Live Long and Prosper: Optimal Nutrition for Today’s

Aging RealitiesSeptember 12, 2012

Presenter:

Nancy Wellman, PhD, RD

Adjunct Professor, Tufts University

Friedman School of Nutrition Science & PolicyModerator:

James M. Rippe, MD – Leading cardiologist, Founder and Director,

Rippe Lifestyle Institute

NUTRI-BITES®

Webinar Series

Approved for 1 CPE (Level 2) by the Academy of Nutrition and Dietetics Commission on Dietetic Registration and the American Culinary Federation

Live Long and Prosper: Optimal Nutrition for Today’s Aging Realities

This webinar covered:•

Nutri-Bites® Summary

• The beneficial effects of nutrition in health promotion, risk reduction and disease management of older Americans

• Federal and community food and nutrition programs available for older adults

• Access issues and opportunities to promote healthful aging and optimal nutrition status

• Strategies food and nutrition professionals can apply to integrate food and nutrition programs and services into home and community settings

• Approaches to help older adults meet their nutrition needs following hospital discharge

Demographics of Aging:Demographics of Aging:Dramatic ChangesDramatic Changes People age 65 + in the US

2010: 40 million = 13% = 1:8 2030: 72 million = 20% = 1:5

doubled compared to Yr 2000

Relatively few (1.3 M, ~3%) of 65+ in nursing homes Percentages increase dramatically w/ age:

1.1%, 65-74 yr; 3.5%, 75-84 yr; 13.2%, 85+ 1970s & 1980s: >21%, 85+

Older Americans 2012 Key Indicators of Well Being, http://agingstats.gov/

Nutrition Prevention Nutrition Prevention Spectrum in AgingSpectrum in Aging

NutritionPrimary

PreventionSecondary Prevention

Tertiary Prevention

Health Promotion Risk Reduction Treatment / Therapy

Definition

Prevent disease & disability by reducing or eliminating potential risk factors

Lessen health risks by screening & early treatment before observable symptoms

Treat or remediate those with diagnosed health conditions

Goals

Enhance/maintain wellness through behavioral or environmental changes

Maintain/improve nutritional status &/or avoid illness among those susceptible due to genetics, lifestyle, age, etc

Prevent/delay disease progression, disability, pain, premature death

Activities

Generalized education or facilitation of healthful diets

Anticipatory screening, detection, early intervention

Individualized nutrition TX for acute conditions & chronic diseases

Diet QualityDiet QualityINDICATOR 23

Impacts of Food & Nutrition on Health

Reduced Quality of Life Lessened Independence Increased Healthcare Costs

Without Adequate Healthy, Safe Food & Nutrition Services:Deafness; Blindness; Reduced Smell &Taste; Chewing & Swallowing Problems; Joint Destruction--Costly Replacements; Confusion, Forgetfulness, Memory Loss; Uncontrolled High Blood Pressure--Heart Attack,

Stroke; Uncontrolled Diabetes--Amputations, Blindness, Nerve Disorders, Dialysis; Osteoporosis--Weakened Bones, Decreased Mobility and Falls; Decreased Immune Response--Flu, Colds, Upper

Respiratory Infections, HIV/AIDS; Decreased Organ Function & Organ Failure; Wasting--“Dwindles” or “Failure to Thrive”; Involuntary Weight Loss: Body Mass Index, Muscle Mass;

Excessive Weight Gain--Obesity; Serum Albumin--Protein Malnutrition; Pressure Ulcers

Longer Hospital

StaysHospital

Re-Admission Premature NH Admission

Low Stamina

Poor Appetite

Depression Anxiety

Sleep

DisturbanceIncreased Morbidity & Mortality

Slower Recovery

CHRONIC DISEASES

Heart Disease; Hypertension; Diabetes; Osteoporosis;

Some Cancers: colon and breast; Arthritis; COPD;

Renal Disease

ACUTE CONDITIONS

Dehydration; Pressure Ulcers; Infections;

Pneumonia; Influenza; Fractures; Tooth Abscesses;

Gum Disease

AGE-RELATED CONDITIONS / DISEASES

Hearing Loss; Macular Degeneration; Destructive Joint

Disease: knees and hips; Loss of Muscle Mass: Sarcopenia; Cognition / Mental Health

POOR DIETSPOOR DIETS

Federally Funded Community Federally Funded Community Food & Nutrition ProgramsFood & Nutrition Programs

USDAUSDA SNAP (Food Stamps) SNAP-Education Commodity Supplemental

Food Program The Emergency Food

Assistance Program TEFAP Senior Farmers’ Market

Nutrition Program Child & Adult Care Food

Program

US DHHSUS DHHS Older Americans Act Nutrition

Program (“meals-on-wheels”)including Nutrition Services Incentive Program (NSIP)

Eldercare Locator: Connecting you to Community Services http://eldercare.gov/Eldercare.NET/Public/Index.aspx

Medicare & Medicaid

Disconnect between Hospital Disconnect between Hospital & Home& HomeHospital-based Health

Care System Hospital Discharge

Planners: “community nutrition services not readily available”

RDs: not involved in discharge planning; low awareness of community nutrition programs

Community-based Social Service System

Social Service Providers: low awareness of nutrition’s importance to health, independence, recovery, re-admissions, LOS, “aging in place”

RDs: too few within the Aging Network

Referrals to community nutrition programs, esp. OAA NUTRITION PROGRAM , in TRANSITION CARE is essential for at-risk older adults.

Care Transition: Problems AheadCare Transition: Problems Ahead Starting next month, Medicare will prod hospitals to

improve practices. Hospitals with high readmissions for 3 conditions (heart attack, pneumonia, heart failure) will be paid less than hospitals with fewer preventable readmissions. http://www.ahrq.gov/consumer/cc/cc090412.htm

*Transition from one care source to another: moment with high risk for communications failures, procedural errors & unimplemented plans.

*People with chronic conditions, organ system failure & frailty: at highest risk because their care is more complicated & they are less resilient when failures occur.

*Strong evidence: possible to significantly reduce hospital readmissions caused by flawed transitions.

*A Morgan, 8/24/12; Administration for Community Living

Nutrition isn’t considered Nutrition isn’t considered important for healthier agingimportant for healthier aging … be it food security, food safety, public health, health care,

hospital discharge planning, transition care, LTSS/LTC, Medicare, Medicaid, NH, ALFs, Board & Care homes.

Non-scientists & social service persons don’t think the evidence is there &/or find the science too complicated.

OR Food/nutrition is too simple – attitudinal challenge for many,

including MDs & PhDs. Health care & social science is embracing physical activity

better & faster.

Lip service only re importance of Lip service only re importance of nutrition for healthier agingnutrition for healthier aging

OpportunityOpportunity

Today RDs have a unique opportunity to make a differenceopportunity to make a difference in the lives of the growing number of older adults & the quality of programs & systems being developed for transition care & in the Affordable Care Act.

Affordable Care Act: State LedAffordable Care Act: State LedAcademy of Nutrition & Dietetics Step-by-Step Guide to include nutrition services by building

connections with state officials & being involved in state demonstration projects – what are you & your state doing?

Policy Initiatives & Advocacy Committees/Task Forces: State Regulatory Specialists, State Policy Reps, Public Policy Coordinators, Reimbursement Reps

Medicare & Medicaid now emphasize prevention – Incentivizing hospitals to make appropriate referrals by

linking reimbursement to preventable adverse events following discharge, eg, re-admissions, etc. – what are you & your hospital doing?

Affordable Care Act / Health Care Reformhttp://www.eatright.org/healthcarereform/ Rules & Programs Step-by-Step Guide for Success Resources Sample Affiliate (State Dietetic Association)

Plan of Action

Make a difference for RDs in your state! Make a difference for RDs in your state! Make a difference for public health in your state!Make a difference for public health in your state!

Roles for DietitiansRoles for DietitiansAdvocate forAdvocate for Inclusion of food & nutrition

services in transition care & HCBS

Establishment of screening & referral systems in HCBS

Adequate & sustained funding for meals & nutrition services

Comprehensive & coordinated community based nutrition services in transition care

Comprehensive nutrition services in Medicare & Medicaid via the Affordable Care Act

Position: Food & Nutrition Programs for Community Residing Older Adults. 2010.

Participate inParticipate in Service provision in HCBC & transition

care Documenting cost effectiveness &

efficiency Providing technical assistance &

training Developing & implementing evidence

based nutrition education

EducateEducate Physicians, Discharge Planners, Case

Managers, RNs, Administrators, Social Workers

Older Adults & Caregivers

Opportunities/Challenges for Home & Community Based Services

State programs vary: Get involved! Service system, structure Parallel system collaborations Funding Resources Capacity Expertise

Food & nutrition services are limited: Get involved! May not be perceived as essential Dietitians may not be valued

POSITION PAPERSPOSITION PAPERS Food & Nutrition for Older Adults: Promoting Health & Wellness.

J Acad Nutr Diet 2012;112:1255. www.eatright.org/About/Content.aspx?id=8374

Food & Nutrition Programs for Community-Residing Older Adults. J Am Diet Assoc 2010;110:46.

www.eatright.org/About/Content.aspx?id=6442451115 Individualized Nutrition Approaches for Older Adults in Health Care Communities.

J Am Diet Assoc 2010;110:1549. www.eatright.org/About/Content.aspx?id=8373

AFFORDABLE CARE ACT / HEALTH CARE REFORMAFFORDABLE CARE ACT / HEALTH CARE REFORMhttp://www.eatright.org/healthcarereform/ Rules & Programs Step-by-Step Guide for Success Resources Sample Affiliate (State Dietetic Association) Plan of Action