Nutrition, Physical Activity, and Obesity: Effectiveness of Home-delivered and Congregate Meal Services for Older Adults.

Community Preventive Service Task Force (CPSTF) (2021)

CPSTF - doi.org/10.15620/cdc/164249

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Evidence Categories

• Care setting: Family/Home Setting
• Care setting: Community setting
• Population group: Older adults
• Intervention: Intra-/Inter-personal: Food provision
• Outcome: Healthy Eating: Energy intake
• Outcome: Healthy Eating: Fruit and veg intake
• Outcome: Healthy Eating: Salt intake
• Outcome: Healthy Eating: Protein intake
• Outcome: Healthy Eating: Calcium intake
• Outcome: Healthy Eating: Whole diet quality

Type of Evidence

Guidance

Overview

The systematic review, which underpins this CPSTF recommendation, provides evidence on the following topic:

• ”Older adults are at greater risk of malnutrition, which is defined as inadequate nutritional intake or absorption"
• "Older adults living on fixed incomes may be forced to choose between paying for rent, utilities, or medication versus paying for groceries (Mabli et al., 2010). This may put older adults at risk for food insecurity (Goldberg et al., 2014 )."
• "Meal services provide nutritious meals to adults 60 years and older who are living independently (i.e., not residents of senior living or retirement community centers)."
• "Interventions prioritize older adults with greater social and economic needs and are delivered in one of two ways:
  • Home-delivered meal services bring meals to older adults in their homes. These programs differ in how they operate, the specific services offered, eligibility requirements for participants, and the types of meals delivered to older adults.
  • "Congregate meal services provide meals in congregate settings and in addition to offering a balanced meal, they provide opportunities for socializing."
• "Prepared meals may be modified to meet cultural- or health-related needs, such as vegetarian, diabetic, low sodium, or modified texture. Meals typically follow nutritional guidelines and are provided five days per week."
• "Among older adults it is not desirable to promote low energy and protein intake because of physiological changes that may decrease lean body mass and place older adults at higher risk for malnutrition (Morley 2007). The review team considered increases or maintenance of energy and protein intake as favorable if baseline levels were below or meeting recommended daily allowances."

The authors state:

• "The CPSTF recommendation is based on evidence from a systematic review of 20 studies."
• "Included studies were conducted in the United States (11 studies), Australia (2 studies), Canada (2 studies), the United Kingdom (2 studies), Finland (1 study), the Netherlands (1 study), and South Korea (1 study)."
• "Study designs included randomized controlled trials, (1), other design with concurrent comparison (5 studies), retrospective self-controlled (3 studies), retrospective cohort (5 studies), and single group pre-post (6 studies)."
• "Study arms assessed the effectiveness of home-delivered meal services (19 study arms), congregate meal services (4 study arms), or the provision of home-delivered meal services or congregate meal services (1 study arm)."
• "Evidence from the included studies showed both home-delivered and congregate meal services intervention approaches reduced malnourished status among older adults"
• "CPSTF noted potential benefits for both intervention approaches could include reductions in cooking-related injuries due to less meal preparation; reductions in food expenditures (which would make it easier to purchase other necessities, such as medications); and reductions in number of trips to the grocery store (which could reduce risk of injury from falls, exposure to communicable diseases, and crime)."
• "None of the included studies reported any potential harms for either intervention approach. CPSTF noted potential harms for both intervention approaches could reduce the number of trips to the grocery store, which may have benefits but could reduce opportunities for social connectedness. In addition, there could be increased risk of foodborne illnesses due to improper food handling or temperature control. Congregate meal service participants may also be at increased risk for exposure to communicable diseases."

Recommendations

Taking into consideration evidence and stakeholder input, the CPSTF recommends:

• "The Community Preventive Services Task Force (CPSTF) recommends home-delivered and congregate meal services for older adults living independently (i.e., not residents of senior living or retirement community centers) based on sufficient evidence of effectiveness showing reductions in malnutrition.
• "For home-delivered meal services, CPSTF also finds sufficient evidence of effectiveness for increasing energy intake and improving health-related quality of life and well-being."
• "For congregate meal services, additional research is needed to determine whether these services improve energy and protein intake and health-related quality of life and well-being."