1. 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

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

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

4. 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
Hungry Seniors in Washington: An Update

5. 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
Hungry Seniors in Washington: An Update

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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 CDC
Hungry Seniors in Washington: An Update

12. 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 University of Kentucky and University of Illinois.
Hungry Seniors in Washington: An Update

13. 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

14. Hunger is increasing….

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

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

17. 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
Hungry Seniors in Washington: An Update

18. 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: /jn
Hungry Seniors in Washington: An Update

19. 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

20. 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

22. 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

23. 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

24. 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
Hungry Seniors in Washington: An Update

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. The problem with funding…

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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
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

41. 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

42. Nutrition and Aging Resources
US Administration on Aging
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
Position of the Academy of Nutrition and Dietetics: Food and Wellness for Older Adults: Promoting Health and Wellness
Hungry Seniors in Washington: An Update

43. Hungry Seniors in Washington: An Update 2013