Hungry Seniors in Washington:
An Update
Washington Food Coalition
Annual Conference
Martha Peppones MS, RDN, CSG, CD
Nutrition Director
Senior Services of Snohomish County
Overview
• Demographics
• Nutritional needs of older adults
• Senior hunger
• Impacts of hunger
• Solutions
▫ Food assistance programs
▫ Other types of assistance
▫ Resources
Number of Older Americans
100
90
80
in millions
70
60
65 and over
50
85 and over
40
30
20
10
0
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2010
2020
2030
2040
2050
Older Americans in Poverty
• 8.7% live below FPL
• 15% are below the Supplemental Poverty
Measure
▫ Considers regional variations of housing costs,
non-discretionary expenditures, medical out-ofpocket expenses
Source: Administration on Aging. A Profile of Older Americans: 2012
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2012/Index.aspx
Older Americans in Poverty
• Racial/ethnic
▫ 6.7% of elderly whites
▫ 17.3% of elderly African
Americans
▫ 11.7% of elderly Asians
▫ 18.7% of elderly
Hispanics
• Gender
▫ 10.7% women
▫ 6.2% men
Source: Administration on Aging. A Profile of Older Americans: 2012
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2012/Index.aspx
Older Americans in Poverty
• Living arrangements
▫ 5 % living with families
▫ 16.5% living alone
• Location
▫ 11.7% in principal cities
▫ 10.1% South
• Highest poverty rates
▫ Hispanic women who
live alone (38.8%)
▫ African American
women living alone
(32.2%)
Source: Administration on Aging. A Profile of Older Americans: 2012
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2012/Index.aspx
Nutrition & Health
• Adequate nutrition is
essential for
▫ Health
▫ Functionality
▫ Independence
▫ Quality of life
Nutrients of concern in older adults
• Energy needs
• Vitamins and minerals
• Fluid
• Protein
or
Nutrient Concerns – con’t
• Fiber
• Vitamin D and Calcium
• Vitamins B12, folic acid, and B6
• Antioxidants
Factors Affecting Nutritional Well Being of Older
Adults
Medical
Money
Crime/
Abuse
Neighborhood
Transportation
Mental
Disorders,
Dementia
Dental Chewing/
Swallowing Skills
Exercise &
Recreation
Problems
Family
Friends
Diet
Modifications
Shopping
Skills
Nutritional
Well-Being
Medications
Religion
Physiological
Changes
Cooking
Skills
Housing
Washington Report Card for Health
• 42.7% report having a disability
• 60% are not eating recommended 2 servings of fruit per
day
• 70% not eating 3 servings of vegetables per day
• One in four older adults are obese
• 32% older adults have lost ≥ 5 natural teeth
Source: The State of Aging and Health in America 2013 CDC
http://nccd.cdc.gov/DPH_Aging/default.aspx
Senior hunger – the 2011 numbers
National
• 4,800,000 at risk of hunger (8.4%)
Washington State
• 7.6% at risk of hunger
SOURCE: Ziliak, J. & Gundersen, C. (2013). Spotlight on Food
Insecurity among Senior Americans 2011. University of Kentucky
and University of Illinois.
Hunger will continue to increase
• The senior food insecurity rate has more than
doubled since 2001
• 10,000 adults will turn 65 every day until 2030
Hunger is increasing….
Who’s more likely to be hungry?
• Poor, near poor (up to
200% FPL)
• African American (17%),
Hispanic (18%)
• Single – widowed,
divorced
• Unemployed
• Younger than 74 –
especially 60-64
• Disabled
• Female
• Living with grandkids
• Lives in southern US
Being food insecure is like being functionally 14
years older.
Ziliak et al. Causes, Consequences & Future of Senior Hunger in America,
Meals on Wheels Foundation. March 2008. www.mowaa.org/
Chronic illness and food insecurity
• 80% of older adults have one chronic condition
• 50% have at least two
• Increased number of chronic conditions related
to higher level of food insecurity
▫ Additional health care costs
▫ Limited ability to manage with
scarce resources
Tarasuk V, et al. Chronic Physical and Mental Health Conditions Among Adults May
Increase Vulnerability to Household Food Insecurity. J Nutr. Doi:10.3945/jn.113.178483.
2013
Impacts of food and nutrition on health
POOR DIETS
AGE-RELATED
CONDITIONS / DISEASES
(Hearing Loss; Macular
Degeneration; Destructive Joint
Disease: knees and hips; Loss
of Muscle Mass: Sarcopenia;
Cognition / Mental Health)
CHRONIC DISEASES
(Heart Disease; Hypertension;
Diabetes; Osteoporosis; Some
Cancers: colon and breast;
Arthritis; COPD; Renal Disease)
ACUTE CONDITIONS
(Dehydration; Pressure Ulcers;
Infections; Pneumonia;
Influenza; Fractures; Tooth
Abscesses; Gum Disease)
WITHOUT ADEQUATE HEALTHY, SAFE FOOD AND
NUTRITION SERVICES
Slower
recovery
Longer
hospital
stays
Hospital
readmission
Premature
institutionali- Increased
morbidity
zation
& mortality
Poor
appetite
Depression
& anxiety
Sleep
disturbance
Low
stamina
IMPACT OF MALNUTRITION ON FUNCTIONALITY
Malnutrition
Underweight
Obesity
Limits Muscle Strength
Reduces Stamina
Prevents Physical Activity
Decreases ability to:
Perform ADLs & IADLs: Eat, Walk, Grocery Shop, Prepare Meals
Grip Items & Lift Heavy Objects
Increases Dependency
Increases Need for Caregiver Assistance
Increases Risk for Falls & Fractures
Threatens Independence
Reduces Quality of Life
Increases Healthcare Costs
20
Solutions?
• Access to coordinated, comprehensive food and
nutrition services
• Federal food and nutrition programs
▫
▫
▫
▫
▫
▫
SNAP
OAA
CSFP
CACFP
SFMNP
TEFAP - Local food banks and pantries
SNAP and older adults
Barriers to SNAP participation
• Perceived low benefits
▫ In 2009, actual monthly benefit for 60+ was $102
• Less aware of eligibility requirements
• Stigma
• Mobility/technology
http://frac.org/initiatives/addressing-senior-hunger/seniorsand-snapfood-stamps/
Older Americans Act Nutrition Programs
• Established 1965,
Nutrition added 1972
• No income requirements
– need based
• Age 60+
• Targeted to those with
highest needs
▫ Greatest social and
economic need
▫ Low income minorities
▫ Rural
▫ Limited English speaking
More than a meal….
• Nutrition Services – includes meals, nutrition
screening, assessment, education, Medical
Nutrition Therapy to older adults and caregivers
• Socialization and access to services
• Promote independence….Aging in Place
OAA Purpose
• Reduce hunger and food
insecurity
• Promote socialization of
older individuals
• Promote the health and
well-being of older
individuals through disease
prevention and health
promotion services
OAA Home Delivered Meals
• Age 60+
• Spouse of any age
• Homebound
• Lacking support
• Unable to prepare own
meals
OAA Congregate Meals
• Age 60+ (Native
Americans, 50+)
• Spouse of any age
• Younger disabled person
living with eligible person
OAA Participant Profile
• 66% - meal provides half of
daily intake
• 61% live alone
• 73% age 75+
• Half are at nutrition risk
• 84% need help with IADLs
• 1:3 Meals on Wheels clients
need help with 3+ ADLs
and are nursing home
eligible
• 8% congregate, 19% HDM
use SNAP
• 29% rate own health as
poor
• 58% HS grad, 7% college
• One-third at or below
poverty level; 85% low
income
(< $20,000)
The problem
with funding…
Commodity Supplemental Food Program
• Low income
▫
▫
▫
▫
Pregnant and breastfeeding women
Other new mothers <1 yr postpartum
Infants and kids up to 6 yrs
Age 60+
• Older adults have to be poorer
▫ < 130% poverty for older adults
▫ <185% poverty for all others
Commodity Supplemental Food Program
• Food packages include:
▫ Infant formula and cereal
• In 36 States and 2 Tribal
Organizations
▫ NFDM and UHT fluid milk;
juice
• Serves >518,000 per year
▫ Cereals, rice, pasta
▫ Peanut butter, dry beans
▫ Canned meat/poultry/fish
▫ Canned fruits/vegetables
▫ 96% are age 65+
• But….the quantities are often
impractical for 1-2 person
households
Child and Adult Care Food Program
• Low income children
• Functionally impaired adults or age 60+
• Serves 3.2 M children, 112,000 adults
• Reimbursement tiers as in free/reduced/full school
meals
• Federally regulated, State administered
Senior Farmers Market Nutrition Program
• Goal: Help farmers and improve
nutrition for seniors
• Age 60+, income < 185% poverty
• Washington State
• Served 20,700 people in 2013
• $40/year per person
TEFAP
• 3 million seniors served by Feeding America
• 18.6% households have 1 member age 65+
• Difficult choices
▫ 30% chose between food and medical care
▫ 35% chose between food and paying for
heat/utilities
Barriers to Participation
• Lack of awareness
• Reluctance to accept help
• Inadequate funding of programs, wait lists
• Lack of transportation
Getting By with Federal Nutrition Assistance
• BK - 79 years old
• Widow
• Generally good health, overweight, hypertensive,
arthritis
• Worked part-time
• Lives alone, has children who live near by
• Relies on husband’s social security and small pension
Wellman, N.S. & B. Kamp. Federal Food and Nutrition Assistance
Programs for Older People.
Generations. Fall. 2004
DESCRIPTION
BK’s
Finances
Monthly
Income
Social Security
$920
Widow’s Pension
$420
Monthly
Expenses
Rent
$600
Food
$155
Utilities
$120
Misc., transportation, clothing, etc.
$ 80
Health insurance
$157
Drugs/Medications
$ 80
Medical Services
$ 50
Medical Supplies
$ 14
BALANCE
$84
FEDERAL NUTRITION ASSISTANCE
OA Nutrition Programs: Value of meals
$100
Food Stamps
$ 50
CSFP: Actual retail value generally higher
$ 17
SFMNP: $40 annual benefit divided by 12
$
TOTAL VALUE
$170
3
Other services available
• Senior Information and Assistance/Referral
▫ Connects older adults to services
• SHIBA
▫ Information about affordable health care
• Elder Abuse Prevention
• Call your local Area Agency on Aging or use the
Eldercare Locator 800-677-1116
One last note on funding…..
• OAA
• WIC
▫ Serves < 5% of older
adults
▫ Serves 53% of all
infants born in the US
▫ $125 M in 1975
▫ $20.6 M in 1974
▫ $816 M in 2012
▫ $7.1 B in 2012
• 7-fold increase
• 344-fold increase
Nutrition and Aging Resources
 US Administration on Aging
 www.aoa.gov
 www.gpra.net
• Food and Nutrition Programs for Community-Residing Older
Adults
Position of the American Dietetic Association, the American Society for
Nutrition, and the Society for Nutrition Education – March 2010
http://www.eatright.org/About/Content.aspx?id=6442451115
 Position of the Academy of Nutrition and Dietetics: Food and
Wellness for Older Adults: Promoting Health and Wellness 2012
http://www.eatright.org/About/Content.aspx?id=8374