Transcript Hunger is Not Getting Any Younger - panas

Hunger is Not Getting Any Younger
Amanda Panas
Clinical RD
Sibley Memorial Hospital Elderly
Patient Statistics
 Initiation of NICHE program at Sibley Memorial Hospital
 Designed to meet the specialized needs of geriatric patients
 In general, 50% of hospitalized patients are at least 65 years
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old
55% of Sibley Memorial Hospitals inpatient admissions are
people over 65 years of age
Within 30 years the population over 85 will double to 8.5
million
Average age of Medicare patients is 77
19% of patients admitted to Sibley Memorial hospital are
over 85 (Vincent, 2011)
National Food Insecurity
 40 million Americans struggle for enough to eat each day
 US poverty rate for adults over age 65 is 9.7%
 3.5 million elderly adults live in poverty (Society, 2011)
 5.3% of the people with food insecurity are elderly and 4.8%
are elderly people living alone (Coleman, 2010)
 60% of low income seniors qualified for state or federal
nutrition programs are not enrolled (Hunger, 2009)
Elderly food insecurity in the DC area
 DC consists of 61.4 miles, over 9,000 people live in each mile,
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11.9% of this population is over the age 65, 17.1% of the DC
population lives under the poverty line (DC, 2011)
1 in 8 households struggle with hunger, 13% per USDA report
2008-2010
DC priority to make programs easier to access per Alex Ashbrook,
Director of DC Hunger Solutions (Healthy, 2006)
“The Older Americans Act Nutrition program works to improve
the nutritional status of participants and helps them to maintain
their independence and quality of life
2 million of the 9 million older adults living alone believe that they
have no one to turn to for assistance (Baker, 2005)”
Signs/Symptoms of Malnutrition
 Malnutrition: deficiency of energy, protein, and other nutrients causing
adverse effects on the body and functional outcome (Ahmed, 2010)
 Impaired muscles function
 Decreased lean body muscle
 Immune dysfunction
 Anemia
 Poor wound healing
 Muscle wasting
 Cachexia (Ahmed, 2010)
 Low BMI
 Decreased albumin level/ pre-albumin level
 Vitamin/micronutrient deficiencies
(Lane, 2011)
Causes of Malnutrition
 Following a meal, older adults experience less hunger and
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remain satisfied/fuller longer following a meal
Aging leads to decreased food intake, “anorexia of aging”
Loss of taste and sense of smell
Less responsive to hunger cues, leads to decreased energy
intake (Gregersen, 2011)
Social isolation (Ahmed, 2010)
Hunger and poverty
 High cost of multiple medications
(Wellman, 2007).
Focus of the negative health
consequences of malnutrition
 “Older adults living alone do not consume adequate amounts
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of food, 40% of the frail homebound suffer from proteinenergy malnutrition (Baker, 2005).”
Decrease quality of life
Increased frailty
Depression
Mortality (Jutkowitz, 2011)
Factors that lead to Food Insecurity
 Lack of transportation to the grocery store
 Functional limitations
 Inability to stand long enough to prepare meals
 Financial constraints
 Poor dentition (Baker, 2005)
 Cognitive impairment (Lane, 2011)
 Medications which decrease appetite, altered taste, and
interfere with absorption (Hunger, 2009)
Local Resources within Five Miles of
the Hospital, including MD & N. VA
 OAA is the largest federally funding program for people over the
age of 65, initiated in 1972
 US Administration of Aging- “Meals on Wheels”
 Each DC site must be individually contacted to determine eligibility
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requirements
Annually produces 250 million nutritious meals, and social
opportunities for 3 million adults
Sometimes only meal of the day for elderly participants
Nutrition services- screenings, education, counseling
4,000 local agencies, 20-1000 clients per site
 “Eat Better & Move” program (Wellman, 2007)
 Increased social contact, promotes healthful eating (Hunger, 2009)
Obtaining Material of Local Programs
 25 locations for Free meals and emergency groceries sources within 4 miles of Sibley
Memorial Hospital
 Capital Area Food Bank Hunger lifeline (202) 639-9770, website:
http://www.dchunger.org/resources/dcfoodfinder.html
 4 food pantry and soup kitchens available in Bethesda MD, within 5 miles of the hospital
 Other Options:
 So Others Might Eat, increase self-reliant, provided 262,101 hot nutritious meals for
residents of Dwelling Place Shelter for Abused and Neglected Elderly, 133 low income
seniors enjoyed meals, activities, and case management, 63 seniors, homebound, received
362 case manager visits, 595 food deliveries with Homebound Senior Program
 Bethesda Cares- 4 churches providing lunch, feed homeless and food insecure
 Home Instead Senior Care (VA)- offers errands, shopping, meal assistance
(companionship, transportation, personal, meal preparation, household chores, home
monitoring, medication) including grocery shopping, meals planning and preparation,
monitoring diet and eating, record and arrange recipes, monitoring food expirations, clip
coupons for shopping
Obtaining Material of Local Programs
 Meals on Wheels in DC is complicated, grassroots program,
each site has its own eligibility requirements and application,
Central Headquarters (703) 548-5558
 Meals on Wheels locations within 5 miles from Sibley
Memorial Hospital:
 Arlington AAA 4.3 miles
 Bethesda-Chevy chase Meals on Wheels 4.6 miles
 Arlington Meals on Wheels 5.0 miles
Obtaining paperwork for Programs
 IONA Senior Service center, 1 mile, serves DC ward 2 & 3, call
24 hours in advance to make an appointment, deliver two meals
on Saturday for homebound/frail adults, those unable to afford
additional help
 St Albans Episcopal Church, Super Sixties, group meal, exercise,
recreation, creative writing, nutrition counseling/education, field
trips, 1.4 miles, $2 donation
 VIDA Senior Centers, improve maintenance and quality of life,
increase wellness, increase self sufficiency, independence for
seniors, Latinos and other older adults, living in isolation
 Harvard Towers, 3 miles, senior meals, group meals, recreation,
health promotion programs, nutrition counseling/education
Obtaining paperwork for Programs
 Sarah’s Circle, 3.25 miles, group meal center and wellness
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programs
Columbia Heights, 3.5 miles, group meals
Campbell Heights, 3.6 miles, group meals for seniors, library,
daily clinic for nursing assistance and weekly podiatrist care
St. Mary’s Court, 3.7 miles, ID must be shown, provides lunches,
social services, transportation services, referrals, adult day care,
flu shots, fitness and computer classes
Emmaus Services for the Aging, 4.4 miles, DC residents over 60,
free grocery market on Fridays, free lunch, legal help, referrals,
assistance enrolling in benefits
Conclusion
 Multi-disciplinary communication and teamwork
 Proactive discharge planning, involve patient in discussion if
appropriate, as the population of older adults increases
(Baker, 2005)
 Open dialogue, flexibility (Scarinci, 2009)
 Effective discharge planning prevent re-admission, offering
services to maximize effectiveness, care at home, assistance
options (Wong, 2011)
 Discuss hiring nursing aid to provide meal assistance
References
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Baker, E. B., & Wellman, N. S. Nutrition concerns in discharge planning for older Americans: a need for multidisciplinary collaboration. J Am Diet Assoc.
2005(105),603-607. Retrieved October 8, 2011.
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Scarinci, I. C., Johnson, R. E., Hardy, C., Marron, J., & Partridge, E. E. Planning and implementation of a participatory evaluation strategy: a viable approach
in the evaluation of community-based participatory programs addressing cancer disparities. Eval Program Plann. 2009. 32(3):221-228. Retrieved Ocoober 8,
2011.
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Vincent, J. M. Introduction to the NICHE program. Sibley memorial hospital power point presentations. (2011). Washington, DC.
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Jutkowitz, E., Gitlin, L. N., Pizzi, L. T., Lee, E., & Dennis, M. P. Cost effectiveness of a home-based intervention that helps functionally vulnerable older
adults in place at home. J Aging Res. 2011(12),106. Retrieved October 17, 2011 from PMC 3157760.
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Wong, E. L. Y., Yam, C. H. K., Cheung, A. W. L., Leung, M. C. M., Chan, F. W. K., Wong, F. Y. Y., & Yeoh, E. K. Barriers to effective discharge
planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Services Research.2011. (11),242. Retrieved October
17, 2011, from PMC 3190337.
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Society of St. Andrew. 2010. Retrieved October 8, 2011, from http://www.endhunger.org/.
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Gregersen, N. T., Moller, B. K., Kristensen, S. T., Holm, L., Flint, A., Astrup, A., & Raben, A. Determinants of appetite ratings: the role of age, gender,
BMI, physical activity, smoking habits and diet/ weight concerns. Food Nutr Res. 2011 (55). Retrieved October 3, 2011, from PMC ID: PMC3160809.
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Lane, R. L., Talley, M. C., Shamilyan, T., & Pacula, J. T. Common syndromes in older adults related to primary and secondary prevention. Agency for health
care research and quality. 2011. Retrieved October 3, 2011, from PMID: 21901865.
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Ahmed, T., & Haboui, N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 2010. 2010(5), 207-216.
Retrieved October 3, 2011, from PMCID: PMC2920201.
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Wellman, N. S, Kamp, B, Kirk-Sanchez, N. J., & Johnson, P. M. Eat better and move more: a community based program designed to improve diets and
increase physical activity among older adults. Am J Public Health. 2007, 97(4), 710-171. Retrieved October 3, 2011, from PMC 1829349.
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DC MapStats. Retrieved October 3, 2011, from http://www.fedstats.gov/qf/states/11000.html.
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Coleman-Jensen, A., Nord, M., Andrews, M., & Carlson, S. Household food security in the US in 2010. USDA. 2011. Retrieved October 3, 2011, from
http://www.ers.usda.gov/Publications/ERR125/ERR125.pdf.
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Healthy food, healthy communities. DC Hunger Solutions. 2006. Retrieved October 7, 2011, from http://www.dchunger.org/pdf/healthfoodcomm.pdf.
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Hunger and the senior: 5 million seniors at risk of malnutrition. Comfort Keepers. (2009). Retrieved October 3, 2011, from
http://www.comfortkeepers.org/information-center/news-and-highlights/hunger-and-the-senior.
Questions?