Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries

Older adults' acceptability of and preferences for food-based protein fortification in the UK, France and Norway

Research suggests that as we age, protein intake, recognised as vital for combating negative health outcomes, consistently falls below recommendations in older adults. Decreased food intake, combined with age-related eating complications is a major determinant of this protein undernutrition. If nutritional interventions are to be effective and sustainable, they must enable eating pleasure, cater for personal preferences and be adaptable to different eating patterns. As such, we aimed to identify successful strategies for at-home protein-fortification to empower older adults to take a personalised approach to their nutrition, without requiring a large behavioural change. To explore healthy older adults' (age 70+) acceptability and preferences for at-home protein fortification, European project Fortiphy led discussions with older adults (n = 37) and caregivers of older adults (n = 15) to develop high-protein recipes, which were then utilised in a home-use trial with healthy older adults (n = 158). Each fortified recipe was paired with a questionnaire to rate the ease of preparation and liking, and an end-of-study questionnaire was provided to capture overall opinions and preferences. The uniqueness of this study is that the protein fortified recipes were prepared and tested by older adults themselves, in their own homes. Findings showed that older adults were unaware of the importance of protein in ageing and did not have a desire to fortify their foods at present. Yet, they were positive regarding the concept and highlighted the importance of taste, familiar ingredients, and preferred preparation methods. Cultural preferences across countries were identified as having the most influence on the liking of fortified meals. This study also indicated a need for increased awareness of protein requirements to influence the motivation to use fortification.

Prevalence of Undernutrition and Risk of Undernutrition in Overweight and Obese Older People

Older people with excess body weight are not spared from undernutrition. They may face appetite decline which may lead to insufficient nutrient intake. They also have a higher risk of developing chronic diseases which may have a negative impact on protein-anabolic pathways. The present study aimed to determine the prevalence of undernutrition in overweight and obese older people from a secondary analysis on data collected through two French surveys among people aged 65 or over (n = 782; 31% men; 65–103 years old). Undernutrition was assessed using the MNA screening tool (Mini-Nutritional Assessment). Results showed that 2% of the respondents with a BMI over 25 were undernourished (MNA score below 17/30) and 23% were at risk of undernutrition (MNA score of 17–23.5). Specifically, 18% of overweight and 29% of obese respondents were at risk of undernutrition. Taking into account the most recent French census data, it can be estimated that in France, around 1,7 million people aged over 65 with a BMI over 25 are undernourished or at risk of undernutrition. Given the worldwide increase in the number of overweight/obese individuals in the last few decades, further research will be needed to develop strategies to tackle nutritional risk in overweight/obese older adults.

Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients

Home-delivered meal (HDM) recipients are a highly vulnerable group of older adults at risk for malnutrition and subsequent health decline. To help HDM recipients increase their nutritional intake, HDM agencies may provide expanded meal options that allow older adults to have greater autonomy over their meal selection; however, the extent to which recipients are able to select nutritious meals that are responsive to their health complexities is unknown. This study examined the nutritional content of meals selected by HDM recipients enrolled in an expanded menu plan through a large HDM agency. Data were drawn from a retrospective chart review of 130 HDM recipients who had the option of selecting their own HDM meals and frequency of meal delivery. Findings indicate that older adults who selected their own meals chose meals that were significantly lower in protein, potassium, fat, and calories. The lack of these nutrients suggests that older adults enrolled in expanded menu plans should be referred to registered dietitian nutritionists who can provide skilled guidance in meal selection. To address this need, we also describe and provide preliminary data representing a referral program designed to connect HDM recipients to dietetic services with the goal of optimizing older adult nutrition and health-related outcomes.