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Hunger is Not Getting Any Younger

Hunger is Not Getting Any Younger. Amanda Panas Clinical RD. Sibley Memorial Hospital Elderly Patient S tatistics . Initiation of NICHE program at Sibley Memorial Hospital Designed to meet the specialized needs of geriatric patients

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Hunger is Not Getting Any Younger

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  1. Hunger is Not Getting Any Younger Amanda Panas Clinical RD

  2. Sibley Memorial Hospital Elderly Patient Statistics • Initiation of NICHE program at Sibley Memorial Hospital • Designed to meet the specialized needs of geriatric patients • In general, 50% of hospitalized patients are at least 65 years old • 55% of Sibley Memorial Hospitals inpatient admissions are people over 65 years of age • Within 30 years the population over 85 will double to 8.5 million • Average age of Medicare patients is 77 • 19% of patients admitted to Sibley Memorial hospital are over 85 (Vincent, 2011)

  3. National Food Insecurity • 40 million Americans struggle for enough to eat each day • US poverty rate for adults over age 65 is 9.7% • 3.5 million elderly adults live in poverty (Society, 2011) • 5.3% of the people with food insecurity are elderly and 4.8% are elderly people living alone (Coleman, 2010) • 60% of low income seniors qualified for state or federal nutrition programs are not enrolled (Hunger, 2009)

  4. Elderly food insecurity in the DC area • DC consists of 61.4 miles, over 9,000 people live in each mile, 11.9% of this population is over the age 65, 17.1% of the DC population lives under the poverty line (DC, 2011) • 1 in 8 households struggle with hunger, 13% per USDA report 2008-2010 • DC priority to make programs easier to access per Alex Ashbrook, Director of DC Hunger Solutions (Healthy, 2006) • “The Older Americans Act Nutrition program works to improve the nutritional status of participants and helps them to maintain their independence and quality of life • 2 million of the 9 million older adults living alone believe that they have no one to turn to for assistance (Baker, 2005)”

  5. Signs/Symptoms of Malnutrition • Malnutrition: deficiency of energy, protein, and other nutrients causing adverse effects on the body and functional outcome (Ahmed, 2010) • Impaired muscles function • Decreased lean body muscle • Immune dysfunction • Anemia • Poor wound healing • Muscle wasting • Cachexia (Ahmed, 2010) • Low BMI • Decreased albumin level/ pre-albumin level • Vitamin/micronutrient deficiencies (Lane, 2011)

  6. Causes of Malnutrition • Following a meal, older adults experience less hunger and remain satisfied/fuller longer following a meal • Aging leads to decreased food intake, “anorexia of aging” • Loss of taste and sense of smell • Less responsive to hunger cues, leads to decreased energy intake (Gregersen, 2011) • Social isolation (Ahmed, 2010) • Hunger and poverty • High cost of multiple medications (Wellman, 2007).

  7. Focus of the negative health consequences of malnutrition • “Older adults living alone do not consume adequate amounts of food, 40% of the frail homebound suffer from protein-energy malnutrition (Baker, 2005).” • Decrease quality of life • Increased frailty • Depression • Mortality (Jutkowitz, 2011)

  8. Factors that lead to Food Insecurity • Lack of transportation to the grocery store • Functional limitations • Inability to stand long enough to prepare meals • Financial constraints • Poor dentition (Baker, 2005) • Cognitive impairment (Lane, 2011) • Medications which decrease appetite, altered taste, and interfere with absorption (Hunger, 2009)

  9. Local Resources within Five Miles of the Hospital, including MD & N. VA • OAA is the largest federally funding program for people over the age of 65, initiated in 1972 • US Administration of Aging- “Meals on Wheels” • Each DC site must be individually contacted to determine eligibility requirements • Annually produces 250 million nutritious meals, and social opportunities for 3 million adults • Sometimes only meal of the day for elderly participants • Nutrition services- screenings, education, counseling • 4,000 local agencies, 20-1000 clients per site • “Eat Better & Move” program (Wellman, 2007) • Increased social contact, promotes healthful eating (Hunger, 2009)

  10. Obtaining Material of Local Programs • 25 locations for Free meals and emergency groceries sources within 4 miles of Sibley Memorial Hospital • Capital Area Food Bank Hunger lifeline (202) 639-9770, website: http://www.dchunger.org/resources/dcfoodfinder.html • 4 food pantry and soup kitchens available in Bethesda MD, within 5 miles of the hospital • Other Options: • So Others Might Eat, increase self-reliant, provided 262,101 hot nutritious meals for residents of Dwelling Place Shelter for Abused and Neglected Elderly, 133 low income seniors enjoyed meals, activities, and case management, 63 seniors, homebound, received 362 case manager visits, 595 food deliveries with Homebound Senior Program • Bethesda Cares- 4 churches providing lunch, feed homeless and food insecure • Home Instead Senior Care (VA)- offers errands, shopping, meal assistance (companionship, transportation, personal, meal preparation, household chores, home monitoring, medication) including grocery shopping, meals planning and preparation, monitoring diet and eating, record and arrange recipes, monitoring food expirations, clip coupons for shopping

  11. Obtaining Material of Local Programs • Meals on Wheels in DC is complicated, grassroots program, each site has its own eligibility requirements and application, Central Headquarters (703) 548-5558 • Meals on Wheels locations within 5 miles from Sibley Memorial Hospital: • Arlington AAA 4.3 miles • Bethesda-Chevy chase Meals on Wheels 4.6 miles • Arlington Meals on Wheels 5.0 miles

  12. Obtaining paperwork for Programs • IONA Senior Service center, 1 mile, serves DC ward 2 & 3, call 24 hours in advance to make an appointment, deliver two meals on Saturday for homebound/frail adults, those unable to afford additional help • St Albans Episcopal Church, Super Sixties, group meal, exercise, recreation, creative writing, nutrition counseling/education, field trips, 1.4 miles, $2 donation • VIDA Senior Centers, improve maintenance and quality of life, increase wellness, increase self sufficiency, independence for seniors, Latinos and other older adults, living in isolation • Harvard Towers, 3 miles, senior meals, group meals, recreation, health promotion programs, nutrition counseling/education

  13. Obtaining paperwork for Programs • Sarah’s Circle, 3.25 miles, group meal center and wellness programs • Columbia Heights, 3.5 miles, group meals • Campbell Heights, 3.6 miles, group meals for seniors, library, daily clinic for nursing assistance and weekly podiatrist care • St. Mary’s Court, 3.7 miles, ID must be shown, provides lunches, social services, transportation services, referrals, adult day care, flu shots, fitness and computer classes • Emmaus Services for the Aging, 4.4 miles, DC residents over 60, free grocery market on Fridays, free lunch, legal help, referrals, assistance enrolling in benefits

  14. Conclusion • Multi-disciplinary communication and teamwork • Proactive discharge planning, involve patient in discussion if appropriate, as the population of older adults increases (Baker, 2005) • Open dialogue, flexibility (Scarinci, 2009) • Effective discharge planning prevent re-admission, offering services to maximize effectiveness, care at home, assistance options (Wong, 2011) • Discuss hiring nursing aid to provide meal assistance

  15. References • Baker, E. B., & Wellman, N. S. Nutrition concerns in discharge planning for older Americans: a need for multidisciplinary collaboration. J Am Diet Assoc. 2005(105),603-607. Retrieved October 8, 2011. • Scarinci, I. C., Johnson, R. E., Hardy, C., Marron, J., & Partridge, E. E. Planning and implementation of a participatory evaluation strategy: a viable approach in the evaluation of community-based participatory programs addressing cancer disparities. Eval Program Plann. 2009. 32(3):221-228. Retrieved Ocoober 8, 2011. • Vincent, J. M. Introduction to the NICHE program. Sibley memorial hospital power point presentations. (2011). Washington, DC. • Jutkowitz, E., Gitlin, L. N., Pizzi, L. T., Lee, E., & Dennis, M. P. Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults in place at home. J Aging Res. 2011(12),106. Retrieved October 17, 2011 from PMC 3157760. • Wong, E. L. Y., Yam, C. H. K., Cheung, A. W. L., Leung, M. C. M., Chan, F. W. K., Wong, F. Y. Y., & Yeoh, E. K. Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Services Research.2011. (11),242. Retrieved October 17, 2011, from PMC 3190337. • Society of St. Andrew. 2010. Retrieved October 8, 2011, from http://www.endhunger.org/. • Gregersen, N. T., Moller, B. K., Kristensen, S. T., Holm, L., Flint, A., Astrup, A., & Raben, A. Determinants of appetite ratings: the role of age, gender, BMI, physical activity, smoking habits and diet/ weight concerns. Food Nutr Res. 2011 (55). Retrieved October 3, 2011, from PMC ID: PMC3160809. • Lane, R. L., Talley, M. C., Shamilyan, T., & Pacula, J. T. Common syndromes in older adults related to primary and secondary prevention. Agency for health care research and quality. 2011. Retrieved October 3, 2011, from PMID: 21901865. • Ahmed, T., & Haboui, N. Assessment and management of nutrition in older people and its importance to health. ClinInterv Aging 2010. 2010(5), 207-216. Retrieved October 3, 2011, from PMCID: PMC2920201. • Wellman, N. S, Kamp, B, Kirk-Sanchez, N. J., & Johnson, P. M. Eat better and move more: a community based program designed to improve diets and increase physical activity among older adults. Am J Public Health. 2007, 97(4), 710-171. Retrieved October 3, 2011, from PMC 1829349. • DC MapStats. Retrieved October 3, 2011, from http://www.fedstats.gov/qf/states/11000.html. • Coleman-Jensen, A., Nord, M., Andrews, M., & Carlson, S. Household food security in the US in 2010. USDA. 2011. Retrieved October 3, 2011, from http://www.ers.usda.gov/Publications/ERR125/ERR125.pdf. • Healthy food, healthy communities. DC Hunger Solutions. 2006. Retrieved October 7, 2011, from http://www.dchunger.org/pdf/healthfoodcomm.pdf. • Hunger and the senior: 5 million seniors at risk of malnutrition. Comfort Keepers. (2009). Retrieved October 3, 2011, from http://www.comfortkeepers.org/information-center/news-and-highlights/hunger-and-the-senior.

  16. Questions?

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