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Older Americans: Population Growth and Issues in Health Promotion

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In 1972 Congress enacted the National Nutrition Program for the Elderly as part of the Older Americans Act (OAA). The program provides home delivered meals (commonly called meals on wheels) and congregate meals (sometimes called senior dining) as well as nutrition screening, education and counseling and other health services (Marra & Wellman, 2008; Nancy S Wellman, Rosenzweig, & Lloyd, 2002). The OAA is based on the underlying causes of malnutrition which include: affordability of nutritious foods, insufficient skills in selecting and preparing nourishing and well balanced meals, limited mobility impairing their ability to shop and cook for themselves and feelings of loneliness and rejection associated with eating meals alone. Therefore the specific purposes of the program are limited to simply providing meals, but include: decreasing malnutrition, preventing physical and mental deterioration, promoting health, reducing social isolation and connecting older adults to social services (Nancy S Wellman et al., 2002).

The program is available to all individuals age 60 and over, but targets those with the greatest social and economic need. Administered by the U.S. Department of Health and Human Services Administration, the program employs a vast network of 57 state units and 655 area agencies related to aging as well as thousands of local providers. Funding for the program has increased from $125 million in 1975 to almost $600 million in 2002 (Nancy S Wellman et al., 2002). By 2006 the OAA Nutrition Program served about 238 million meals to 2.6 million older adults, approximately 59% of whom are homebound. At that time the OAA programs served more than 9 million Americans, which was about 19% of the older adult population (Penn, Fischer, Sun Lee, Hausman, & Johnson, 2009) and had an expenditure of $1.23 billion making it the largest food and nutrition program serving older adults (Nancy S Wellman et al., 2002). Over 4,000 local agencies, mostly with modest budgets and volunteer staff contribute to the OAA Nutrition program (N. S. Wellman, Kamp, Kirk-Sanchez, & Johnson, 2007)

The Eat Better & Move More (EBMM) program was developed for local OAA Nutrition site and administered by the Administration on Aging's You Can! Campaign, which encourages Americans to lead healthy lives by being physically active, healthy eating and making healthy choices (N. S. Wellman et al., 2007). Wellman and colleagues (2007) conducted a multisite study designed as a collaboration between the National Resource Center on Nutrition, Physical Activity and Aging in 2005. 10 Programs representing congregate dining, neighborhood recreation centers, inner-city housing complexes and Native American reservations. A total of 999 participants were selected. The intervention was based on the Stages of Change model. Participants' stage of change was determined using a nutrition and physical activity questionnaire where the selected from 5 statements representing each stage of change (N. S. Wellman et al., 2007). The program consisted of informational handouts, walking sessions, step counters and the combination of nutrition and physical activity (N. S. Wellman et al., 2007).

Approximately 40% of individuals 65 years of age and older are effected by inadequate nutrient intake (Schneider, 2002; Nancy S Wellman et al., 2002). Age and gender distributions were consistent with those of OAA Nutrition Program participants. The EBMM program has an overall 62% completion rate. Outcomes were reported to be positive for all 10 sites although there was a significant differential in completion between programs ranging from 35% to 85%. Participants completing the program were reported to



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