White Paper

Public Policy Strategies for Nutrition and Aging
 
Good nutrition is essential to the health, independence and quality of life of older adults and one of the major determinants of successful aging.  Many older Americans, however, receive sub-optimal nutrition.  About 30 million live with chronic diseases for which nutrition therapies can be effective in managing and treating.  Meanwhile the vast majority of homebound older adults rely on informal caregivers, most of whom are untrained and unprepared for care management.  In long-term care settings, many are at risk for malnutrition and dehydration.
 
Dietetic professionals are uniquely qualified to work with older adults, promoting health and functionality to maintain quality of life among the healthy, as well as provide medical nutrition therapy (MNT) in disease management strategies that lessens chronic diseases risk, slows disease progression, and reduces symptoms.  A broad array of culturally appropriate food and nutrition services as well as physical activities and supportive care are vital for maintaining the health of this growing segment of the U.S. population.     
 
GUIDING KNOWLEDGE: 
 
ADA’s strategic work on nutrition and aging issues is based on the following:
 
Enjoyment of food, along with its social and nurturing aspects, contributes to quality of life for older adults.
 
As people age, accompanying physiological and functional changes affect nutrient needs.

  • Research has shown that older adults have specialized requirements for a variety of nutrients as aging effects absorption, utilization and excretion.

Nutritional maintenance and treatment strategies are both needed.

  • Physiological, social, family, environmental, economic and other factors affect the nutrition intakes of older adults.  As older adults experience change in circumstances, adequate attention to and resources for nutrition may slip.
  • Nutrition screening is a process of identifying individuals at nutritional risk or with malnutrition, facilitating interventions that can help older adults maintain their independence and personal well-being.
  • To address specific diseases or conditions, Medical Nutrition Therapy’s (MNT) two-phase process offers assessment of nutritional status and development of an individualized intervention plan that can reduce risk, slow disease progression and reduce symptoms. 
  • With an estimated 30 million people living with cardiovascular disease, diabetes mellitus, kidney disease, hypertension, obesity, and osteoporosis - conditions responsive to MNT -- management of these conditions through medical nutrition therapy would bring down their $300 billion annual price tag. 
  • Evidence shows that services that improve nutrition among older adults produce positive health outcomes and reduce healthcare costs for older adults.
  • Adults with poor nutritional status, especially those consuming inadequate food and fluids, are more likely to have serious complications, require institutional or home-based care, and have greater reliance on prescription drugs. 

Nutrition services are needed in the wide variety of settings in which older adults live, dine and receive health care.   These include acute, sub acute, skilled nursing, rehabilitation, community health, congregant feeding, home care, adult day care, life care, assisted-living, and nursing facilities.   

  • Between 35 percent and 85 percent of long-term care residents are at risk for malnutrition and dehydration.   About 75 percent of nursing home residents fail to finish 75 percent of their meals, a major determinant of mortality. 
  • Research indicates that the more time dietitians spend in nursing homes, the less time residents spend in hospitals.  
  • Although food and nutrition services are currently provided to older adults through health care and social support systems, these services are not universal.  In addition, these parallel, but separate systems, do not assure continuity of care.
  • Public and private initiatives are needed to improve the safety net for nutrition among the nation’s older adults.
  • Government, academia, the health care community, civic and religious institutions and individuals all have roles to play in assuring that older adults’ nutritional needs are met.  Support and coordination of activities and partnerships are vital if improvements are to be made and sustained.

ADA STRATEGIES FOR ADDRESSING NUTRITION PROBLEMS AMONG THE AGING:
 
To improve care and broaden access to nutrition services along the continuum of care for older adults, ADA supports the following:
 
Expansion and funding of federal and state nutrition services in home and community-based programs, such as the Older Americans Act Nutrition Program, Medicaid waiver and caregiver support programs. 

  • Innovative opportunities can integrate MNT within all health care delivery systems serving older adults; proactively funding for nutrition services, such as risk reduction, risk management, home care, nutrition education, health promotion, wellness, caregiver training, etc., can yield substantial savings in other areas.
  • Reimbursement for MNT for unintended weight loss, dehydration and wounds would mean more older adults could obtain services.

State and local associations address key issues associated with nutrition care for older adults.  

  • State groups may work to strengthen state legislation and regulations to better meet the needs of today’s dependent older adults. 
  • Requirements for RD coverage in the nation’s 17,000 nursing homes should reflect the increased acuity of residents. 
  • State regulations for assisted living facilities, board and care homes should recognize the unique knowledge and skills of dietetics professionals within the health care team serving older adults.

Garner support for applied research on nutrition and aging. 

  • Applied nutrition and aging research is needed to determine the nutritional needs and optimal diets in nursing homes and home care and for the very old.
  • Outcomes research should validate how dietetics professionals influence positive clinical and quality of life outcomes in LTC, home health, and community programs.  In addition funding to validate instruments such as nutrition assessment criteria, nutrition risk assessment tool, and nutrition quality of life measurement is needed.

Recruitment and retention in allied health professions to meet future projected healthcare demands.

  • Public policy investment to attract students to these professions - similar to that in the Nurse Reinvestment Act of 2002 - can offer loans, grants, public education, outreach and other assistance to recruit, retain and advance dietetic and other allied health professionals serving the elderly.  With the projection that 20 percent of the U.S. population will be composed of people 75 and older by 2030, it is vital to attract and reward knowledgeable and skilled health care providers. 
  • New dietetic education supervised practice programs in new settings may better prepare those who will provide nutrition services.

The American Dietetic Association is the nation’s largest association of food and nutrition professionals. Guided by a reliance on sound science and evidence-based practice, the organization is a sought-out participant in the deliberation and resolution of food, nutrition and health issues.  ADA members’ unique education, supervised practice experience, national registration examination, and mandated continuing professional education equip them to collaboratively provide nutrition and related health care services at all stages of the life span and in a myriad of educational, community, medical, commercial, and research environments.