Leveraging Home-Delivered Meal Programs to Address Unmet Needs for At-Risk Older Adults: Preliminary Data.
Aged
Aged, 80 and over
Female
Food Services
/ statistics & numerical data
Health Services Needs and Demand
/ statistics & numerical data
Home Care Services
/ statistics & numerical data
Homebound Persons
/ statistics & numerical data
Humans
Male
Pilot Projects
Preliminary Data
Program Evaluation
Social Welfare
/ statistics & numerical data
care navigation
home-delivered meal programs
social needs
vulnerable older adults
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
12
02
2019
revised:
17
04
2019
accepted:
20
04
2019
pubmed:
13
6
2019
medline:
14
5
2020
entrez:
13
6
2019
Statut:
ppublish
Résumé
Home-delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social. A pilot study was designed to test the feasibility of leveraging routine meal-delivery service in two home-delivered meal programs to proactively identify changes in older adult meal recipients' (clients') health, safety, and well-being and address unmet needs. Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services. Over a 12-month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self-care or personal safety (12%) and mobility (11%). On follow-up, a total of 132 referrals were issued, with most referrals for self-care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution. Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early-warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home-delivered meal programs. J Am Geriatr Soc 67:1946-1952, 2019.
Sections du résumé
BACKGROUND
Home-delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social.
DESIGN
A pilot study was designed to test the feasibility of leveraging routine meal-delivery service in two home-delivered meal programs to proactively identify changes in older adult meal recipients' (clients') health, safety, and well-being and address unmet needs.
INTERVENTION
Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services.
RESULTS
Over a 12-month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self-care or personal safety (12%) and mobility (11%). On follow-up, a total of 132 referrals were issued, with most referrals for self-care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution.
CONCLUSION
Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early-warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home-delivered meal programs. J Am Geriatr Soc 67:1946-1952, 2019.
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1946-1952Informations de copyright
© 2019 The American Geriatrics Society.
Références
CSDH. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Final Report of the Commission on Social Determinants of Health. Geneva, Switzerland: World Health Organization; 2008.
Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-1104.
Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381-398.
Hood CM, Gennuso KP, Swain GR, Catlin BB. County health rankings: relationships between determinant factors and health outcomes. Am J Prev Med. 2016;50(2):129-135.
Alley DE, Asomugha CN, Conway PH, Sanghavi DM. Accountable health communities: addressing social needs through Medicare and Medicaid. 2016;374(1):8-11.
Williams DR, Costa MV, Odunlami AO, Mohammed SA. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract. 2008;14(suppl):S8-S17.
Shier G, Ginsburg M, Howell J, Volland P, Golden R. Strong social support services, such as transportation and help for caregivers, can lead to lower health care use and costs. Health Aff (Millwood). 2013;32(3):544-551.
Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101(8):1456-1465.
Schroeder SA. Shattuck Lecture. We can do better: improving the health of the American people. N Engl J Med. 2007;357(12):1221-1228.
Ornstein KA, Leff B, Covinsky KE, et al. Epidemiology of the homebound population in the United States. JAMA Intern Med. 2015;175(7):1180-1186.
Shan M, Gutman R, Dosa D, et al. A new data resource to examine Meals on Wheels clients' health care utilization and costs. Med Care. 2018;57(3):15-21.
Kemper P, Komisar HL, Alecxih L. Long-term care over an uncertain future: what can current retirees expect? Inquiry. 2005;42(4):335-350.
Freedman VA, Spillman BC. The residential continuum from home to nursing home: size, characteristics and unmet needs of older adults. J Gerontol B Psychol Sci Soc Sci. 2014;69(suppl_1):S42-S50.
Pooler J, Liu S, Roberts A. Issue Brief: Older Adults and Unmet Social Needs Prevalence and Health Implications. Columbia, MD: AARP Foundation and IMPAQ International; 2017.
Taylor LA, Tan AX, Coyle CE, et al. Leveraging the social determinants of health: what works? PLoS One. 2016;11(8):e0160217.
Brewster AL, Kunkel S, Straker J, Curry LA. Cross-sectoral partnerships by area agencies on aging: associations with health care use and spending. Health Aff (Millwood). 2018;37(1):15-21.
Powers MJ. The community's emerging role in value-based health and social services. Generations. 2018;42(1):4-8.
Administration for Community Living, Data Source: State Program Report (SPR). 2017. https://agid.acl.gov/CustomTables/SPR/Results. Accessed April 2, 2019.
Zhu H, An R. Impact of home-delivered meal programs on diet and nutrition among older adults: a review. Nutr Health. 2013;22(2):89-103.
Gollub EA, Weddle DO. Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch. J Am Diet Assoc. 2004;104(8):1227-1235.
Thomas KS, Mor V. The relationship between older Americans Act Title III state expenditures and prevalence of low-care nursing home residents. Health Serv Res. 2013;48(3):1215-1226.
Sahyoun NR, Vaudin A. Home-delivered meals and nutrition status among older adults. Nutr Clin Pract. 2014;29(4):459-465.
Xu H, Weiner M, Paul S, et al. Volume of home- and community-based Medicaid waiver services and risk of hospital admissions. J Am Geriatr Soc. 2010;58(1):109-115.
Wright L, Vance L, Sudduth C, Epps JB. The impact of a home-delivered meal program on nutritional risk, dietary intake, food security, loneliness, and social well-being. J Nutr Gerontol Geriatr. 2015;34(2):218-227.
Berkowitz SA, Terranova J, Hill C, et al. Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries. Health Aff (Millwood). 2018;37(4):535-542.
Thomas KS, Mor V. Providing more home-delivered meals is one way to keep older adults with low care needs out of nursing homes. Health Aff (Millwood). 2013;32(10):1796-1802.
Thomas KS, Akobundu U, Dosa D. More than a meal? a randomized control trial comparing the effects of home-delivered meals programs on participants' feelings of loneliness. J Gerontol B Psychol Sci Soc Sci. 2016;71(6):1049-1058.
Malbi J, Gearan E, Cohen R, et al. Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants' Food Security, Socialization, and Diet Quality. Cambridge, MA; Mathematica Policy Research 2017.
Thomas KS, Gadbois EA, Shield RR, Akobundu U, Morris AM, Dosa DM. "It's not just a simple meal: it's so much more": interactions between Meals on Wheels clients and drivers. J Appl Gerontol. 2018. https://doi.org/10.1177/0733464818820226.
ServTracker. https://accessiblesolutions.com/meal-delivery-software. Accessed February 4, 2019.
Healthy People 2020: Social Determinants of Health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed April 3, 2019.
Billioux A, Verlander K, Anthony S, Alley D. Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool (Discussion Paper). Washington, DC: National Academy of Medicine 2017:1-9.
Alteryx. 2018. https://www.alteryx.com/. Accessed February 4, 2019.