Overview1

The U.S. population of older adults2 is predicted to grow rapidly as baby boomers (those born between 1946 and 1964) begin to reach 65 years of age. Simultaneously, advancements in medical care and improved awareness of healthy lifestyles have led to longer life expectancies. The Census Bureau projects that the population of Americans 65 years of age and older will rise from approximately 40 million in 2010 to 55 million in 2020, a 36 percent increase (AoA, 2010). Furthermore, older adults are choosing to live independently in the community setting rather than residing in an institutional environment. This increase in the older population will result in a surge in the demand for delivery of services and create new challenges for older people, their caregivers, and nutrition and social services professionals who seek to ensure the availability of services to this population.

The types of services needed by this population are shifting due to changes in their health issues. Older adults have historically been viewed as underweight and frail; however, over the past decade there has been an increase in the number of obese older persons. Obesity in older adults is not only associated with medical comorbidities such as diabetes; it is also

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1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.

2 According to the World Health Organization, “most developed world countries have accepted the chronological age of 65 years as a definition of…older person.” http://www.who.int/healthinfo/survey/ageingdefnolder/en/index.html.



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Overview1 The U.S. population of older adults2 is predicted to grow rapidly as baby boomers (those born between 1946 and 1964) begin to reach 65 years of age. Simultaneously, advancements in medical care and improved aware- ness of healthy lifestyles have led to longer life expectancies. The Census Bureau projects that the population of Americans 65 years of age and older will rise from approximately 40 million in 2010 to 55 million in 2020, a 36 percent increase (AoA, 2010). Furthermore, older adults are choosing to live independently in the community setting rather than residing in an institutional environment. This increase in the older population will result in a surge in the demand for delivery of services and create new challenges for older people, their caregivers, and nutrition and social services profes- sionals who seek to ensure the availability of services to this population. The types of services needed by this population are shifting due to changes in their health issues. Older adults have historically been viewed as underweight and frail; however, over the past decade there has been an increase in the number of obese older persons. Obesity in older adults is not only associated with medical comorbidities such as diabetes; it is also 1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus. 2 According to the World Health Organization, “most developed world countries have accepted the chronological age of 65 years as a definition of . . . older person.” http://www. who.int/healthinfo/survey/ageingdefnolder/en/index.html. 1

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2 NUTRITION AND HEALTHY AGING a major risk factor for functional decline and homebound status (Jensen et al., 2006). The baby boomers have a greater prevalence of obesity than any of their historic counterparts, and projections forecast an aging population with even greater chronic disease burden and disability. Nutrition is a key component to promoting healthy and functional liv- ing among older adults. The 2000 Institute of Medicine (IOM) report The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population highlighted priorities for enhanced coverage and coordination of nutrition services in the community setting. Little progress has been made toward meeting those priorities during the decade since the report was published. Nutrition services are fragmented and poorly integrated with other services. In addi- tion, coverage and reimbursement continue to have serious limitations, thus increasing the possibility that older adults requiring nutrition services will fall through gaps in this tenuous service net. In light of the increasing numbers of older adults choosing to live independently rather than in nursing homes, and the important role nutri- tion can play in healthy aging, the IOM convened a public workshop to illuminate issues related to community-based delivery of nutrition services for older adults and to identify nutrition interventions and model programs which promote (1) successful transitions from acute, subacute, and chronic care to home and (2) health and independent living in the community, as well as to highlight needed research priorities. It is envisioned that the workshop will improve awareness and understanding of technical and policy issues related to nutrition needs of older adults in community set- tings by fostering increased dialogue among health, nutrition, and social services policy makers and researchers. This foundation will facilitate better informed and more effective plans and decisions by government and non- government policy makers, implementing agencies, and others informed by the workshop and this summary. The workshop, sponsored by the Department of Health and Human Services Administration on Aging, the National Institutes of Health Division of Nutrition Research Coordination and Office of Dietary Supplements, the Meals On Wheels Association of America, the Meals On Wheels Research Foundation, and Abbott Nutrition, was held on October 5–6, 2011, in Washington, DC. The workshop agenda appears in Appendix A. The IOM- appointed workshop planning committee was chaired by Dr. Gordon L. Jensen of The Pennsylvania State University, who also served as the overall moderator for the workshop. Each member of the planning committee, listed in the front matter of this report, contributed to the substance of the agenda and moderated the presentations and discussions for the five sessions. This report is a summary of the presentations and discussions prepared from the workshop transcript and slides. The report is organized accord-

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3 OVERVIEW ing to the chronological order of the proceedings. Chapter 1 provides an introduction; a summary of the keynote address on the demographics of the aging population and resources available to them; and a case study of an older adult who, with the assistance of nutrition and other services, transi- tioned from acute care to his home. Chapter 2 examines nutrition-related issues of concern experienced by older adults in the community including nutrition screening, food insecurity, sarcopenic obesity, dietary patterns for older adults, and economic issues. Chapter 3 explores transitional care as individuals move from acute, subacute, or chronic care settings to the community, and Chapter 4 provides models of transitional care in the com- munity. Chapter 5 provides examples of successful intervention models in the community setting, and Chapter 6 covers the discussion of research gaps in knowledge about nutrition interventions and services for older adults in the community. This workshop summary highlights issues and presents recommendations made by individual speakers, but it does not represent consensus recommendations of the workshop. Appendixes at the end of the report provide additional information. As mentioned above, the workshop agenda is reproduced in Appendix A. The workshop planning committee and speakers’ biographical sketches appear in Appendix B, the names and affiliations of workshop attendees are com- piled in Appendix C, and a guide to the acronyms and abbreviations used throughout the report is provided in Appendix D. REFERENCES AoA (Administration on Aging, Department of Health and Human Services). 2010. A Profile of Older Americans: 2010. http://www.aoa.gov/AoARoot/Aging_StatisticsProfile/2010/ docs/2010profile.pdf (accessed October 18, 2011). Jensen, G. L., H. J. Silver, M.-A. Roy, E. Callahan, C. Still, and W. Dupont. 2006. Obesity is a risk factor for reporting homebound status among community-dwelling older persons. Obesity 14(3):509–517.

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