participation rates for seniors are lower than any other group – 73% of them live alone Hungry Seniors in Washington: An Update 2013

Barriers to SNAP participation Perceived low benefits In 2009, actual monthly benefit for 60+ was $102 Less aware of eligibility requirements Stigma Mobility/technology Stigma – embarrassed to ask for help, will they be judged in grocery store or by family/friends? Don’t want to take food out of children’s mouths More likely to enroll in just one food assistance program – either OAA or food stamps….. Our state proactive in basic food – seniors without working income don’t have to have a phone interview – generally getting their cards within 7 days of when the application is submitted http://frac.org/initiatives/addressing-senior-hunger/seniors-and-snapfood-stamps/ Hungry Seniors in Washington: An Update 2013

Older Americans Act Nutrition Programs Established 1965, Nutrition added 1972 No income requirements – need based Age 60+ Targeted to those with highest needs Greatest social and economic need Low income minorities Rural Limited English speaking

More than a meal…. Nutrition Services – includes meals, nutrition screening, assessment, education, Medical Nutrition Therapy to older adults and caregivers Socialization and access to services Promote independence….Aging in Place

OAA Purpose Reduce hunger and food insecurity Promote socialization of older individuals Promote the health and well-being of older individuals through disease prevention and health promotion services

OAA Home Delivered Meals Age 60+ Spouse of any age Homebound Lacking support Unable to prepare own meals Meals on Wheels Hungry Seniors in Washington: An Update 2013

OAA Congregate Meals Age 60+ (Native Americans, 50+) Spouse of any age Younger disabled person living with eligible person Hungry Seniors in Washington: An Update 2013

OAA Participant Profile 61% live alone 73% age 75+ 29% rate own health as poor 58% HS grad, 7% college One-third at or below poverty level; 85% low income (< $20,000) 66% - meal provides half of daily intake Half are at nutrition risk 84% need help with IADLs 1:3 Meals on Wheels clients need help with 3+ ADLs and are nursing home eligible 8% congregate, 19% HDM use SNAP

The problem with funding…

Commodity Supplemental Food Program Low income Pregnant and breastfeeding women Other new mothers <1 yr postpartum Infants and kids up to 6 yrs Age 60+ Older adults have to be poorer < 130% poverty for older adults <185% poverty for all others

Commodity Supplemental Food Program Food packages include: Infant formula and cereal NFDM and UHT fluid milk; juice Cereals, rice, pasta Peanut butter, dry beans Canned meat/poultry/fish Canned fruits/vegetables In 36 States and 2 Tribal Organizations Serves >518,000 per year 96% are age 65+ But….the quantities are often impractical for 1-2 person households Hungry Seniors in Washington: An Update 2013

Child and Adult Care Food Program Low income children Functionally impaired adults or age 60+ Serves 3.2 M children, 112,000 adults Reimbursement tiers as in free/reduced/full school meals Federally regulated, State administered Adult Day Health or Day Care Hungry Seniors in Washington: An Update 2013

Senior Farmers Market Nutrition Program Goal: Help farmers and improve nutrition for seniors Age 60+, income < 185% poverty Washington State Served 20,700 people in 2013 $40/year per person Very small program - $21M nationally, $829,000 WA State $40/yr averages to $3.33/mo Until those benefits increase, I doubt we’ll see much improvement in nutr status Hungry Seniors in Washington: An Update 2013

TEFAP 3 million seniors served by Feeding America 18.6% households have 1 member age 65+ Difficult choices 30% chose between food and medical care 35% chose between food and paying for heat/utilities 8% of all clients are age 65+ Hungry Seniors in Washington: An Update 2013

Barriers to Participation Lack of awareness Reluctance to accept help Inadequate funding of programs, wait lists Lack of transportation Inadequate funding – wait lists Hungry Seniors in Washington: An Update 2013

Getting By with Federal Nutrition Assistance BK - 79 years old Widow Generally good health, overweight, hypertensive, arthritis Worked part-time Lives alone, has children who live near by Relies on husband’s social security and small pension Wellman, N.S. & B. Kamp. Federal Food and Nutrition Assistance Programs for Older People. Generations. Fall. 2004

BK’s Finances DESCRIPTION Monthly Income Monthly Expenses Social Security $920 Widow’s Pension $420 Rent $600 Food $155 Utilities $120 Misc., transportation, clothing, etc. $ 80 Health insurance $157 Drugs/Medications Medical Services $ 50 Medical Supplies $ 14 BALANCE $84 FEDERAL NUTRITION ASSISTANCE OA Nutrition Programs: Value of meals $100 Food Stamps CSFP: Actual retail value generally higher $ 17 SFMNP: $40 annual benefit divided by 12 $ 3 TOTAL VALUE $170 BK’s Finances And this doesn’t count the impact of other discounts available for low income older adults. So we can make a real difference Hungry Seniors in Washington: An Update 2013

Other services available Senior Information and Assistance/Referral Connects older adults to services SHIBA Information about affordable health care Elder Abuse Prevention Call your local Area Agency on Aging or use the Eldercare Locator 800-677-1116 I&A: nursing homes, senior housing, retirement/assisted living, home care services, adult day care/respite, senior centers, dental resources, utility discounts, employment programs, and transportation options SHIBA: counsel people about Medigap coverage, employment-related health benefits, managed care, long-term care insurance, health care fraud/abuse, health care resources for low income people, and more. Elder abuse prevention: scams/frauds, financial exploitation Hungry Seniors in Washington: An Update 2013

One last note on funding….. OAA Serves < 5% of older adults $125 M in 1975 $816 M in 2012 7-fold increase WIC Serves 53% of all infants born in the US $20.6 M in 1974 $7.1 B in 2012 344-fold increase There’s still a lot of work to do……… Hungry Seniors in Washington: An Update 2013

Nutrition and Aging Resources US Administration on Aging www.aoa.gov www.gpra.net Food and Nutrition Programs for Community-Residing Older Adults Position of the American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education – March 2010 http://www.eatright.org/About/Content.aspx?id=6442451115 Position of the Academy of Nutrition and Dietetics: Food and Wellness for Older Adults: Promoting Health and Wellness 2012 http://www.eatright.org/About/Content.aspx?id=8374 Hungry Seniors in Washington: An Update 2013

Hungry Seniors in Washington: An Update 2013