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Administration on Aging Listening Session on Older Americans Act - ADA President Susan Borra, Dec. 4, 2001

On behalf of my fellow food and nutrition professionals at the American Dietetic Association, I appreciate the opportunity to talk with you today about the Older Americans Act. Almost half the OAA $1.1 billion budget goes to Title III nutrition services. The American Dietetic Association supports the provision of comprehensive food and nutrition services to older adults, and for making these services accessible and flexible, especially in home and community care systems. We also support the continuation and expansion of research to identify the most effective food and nutrition interventions for older adults over the continuum of care.

The American Dietetic Association is the nation's largest organization of food and nutrition professionals. Today, you also will hear from dietitians representing a specialized practice group within ADA that focuses on gerontological nutrition, as well as other dietitians working at the state level with Older Americans Act Nutrition Programs-congregate nutrition program and Meals on Wheels. We will each provide input to be considered as regulations are proposed for the reauthorized Older Americans Act.

It is well established by numerous studies that good nutrition helps keep older adults healthy and independent. Nutrition-related services, including screening, assessment, education, counseling for both healthy weight maintenance and disease management, congregate and home delivered meals, make it possible for millions of older citizens to remain healthy and independent. We believe they should be available across all home and community settings.

The regulations need to offer good potential for improved nutritional care. For example, requirements should establish that meals comply with the current edition of the U.S. Dietary Guidelines for Americans and the most recent Daily Reference Intakes.

The section of the Act on nutrition specifies that a State shall solicit the advice of a dietitian or "individual with comparable expertise in the planning of nutritional services." Greater clarity is needed here. A number of State Units on Aging, or SUAs, have no lead dietitian. Hence, there is no state nutrition leadership for nutrition policy, program planning and oversight, technical assistance, program evaluation, data coordination or outcomes research. In some states, Area Agencies on Aging and local providers have more expertise concerning nutrition services than the SUAs. The regulations also should define comparable expertise, as well as the qualifications of this individual. We believe more nutrition professionals with a range of specific advanced knowledge and skills are needed throughout the aging network and that their responsibilities be broad enough to maximize the benefits of good nutrition.

We recommend more emphasis on nutrition screening, education and counseling. They are an integral part of the continuum of services that should be provided through the AAA or at the local level. AoA should specify who, when, and how individuals are screened and provide technical assistance and support. AoA regulations should seek to define the qualifications of individuals providing these services in order to best protect older adults.

On another important note, ADA is also concerned about the nutritional status of caregivers. Comprehensive nutrition services are important to ensure the health, nutritional status and well being achieved. Nutrition services, including home-delivered meals, should be provided to caregivers along with recipients.

ADA supports programs such as those conducted at the National Policy and Resource Center on Nutrition and Aging at Florida International University. This Center is well positioned to conduct the necessary policy and scientific research that is critical to our understanding of the needs of older adults. We are pleased the American Dietetic Association is named in Section 337 as a consultant to the Assistant Secretary. The Florida International University Nutrition center can help the Agency implement this section. The Center, the Older Americans Act's first and only University-based Nutrition Center, provides training and technical assistance, disseminates information online, analyzes policy, and facilitates outcomes measurements. We believe such nutrition expertise is essential to the Aging Network.

In comparison to other federal nutrition assistance programs, such as, school lunch, WIC, and even food stamps, whose budgets have grown tremendously in the last 30 years, OAA appropriations have not kept pace with the graying of America. This is partly due to the shortage of outcome data and lack of a nutrition infrastructure. The FIU Center is helping to ensure that Programs serve safe, nutritious, tasty meals and that outcomes, such as Medicare and Medicaid savings, are beginning to be documented.

Thank you for the opportunity to present these views. References to ADA's relevant position papers as well as the Institute of Medicine's report on "The Role of Nutrition in Maintaining Health in the Nation's Elderly" are provided.

REFERENCES

1. Mathematica Policy Research, Inc. Serving Elders at Risk, National Evaluation of the Elderly Nutrition Programs 1993-1995. Washington, DC: US Department of Health and Human Services; 1996.
2. Weddle DO, Fanelli-Kuczmarski MF. American Dietetic Association Position Paper: Nutrition, aging, and the continuum of care. J Am Diet Assoc. 2000;100:580-595.
3. Shafer L, Gillespie A, Wilkins JL, Borra ST. American Dietetic Association Position Paper: Nutrition education for the public. J Am Diet Assoc. 1996;96:1183-1187.
4. Contento I, Balch GI, Bronner YL, Lytle LA, Maloney SK, Olson CM, Swadener SS. The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. J Nutr Educ. 1995;27(6):277-422.
5. Healthy People 2010. Washington, DC: US Department of Health and Human Services; 2000.
6. Committee on Nutrition Services for Medicare Beneficiaries, Institute of Medicine. The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: National Academy Press. 1999.
7. National Center for Health Statistics. 1997. Third National Health and Nutrition Examination Survey (Series 11, #1, SETS Version 1.22a) [CD-ROM]. Washington, DC: US Government Printing Office.
8. Thomson C, Bloch AS, Hasler CN. American Dietetic Association Position Paper: Functional foods. J Am Diet Assoc. 1999;99:1278-1285.
9. Committee on Opportunities in the Nutrition and Food Sciences, Food and Nutrition Board, Institute of Medicine. Thomas PR, Earl R, eds. Opportunities in the Nutrition and Food Sciences: Research Challenges for the Next Generation of Investigators. Washington, DC: National Academy Press; 1994.
10. Fey-Yensan N, English C. Ash S, Wallace C, Museler H. Food safety risk identified in a population of elderly home delivered meal participants. J Am Diet Assoc. 2001;101:1055-1057.
11. Ingham S, Thies ML. American Dietetic Association Position Paper: Food and water safety. J Am Diet Assoc. 1997;97:184-189.
12. Health Care Financing Administration. Home and community-based services 1915(c) waivers. Available at: http://www.hcfa.gov/medicaid/hpg4.htm. Accessed November 21, 2001.
13. Silver HJ, Wellman NS. Nutrition education may reduce burden in family caregivers. J Nutr Educ. In press 2001.