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Nutrition

Evaluations Report

Vol 1. Chapter II. CHARACTERISTICS OF TITLE III NUTRITION PROGRAM PARTICIPANTS

B. CHANGES IN PARTICIPANT CHARACTERISTICS AND SERVICE USE OVER TIME

One of the research objectives mandated by Congress was to examine changes, if any, in the characteristics and service use of Title III meal program participants over time. This section addresses this objective by comparing findings on participant characteristics and service use from the present evaluation with those from the previous national evaluation conducted by Kirschner et al. (1983). Kirschner reports findings from a cross-sectional survey of participants in 1981; the present evaluation describes participant characteristics in 1994, more than 10 years later.

TABLE II.19

MEAL PROGRAM PARTICIPANTS’ MONTHLY NUMBER OF SOCIAL INTERACTIONS


Title III Congregate Meal Participants


Title III Home-Delivered Meal Participants


Mean

Median


Mean

Median

Times Per Month Talk on the Telephone or Visit Family, Friends, or Neighbors, or Attend Church or Clubs

66

43


57

39

Times Per Month Attend Congregate Site or Have Contact with Person Delivering Program Meal

18

22


21

22

Times Per Month Have Social Contact with Providers of In-Home Supportive Services or Other Supportive Servicesa

11

2


23

10

Total from All Sources

95

74


100

86

Unweighted Sample Size

1,040

1,040


818

818

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations.

NOTE: Tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

aParticipant receives service from public or private source only.

The comparisons between studies indicate that current congregate participants are older and are somewhat more functionally impaired than congregate participants 10 years ago. A somewhat higher proportion of racial and ethnic minorities are currently participating, compared with 10 years ago. Because of differences in definitions and methodologies, however, it is difficult to assess whether there has been any change over time in the proportion of participants with low incomes.

1. Changes in the Demographic and Health Characteristics of Participants

The most dramatic change in the measured participant characteristics during the past 10 years is the aging of congregate participants. The average age of congregate participants in 1981 was 73 years. The average age of congregate participants currently enrolled in the program is 76 years (Table II.20). This increase in the average age of congregate participants reflects the general aging of the population, and in particular, the "aging-in-place" phenomenon experienced by elderly people living in the community. In contrast, the average age of home-delivered meal program participants, which has not changed during the past 10 years, equals 78 for both evaluations. The proportion of participants from racial and ethnic minority groups is higher now than compared with 10 years ago. When the data are weighted to reflect the overall population of participants who ever attend the program, the estimated percentages of current participants who are minorities decrease somewhat, but still are higher than their proportions 10 years ago. Compared with their counterparts 10 years ago, roughly the same proportions of current congregate and home-delivered participants live alone, are female, and are currently married.

The large differences in the percentages of low-income and minority participants are probably attributable to differences in definitions and methods between the two studies, and do not necessarily reflect changes over time in the characteristics of participants. For example, the current evaluation shows that 35 percent of congregate participants and 48 percent of home-delivered participants have low incomes,

TABLE II.20

COMPARISON OF SELECTED DEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS:

CURRENT EVALUATION AND KIRSCHNER EVALUATION

(Percentages, Unless Stated Otherwise)


Title III Congregate Meal Participants


Title III Home-Delivered Meal Participants

Characteristic

Current Evaluation

Kirschner Evaluation


Current Evaluation

Kirschner Evaluation

Average Age (Years)

76

73


78

78

Female

69

73


70

71

Married

30

34


27

28

Live Alone

57

55


60

61

Minority Statusa

27

19


25

15

Income Below Povertyb

35

52


48

65

Receive Food Stampsc

10

13


18

19

Receive Medicaidc

16

18


23

30

Unweighted Sample Size

1,040

1,735


818

415

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations; and Kirschner et al. (1983), Table III-1.

NOTES: Current evaluation tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

aRegarding race and ethnicity, the current evaluation used detailed Census Bureau questions to obtain information on race and Hispanic origin to classify minority status. The Kirschner evaluation used interviewer observation to classify race and ethnicity.

bRegarding low income, the current evaluation used a two-question sequence to determine if monthly income is below 100 percent, between 100 and 200 percent, and greater than 200 percent of the DHHS poverty guidelines, based on an elderly person’s family income and family size. Although the Kirschner evaluation compared annual income to the poverty threshold, it used the poverty threshold for a two-person household--it did not compare a participant’s family income directly to the appropriate threshold based on the participant’s actual family size (see discussion in the report).

cCurrent evaluation percentages refer to participants receiving food stamps or Medicaid benefits; Kirschner evaluation percentages refer to anyone in the household receiving food stamps or Medicaid benefits.

compared with 52 percent and 65 percent, respectively, in the Kirschner evaluation. However, this difference probably does not reflect a reduction in the proportion of low-income participants served by the program over time. To the contrary, it probably largely reflects differences in methodology used by the studies to identify low-income participants. Specifically, the current evaluation used a two-question sequence to determine if participants' monthly family income is below 100 percent ("low income" or "greatest economic need"), between 100 percent and 200 percent, or above 200 percent of the DHHS poverty guidelines, based on the participant respondent's family income and family size. In contrast, the Kirschner evaluation compared annual income to the poverty threshold at the time, but it used the poverty threshold for a two-person household; it did not compare family income directly to the number of persons in the family. Yet, 55 percent of congregate participants and 61 percent of home-delivered participants in 1981 lived alone--their income was compared with the much higher poverty threshold for a two-person family, rather than a one-person family. Consequently, the Kirschner evaluation overstated the proportion of low-income participants.

Table II.21 compares participants over time on health and functional characteristics. Current participants, especially congregate ones, are somewhat less healthy and more impaired than participants 10 years ago. For example, 33 percent of current congregate participants rate their health as "fair" or "poor," compared with 25 percent of congregate participants 10 years ago. Current congregate participants are slightly more likely to have been in a hospital or nursing home during the past year. Thirty-three percent of home-delivered participants are unable to prepare hot meals if they have to, compared with 26 percent 10 years ago. While the reasons for these changes are not entirely clear, the overall policy concern they pose is how the program can best respond to the needs of this aging and frail population.

2. Changes in Participants' Dietary Intake

As measured by the proportion consuming two-thirds or more of the RDA during a 24-hour period, the dietary intake of participants has not changed much during the past 10 years. Somewhat greater

TABLE II.21

COMPARISON OF SELECTED HEALTH AND FUNCTIONAL CHARACTERISTICS OF

PARTICIPANTS: CURRENT EVALUATION AND KIRSCHNER EVALUATION

(Percentages, Unless Stated Otherwise)


Title III Congregate Meal Participants


Title III Home-Delivered Meal Participants

Characteristic

Current Evaluation

Kirschner Evaluation


Current Evaluation

Kirschner Evaluation

Get Out of the House Nearly Every Day

73

81


15

24

Can Clean and Maintain Home

88

89


41

41

Spent Time in Hospital or Nursing Home in Past Year

26

23


43

44

Fair or Poor Current Health

33

25


63

59

Normally Eat Alone

51

58


61

65

Unable to Prepare Hot Meals at Home

6

4


33

26

Unweighted Sample Size

1,040

1,735


818

415

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations; and Kirschner et al. (1983), Table III-2 and Table III-3.

NOTE: Current evaluation tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

percentages of current Title III congregate and home-delivered participants achieve two-thirds or more of the RDAs for calcium, niacin, and iron than participants 10 years ago; the differences range from four to nine percentage points (Table II.22). Somewhat smaller percentages of current Title III participants achieve two-thirds of the RDA for food energy (calories) than participants 10 years ago. Kirschner et al. did not report findings on the intake of macronutrients, sodium, or cholesterol, so we are unable to assess whether changes have occurred in the macronutrient content of participants' diets over time.

3. Changes in Participation Patterns

As a group, current Title III program participants have been participating longer than participants 10 years ago. Eighty-five percent of currently enrolled congregate participants have been participating for more than one year, compared with 69 percent of congregate participants in 1981 (Table II.23). The comparable proportions for home-delivered meal program participants are 65 percent and 55 percent, respectively.

Current meal program participants are more likely to be frequent recipients of program meals than their counterparts of 10 years ago. Fifty-nine percent of current congregate participants usually receive four or more meals per week, compared with 47 percent in 1981. Similarly, 96 percent of currently enrolled home-delivered meal program participants receive four or more meals per week, compared with 85 percent 10 years ago.

Although comparisons are limited, because the previous evaluation asked participants more limited questions about services they may be receiving, current participants appear more likely to use program services than participants 10 years ago. This may be in part due to greater availability and/or awareness of these services now than in the past. For example, 68 percent of current congregate participants reported receiving nutrition education from their meal site during the past year, compared with 39 percent of congregate participants 10 years ago.

TABLE II.22

COMPARISON OF PARTICIPANTS CONSUMING AT LEAST TWO-THIRDS OF DAILY RDA:

CURRENT EVALUATION AND KIRSCHNER EVALUATION

(Percentages)


Title III Congregate Meal Participants


Title III Home-Delivered Meal Participants

Nutrient

Current Evaluation

Kirschner Evaluation


Current Evaluation

Kirschner Evaluation

Food Energy (Calories)

66

70


56

64

Protein

94

96


86

95

Vitamin A

73

70


68

64

Vitamin C

80

79


69

73

Thiamin

93

92


89

90

Riboflavin

95

95


91

94

Niacin

95

86


88

81

Calcium

68

64


66

58

Iron

89

84


84

79

Unweighted Sample Size

1,040

800


818

340

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations; and Kirschner et al. (1983), Table IV-1.

NOTES Current evaluation tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day. Current evaluation tabulations include 25 congregate participants and 72 home-delivered participants who did not consume a program meal during the recall period; Kirschner evaluation tabulations include only those participants who ate a program meal during the recall period.

TABLE II.23

COMPARISON OF SELECTED PARTICIPATION CHARACTERISTICS OF PARTICIPANTS:

CURRENT EVALUATION AND KIRSCHNER EVALUATION

(Percentages)


Title III Congregate Meal Participants


Title III Home-Delivered Meal Participants

Characteristic

Current Evaluation

Kirschner Evaluation


Current Evaluation

Kirschner Evaluation

Began Participating More than One Year Ago

85

69


65

55

Receive 4 or More Meals Per Week

59

47


96

85

Receive Nutrition Education from Meal Site

68

39


N.A.

N.A.

Receive Shopping Assistance from Meal Site

16

12


19

8

Participate in Recreational Activities at Meal Site

70

58


N.A.

N.A.

Unweighted Sample Size

1,040

1,735


818

415

SOURCE: Elderly Nutrition Program Evaluation, participant survey, weighted tabulations; and Kirschner et al. (1983), Table III-1.

NOTE: Current evaluation tabulations are weighted to be representative of a cross-section of participants receiving Title III meals on a given day.

N.A. = Not applicable.




Last Modified: 12/31/1600