1. Older Americans Act Nutrition Performance Outcome Report
Mathematica Policy Research
Administration on Community Living Final Report – Part 1
April 21, 2017

2. Preliminary Analysis – July 17, 2017
Completed by Susan C. Real, Executive Director
East Central Illinois Area Agency on Aging
To be presented to ECIAAA Nutrition Service Providers during the July 17, 2017 Quarterly Nutrition Provider Webinar
PowerPoint will also be posted on ECIAAA’s Website

3. Evaluation Objectives
Provide information to support program planning, including an analysis of program processes
Develop information about program efficiency and cost issues
Assess program effectiveness, as measured by the program’s effects on a variety of important outcomes, including diet quality, socialization opportunities, health outcomes and – ultimately – helping older adults avoid institutionalization.

4. Sampling Design
The evaluation used a multistage clustered sample design. The stages of sampling were:
1. AAAs
2. Local Service Providers within AAAs
3. Congregate meal sites and HDM distribution locations within Local Service Providers
4. HDM routes within HDM distribution locations
5. Congregate participants and HDM participants

5. Response Data
Random sampling of OAA Nutrition Service Program (NSP) Participants
591 Congregate Participants
502 HDM Participants
76.1% Response Rate – Congregate
54.1% Response Rate - HDM

6. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
1. Demographic characteristics-
Congregate and home-delivered meal participants were similar in terms of gender, veteran status, living alone.
Home-delivered meal participants, on average, were older, had less education and were more likely to be widowed.

7. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
1. Demographic characteristics-continued
77 average age of congregate participant
82 average age of home-delivered meal participant
More than 2/3 of congregate and home-delivered meals participants were women
Non-Hispanic blacks constituted 14% of Congregate and 18% of HDM clients served
Hispanics constituted 13% of Congregate and9 % of HDM clients served

8. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
2. Health status, functional ability and mobility
Nearly half (46%) of home-delivered meal participants reported being in fair or poor health, compared to 23 percent of congregate meal participants
Nutrition Risk Assessment reports conditions such as underweight, trouble eating due to tooth problems, taking 3 or more medications daily

9. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
2. Health status, functional ability and mobility
Prevalence of doctor-diagnosed chronic health conditions was higher for HDM participants
Prevalence of recent falls and injuries from falls was much higher for HDM participants compared to congregate meal participants
A substantial proportion of HDM participants reported functional impairments and needed help performing one or more activities critical for them to remain in their homes.
12% of HDM participants reported unable to walk.

10. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
3. Diet and eating behaviors
11% Congregate participants reported appetite as poor
29% HDM participants reported appetite as poor
27% Congregate participants reported on special diets
34% HDM participants reported on special diets

11. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
3. Diet quality
The evaluation used 24-hour dietary recalls to measure total nutrient intakes
Found that NSP meals contribute substantially to both Congregate and HDM participants’ diets
Congregate participants obtained 41% of daily calories from NSP meals
HDM participants obtained 38% of daily calories from NSP meals

12. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
4. Receipt of nutrition and supportive services
43% Congregate participants receiving 5+ meals per week
82% Congregate participants receiving 3+ meals per week
71% HDM participants receiving 5+ meals per week
85% HDM particpiants receiving 3+ meals per week

13. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
4. Receipt of nutrition and supportive services
Many participants reported using supportive services outside the scope of NSP
41% of HDM participants reported using personal care services versus 6% of Congregate participants
61% of HDM participants reporting using case management services versus 13% of Congregate participants

14. Study Findings
NUTRITION SERVICES PROGRAM participant characteristics and circumstances
5. Food security and food coping strategies
16% of Congregate participants and 23% of HDM participants reported food access limitations during the past month due to lack of money or other resources – they were food insecure
42% of Congregate participants and 61% of HDM participants indicated they would skip meals or eat less if no OAA Nutrition Service Program

15. Outcome Measures
FOOD SECURITY
SOCIALIZATION
DIET QUALITY

16. The Effect Summarized
The effect of Congregate and HDM participation on food security, socialization, diet quality was estimated using data from program participants and a matched sample of nonparticipants. Congregate Program nonparticipants HDM Program – 514 nonparticipants

17. Food Security
Congregate participants had a lower rate of food insecurity than did nonparticipants
The prevalence of very low food security was 4.2 percentage points higher among participants compared to nonparticipants
For the vast majority of participants who receive meals 5+ per week, the prevalence of very low food security among participants was similar to nonparticipants
For participants receiving meals fewer than 5 d/p/w experienced greater rates of very low food security than did nonparticipants

18. Socialization
Impact of program participation on socialization outcomes was assessed using three measures:
1. Loneliness – Revised UCLA Loneliness Scale
The scale is based on responses to three questions related to how often individuals feel they lack companionship, feel left out, and feel isolated from others

19. Socialization
Impact of program participation on socialization outcomes was assessed using three measures:
2. Depression – Patient Health Questionnaire 2 (PHQ-2)
assesses the frequency of depressed mood over a two-week period

20. Socialization
Impact of program participation on socialization outcomes was assessed using three measures:
3. Socialization –
based on a single question measuring individuals’ self-reported satisfaction with spending time with other people

21. Socialization Outcomes - Congregate
Congregate participants generally had greater socialization outcomes compared to nonparticipants
No significant difference in loneliness scores between participants and nonparticipants
Congregate participants were less likely than nonparticipants to screen positively for depression
Participants reported greater satisfaction with their socialization opportunities (+8%) than nonparticipants.

22. Socialization Outcomes – Home Delivered Meals
Results were mixed
Average loneliness score was higher for HDM participants compared to nonparticipants
No significant effects of HDM participants screening positively for depression when compared to nonparticipants
However, for HDM participants receiving fewer than five meals per week, experienced greater loneliness and were less likely to be satisfied with socialization opportunities when compared to nonparticipants

23. Diet Quality
Effect of program participation on diet quality outcomes was estimated using two measures:
1. the prevalence of adequate and excessive nutrition intakes
2. the HEI-2010, which assesses overall diet quality
Both measures were estimated based on participants’ and nonparticipants’ daily intakes

24. Diet Quality – General Outcomes
The findings indicate that congregate meal participants generally had healthier diets compared to nonparticipants, both in terms of adequacy of their usual daily nutrient intakes and overall quality of their diets
Participants were more likely than nonparticipants to have adequate intakes of many nutrients, participants were more likely to have excessive sodium intakes
Percentage of Congregate participants with excessive sodium intakes was 30.6% higher compared to nonparticipants

25. Diet Quality – General Outcomes
Sizeable difference between Congregate participants and nonparticipants in total HEI-2010 scores, which provides an overall measure of diet quality
The total score for participants was 6.1 points higher than for nonparticipants
Congregate participants received higher scores for three “adequacy” components (total fruit, dairy and total vegetables)

26. Diet Quality – General Outcomes
HDM participants were more likely than nonparticipants to have adequate nutrition intakes
Few significant differences existed between HDM participants and nonparticipants in the HEI-2010 scores
Scores for dairy and refined grains were significantly higher for participants than non participants (indicating higher diet quality)
There were no significant differences in scores for any other components or for the total score

27. Final Observations
Majority of participants had a positive impression of the Nutrition Services Program 92% Congregate participants and 96% HDM participants rated the nutrition program overall as good, very good, or excellent Most participants (81% Congregate & 96% HDM) reported the NSP helped them eat healthier foods 68% Congregate & 78% HDM participants indicated the NSP had improved their health and helped them achieve or maintain a healthy weight

28. Final Observations
The majority, 71% of Congregate and 90% HDM participants reported the program helped them to live independently and remain in their own home The evaluation brought to light a few areas that warrant further exploration: 1.Findings suggest many HDM participants may not be receiving a sufficient number of meals per week – resulting in increased levels of food insecurity 2.Findings suggest that low-income Congregate participants were not as satisfied with socialization opportunities presented at meal sites