Impact

The Impact of Meals On Wheels of Tampa on Seniors and the Homebound

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A Community-University Partnership to Improve Access to Fresh Produce among Homebound Seniors

Faculty and students from The University of South Florida and staff from Meals On Wheels of Tampa collaborated to develop and evaluate the impact of a produce delivery program. Data was collected from January-May of 2015.

Full text is available in the Florida Public Health Review Journal 2017.


Diets that are high in fruits and vegetables lower an individual’s risk of chronic disease and contribute to healthy aging. The rising senior population is at an increased risk of developing chronic disease and age related health issues such as cognitive decline and frailty. Research suggests that the risk of these diseases can be decreased with adequate consumption of fruits and vegetables (F&V)1. It is suggested that adults over 65 consume 2.5 cups of both fruits and vegetables per day in order to prevent disease.2 Yet less than half of older adults eat the recommended five servings of fruit and vegetables per day.3 There are many barriers seniors face which contribute to them not consuming recommended amounts. Up to 9% of older adults are living in impoverished households and spend up to 29% of their household income on out of pocket health expenditures leaving less income for food.4 Seniors also lack access to fruits and vegetables, which contributes to their underconsumption. Nearly 3 million seniors are homebound with functional limitations preventing them from shopping for groceries.

What is the project about?

Meals On Wheels of Tampa’s mission is to “Nourish, Enrich, and Strengthen” the community and this is demonstrated by a hot nutritious meal and friendly visit from a volunteer daily.  This study evaluated the effectiveness of one of the first produce delivery programs for homebound seniors in the country.

What We Did

A pretest-posttest, descriptive study was conducted at Meals on Wheels of Tampa. A convenience sampling of MOW recipients participating in the POW! program was utilized. The recipient population is comprised of 23% African-American, 19% Hispanic, 58% Caucasian. The average age of the recipients is 74 years. Sixty-six percent of the recipients are female and 34% are male. Approval for the study was obtained from the University Institutional Review Board.

All clients who wanted to participate in the POW! program were randomized. A member of the research team contacted recipients by phone to describe the study and invite clients to participate. Verbal consent was obtained from those who agreed. The pre-test survey, which consisted of questions pertaining to access, importance, and intake, was the administered over the phone. The survey took approximately 5 minutes to complete. After three months of POW! deliveries, clients received a second call to collect post-test data. Clients were asked the same questions on access, importance, and intake.

A process evaluation was completed after the first monthly delivery of produce. A member of the research team conducted in-home interviews with recipients of the POW! program. Interviewees were chosen based on geographic location. Four diverse areas in the participating county were selected in order to obtain a sample that was able to be generalized. Verbal consent was obtained prior to the start of the interview. To assess overall usability of the program, participants were asked to describe the general quality of the produce, relevance of the educational materials, and the overall benefits of the program. Participants were also asked to give general
thoughts and suggestions to further improve the program.

Results

Produce on Wheels program increases servings of fruit and veggies each day.

The study findings confirm that the program was effective in increasing the fruit and vegetable intake of participants. Participants averaged an increase of almost 1 serving of fruit and ½ serving of vegetables each day. The increase in fruit and vegetable intake was not only statistically significant but clinically significant as well. Given the “5-a-day” recommendation of fruit and vegetable intake, our participants increased their intake by 30% toward the recommendation.

Discussion- What does this all mean?

Meals on Wheels of Tampa, established in 1975, had not measured the outcomes of their program prior to this partnership, lacking the expertise and resources to conduct such a report. The resulting study has been a valuable tool for the organization and its community partners as well as a resource for other meal providers.

The university assisted MOW with the design, outcome measurement, and process evaluation of the POW! program. USF COPH provided a graduate student the opportunity to complete their required field experience by assisting MOW staff in the implementation and evaluation of the program. This opportunity provided a graduate student intern with new knowledge and advanced skills in program development, program evaluation and program sustainability.

The university and community partnership has also allowed MOW to expand their network of non-profit to non-profit partnerships. These new partnerships help to increase awareness, promote student engagement, and increase the opportunity for further collaborative and community-based research. An increase in university and community partnerships may ultimately result in a stronger community.

Future steps?

With additional resources, we hope to increase the number of fresh produce deliveries from once per month to twice monthly. We also hope to expand this research by using a larger sample size over a longer period of time. This project was not without limitations that may have influenced the results. The lack of paired data samples did not allow for analysis of changes within-subjects. Further, a convenience sample was utilized and participant demographics were not obtained – only overall program demographics. Finally, the responses could have been affected by factors such as social desirability.

Conclusion

Overall this pilot study was an important first step in demonstrating the benefits of university-community partnerships in effectively increasing the fruit and vegetable intake of homebound seniors and disabled. We hope this information helps you to better understand the impact of the Produce on Wheels (POW) program on Meals On Wheels Tampa’s recipients, and that you are able to translate the significance when speaking on behalf of the program.

For more information please contact Lauren Vance at  l.vance@mowtampa.org

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Importance of Senior Nutrition, Food Insecurity, Loneliness

This study was conducted by faculty and graduate students from the University of South Florida’s College of Public Health. Data was collected from January-April of 2014.

Please click here for the abstract.  Full text is available in the Journal of Nutrition in Gerontology and Geriatrics.


In the United States, $250 billion is spent annually on medical care for older adults. The aging ‘baby boomer’ population will undoubtedly increase the demand of health care services exponentially over the next 15 years. Keeping seniors in their own home not only saves healthcare dollars but also increases their emotional wellbeing. Home-delivered meal programs is one aid in assisting seniors to stay in their homes and Meals On Wheels of Tampa has been providing this service for nearly 40 years.

The elderly are at increased risk of malnutrition, food insecurity, social isolation, and poor mental wellbeing.  Malnutrition rates are higher among those that are economically disadvantaged, socially isolated or disabled. Nearly 1 in 6 seniors living in Florida are food insecure, meaning they do not know where their next meal is coming from.  Malnutrition and food insecurity among seniors increases the risk for injury, illness, certain chronic diseases including cardiovascular disease, hypertension, diabetes, cancer and osteoporosis, and premature institutionalization, all of which increases financial burdens.

In addition to undernutrition and food insecurity, seniors are also more vulnerable to social isolation and poor mental wellbeing than the rest of the population.  Therefore, a clear relationship exists between health status, nutritional intake and social connectedness among the elderly.

What is the project about?

Meals On Wheels of Tampa’s mission is to “Nourish, Enrich, and Strengthen” the community and this is demonstrated by a hot nutritious meal and friendly visit from a volunteer daily.  The purpose of this project was to measure the impact of the services Meals On Wheels of Tampa provides.

What We Did

Study participants were initially identified for eligibility criteria by the Recipient Intake Coordinator, between January and April this past year.  If eligible, the coordinator described the study and invited them to participate.  Clients were eligible if they were 55 years or older, received at least 3 meals per week, were English speakers, had telephone access, were able to provide informed consent and answer survey questions.

Those participants who agreed to participate were telephoned by a member of the research team to provide a detailed description of the study and obtain verbal informed consent.  After informed consent was obtained, participants were interviewed by phone prior to receiving their first meal from MOW of Tampa.

A survey was developed that measured 5 different factors, nutritional status, dietary intake, mental well-being, loneliness, and food security. The survey developed was used as a pretest-posttest tool. The recipient interview took approximately 30 minutes and consisted of questions pertaining to nutrition, diet, well-being, loneliness and food security. 2 months after meal delivery service began and the initial telephone interview, clients received a second call to collect post-test data.  Clients were asked the same questions on nutritional status, dietary intake, mental well-being, loneliness, and food security as the pre-test interview. Please click here for Impact Survey tool.

Results

Merch Bag. Brown. FINAL FOR PRINT

62 seniors enrolled in the study and the average age was 74 years old. 66% of the participants were female and 34% were male. The majority (58%) of the participants were Caucasian, 19.4% were Hispanic and 22.6% were African-American. 51 seniors completed the study; 11 seniors did not complete the program due to moving out-of-state, hospitalization, no longer participating in MOW or refusal to complete post-survey. All analyses were conducted using only completers.

Overall, 51% of participants’ nutritional status improved, 66% of participants were consuming more calories and grams of protein.  The statistics indicated an improvement in general emotional health, nearly 30% reported decreased feelings of loneliness, and nearly 30% reported improved wellbeing.  34% were malnourished, now only 5% are malnourished.  Overall, 100% of participants were more food secure as a result of MOW of Tampa.

Discussion- What does this all mean?

This is one of the first studies to look at outcomes of a home-delivered meal program on nutritional status, dietary intake, wellbeing, loneliness and food security levels. The study findings confirm that home-bound elderly have a high prevalence of malnutrition and nutrition risk.  Only 8% of participants were considered to have a normal nutritional status at the start of the program. After two months on the home-delivered meal program, there was a clear improvement in nutritional status; This improvement is most directly attributed to improved dietary intake. Both calorie and protein intake increased significantly after being enrolled in the program for two months. Given the high prevalence of malnutrition, the increase in nutrient intake is clinically significant. Overall, these marked improvements in nutritional status and dietary intake may translate into better quality of life and health outcomes, allowing our seniors to remain independent in their own homes

Quality of emotional functioning also improved. Taken together, participants improved on both the loneliness/social isolation factor and on wellbeing. The aim of the MOW program includes enriching the lives of our seniors to improve life outcomes. Because these emotional needs are met less well in elder populations, this outcome is particularly significant, and the benefit may extend to several other problem areas that are correlated with loneliness and emotional wellbeing in elders, such as mental health problems and both actual and perceived physical health problems.

We found that 71% of the sample was food insecure at the start of the program. This is significantly higher than the national average of 9.1% of households of seniors living alone. The high prevalence of very low food security seems to indicate that seniors in our study delayed entry into the meal program until there were no other options. This may have also contributed to the higher levels of malnutrition found. After two months on the home-delivered meal program, there was a clear improvement in food security level; only 5% of participants were food insecure.  Because of the role of food insecurity in malnutrition and increased risk of chronic disease, the improvement in food security level demonstrated in this study has strong public policy implications. Given the state of future funding, this study provides valuable information on the effectiveness that MOW has on the health of seniors. Further, with an average meal cost of less than $5, the cost-savings of such a program is tremendous when compared to the cost of malnutrition.

Future steps?

What’s next? With additional resources, we hope to continue this research on a bigger scale in terms of a larger sample size and over a longer period of time. The project had a small sample size and participants were reevaluated after only two months in the program. A longer study period may yield somewhat different results, versus the identified short-term results.  Also, a convenience sample was utilized; using a randomized sample might show different results. Finally, although standardized instruments were used, the responses could have been affected by factors such as social desirability.

Conclusion

Overall this pilot study was an important first step in demonstrating the effectiveness of Meals On Wheels of Tampa on the nutritional and emotional health of our seniors. We hope this information helps you to better understand the impact of Meals On Wheels Tampa on its recipients, and that you are able to translate the significance when speaking on behalf of the program.

For more information please contact Lauren Vance at  l.vance@mowtampa.org

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