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Nutrition: Home-delivered and Congregate Meal Services for Older Adults

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What the CPSTF Found

About The Systematic Review

This CPSTF finding is based on evidence from a systematic review published in 2020 (Walton et al., 20 studies, search period database inception – January 2019) combined with more recent evidence (8 studies, search period January 2019 to May 2021).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to nutrition.

Context

Older adults are at greater risk of malnutrition, which is defined as inadequate nutritional intake or absorption (Norman et al., 2021). Malnutrition among older adults results from physiological changes that occur with aging and may include changes in cognitive functioning, metabolism, body composition, chronic diseases and conditions, and use of multiple medications that may affect intake and absorption of nutrients (U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2020). Additionally, social factors associated with aging may include reduced social connectedness, loneliness, and depression (Krondl et al., 2008).

The Older Americans Act Nutrition Programs address these needs by providing home-delivered meal and congregate meal services to reduce hunger, food insecurity and malnutrition; enhance socialization; and promote health and well-being among older Americans (U.S. Department of Health and Human Services, 2021). Both programs target older adults who have lower incomes, live in rural communities, speak limited English, or are at risk for institutional care.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 20 studies (24 study arms). Studies assessed home-delivered meal services (19 study arms), congregate meal services (4 study arms), or either (1 study arm).

Home-delivered Meal Services

Dietary Behaviors
  • Percent meeting Recommended Daily Allowances (RDA) for energy increased by 7.1 percentage points (6 studies)
  • Percent meeting Recommended Daily Allowances (RDA) for protein increased by 5.9 percentage points (6 studies)
Food and Nutrition Security

Percent malnourished decreased by 15.5 percentage points (9 studies, 10 study arms)

Congregate Meal Services

Food and Nutrition Security

Percent malnourished decreased by 9.0 percentage points (2 studies, 3 arms)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the systematic review, the CPSTF finding should be applicable to older adults living independently in urban or rural settings in the United States, independent of socioeconomic status.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How does intervention effectiveness vary by the following:
    • Race or ethnicity?
    • Extent of participants’ support systems (e.g., friend networks, children)?
    • Participants’ literacy level, education, and English proficiency?
    • Access to food (proximity to grocery stores)?
    • Frequency of meals provided?
  • What is the impact on dietary intake of including nutrition education?
  • Are participants more likely to be referred to other community-based supports and programs than older adults who are not receiving meal services?
  • Does participation affect activities of daily living, instrumental activities of daily living, or medication adherence?
  • Do interventions demonstrate improvements for aging in place? Long term studies would be beneficial.

Study Characteristics

  • 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).
  • Studies were conducted in urban and rural populations (5 studies), urban populations (4 studies, and rural populations (1 study).
  • All eleven studies conducted in the United States reported racial and ethnic distributions. Studies included participants who self-identified as White (median 63.4%; 13 studies), Black or African American (median 30.9%; 10 studies), Hispanic or Latino (median 16.1%; 6 studies), Asian (median: 1.7%; 2 studies), American Indian or Alaska Native (0.7%; 3 studies), or other race/ethnicity (median 11.1%; 2 studies). None of the studies included participants who self-identified as Native Hawaiian or other Pacific Islander.
  • Eleven studies reported on socioeconomic status and living situation (either alone or with family members).
    • The median proportion of participants with low levels of socioeconomic status was 68.0%.
    • The median proportion of participants living alone was 56.2%.