Johnson also called for the integration of food and nutrition care and services among all settings, including community, outpatient, rehabilitation, assisted living, and nursing homes. Older adults who need nutrition services should be targeted through well-designed screening programs. Interventions need to be developed and implemented that are tailored to diverse cultures, geographic locations, and characteristics of older adults in those settings. Johnson believes patient-directed services, with a dietitian or health care provider functioning as a coach, will likely be embraced by older adults. Elizabeth Walker suggested research on how to educate people to make competent health-related decisions, such as selecting nutrition services as a patient-directed benefit.

Judy Simon raised the issue of the disconnect between the requirement that meals provided by the Older Americans Act (OAA) Nutrition Program meet current dietary guidelines and the food preferences of older adults. She suggested research examine how to bridge that gap and determine if different meal standards and more palatable meals would attract more people into the declining congregate meal programs. She added that it is essential to determine the effect of changing dietary guidelines on program costs. Very few caterers bid on providing foods for these programs because it is not cost-effective to prepare these meals since the nutrition programs are small and have restrictions related to nutrient requirements.


Another research gap identified by Johnson is the refinement of outcome measures for interventions to demonstrate cost effectiveness and improved quality of life. Robert Russell concurred and, as noted earlier in the workshop, pointed out that one of the major goals of the Administration on Aging (AoA) is to have people remain in their homes as long as possible instead of going into a nursing home. However, the evaluations of AoA programs have been small in scale and have not addressed the main interest of Congress—do the interventions prevent people from being institutionalized and reduce health care expenses? Furthermore, if current evaluations tying these programs to Medicare and Medicaid outcomes show ineffectiveness and do not result in reduced health care spending, it must be determined why they are unsuccessful so improvements can be made.

Wellman also emphasized the need for more outcome data on the cost effectiveness of the OAA Nutrition Program. About 40 percent of older adults who participate in the home-delivered meal program are in and out of the hospital during the year. She proposed that many of these homebound people should be identified through nutrition assessment at the

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