Malnutrition a significant danger to elderly
443,770 older Ohioans at risk of going hungry, state panel suggests.
As many as half of older Americans are at risk of becoming malnourished, and as the nation ages, the problem of getting nutritious food to seniors is poised to get worse.
Leona Miller generally has toast and coffee for breakfast, and maybe a Wendy’s chili or some soup for dinner.
And four days a week, she receives a hot lunch delivery from LifeCare Alliance’s Mealson-Wheels.
The 94-year-old Hilltop woman rarely gets out anymore to shop or eat with friends at the local Moose Lodge. She tires too easily. And cooking is tough because she can’t stand on her feet for very long. Still, she’s cheerful and “doing great.”
“I get my meals and always have stuff in my house to fill in,” she said. “I feel pretty good.”
Miller is one of about 20,000 people in five central Ohio counties who benefit from the LifeCare Alliance program that seeks to provide regular, nutritious meals to Ohioans who are elderly or have medical problems.
With advocacy groups reporting that as many as half of older Americans are at risk of becoming malnourished, an Ohio commission is recommending the expansion of programs that provide seniors with the food and nutritional support they need.
The Malnutrition Prevention Commission, formed in 2016 by the state legislature, issued a report in March detailing 16 recommendations aimed at preventing and addressing senior malnutrition, creating awareness, increasing screenings and assessments, encouraging proposals from researchers and establishing more complete data.
Malnutrition is a leading cause of illness and death among seniors, the report says. Citing data from a 2017 Meals on Wheels America report, it notes that 671,333, or 26 percent, of Ohio’s 2.6 million older adults were isolated and living alone; 443,770 (17 percent) were at risk of hunger; and 694,565 (27 percent) were living in or near poverty.
And data from the Scripps Gerontology Center at Miami University of Ohio indicate that 30 percent of Ohioans will be 60 or older in 2040, compared with just fewer than 20 percent today.
Ohio is a “benchmark state” in addressing malnutrition in older adults, with six other states also tackling the issue in recent years, said Dr. Mary Kate Francis, commission chair and assistant medical director at the Ohio Department of Health.
“Good nutrition has been shown to support a healthy, active lifestyle, reduce frailty and disability and improve health outcomes,” she said. “Given all those things, it also does reduce health care costs.”
The report is an important acknowledgment by a legislatively created commission that senior malnutrition is a serious problem, said Beth Kowalczyk, commission member and chief policy officer for the Ohio Association of Area Agencies on Aging, which represents 12 agencies that provide services to seniors.
She urged the panel to recommend more financial support from the government for cashstrapped programs that enable older adults to live at home by providing at-home or community-based meals, social engagement, transportation, posthospitalization nutrition skills and other care needs.
The report includes examples of 10 state programs and about a dozen community efforts that assist seniors. Though it doesn’t specifically call for funding increases, it does recommend encouraging health care, community organizations and government agencies to “support the expansion of ” innovative malnutrition programming and cost-efficient, wellness programs that exhibit positive results.
Kowalczyk told the panel that many senior nutrition programs have wait lists and must resort to cost-saving measures, with state grant funds cut from more than $15 million to less than $7 million since 2001.
The report also notes that the maximum per-meal benefit under the federally funded Supplemental Nutrition Assistance Program is $1.86; the average per-meal cost for an Ohioan with unreliable food access is $2.72, or 27 percent higher, according to data from the Feeding America network of food banks.
Also important in the report, Kowalczyk said, are recommendations that encourage the education of health care providers to assess individual nutrition needs in long-term care, hospital and primary-care settings. Others suggest use of posthospitalization plans to help ensure seniors are not returning to homes without nutritional support.
The report points to poverty, loss of appetite, limited ability to chew or swallow, painful dental problems, multiple medications, cognitive issues and functional decline as reasons why seniors might become malnourished. Chronic disease, social isolation, mental health struggles, repeated hospitalizations and embarrassment are other factors.
About 70 percent of LifeCareAlliance’s Meals-on-Wheels clients must live on less than $1,200 a month and are forced to choose where to spend that money, said Chuck Gehring, the group’s president and chief executive.
Some take only a portion of prescribed medications or skip doctor visits to avoid co-pays. Others keep air conditioning turned off in the summer or set the thermostat at 60 degrees in the winter. Many forgo fruits and vegetables for cheaper, prepared food. Or they share meals with a pet in lieu of buying pet food.
“There are people out there who are very well off, but by the time they get to that Social Security check, there’s not enough,” Gehring said.
Complicating the problem, Gehring said, is that some seniors shun services because they are “tough” and want to take care of themselves. Others simply don’t know what’s available. And they want to stay living at home.
“They feel that if their family finds out they’re struggling in some way, they will be taken from their home and put into a nursing home — and boy they will fight tooth and nail to avoid that,” Gehring said.
For Miller, the meals help ensure she stays in the home that she and her late husband, Raymond, moved to in 1958. A recent delivery included a “fiesta bowl” of brown rice, black beans, peppers, onion and cheese, along with sides of corn and carrots. An orange and 2 percent milk completed the meal.
Gehring said the report’s recommendations are good ones, but “it’s just a case of ‘who pays for it?’”