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Nutrition
Evaluations Report
Vol. 1 Chapter II. CHARACTERISTICS OF TITLE III NUTRITION
PROGRAM PARTICIPANTS
A: CHARACTERISTICS OF PARTICIPANTS
A primary objective of this evaluation is to identify the characteristics
of Title III Elderly Nutrition Program (ENP) participants as accurately
as possible. This is particularly important for two reasons. First,
two of the program's components--the congregate and home-delivered
meal programs--are designed to serve somewhat different populations
of older individuals needing nutrition and supportive services. Second,
although the program is available to any individual 60 years of age
or older, amendments to the Older Americans Act (OAA) over the years
have required State and Area Agencies on Aging to target program
services to persons with the greatest social or economic need, with
particular attention to low-income and minority older persons.
This chapter examines the demographic, economic, health, social,
food, and nutrition characteristics, as well as the service use,
of older persons who receive Title III congregate and home-delivered
meals to determine whether the program is serving them as intended
and the extent to which the program successfully targets priority
subgroups of elderly people. Using data collected from program participants
for the current evaluation, as well as from other data sources, this
chapter (1) describes the characteristics of meal program participants,
compares participants with the overall elderly U.S. population, and
describes key differences and similarities between congregate and
home-delivered participants; (2) describes changes over time in participant
characteristics and use of program services; and (3) assesses program
effectiveness in serving special populations of older individuals.
The current evaluation found that Title III of the ENP serves highly
vulnerable people with characteristics that tend to put them at increased
health and nutritional risk. The program is successful at targeting
nutrition services to low-income and minority elderly people. Compared
with the overall population of elderly individuals age 60 and older,
the elderly individuals served by Title III ENP tend to be older
and to have lower incomes. They are also more likely to be members
of racial or ethnic minority groups and to live alone. In general,
home-delivered participants are older, more functionally impaired,
have lower incomes, get out of their homes less often, and have more
need for a variety of in-home supportive services than do congregate
participants. Older participants in both components of the program,
however, are similar along most demographic dimensions, and a significant
proportion of congregate participants have low incomes, are racial/ethnic
minorities, and have one or more chronic health conditions and impairments.
Thus, the program's two components--the congregate and home-delivered
meal programs--are reaching the intended targeted groups.
A. CHARACTERISTICS OF PARTICIPANTS
This section of the report describes the characteristics of Title
III meal program participants who receive a program meal on a typical
day. Emphasis is placed on describing participants along key demographic,
health, nutrition, and lifestyle dimensions; comparing participants
with the overall elderly population; and describing differences and
similarities between congregate and home-delivered meal program participants.
1. Demographic Characteristics
The average Title III congregate meal program participant is 76
years old; the average home-delivered participant is age 78 (Table
II.1). Fourteen percent of congregate participants and 26 percent
of home-delivered participants are 85 or older. Most congregate and
home-delivered meal program participants are female, with the ratio
of female to male participants exceeding 2 to 1. More than one-half
of Title III meal program participants (57 percent of congregate
participants and 60 percent of home-delivered meal participants)
live alone. Twenty-eight percent of congregate participants and 16
percent of home-delivered participants reside in rural areas (places
with fewer than 2,500 inhabitants).
TABLE II.1
SELECTED DEMOGRAPHIC CHARACTERISTICS OF MEAL PROGRAM PARTICIPANTS
(Percentages, Unless Stated Otherwise)
|
Characteristic
| Title
III Congregate
Meal Participants
| Title
III Home-Delivered
Meal Participants
| Overall
U.S Elderly
(60+)
Populationc
|
|
Age
|
|
|
|
Less
than
60
| 1
| 2
| --
|
60-74
| 43
|
30
| 67
|
75-84
|
42
| 42
| 25
|
|
85
and
older
| 14
| 26
|
8
|
Average
Age
(Years)
| 76
| 78
| 72
|
|
Female
| 69
| 70
|
58
|
Live
Alone
| 57
| 60
| 25
|
|
Rurala
| 28
|
16
| 25
|
|
Minority
Status
|
|
|
|
|
Non-Hispanic
blacks
| 12
|
18
| 8
|
Hispanics
| 12
| 5
|
4
|
All
minorities
| 27
| 25
| 14
|
|
Income
Status
|
|
|
|
Below
100%
of
the
DHHS
poverty
guidelines
| 34
| 48
|
15
|
Below
200%
of
the
DHHS
poverty
guidelines
| 79
| 90
|
38
|
Low-Income
Minority b
|
15
| 16
| 4
|
|
Unweighted
Sample
Size
| 1,040
|
818
| 40,116,501
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
- Participant zip codes were used to define rural and urban location
according to the Census definition. As defined by the Census, urban
areas comprise (1) urbanized areas (incorporated places and adjacent
densely settled territory with a combined minimum population of
50,000), and (2) all other places with 2,500 or more persons. Rural
areas include any area not defined as urban.
- "Low-income" refers to less than 100 percent of the
DHHS poverty guidelines.
- Authors' tabulations based on 1990 Census of Population and Housing
Data (U.S. Bureau of the Census, 1994)
DHHS = U.S. Department of Health and Human Services.
Means tests for participation in the meals program are prohibited,
yet most participants are poor or near poor. One-third of congregate
participants and nearly one-half of home-delivered participants have
family incomes below 100 percent of the U.S. Department of Health
and Human Services (DHHS) poverty threshold (Table II.1). Most of
the rest are among the near poor, with family incomes between 100
and 200 percent of the DHHS poverty threshold. Overall, 79 percent
of congregate participants and 90 percent of home-delivered participants
have family incomes below 200 percent of the DHHS poverty threshold.
Congregate and home-delivered meal program participants are largely
non-Hispanic white elderly individuals, but a significant percentage
of participants in both program components are members of racial
and ethnic minorities. For example, non-Hispanic blacks constitute
approximately 12 percent of congregate participants and 18 percent
of home-delivered participants (Table II.1). Hispanics make up another
12 percent and five percent, respectively, of participants in the
two components. Overall, racial and ethnic minorities constitute
27 percent of congregate and 25 percent of home-delivered participants.
Along most of the demographic dimensions examined, elderly recipients
of home-delivered meals are very similar to congregate meal program
participants. However, there are a few notable exceptions. Home-delivered
meal program participants are, on average, older and poorer. They
are also less likely than congregate participants to reside in rural
locations.
On the basis of 1990 Census data, comparing the demographic characteristics
of Title III congregate and home-delivered participants with those
of all elderly (60 years or older) persons in the United States shows
that program participants are more likely to be older and female,
live alone, have low income, and belong to a racial or ethnic minority
group (see Table II.1). For example, 60 percent of both congregate
and home-delivered meal program participants live alone, compared
with 25 percent of all elderly persons. About 25 percent each of
congregate and home-delivered participants are racial or ethnic minorities,
compared with 14 percent of all elderly persons. Approximately 15
percent each of congregate and home-delivered meal program participants
are from low-income minority groups, compared with just 4 percent
of the overall U.S. elderly population. As discussed in greater detail
in Section C, these data indicate that the program successfully attracts
and recruits elderly people who have low incomes and are members
of racial or ethnic minorities, when their proportion in the overall
elderly population is used as a benchmark.
2. Health, Functional Ability, and Mobility
Health Status. The average number of self-reported diagnosed chronic
health conditions is 2.4 for congregate participants, compared with
3.0 for home-delivered participants (Table II.2). Forty-one percent
of congregate participants have three or more chronic conditions;
59 percent of home-delivered participants have three or more diagnosed
chronic conditions. The most common health problems, reported by
about one-fifth to more than one-half of Title III participants,
include arthritis, hypertension, heart disease, lung or breathing
problems, elevated blood cholesterol levels, and diabetes. Eleven
to 20 percent of Title III congregate and home-delivered participants
also reported a history of stroke or cancer. Eighteen percent of
congregate participants and 30 percent of home-delivered participants
reported that they recently lost or gained 10 pounds involuntarily.
Recent and severe involuntary changes in body weight have been shown
to be associated with an increased risk of poor nutritional status
and adverse health problems (Nutrition Screening Initiative 1991).
Except for high blood cholesterol levels, the prevalence of each
chronic condition is higher for home-delivered than congregate participants,
for some conditions by twice as much.
TABLE II.2
SELECTED HEALTH CHARACTERISTICS OF MEAL PROGRAM PARTICIPANTS
(Percentages, Unless Stated Otherwise)
Characteristic
| Title
III Congregate Meal Participants
| Title
III Home-Delivered Meal Participants
|
Medical
Doctor Has
Diagnosed:
|
|
|
Hypertension
|
52
| 55
|
Arthritis
|
51
| 64
|
Heart
disease
| 28
| 44
|
|
High
blood cholesterol
| 28
| 20
|
Diabetes
| 18
| 25
|
Breathing/lung
problems
| 18
| 30
|
|
Cancer
| 13
| 16
|
|
Stroke
| 11
| 20
|
|
Anemia
| 9
| 15
|
|
Osteoporosis
| 7
| 17
|
|
Kidney
disease
| 6
| 7
|
|
Average
Number of
Diagnosed
Chronic Health
Conditions
| 2.4
| 3.0
|
|
Have
3 or More
Chronic Health
Conditions
| 41
| 59
|
|
Hospital
Stay During
the Past
Year
| 25
| 43
|
|
Nursing
Home or Convalescent
Home Stay
During the
Past Year
| 1
| 5
|
|
Hospital
or Nursing
Home Stay
During the
Past Year
| 26
| 43
|
|
Take
Three or
More Prescription
or Over-the-Counter
Drugs Daily
| 40
| 61
|
|
Smoke
Cigarettes
Regularly
| 7
| 11
|
Three
or More Drinks
of Alcohol
Per Day
|
2
| 1
|
|
Body
Mass Index
Below 22
(Indicative
of Risk for
Nutrient
Deficiency)b
| 19
| 32
|
|
Body
Mass
Index
Above
27
(Indicative
of
Risk
for
Obesity)b
| 42
| 32
|
|
Involuntarily
Lost
or
Gained
10
Pounds
in
the
Past
Six
Months
| 18
| 30
|
|
Fair
or
Poor
Current
Health
| 33
| 63
|
Has
Usual
Place
for
Medical
Care
|
94
| 95
|
|
Health
Insurance
Coverage
|
|
|
|
Medicare
and
private
insurance
| 52
| 47
|
|
Medicare
only
| 23
| 27
|
|
Medicare
and
Medicaid
| 11
| 17
|
|
Medicaid
only
| 3
| 3
|
|
Other
combinations
| 8
| 5
|
|
No
coverage
| 4
| 1
|
|
Unweighted
Sample
Size
| 1,040
| 818
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
- Tabulations are based mainly on self-reported data.
- Body Mass Index (BMI) is based on measured height and weight.
However, if a respondent could not be or refused to be weighted
or have his or her height measured, we took self-reported weight
and height.
Twenty-five percent of congregate participants reported one or more
separate overnight hospital stays during the past year, compared
with 43 percent of home-delivered participants (Table II.2). Home-delivered
meal program participants were also more likely than congregate participants
to have multiple hospital stays during the past year. Eight percent
of home-delivered participants had three or more separate hospital
stays during the past year, compared with three percent of congregate
participants (tabulations not shown). Just one percent of congregate
participants reported a nursing or convalescent stay during the past
year, compared with five percent of home-delivered participants.
Many elderly participants take multiple medications concurrently,
which increases the potential for adverse drug-nutrient interactions;
adverse effects of malnutrition on drug absorption, metabolism, or
utilization; and risk of malnutrition. Sixty-one percent of home-delivered
participants take three or more prescription or over-the-counter
drugs daily, whereas 40 percent of congregate participants report
taking three or more drugs daily.
About one-third each of Title III congregate participants and home-delivered
participants have an estimated Body Mass Index (BMI) in the "ideal" range
(between 22 and 27). Most are either over- or underweight, placing
them at increased risk for nutrition and health problems. Thirty-two
percent of home-delivered participants are estimated to have BMI
below 22, indicating that they may be underweight and at risk for
health and nutrition-related problems, whereas 42 percent of congregate
participants are estimated to have BMI greater than 27, indicating
that they may be overweight and at risk for problems related to obesity
and nutritional excess.
Significant percentages of Title III participants say they are in "poor" or "fair" health.
One-third of congregate participants and nearly two-thirds of home-delivered
participants rate their current health as either "poor" or "fair."
Nearly all Title III participants report having a health care provider
(clinic, doctor, health center, or other) where they can go when
they are ill and need health advice or routine care. Virtually all
have private or public health insurance coverage. Four percent of
congregate participants and just one percent of home-delivered participants
report not having either private or public health care insurance.
About half of congregate and home-delivered participants have Medicare
and private health insurance.
Overall, the health characteristics of Title III congregate and
home-delivered meal participants differ in a number of important
ways. Compared with congregate participants, home-delivered participants
are nearly twice as likely to report being in "poor" or "fair" health
and are more likely to report multiple chronic health problems. Home-delivered
meal program participants are nearly twice as likely to have had
a hospital or nursing home stay during the past year and are nearly
three times as likely to have had multiple hospital stays. They are
more likely than congregate participants to be taking multiple prescription
drugs and over-the-counter medications. Among home-delivered meal
participants, proportionately more are underweight by BMI standards
and proportionately fewer are overweight. However, congregate and
home-delivered participants report a similar overall number of diagnosed
chronic health conditions, and congregate participants report a health
profile that also places them at risk for nutrition-related problems.
Indeed, at least half of congregate participants and home-delivered
meal participants have nutrition-related chronic diseases. For example,
significant minorities of both groups--one-fifth of congregate and
nearly one-third of home-delivered meal participants--may be underweight,
and the prevalence of obesity, which imposes risk for complications
of chronic disease, may be high in both groups.
Compared with the overall elderly population, both congregate and
home-delivered meal program participants generally fare worse on
most of the health dimensions examined for which we have comparable
data. (Data on health characteristics of the overall elderly population
are not shown in Table II.2.) Home-delivered participants are considerably
less healthy relative to the overall elderly population. For example,
48 percent of all elderly (age 65 and older) have arthritis, compared
with 51 percent and 64 percent of congregate and home-delivered participants,
respectively. Thirty-eight percent of all elderly people (age 65
and older) have hypertension, compared with about 50 percent each
of congregate and home-delivered meal program participants. Sixty-three
percent of home-delivered participants and 33 percent of congregate
participants rate their current health as "fair or poor," compared
with 29 percent of the overall elderly population.
Functional Status. A substantial proportion of Title III home-delivered
meal program participants are severely functionally impaired and
need daily help performing one or more activities critical for them
to remain in their homes or the community and to avoid unnecessary
and costly institutionalization. Sixty-five percent of home-delivered
participants are unable to perform one or more Activities of Daily
Living (ADLs) or Instrumental Activities of Daily Living (IADLs)
without the assistance of another person or the use of physical devices;
77 percent are either unable to perform or have much difficulty performing
one or more ADLs or IADLs without assistance (results not shown).
The remainder of this section defines participants as impaired in
a particular ADL or IADL if they report that they are either unable
to perform or have much difficulty performing the activity. Table
II.3 shows that, for any particular ADL category, most Title III
congregate participants do not report a functional impairment. In
contrast, 37 percent of Title III home-delivered meal program participants
are unable to walk or have much difficulty walking without assistance.
Similarly, 36 percent are unable to take a bath or shower or have
much difficulty doing so without assistance. One-quarter of home-delivered
participants are either unable to dress themselves or have much difficulty
doing so without assistance. Regarding IADLs, the majority (64 percent)
of home-delivered meal program participants are unable to shop or
have much difficulty shopping for groceries without assistance, and
59 percent are unable or have much difficulty doing household chores
without assistance. More than 40 percent of home-delivered participants
are unable to prepare or have much difficulty preparing meals without
assistance. Home-delivered meal participants, on average, are impaired
on two ADLs and two IADLs. Overall, they are impaired on 4 ADLs/IADLs,
and 20 percent of home-delivered meal participants are impaired on
7 or more of the 14 ADLs and IADLs.
TABLE II.3
PREVALENCE OF FUNCTIONAL LIMITATIONS IN THE MEAL PROGRAM
PARTICIPANT POPULATION
(Percentage, Unless Stated Otherwise)
|
Much Difficulty Performing or Unable to Perform
Activity Without Assistance
|
|
Functional Activities
|
Title III Congregate
Meal Participantsa
|
Title III
Home-Delivered
Meal Participantsa
|
Elderly
(65+)
Medicare
Beneficiariesb
|
|
Activities
of
Daily
Living
|
|
|
|
|
Personal
Grooming
|
1.6
|
18.7
|
N.A.
|
|
Eating
|
0.6
|
7.3
|
0.6
|
|
Getting
In
and
Out
of
Bed
|
1.9
|
15.0
|
3.8
|
|
Walking
|
4.7
|
37.4
|
10.7
|
|
Taking
a
Bath
or
Shower
|
4.2
|
35.7
|
6.4
|
|
Using
the
Toilet
|
0.7
|
12.3
|
2.4
|
|
Dressing
|
2.8
|
25.3
|
2.1
|
|
Maintaining
Continence
|
1.5
|
15.9
|
3.8
|
|
Average
Number
of
ADLs
Have
Difficulty
Performing
or
Unable
to
Perform
Without
Assistance
|
0.2
|
1.7
|
--
|
|
Percentage
with
Difficulty
Performing
or
Unable
to
Perform
One
or
More
ADLs
Without
Assistance
|
9
|
52
|
--
|
|
Instrumental
Activities
of
Daily
Living
|
|
|
|
|
Using
the
Telephone
|
3.1
|
9.9
|
3.0
|
|
Taking
Medication
|
2.1
|
9.3
|
N.A.
|
|
Managing
Money
|
6.3
|
23.7
|
5.1
|
|
Preparing
Meals
|
7.5
|
41.3
|
6.6
|
|
Doing
Housework c
|
11.9
|
59.1
|
7.8
|
|
Grocery
Shopping
|
12.8
|
63.9
|
11.5
|
|
Average
Number
of
IADLs
Have
Difficulty
Performing
or
Unable
to
Perform
Without
Assistance
|
0.4
|
2.1
|
--
|
|
Percentage
with
Difficulty
Performing
or
Unable
to
Perform
One
or
More
IADLs
Without
Assistance
|
21
|
76
|
--
|
|
Unweighted
Sample
Size
|
1,040
|
818
|
3,485
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of program participants receiving Title III meals
on a given day.
- In the current evaluation, the questions were: "Now I am
going to read a list of activities. Please tell me how much difficulty
you have doing these things without the use of aids or another
person. What about . . . ? Do you have no difficulty, some difficulty,
much difficulty, or are you unable to . . . at all by yourself?"
- In the National Survey of Self-Care and Aging, the questions
were: "Because of a health or physical problem, do you have
difficulty . . . ?" If response was "yes," the subject
was asked: "Do you have some difficulty, a lot of difficulty,
or are you unable to . . . ?"
- Refers to "doing light housework" in the National Survey
of Self-Care and Aging.
N.A. = Not asked.
Title III home-delivered meal program participants are considerably
more functionally impaired than congregate participants. After examining
each ADL category separately, we found that home-delivered meal program
participants are approximately 7 to 18 times more likely than congregate
participants to be impaired in ADLs. For example, 37 percent of home-delivered
participants are unable to walk or have much difficulty walking without
assistance, compared with five percent of congregate participants.
Home-delivered participants are three to six times more likely than
congregate participants to be impaired in IADLs. Sixty-four percent
of home-delivered meal program participants are unable to shop or
have much difficulty shopping for groceries without assistance, compared
with 13 percent of congregate participants; 41 percent of home-delivered
participants are unable to prepare or have much difficulty preparing
meals without assistance, compared with 7 percent of congregate participants.
Home-delivered meal participants, on average, are impaired in 2 ADLs
and 2 IADLs, compared with 0.2 and 0.4 for congregate participants,
respectively. Overall, home-delivered meal participants, on average,
are unable to perform or have much difficulty performing four ADLs
and IADLs, compared with less than one for congregate participants.
A comparison of Title III participants with the Medicare beneficiary
population age 65 and over on their ability to perform ADLs and IADLs
shows that home-delivered meal participants are considerably more
impaired in both ADLs and IADLs (Table II.3). In general, Title III
congregate participants are somewhat more impaired in IADLs, but
somewhat less impaired in ADLs, than elderly Medicare beneficiaries.
Mobility and Leisure Time Physical Activity. Title
III congregate participants as a group are very mobile and physically
active, and they are considerably more mobile and physically active
than Title III home-delivered meal participants. Ninety-one percent
of congregate participants report getting out of their homes at least
once per week; 73 percent report getting out of the house five or
more times per week (Table II.4). In contrast, 46 percent of home-delivered
participants report getting out of the house at least once per week,
and only 15 percent get away from their home five or more times per
week. About 70 percent of Title III congregate participants report
that they participated in leisure time activities during the past
month. These activities include walking, other forms of exercise,
gardening, or other physical activities. Congregate participants
report, on average, 21 leisure time physical activities during the
past month (the median number is 13). In contrast, less than half
(42 percent) of home-delivered meal program participants report any
leisure time physical activities during the past month. Home-delivered
meal participants report an average of 10 leisure time physical activities
during the past month (the median is zero).
TABLE II.4
MOBILITY AND LEISURE TIME PHYSICAL ACTIVITY OF MEAL PROGRAM
PARTICIPANTS
(Percentages, Unless Stated Otherwise)
|
Title III Congregate Meal Participants
|
Title III Home-Delivered Meal Participants
|
|
Unable to Walk or
Have Much Difficulty
Walking Without Assistance
|
5
|
37
|
|
Get Out of the House
At Least Once Per Week
|
91
|
46
|
|
Get Out of the House
5 or More Days Per
Week
|
73
|
15
|
|
Some Leisure Time
Physical Activity During
the Past Month
|
72
|
42
|
|
Number of Leisure
Time Physical Activities
During the Past Month
|
|
|
|
Mean
|
21
|
10
|
|
Median
|
13
|
0
|
|
Unweighted Sample
Size
|
1,040
|
818
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
Summary. In summary, both Title III congregate
and Title III home-delivered meal participants appear to have significant
numbers of health problems, based on self-reports of health history
and health status. However, health problems are somewhat more prevalent
among the home-delivered meal group. When ADL and IADL indicators
and direct measures of mobility are considered, the picture that
emerges is that most congregate meal participants retain relatively
high degrees of functional ability, but the typical home-delivered
meal recipient has significant limitations in functional status.
3. Food and Dietary Behaviors, Nutritional Risk, and Food
Insecurity
Food and Dietary Behaviors. Most Title III congregate
and home-delivered meal participants report consuming about three
meals a day, including daily breakfast (Table II.5). About half of
congregate participants and nearly two-thirds of home-delivered meal
participants usually eat alone when they consume meals at home. The
vast majority (95 percent) of congregate participants and the majority
(67 percent) of home-delivered participants can prepare hot meals
if they absolutely have to. Yet, fully one-third of home-delivered
meal participants are unable to prepare hot meals for themselves.
A minority (15 percent) of congregate participants report their current
appetite as "poor" or "fair," compared with 36
percent of home-delivered meal program participants. More than 20
percent of congregate participants and 31 percent of home-delivered
meal program participants are on special diets, most commonly to
lower blood cholesterol levels. About half of those on special diets
are on two or more special diets concurrently. About one-third of
Title III meal program participants have an illness or condition
that has changed the kind or amount of food eaten. About 40 percent
of congregate and home-delivered participants report taking vitamin
supplements daily; half of these persons report consuming two or
more supplements daily.
TABLE II.5
SELECTED DIETARY CHARACTERISTICS AND BEHAVIORS OF MEAL PROGRAM
PARTICIPANTS
(Percentages)
|
Characteristic
|
Title III Congregate
Meal Participants
|
Title III Home-Delivered
Meal Participants
|
|
Eat
Fewer than
Three Meals
Per Day
|
22
|
29
|
|
Rarely
or Never
Eat Breakfast
|
7
|
11
|
|
Cannot
Prepare Hot
Meals if
Need to
|
6
|
33
|
|
Usually
Eat Alone
|
51
|
61
|
|
Current
Appetite
Is Fair or
Poor
|
15
|
36
|
|
Have
Illness or
Condition
that Has
Changed Eating
Habits
|
30
|
34
|
|
Eat
Few Fruits
Daily
|
24
|
35
|
|
Eat
Few Vegetables
Daily
|
17
|
27
|
|
Consume
Few Milk
Products
Daily
|
32
|
38
|
|
Regularly
Take Vitamin
or Mineral
Supplements
|
41
|
40
|
|
Currently
on Special/Therapeutic
Diet
|
22
|
31
|
|
Unweighted
Sample
Size
|
1,040
|
818
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
Title III congregate and home-delivered meal recipients differ
in several important characteristics related to their nutrition habits.
Home-delivered meal recipients are far less likely to be able to
prepare a hot meal if they have to and are far more likely not to
cook. They are more likely to report their appetites as "fair" or "poor," more
likely to be on medically prescribed therapeutic diets, and more
often on multiple concurrent prescriptions. They are slightly more
likely to eat alone or to have a current illness that interferes
with eating.
Characteristics and Behaviors Suggestive of Increased Nutritional
Risk. As shown in Table II.6, 22 percent of congregate
participants and 48 percent of home-delivered participants report
a combination of characteristics or behaviors that place them at
high risk for nutritional problems, as measured by an approximation
of the NSI Checklist (Nutrition Screening Initiative 1991). These
characteristics increase the likelihood of risk for nutritional
problems (Posner et al. 1994), as indicated by a score of 6 or
more on our approximation of the NSI Checklist. Scores for about
40 percent each of congregate and home-delivered meal program participants
ranged from 3 to 5, suggesting moderate nutritional risk. Overall,
64 percent of congregate and 88 percent of home-delivered participants
have characteristics associated with moderate to high nutritional
risk.
Food Insecurity. Food insecurity is a condition
in which the household in which the individual resides does not always
have adequate food, the individual cannot always afford to buy enough
food and/or cannot always get to markets or food programs to obtain
food, or the individual cannot prepare and gain access to the food
available in the household (Burt 1993). Food insecurity was operationalized
in the current evaluation using four questions about household circumstances
that several researchers recently used to assess the degree of food
insecurity in the United States (Burt 1993; Cohen and Young 1993;
and Food Research and Action Center 1987). These household circumstances
refer to one or more of the following during the past month: (1)
on one or more days the participant had no food in the house and
no money or food stamps to buy food; (2) the participant had to choose
between buying food and buying medications; (3) the participant had
to choose between buying food and paying rent or utility bills; or
(4) the participant skipped one or more meals because he or she had
no food in the house and had no money or food stamps to buy food.
TABLE II.6
NUTRITIONAL RISK OF MEAL PROGRAM PARTICIPANTS, BASED ON
NUTRITION SCREENING INITIATIVE CHECKLIST
(Percentages, Unless Stated Otherwise)
|
Title III Congregate Meal Participants
|
Title III Home-Delivered Meal Participants
|
|
Components of Index
(Score)
|
|
|
|
Have Illness or Condition
that Changed the Kind
and/or Amount of Food
Eaten (2)
|
30
|
34
|
|
Eat Fewer than Two
Meals Per Day (3)
|
2
|
4
|
|
Eat Few Fruits, Vegetables,
or Milk Products (2)
|
48
|
58
|
|
Consume Three or More
Drinks of Beer, Liquor,
or Wine Almost Every
Day (2)
|
2
|
1
|
|
Have Tooth or Mouth
Problems that Make
Eating Hard (2) a
|
--
|
--
|
|
Don’t
Always
Have
Enough
Money
to
Buy
Food
(4)
|
12
|
18
|
|
Eat
Alone
Most
of
the
Time
(1)
|
51
|
61
|
|
Take
Three
or
More
Different
Prescription
or
Over-the-Counter
Drugs
a
Day
(1)
|
40
|
61
|
|
Without
Wanting
to,
Have
Lost
or
Gained
10
Pounds
in
the
Past
Six
Months
(2)
|
18
|
30
|
|
Not
Always
Physically
Able
to
Shop,
Cook,
and/or
Feed
Self
(2)
|
12
|
65
|
|
Nutritional
Health
Index
Score
|
|
|
|
0
to
2
(Good)
|
36
|
11
|
|
3
to
5
(Moderate
Risk)
|
42
|
40
|
|
6
or
More
(High
Risk)
|
22
|
48
|
|
Mean
|
3.7
|
5.6
|
|
Median
|
3.0
|
5.0
|
|
Unweighted
Sample
Size
|
1,040
|
818
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
a.Question not asked.
Most Title III meal program participants report having enough food
to eat. Relatively small but meaningful proportions of congregate
and home-delivered participants, however, report one or more circumstances
of food insecurity during the past month. Ten percent of congregate
participants and 16 percent of home-delivered meal program participants
mentioned experiencing one or more of these instances of food insecurity
during the past month (Table II.7). Note that while the percentages
appear relatively modest, they mean that, within the 30 days preceding
the interview, approximately 237,000 congregate participants and
127,000 home-delivered participants experienced food insecurity.
Food insecurity is somewhat higher for home-delivered meal participants
than for congregate participants (16 percent versus 10 percent).
TABLE II.7
FOOD INSECURITY EXPERIENCED BY MEAL PROGRAM PARTICIPANTS
IN A ONE-MONTH PERIOD
(Percentages)
|
All Eligible Elderly
|
|
Title III Congregate Meal
Eligible Elderly
|
|
Title III Home-Delivered
Meal
Eligible Elderly
|
|
Elderly
Target Group
|
Program
Participantsa
|
Elderly
Populationb
|
|
Program
Participantsc
|
Elderly
Populationd
|
|
Program
Participantse
|
Elderly
Populationf
|
|
Non-Hispanic
Blacks
|
15.68
|
8.21
|
|
10.69
|
7.25
|
|
18.72
|
12.81
|
|
Non-Hispanic
American
Indians,
Eskimos,
or
Aleuts
|
1.18
|
0.40
|
|
1.22
|
0.36
|
|
1.16
|
0.56
|
|
Non-Hispanic
Asians
or
Pacific
Islanders
|
0.38
|
1.58
|
|
0.99
|
1.56
|
|
0.01
|
1.68
|
|
Hispanics
|
5.31
|
3.90
|
|
6.70
|
3.68
|
|
4.47
|
4.93
|
|
All
Racial
and
Ethnic
Minorities
|
22.89
|
14.12
|
|
19.92
|
12.88
|
|
24.69
|
20.03
|
|
All
Low-Income
Elderly
|
41.16
|
14.58
|
|
33.78
|
12.54
|
|
45.79
|
24.34
|
|
Low-Income
Racial
and
Ethnic
Minorities
|
13.52
|
4.10
|
|
11.05
|
3.36
|
|
15.07
|
7.62
|
|
Low-Income
Nonminorities
|
27.63
|
10.49
|
|
22.68
|
9.18
|
|
30.74
|
16.72
|
|
Rural
Elderly
|
25.51
|
25.36
|
|
39.57
|
25.54
|
|
16.97
|
24.48
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
a Percentage of participants who experienced one or more of the
four preceding food insecurity circumstances during the past month.
Examining the individual food insecurity indicators shows that the
most frequently mentioned circumstances involve a choice of how to
spend scarce household resources--whether to buy food or pay for
rent, utility bills, or needed medicines. Ten percent of home-delivered
meal program participants said that they had to choose between buying
food and medicines during the past month; 10 percent also reported
having to choose between buying food and paying rent or utility bills.
The percentages for congregate participants are lower, at seven percent
and five percent, respectively. Smaller percentages of home- delivered
and congregate participants report having no food in the house or
skipping meals because they had no food or resources to buy food
during the past month. Approximately five percent each of congregate
and home-delivered participants report these circumstances.
Title III participants are much more likely to experience food insecurity
than elderly persons in the overall U.S. population. Using the same
four questions, but using the preceding six months as a reference
period, Burt (1993) found that five percent of elderly persons age
65 and older in the overall population experienced one or more of
the four food insecurity circumstances. Thus, 1 in 10 congregate
participants and 1 in 6 home-delivered participants experienced food
insecurity during the preceding month, compared with 1 in 20 elderly
persons in the overall U.S. population who experienced food insecurity
in the preceding six months. The differences between Title III participants
and the overall elderly population would probably be even larger
if the current evaluation had used a six-month reference period.
4. Overall 24-Hour Dietary Intake
Program participants, on average, have daily nutrient intakes that
meet or exceed the Recommended Dietary Allowances (RDAs) of the National
Research Council (NRC) for most nutrients. However, significant numbers
of participants fail to attain the RDAs. When a more conservative,
albeit somewhat arbitrary, target criterion of meeting two-thirds
of the RDAs is used, the percentage of Title III participants meeting
the RDA targets, based on analysis of a single day's intake, is considerably
higher. The appropriateness of the RDA for the older population is
controversial. These recommendations are designed to meet the needs
of healthy persons, but do not consider increased nutrient requirements
that may be introduced by chronic health problems, medications that
interfere with nutrient utilization, physiological changes with advanced
age, and so forth. The interpretation of these findings, particularly
in reference to the two-thirds RDA benchmark, must be done cautiously.
Our examination of total intake of macronutrients, sodium, and dietary
cholesterol over the 24-hour period shows that participants' intake
of total fat and saturated fat as a percentage of total calories
and the intake of sodium are somewhat higher than recommended daily
levels, and that the intake of carbohydrate as a percentage of total
calories is lower than the recommended level. When interpreting the
findings on the macronutrient content of participants' overall diets,
it should be noted that some nutrition experts believe the recommended
levels of total fat and saturated fat as a percentage of calories
for elderly people may be overly stringent. The argument is that
the full implications of lowering total and saturated fat intake
on longer-term health outcomes in the elderly are unknown. Furthermore,
reducing total and saturated fat intake may result in lowering the
intake of much needed calories and other essential nutrients for
this population, and this intake needs to be carefully managed to
preserve the nutrient density of the diet.
As a context for assessing participants' 24-hour nutrient intake,
it is important to describe the requirements used to assess the adequacy
of participants' diets first. This information is provided next.
a. Description of Dietary Requirements Used to Assess Participants'
Diets
The 1992 amendments to the Older Americans Act require the meals
served by the program to comply with the Dietary Guidelines for Americans,
published by DHHS and the U.S. Department of Agriculture (USDA),
and to meet the RDAs. We used these recommendations to assess the
dietary adequacy of all meals eaten by program participants during
the 24 hour period, inclusive of program and nonprogram meals.
The Dietary Guidelines make several recommendations about how Americans
should eat; however, most of the recommendations are not specified
in quantitative terms. The following specific quantitative recommendations,
are provided for total fat and saturated fat in an individual's overall
diet:
- Intake from total fat should not exceed 30 percent of total food
energy (calories).
- Intake from saturated fat should not exceed 10 percent of total
food energy (calories).
The NRC does provide some quantitative benchmarks for some of the
recommendations in the Dietary Guidelines:
- Intake from carbohydrates should exceed 55 percent of total food
energy (calories).
- Intake of dietary cholesterol should not exceed 300 mg per day.
- Intake of sodium should not exceed 2,400 mg per day.
- Intake of protein should not exceed twice the RDA for protein.
The NRC recommendations are used in the current evaluation to operationalize
the nonquantitative recommendations of the Dietary Guidelines and
to provide additional quantitative measures for assessing the adequacy
of participants' diets.
b. 24-Hour Intake of Food Energy and Nutrients
Program participants, on average, have daily nutrient intakes that
meet or exceed the RDAs for most nutrients. The mean intakes of both
congregate and home-delivered meal program participants meet or exceed
the RDAs for protein, Vitamin A, Vitamin C, Vitamin D, thiamin, riboflavin,
niacin, folate, Vitamin B12 , iron, phosphorous, and potassium (Table
II.8). Participants' average intake of food energy (calories) is
below the RDA, equaling 79 percent for congregate participants and
71 percent for home-delivered participants. Mean intakes are below
the RDAs for only five nutrients other than food energy: (1) Vitamin
E; (2) Vitamin B6; (3) calcium; (4) magnesium; and (5) zinc. However,
the average intake of Vitamin E, Vitamin B6, and calcium are close
to the RDAs--the mean intake of each exceeds 90 percent. The findings
on 24-hour nutrient intake indicate that, on average, participants
consume nutrient-dense diets: their intake of food energy is below
the RDA, but their intake of most nutrients meets or exceeds the
RDAs.
TABLE II.8
MEAL PROGRAM PARTICIPANTS' 24-HOUR NUTRIENT INTAKE
(As a Percentage of the RDAs)
|
Title III Congregate Meal Participants
|
|
Title III Home-Delivered Meal Participants
|
|
Nutrient
|
Mean
|
Median
|
Percentage Attaining
Two-Thirds of the RDA
|
|
Mean
|
Median
|
Percentage Attaining
Two-Thirds of the RDA
|
|
Food Energy (Calories)
|
79
|
76
|
66
|
|
71
|
70
|
56
|
|
Protein
|
124
|
117
|
94
|
|
111
|
105
|
86
|
|
Vitamin A
|
146
|
103
|
73
|
|
136
|
105
|
68
|
|
Vitamin C
|
167
|
144
|
80
|
|
144
|
110
|
69
|
|
Vitamin D
|
108
|
100
|
72
|
|
109
|
101
|
71
|
|
Vitamin E
|
92
|
77
|
62
|
|
73
|
64
|
46
|
|
Thiamin
|
141
|
128
|
93
|
|
128
|
121
|
89
|
|
Riboflavin
|
143
|
131
|
95
|
|
135
|
124
|
91
|
|
Niacin
|
141
|
130
|
95
|
|
122
|
113
|
88
|
|
Vitamin B6
|
99
|
87
|
71
|
|
88
|
81
|
64
|
|
Folate
|
140
|
121
|
86
|
|
125
|
108
|
79
|
|
Vitamin
B12
|
205
|
165
|
91
|
|
192
|
147
|
87
|
|
Calcium
|
94
|
87
|
68
|
|
91
|
83
|
66
|
|
Iron
|
131
|
113
|
89
|
|
123
|
103
|
84
|
|
Phosphorous
|
137
|
129
|
95
|
|
126
|
122
|
89
|
|
Potassium
|
131
|
125
|
95
|
|
115
|
111
|
88
|
|
Magnesium
|
88
|
83
|
73
|
|
78
|
74
|
60
|
|
Zinc
|
76
|
69
|
53
|
|
69
|
62
|
44
|
|
Unweighted
Sample
Size
|
1,040
|
1,040
|
1,040
|
|
818
|
818
|
818
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTE: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day.
RDAs = Recommended Dietary Allowances.
Although the typical congregate and home-delivered participant's
intake of nutrients meets or exceeds the RDAs for most nutrients,
significant numbers of participants fail to attain 100 percent of
the RDAs (results not shown). While the RDA meets the needs of most
healthy adults, they may underestimate the nutritional needs of those
with multiple chronic diseases and medications that may compromise
nutritional status. When a target criterion of two-thirds of the
RDA is used, the percentage of participants meeting the target, based
on analysis of a single day's intake, is considerably higher.
c. 24-Hour Intake of Macronutrients, Sodium, and Dietary
Cholesterol
The typical Title III congregate and home-delivered meal program participants'
diets tend to have too much fat and sodium and too little carbohydrates. On
the other hand, intake of dietary cholesterol is well below the daily maximum.
Congregate and home-delivered participants, on average, consume
53 percent of their food energy in carbohydrates, somewhat below
the 55 percent level recommended by the NRC (Table II.9). About 40
percent of congregate participants and 36 percent of home-delivered
participants meet or exceed the minimum 55 percent recommended level.
For nearly one-quarter each of congregate and home-delivered participants,
the carbohydrate content of their diets is below 45 percent of food
energy (10 percentage points below the recommendation).
TABLE II.9
MEAL PROGRAM PARTICIPANTS' 24-HOUR INTAKE OF MACRONUTRIENTS,
SODIUM, AND CHOLESTEROL
|
Dietary Component
|
Title III Congregate
Meal Participants
|
Title III Home-Delivered
Meal Participants
|
|
Carbohydrate
|
|
|
|
Mean
Percentage
of Food Energy
(Calories)
|
53
|
53
|
|
Median
Percentage
of Food Energy
(Calories)
|
53
|
52
|
|
Distribution
of Intake
as a Percentage
of Food Energy
(Calories)
|
|
|
|
Less
than 45 percent
|
21
|
25
|
|
45
to 55 percent
|
40
|
39
|
|
56
to 65 percent
|
33
|
27
|
|
More
than 65 percent
|
6
|
9
|
|
Total
Fat
|
|
|
|
Mean
Percentage
of Food Energy
(Calories)
|
32
|
32
|
|
Median
Percentage
of Food Energy
(Calories)
|
32
|
32
|
|
Distribution
of Intake
as a Percentage
of Food Energy
(Calories)
|
|
|
|
Less
than 20 percent
|
6
|
8
|
|
20
to 30 percent
|
34
|
34
|
|
31
to 35 percent
|
26
|
25
|
|
36
to 40 percent
|
22
|
19
|
|
41
to 50 percent
|
11
|
13
|
|
More
than 50 percent
|
1
|
1
|
|
Saturated
Fat
|
|
|
|
Mean
Percentage
of Food Energy
(Calories)
|
11
|
12
|
|
Median
Percentage
of Food Energy
(Calories)
|
11
|
12
|
|
Distribution
of Intake
as a Percentage
of Food Energy
(Calories)
|
|
|
|
Less
than 5 percent
|
2
|
5
|
|
5
to 10 percent
|
41
|
35
|
|
11
to 15 percent
|
44
|
44
|
|
16
to 20 percent
|
12
|
15
|
|
More
than 20 percent
|
1
|
2
|
|
Protein
|
|
|
|
Mean
Percentage
of Food Energy
(Calories)
|
17
|
17
|
|
Median
Percentage
of Food Energy
(Calories)
|
17
|
16
|
|
Distribution
of Intake
as a Percentage
of Food Energy
(Calories)
|
|
|
|
Less
than 15 percent
|
41
|
40
|
|
16
to 25 percent
|
55
|
55
|
|
More
than 25 percent
|
4
|
5
|
|
Sodium
|
|
|
|
Mean
Intake (mg
Per Day)
|
2,568
|
2,352
|
|
Median
Intake (mg
Per Day)
|
2,363
|
2,200
|
|
Distribution
of Intake
(Percentage)
|
|
|
|
Less
than 2,400
mg per day
|
51
|
56
|
|
2,401
to 3,000
mg per day
|
20
|
21
|
|
More
than 3,000
mg per day
|
29
|
23
|
|
Dietary
Cholesterol
|
|
|
|
Mean
Intake (mg
Per Day)
|
210
|
196
|
|
Median
Intake (mg
Per Day)
|
169
|
149
|
|
Distribution
of Intake
(Percentage)
|
|
|
|
Less
than 300
mg per day
|
80
|
83
|
|
300
to 400 mg
per day
|
10
|
7
|
|
More
than 400
mg per day
|
10
|
10
|
|
Unweighted
Sample
Size
|
1,040
|
818
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations.
NOTES: Tabulations are weighted to be representative
of a cross-section of participants receiving Title III meals on a
given day. The Dietary Guidelines recommend that (1) total fat intake
should be 30 percent or less of food energy intake, and (2) saturated
fat should be 10 percent or less of food energy intake. The NRC recommends
that (1) the intake of cholesterol should be less than 300 mg per
day, (2) the intake of sodium should not exceed 2,400 mg per day,
and (3) the intake of carbohydrates should be at least 55 percent
of food energy.
The typical congregate and home-delivered participant consumes 32
percent of his or her diet as fat, somewhat above the guideline of
30 percent. About 40 percent in each group are below the 30 percent
guideline. A significant minority of participants (approximately
15 percent in each group) exceed the guideline by 10 percentage points
or more, consuming more than 40 percent of their food energy as fat.
Similar patterns were found for saturated fat intake.
Congregate and home-delivered participants, on average, consume
2,568 mg and 2,352 mg of sodium daily, respectively (Table II.9).
Congregate participants' daily intake of sodium exceeds the 2,400
mg level suggested by the NRC by about seven percent, whereas home-delivered
participants consume somewhat less than this level. About one-quarter
each of congregate and home-delivered participants consume more than
3,000 mg of sodium daily, exceeding the suggested daily recommendation
by more than 25 percent.
Intake of dietary cholesterol, in general, is not a problem for
Title III meal program participants. The mean daily intake of cholesterol
is 210 mg for congregate participants and 196 mg for home-delivered
meal participants--well below the 300 mg suggested recommendation.
About 20 percent of congregate and home-delivered participants consume
more than 300 mg of cholesterol per day.
As stated earlier, some nutrition experts suggest that the recommended
maximum levels of total fat and saturated fat as a percentage of
calories for elderly people are overly stringent. Thus, these slightly
higher-than-recommended daily intakes of total fat and saturated
fat need to be interpreted cautiously, because reducing total and
saturated fat intake, unless carefully managed, may compromise the
nutrient density of their diets.
d. Comparisons with the Overall Elderly Population
To get a sense of how Title III participants fare relative to the
overall elderly U.S. population, Tables II.10 and II.11 compare the
24-hour dietary intakes of Title III congregate and home-delivered
participants with those of the overall U.S. elderly population age
60 and older, separately for females and males. For elderly females,
female congregant participants' mean intake of food energy and nutrients
generally exceeds the mean intake for the overall female elderly
population (Table II.10). Also, on the positive side, their intake
of sodium and dietary cholesterol is more favorable, being less,
on average, than the intake for the overall elderly female population.
In general, the average intake of food energy and all other nutrients
for female home-delivered meal program participants is less than
the intake for the overall elderly female population. Again, female
home-delivered meal participants' average intake of sodium and dietary
cholesterol is lower than that for the overall elderly female population.
The pattern is somewhat different for elderly males. Table II.11
shows that, for virtually all nutrients, the average intake for the
overall elderly male population exceeds the intake for both Title
III congregate and home-delivered meal program male participants.
Exceptions are for carbohydrates, total fat, and dietary cholesterol.
TABLE II.10
AVERAGE DAILY NUTRIENT INTAKE OF FEMALE MEAL PROGRAM PARTICIPANTS
AGE 60 AND OLDER, COMPARED WITH OVERALL U.S. ELDERLY FEMALE POPULATION
|
Nutrient
|
Title III Congregate
Meal Participants
|
Title III Home-Delivered
Meal Participants
|
U.S.
Elderly
Population
(60+)
|
Recommended
Daily
Allowance
|
|
Food
Energy
(Kcal)
|
1,512
|
1,365
|
1,482
|
1,900
|
|
Protein
(g)
|
64
|
57
|
60
|
50
|
|
Vitamin
A
(RE)
|
1,215
|
1,130
|
1,114
|
800
|
|
Vitamin
C
(mg)
|
100
|
84
|
105
|
60
|
|
Vitamin
D
(µg)
|
5.2
|
5.2
|
NA
|
5.0
|
|
Vitamin
E
(mg •-TE)
|
7.6
|
5.8
|
7.9
|
8.0
|
|
Thiamin
(mg)
|
1.4
|
1.3
|
1.4
|
1.0
|
|
Riboflavin
(mg)
|
1.7
|
1.6
|
1.6
|
1.2
|
|
Niacin
(mg)
|
18.4
|
15.6
|
18.3
|
13.0
|
|
Vitamin
B6 (mg)
|
1.6
|
1.4
|
1.6
|
1.6
|
|
Folate
(µg)
|
253
|
218
|
272
|
180
|
|
Vitamin
B12 (µg)
|
3.9
|
3.7
|
3.8
|
2.0
|
|
Calcium
(mg)
|
716
|
708
|
669
|
800
|
|
Iron
(mg)
|
12.4
|
11.5
|
12.7
|
10.0
|
|
Phosphorous
(mg)
|
1,048
|
960
|
987
|
800
|
|
Potassium
(mg)
|
2,542
|
2,233
|
2,427
|
2,000
|
|
Magnesium
(mg)
|
255
|
223
|
246
|
280
|
|
Zinc
(mg)
|
9.4
|
8.3
|
9.0
|
12.0
|
|
Carbohydrate
(g)
|
200
|
180
|
190
|
NA
|
|
Total
Fat
(g)
|
54
|
49
|
55
|
NA
|
|
Saturated
Fat
(g)
|
19.3
|
18.1
|
18.6
|
NA
|
|
Cholesterol
(mg)
|
188
|
177
|
197
|
300a
|
|
Sodium
(mg)
|
2,411
|
2,258
|
2,459
|
2,400a
|
|
Carbohydrate
as
Percentage
of
Food
Energy
|
53.1
|
53.3
|
52.2
|
55.0a
|
|
Protein
as
Percentage
of
Food
Energy
|
17.1
|
17.0
|
16.5
|
15.0a
|
|
Total
Fat
as
Percentage
of
Food
Energy
|
31.5
|
31.4
|
32.3
|
30.0a
|
|
Saturated
Fat
as
Percentage
of
Food
Energy
|
11.3
|
11.6
|
10.9
|
10.0a
|
|
Unweighted
Sample
Size
|
701
|
564
|
1,280
|
NA
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations; National Center for Health Statistics
1994.
NOTES: Tabulations are weighted to be representative
of a cross-section of female participants receiving Title III meals
on a given day. Participant tabulations in this table are for Title
III participants age 60 and older. Figures for U.S. elderly population
are authors' tabulation of published NHANES III data cited under
source.
- a Recommended levels based on Dietary Guidelines and NRC recommendations.
- NA = not available.
- g = grams.
- mg = milligrams.
- Tg = micrograms.
- RE = retinol equivalents.
- mg I-TE = milligrams alpha-tocopherol equivalents.
TABLE II.11
AVERAGE DAILY NUTRIENT INTAKE OF MALE MEAL PROGRAM PARTICIPANTS
AGE 60 AND OLDER, COMPARED WITH OVERALL U.S. ELDERLY MALE POPULATION
|
Nutrient
|
Title III Congregate
Meal Participants
|
Title III Home-Delivered
Meal Participants
|
U.S.
Elderly
Population
(60+)
|
Recommended
Daily
Allowance
|
|
Food
Energy
(Kcal)
|
1,786
|
1,591
|
1,989
|
2,300
|
|
Protein
(g)
|
73
|
68
|
79
|
63
|
|
Vitamin
A
(RE)
|
1,323
|
1,281
|
1,296
|
1,000
|
|
Vitamin
C
(mg)
|
101
|
94
|
104
|
60
|
|
Vitamin
D
(µg)
|
5.9
|
6.1
|
NA
|
5.0
|
|
Vitamin
E
(mg •-TE)
|
8.7
|
7.4
|
9.4
|
10.0
|
|
Thiamin
(mg)
|
1.7
|
1.5
|
1.7
|
1.2
|
|
Riboflavin
(mg)
|
2.0
|
1.9
|
2.1
|
1.4
|
|
Niacin
(mg)
|
21.0
|
19.3
|
23.7
|
15.0
|
|
Vitamin
B6 (mg)
|
1.8
|
1.7
|
2.0
|
2.0
|
|
Folate
(µg)
|
278
|
267
|
318
|
200
|
|
Vitamin
B12 (µg)
|
4.5
|
4.1
|
5.8
|
2.0
|
|
Calcium
(mg)
|
815
|
806
|
830
|
800
|
|
Iron
(mg)
|
14.8
|
13.6
|
16.3
|
10.0
|
|
Phosphorous
(mg)
|
1,183
|
1,129
|
1,296
|
800
|
|
Potassium
(mg)
|
2,800
|
2,518
|
2,964
|
2,000
|
|
Magnesium
(mg)
|
283
|
261
|
311
|
350
|
|
Zinc
(mg)
|
10.8
|
10.1
|
12.4
|
15.0
|
|
Carbohydrate
(g)
|
230
|
203
|
242
|
--
|
|
Total
Fat
(g)
|
67
|
58
|
76
|
--
|
|
Saturated
Fat
(g)
|
24.1
|
21.5
|
25.8
|
--
|
|
Cholesterol
(mg)
|
260
|
235
|
289
|
300a
|
|
Sodium
(mg)
|
2,914
|
2,555
|
3,241
|
2,400a
|
|
Carbohydrate
as
Percentage
of
Food
Energy
|
51.7
|
50.8
|
49.3
|
55.0a
|
|
Protein
as
Percentage
of
Food
Energy
|
16.8
|
17.5
|
16.2
|
15.0a
|
|
Total
Fat
as
Percentage
of
Food
Energy
|
32.9
|
32.7
|
33.5
|
30.0a
|
|
Saturated
Fat
as
Percentage
of
Food
Energy
|
11.9
|
12.1
|
11.4
|
10.0a
|
|
Unweighted
Sample
Size
|
324
|
236
|
1,286
|
--
|
SOURCE: Elderly Nutrition Program Evaluation, participant
survey, weighted tabulations; National Center for Health Statistics
1994.
NOTES: Tabulations are weighted to be representative
of a cross-section of male participants receiving Title III meals
on a given day. Participant tabulations shown in this table are for
Title III participants 60 years of age and older. Figures for U.S.
elderly population are authors' tabulation of published NHANES III
data cited under source.
- a Recommended levels based on Dietary Guidelines and NRC recommendations.
- NA = not available.
- g = grams.
- mg = milligrams.
- Tg = micrograms.
- RE = retinol equivalents.
- mg I-TE = milligrams alpha-tocopherol equivalents.
e. Summary
On average, the daily dietary intakes of ENP participants, counting
program meals, meet the RDA levels for most nutrients. Women in the
program tend to consume somewhat higher levels of nutrients than
women in the overall population age 60 and older, while men in the
program consume somewhat less than men in the overall population
age 60 and older. Consumption of fat is somewhat above the 30 percent
recommended level, but not greatly so. Overall, it appears that dietary
intake levels are relatively satisfactory for most ENP participants.
As discussed next (and in Chapter III), ENP meals are a major factor
leading to this outcome.
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