 Definition  Incidence  Causes  Consequences  Community Roles

 Hunger -a craving or urgent need for food or a specific nutrient -an uneasy sensation occasioned by the lack of food -a weakened condition brought about by prolonged lack of food  Malnutrition -faulty nutrition due to inadequate or unbalanced intake of nutrients or their impaired assimilation or utilization

 Marginal food security -Households had problems at times, or anxiety about, accessing adequate food, but the quality, variety, and quantity of their food intake were not substantially reduced.  Low food security -Households reduced the quality, variety, and desirability of their diets, but the quantity of food intake and normal eating patterns were not substantially disrupted.  Very low food security -Eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money and other resources for food.

Term UsedUSDA Terminology# of CSFM Answered (Core Food Security Module) 10 questions if no children High Food SecurityNo to all questions Threat of HungerMarginal Food SecurityAt least one yes Risk of HungerLow Food SecurityAt least 3 yes Facing HungerVery Low Food SecurityAt least 6 yes

1. "We worried whether our food would run out before we got money to buy more." Was that often, sometimes, or never true for you in the last 12 months? 2. "The food that we bought just didn't last and we didn't have money to get more." Was that often, sometimes, or never true for you in the last 12 months? 3. "We couldn't afford to eat balanced meals." Was that often, sometimes, or never true for you in the last 12 months? 4. In the last 12 months, did you or other adults in the household ever cut the size of your meals or skip meals because there wasn't enough money for food? (Yes/No) 5. (If yes to question 4) How often did this happen--almost every month, some months but not every month, or in only 1 or 2 months?

6. In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food? (Yes/No) 7. In the last 12 months, were you ever hungry, but didn't eat, because there wasn't enough money for food? (Yes/No) 8. In the last 12 months, did you lose weight because there wasn't enough money for food? (Yes/No) 9. In the last 12 months did you or other adults in your household ever not eat for a whole day because there wasn't enough money for food? (Yes/No) 10. (If yes to question 9) How often did this happen-- almost every month, some months but not every month, or in only 1 or 2 months?

1. Mississippi 2. New Mexico 3. Arkansas 4. Texas 5. Tennessee 6. Alabama 7. Georgia 8. South Carolina 9. Florida 10. Nevada

 1 in 7 face the “Threat of Senior Hunger”  Increased from 2001 to 2010 by 78%  Increased from 2006 to 2010 by 34%

% of Texas SeniorsApproximate Number of Texas Seniors Threat of Hunger 18.14%685,000 Risk of Hunger 10.62%401,000 Facing Hunger 4.23%160,000

 African American or Hispanic Populations  At poverty or near poverty  Under age 70 (specifically age 60-64)  Unmarried (divorced or separated)  Renters  Living with grandchildren  Less than 12 years of formal education

 “Food Insecurity- Obesity Paradox” › Obesity › Weight related disability

 Near poor  Whites  Widows  Non-metro  Retired  Women  Households with no grandchildren

At Risk Of Hunger Increased ADLs Disparity between chronological and physical age

Age Related Conditions Hearing loss Macular Degeneration Oral Health Problems Sarcopenia Cognition

Chronic Diseases Heart Disease Hypertension Diabetes Osteoporosis Some cancers COPD Renal Disease

Acute Conditions Dehydration Pressure Ulcers Infections Pneumonia Fractures Gum Disease

Increased Healthcare Costs Re-Admissions Longer Stays Slower Recovery Premature Institutionalization

Reduced QOL/Independence Decreased Mobility Depression/Anxiety Sleep Disturbance Poor Appetite Increased Morbidity Increased Mortality

Threatens Independence--Reduces Quality of Life--Increases Healthcare Costs 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 Consequences of Poor Diet on Functionality

Strategic PlanningTarget ServicesInterventionsCollaborate and CoordinateReferrals

 Assess › Demographics-Risk Factors › Community Hunger and Food Insecurity › Community Need › Partners › Resources  Develop interventions to address

› Access › Referral › Education › Advocacy › Partnerships

 Prioritize to high risk groups  Offer services in geographical areas with high need (ie, rural, food deserts, food swamps)  Offer services in low income housing

Texas Population % of 60+ Below Poverty10.6% African American8.9% Hispanic21.4% Mobility Limitations23.6%

Texas Population % of 60+ Age % Age % Age % %

 To reduce hunger and food insecurity  Promote socialization  Promote the health and well-being of older individuals

 Services required to be provided › Meals, nutrition education  Services that may be provided › Nutrition assessment and counseling, as appropriate  Services that may not be funded › Vitamin/mineral supplements › Dietary supplements

National Survey of OAA Participants, December, 2011

Characteristic% Congregate Participants % Home Delivered Participants Meal enabled living at home6092 Eat healthier foods as a result of the program 7883 Eating meals improves health7887 Meals help feel better8590 National Survey of OAA Participants, December, 2011 OAA Nutrition Services V alue Perceived Benefits

 Provide nutritious, appealing meals › Meet preferences, special needs for therapeutic, religious reasons › Food components that can be eaten later  Increase number of meals › Holiday Meals › Emergency Meals › Second Meals › More than five days

 Nutrition education on low cost food management  Menu planning and shopping assistance  Assist in a access/transportation to grocery stores  Grocery delivery  Individualized nutrition counseling  Cooking classes

 Use the online SNAP application to help families apply Benefits.com

› Senior Farmer’s Market Nutrition Program › TEFAP › CSFP › CACFP › SNAP-ED

 Food Banks  Food Pantries  Soup Kitchens

 Mobile Markets  Community Gardens

 Hunger network organizations and advocacy groups › Texas Hunger Initiative (Baylor University Based) › The Texas Hunger Research Project › Texas Food Bank Network  Home and Community Based Systems (HCBS) network  Aging and Disability Resource Centers (ADRC)  Faith-based organizations

o Community nutrition assessments for planning services › HCBS uniform assessment forms › I & R or ADRC screenings › Identify appropriate referrals  Train all staff: nutrition, case managers, I & R staff about food insecurity  Include outcome and impact measures about food insecurity on evaluations

Prediction 2025 › 75% more will experience food insecurity › 33% more suffer hunger

National Foundation to End Senior Hunger  The Causes, Consequences, and Future of Senior Hunger in America, Ziliak, J., C. Gundersen and M. Haist, 2008  Senior Hunger in the United States: Differences across States and Rural and Urban Areas, Ziliak, J. and C. Gundersen, 2009  Senior Hunger in America 2010: An Annual Report, Ziliak, J. and C. Gundersen, 2010

 Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness. J Acad Nutr Diet. 2012;112:  Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: Food and Nutrition Programs for Community- Residing Older Adults. J Am Diet Assoc. 2010;110:

 USDA Community Food Security Assessment Toolkit _1_.pdf  ACL/AOA AA/index.aspx  USDA ERS-Food Security assistance/food-security-in-the- us/measurement.aspx#survey

 Hunger and Nutrition in America: What’s at Stake for Children, Families and Older Adults - Generations United (2012)  Five Factors that Move the Needle on Reducing Food Insecurity- ConAgra Foods Foundation, Craig Gunderson (2012)

 Linda Netterville ›