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Sheila Moats and Julia Hoglund, Rapporteurs Food and Nutrition Board

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. This study was supported by Contract No. N01-OD-4-2139, Task Order No. 235, between the National Academy of Sciences and the National Institutes of Health (Division of Nutrition Research Coordination and Office of Dietary Supplements) and by Contract No. HHSP233201100557P from the U.S. Department of Health and Human Services (Administration on Aging), and grants from Abbott Labora- tories, the Meals On Wheels Association of America, and the Meals On Wheels Research Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-25310-9 International Standard Book Number-10: 0-309-25310-1 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Nutrition and Healthy Aging in the Community: Workshop Summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON NUTRITION AND HEALTHY AGING IN THE COMMUNITY: A WORKSHOP* GORDON L. JENSEN (Chair), Professor and Head, Department of Nutritional Sciences, Pennsylvania State University, University Park CONNIE W. BALES, Professor of Medicine, Division of Geriatrics, Duke University, NC and the Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, NC ELIZABETH B. LANDON, Vice President, Community Services, CareLink, North Little Rock, AR JULIE L. LOCHER, Associate Professor of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama, Birmingham DOUGLAS PADDON-JONES, Associate Professor, Department of Nutrition and Metabolism, School of Health Professionals, Department of Internal Medicine, The University of Texas Medical Branch, Galveston NADINE R. SAHYOUN, Associate Professor, Department of Nutrition and Food Science, University of Maryland, College Park NANCY S. WELLMAN, Adjunct Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA IOM Staff SHEILA MOATS, Study Director JULIA HOGLUND, Research Associate ALLISON BERGER, Senior Program Assistant ANTON L. BANDY, Financial Associate GERALDINE KENNEDO, Administrative Assistant LINDA D. MEYERS, Director, Food and Nutrition Board *Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Rose Ann DiMaria-Ghalili, Doctoral Nursing Department and Nutrition Sciences Department, Drexel University, Philadelphia, PA Denise K. Houston, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC Gordon Jensen, Department of Nutritional Sciences, Pennsylvania State University, University Park Nadine R. Sahyoun, Department of Nutrition and Food Sciences, University of Maryland, College Park Dennis T. Villareal, New Mexico VA Health Care System, Albuquerque Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report vii

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viii REVIEWERS before its release. The review of this report was overseen by Hugh H. Tilson, University of North Carolina at Chapel Hill. Appointed by the Institute of Medicine, he was responsible for making certain that an inde- pendent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully con- sidered. Responsibility for the final content of this report rests entirely with the authors and the institution.

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Contents Overview 1 1 Introduction 5 2 Nutrition Issues of Concern in the Community 15 3 Transitional Care and Beyond 49 4 Transition to Community Care: Models and Opportunities 63 5 Successful Intervention Models in the Community Setting 83 6 Research Gaps 105 APPENDIXES A Workshop Agenda 113 B Moderator and Speaker Biographical Sketches 119 C Workshop Attendees 133 D Abbreviations and Acronyms 139 ix

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