Recognizing 50 Years of the Nation's First Nutrition Program for Older Adults: Senate Report 117-196

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Senate Report 117-196 of the 117th Congress, 2d Session, dated November 15, 2022, by the Special Committee on Aging, titled Recognizing 50 Years of the Nation's First Nutrition Program for Older Adults. A letter of transmittal dated November 14, 2022 to Kamala Harris, President of the U.S. Senate, submits the report under Senate Resolution 70, agreed to on February 24, 2021. The roster names Robert P. Casey, Jr. as Chairman. Endnotes at the close cite sources such as a Senior Resources year one progress report on its Senior Home Nutrition Program and a news item about a $300,000 donation to nonprofits in South Carolina.

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Issuer: Congressional materials
Document type: Crpt Crpt 117Srpt196 Crpt 117Srpt196
Case: Crpt Crpt 117Srpt196 Crpt 117Srpt196

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117TH CONGRESS REPORT
" SENATE !
2d Session 117–196

RECOGNIZING 50 YEARS OF THE NATION’S
FIRST NUTRITION PROGRAM FOR OLDER
ADULTS

R E P O R T
OF THE

SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE

NOVEMBER 15, 2022.—Ordered to be printed

U.S. GOVERNMENT PUBLISHING OFFICE
39–010 WASHINGTON : 2022

E:\Seals\Congress.#13
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SPECIAL COMMITTEE ON AGING
ROBERT P. CASEY, JR., Pennsylvania, Chairman
KIRSTEN E. GILLIBRAND, New York TIM SCOTT, South Carolina
RICHARD BLUMENTHAL, Connecticut SUSAN M. COLLINS, Maine
ELIZABETH WARREN, Massachusetts RICHARD BURR, North Carolina
JACKY ROSEN, Nevada MARCO RUBIO, Florida
MARK KELLY, Arizona MIKE BRAUN, Indiana
RAPHAEL WARNOCK, Georgia RICK SCOTT, Florida
MIKE LEE, Utah
STACY SANDERS, Majority Staff Director
NERI MARTINEZ, Minority Staff Director

(II)

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LETTER OF TRANSMITTAL

U.S. SENATE,
SPECIAL COMMITTEE ON AGING,
Washington, DC, November 14, 2022.
Hon. KAMALA HARRIS,
President, U.S. Senate,
Washington DC.
DEAR MADAM PRESIDENT: Under authority of Senate Resolution
70 agreed to on February 24, 2021, I am submitting to you a report
of the U.S. Senate Special Committee on Aging entitled: Recog-
nizing 50 Years of the Nation’s First Nutrition Program for Older
Adults.
Senate Resolution 4, The Committee Systems Reorganization
Amendments of 1977, authorizes the Special Committee on Aging
‘‘to conduct a continuing study of any and all matters pertaining
to problems and opportunities of older people, including but not
limited to, problems and opportunities of maintaining health, of as-
suring adequate income, of finding employment, of engaging in pro-
ductive and rewarding activity, of securing proper housing and,
when necessary, of obtaining care and assistance.’’ Senate Resolu-
tion 4 also requires that the result of these studies and rec-
ommendations be reported to the Senate annually.
I am pleased to transmit this report to you.
Sincerely,
ROBERT P. CASEY, Jr.,
Chairman.

(III)

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117TH CONGRESS REPORT
" SENATE !
2d Session 117–196

RECOGNIZING 50 YEARS OF THE NATION’S FIRST
NUTRITION PROGRAM FOR OLDER ADULTS

NOVEMBER 15, 2022.—Ordered to be printed

Mr. CASEY, from the Special Committee on Aging,
submitted the following

R E P O R T

EXECUTIVE SUMMARY
There are more than 77 million adults ages 60 years or older liv-
ing in the United States, representing over 23 percent of the total
population, and the Nation’s aging population is expected to grow
exponentially in the coming years.i ii Older adults are an asset to
American communities though many face barriers to living inde-
pendently as they age. To help address these barriers, the Older
Americans Act (OAA) of 1965 (P.L. 116–131, as amended) author-
ized comprehensive services designed to support older adults living
in their communities.iii In 1972, the OAA was amended (P.L. 92–
258) to establish the Nutrition Program, which now funds commu-
nity-based nutrition programs, including home-delivered and con-
gregate meal services.iv In the 50 years that have followed, the
OAA Nutrition Program has increased access to healthy and afford-
able food for older adults, helping to combat hunger, foster social
connectedness, promote healthy aging, and prevent adverse health
outcomes, as demonstrated in this report.
In 2020, an estimated 5.2 million, or 6.8 percent, of older adults
in the United States ages 60 and older were food insecure.v The
home-delivered and congregate meal programs supported by the
OAA Nutrition Program provide critical lifelines for older adults
and bolster their dietary intake. The 2021 National Survey of OAA
Participants conducted by the Administration for Community Liv-
ing (ACL) found that 70 percent of people who participate in meals
programs at senior centers or other authorized group settings indi-
cated that they eat healthier foods as a result of the program.vi
Seventy-six percent of the people who receive home-delivered meals

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indicated the same.vii The OAA Nutrition Program ensures that
older adults across the country have consistent access to food.
The OAA Nutrition Program often provides more than a meal to
participants and can foster connection among socially isolated or
lonely older adults. Older adults are at an increased risk of loneli-
ness and social isolation because they are more likely to experience
risk factors such as living alone, loss of family or friends, chronic
illness, and hearing loss.viii A report from the National Academies
of Sciences, Engineering, and Medicine (NASEM) found that nearly
one-fourth of community-dwelling adults ages 65 years and older
are socially isolated.ix Social isolation has been found to have the
same adverse impact on health as smoking 15 cigarettes a day.x
Nutrition programs can serve as a critical source of connection for
older adults who are socially isolated or feeling lonely and con-
gregate meal program participants often report more satisfaction
with their socialization opportunities than nonparticipants.xi
Additionally, the OAA Nutrition Program often becomes an entry
way to additional programs and services that support older
adults.xii Participants in both home-delivered and congregate meal
programs can receive nutrition education as well as screening and
counseling in addition to their meal which can lead to further refer-
rals to aging services. This connection to broader aging services
helps to ensure that older adults remain in their homes as they
age.
A core priority of the OAA Nutrition Program is to delay adverse
health outcomes among older adults.xiii Enhanced health outcomes
may enable older adults to stay in their homes and communities
and delay or avoid institutionalization. Many older adults who par-
ticipate in the OAA Nutrition Program are low-income and living
with multiple chronic conditions that place them at increased risk
of adverse health outcomes.xiv
The United States Senate Special Committee on Aging (Com-
mittee) recognizes the positive impact of 50 years of the OAA Nu-
trition Program on older Americans. This report provides a broad
overview of OAA funding for nutritional services, the role of the
aging network and ACL in supporting older adult nutrition, and
the importance of community volunteers and public-private part-
nerships in meeting the needs of each community. Through this re-
port, the Committee seeks to encourage people, communities, and
governments to work together to strengthen food security, foster so-
cial connections, and promote health and well-being among older
adults.
INTRODUCTION
Over the past 50 years, the OAA Nutrition Program has im-
proved the lives of millions of older adults.xv Its success in pro-
viding nutritious meals, wellness and safety checks, and social vis-
its is a testament to the dedicated commitment made by the staff
and volunteers of local nutrition programs throughout the United
States.
The OAA Nutrition Program works to meet the following pur-
poses, as stated in the law:
1. Reduce hunger, food insecurity, and malnutrition;
2. Promote socialization of older individuals; and
3. Promote the health and well-being of older individuals

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a. by assisting such individuals to gain access to nutri-
tion and other disease prevention and health promotion
services
b. to delay the onset of adverse health conditions result-
ing from poor nutritional health or sedentary behavior.xvi
The OAA established the Administration on Aging (AoA), an
agency within ACL under the United States Department of Health
and Human Services (HHS), as the primary federal agency for ad-
ministering most OAA programs.xvii The OAA also established the
aging network, which consists of State Units on Aging, Area Agen-
cies on Aging (AAA), Title VI Native Americans aging programs,
and community-based organizations. This network develops, coordi-
nates, and delivers OAA-sponsored services and supports, including
the OAA Nutrition Program.xviii
AoA coordinates with the 56 State Units on Aging representing
the 50 states, District of Columbia, and five United States terri-
tories as well as with American Indian tribes, Alaska Native vil-
lages, and Native Hawaiian organizations.xix xx AoA provides fund-
ing for the implementation of local nutrition programs through the
form of state, tribal, and territory formula grants.xxi These grants
finance both home-delivered and congregate meals as well as other
services such as nutrition screenings, education, and health pro-
motion.xxii States and territories receive their funding through Title
III of the OAA and are required to provide a funding match of 15
percent, which expands the impact of federal funding.xxiii American
Indian tribes, Alaska Native villages, and Native Hawaiian organi-
zations receive their funding through Title VI, which does not re-
quire a match.xxiv Title III of the OAA also includes the Nutrition
Services Incentive Program, which incentivizes states, territories,
and eligible tribal organizations to serve more meals through the
provision of additional grants.xxv State Units on Aging develop im-
plementation guidelines and rely on more than 600 AAAs and
thousands of local service providers and volunteers to deliver serv-
ices.xxvi xxvii
The population eligible for the OAA Title III Nutrition Program
are adults ages 60 and older and the program strives to reach pop-
ulations with the greatest social and economic need, including
those who are low-income, live in rural communities, have limited
English proficiency, or are at risk of institutional care.xxviii Through
Title VI Native Americans aging programs, American Indian tribes,
Alaska Native villages, and Native Hawaiian organizations can es-
tablish their own eligibility guidelines and often provide services to
those who are under 60.xxix Successive updates to the OAA Nutri-
tion Program expanded eligibility to include the spouse of an older
adult, regardless of age. These updates also give states and terri-
tories the option to create programs that offer meals to certain
qualifying people, such as people with disabilities who live with eli-
gible older adults.xxx
The OAA Nutrition Program provides participants with services
through home-delivered and congregate meal programs. Congregate
meals are served in group settings, such as in a community center,
local religious institution, or adult day center. Congregate meals
provide older Americans the opportunity to eat a nutritious meal
while having a chance to connect with peers and volunteers. These
meals also give older Americans the opportunity to ask questions

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or share concerns with local organizations that can provide infor-
mation on healthy eating habits and healthy aging. In 2020, 48.8
million meals were provided to more than 1.3 million older adults
in congregate meal settings.xxxi
Home-delivered meals are provided to older adults who are un-
able to leave their home and their spouses, if applicable. Forty-one
percent of those who have a meal delivered at home have trouble
going outside of their home, which may include for shopping for
their own groceries or visiting the doctor.xxxii Home-delivered meals
provide older Americans with social contact through their inter-
actions with local staff and volunteers. These social interactions
have proven to be exceedingly important for the well-being of
homebound older adults, especially during the COVID–19 pan-
demic when many faced increased social isolation and loneliness.
An estimated 198.6 million meals were provided to more than 1.4
million older adults in 2020, representing an increase of nearly 50
million meals compared to 2019.xxxiii xxxiv
For most program participants, their source of social connected-
ness comes from volunteers. Volunteers prepare and serve meals in
senior centers or other congregate meal sites as well as deliver
meals to those participating in the home-delivered program. In
2019, volunteers contributed over 62.4 million hours to all OAA
Title III AAAs, which includes the OAA Nutrition Program and
other home and community-based services. The economic value of
their contributions was approximately $1.7 billion. This return on
investment by the volunteers exceeded the total amount of federal
funding provided for all OAA Title III programs in fiscal year 2019,
which was $1.49 billion.xxxv
COVID–19 Pandemic and Congressional Action: During the
early stages of the COVID–19 pandemic, stay-at-home orders and
social distancing guidelines caused local nutrition programs to
change how they provided their services. To ensure older adults
were served, Congress provided funding and flexibilities that al-
lowed for service delivery changes. Over the course of the pan-
demic, about $1.7 billion in additional funding was provided.xxxvi
These funds expanded drive-through and grab-n-go meal options
for congregate meal participants, enhanced services and other sup-
portive services provided through the Native Americans aging pro-
grams.
This funding and flexibility allowed the Florida Department of
Elder Affairs, for example, to provide congregate meals in a drive-
through format so that older Americans who relied on the program
were still provided a meal while also maintaining social distancing
guidelines.xxxvii AAAs were also supported as they adapted to
changing requirements and utilized the flexibilities offered to pro-
vide congregate meals in nearby parks, helping to reduce social iso-
lation, as was done in Lackawanna County, Pennsylvania by the
Lackawanna County AAA.
In 2022, communities across the country are celebrating the 50th
Anniversary of the OAA Nutrition Program. The United States
Senate also recognized this milestone in March 2022 with the pas-
sage of Senate Resolution 550, led by Chairman Casey and Rank-
ing Member Scott, which highlighted the value of the OAA Nutri-
tion Program in addressing hunger, malnutrition, food insecurity,

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and social isolation among older adults while improving their over-
all health and well-being.xxxviii
Section 1: Reducing Food Insecurity Among Older Adults
Adequate nutrition serves as a preventive measure against
chronic illness and is integral to maintaining good health, func-
tional ability, and quality of life across the lifespan.xxxix Yet, over
5 million adults ages 60 and older experienced food insecurity in
2020 and the pandemic exacerbated the challenges older adults
may face in accessing healthy foods.xl xli Food insecurity, as defined
by the U.S. Department of Agriculture (USDA), is the ‘‘limited or
uncertain availability of nutritionally adequate and safe foods, or
limited or uncertain ability to acquire acceptable foods in socially
acceptable ways.’’ xlii Older adults who are lower income, have a dis-
ability, reside in southern states, or are living with grandchildren
are more likely to be food insecure.xliii In addition, many older
adults are malnourished or at risk of malnutrition.xliv According to
ACL, malnutrition is a ‘‘nutrition imbalance that affects both over-
weight and underweight individuals’’ and occurs over time.xlv Other
unique barriers that affect older adults’ ability to meet their nutri-
tional need may include transportation obstacles, functional limita-
tions, language accessibility, and social isolation.xlvi xlvii xlviii
Both food insecurity and malnutrition threaten an older adult’s
ability to remain healthy and independent and may lead to an in-
creased need for long-term care services and supports.xlix Food inse-
curity among older adults has increased by nearly 30 percent since
2001 and disproportionately affects older adults who are racial and
ethnic minorities.l Black older adults experience food insecurity
rates that are nearly four times that of white older adults and His-
panic older adults experience food insecurity rates that are over
two times that of non-Hispanic white older adults.li Similarly, food
insecurity is more prevalent among Asian American, Pacific Is-
lander, and Native American older adults and older adults who
identify as multi-racial than white older adults.lii
Food insecure older adults often have an overall lower diet qual-
ity, which puts them at higher risk for developing chronic condi-
tions, such as diabetes, heart disease, and hypertension.liii liv Food
insecure older adults are 74 percent more likely to have diabetes
and nearly three times more likely to have depression than their
food secure counterparts.lv This ultimately results in adverse
health outcomes, increased medical needs and health care utiliza-
tion, and higher health care costs.lvi
Older Americans Act: Meeting the Needs of Food Inse-
cure Older Adults
The OAA Nutrition Program is an effective intervention aimed at
ameliorating limited food access for older adults. In most commu-
nities, the OAA home-delivered and congregate meal programs
serve a minimum of one meal a day, at least five days a week.lvii
More than 900,000 meals are provided each day through 5,000 par-
ticipating local service providers across the country.lviii The OAA
Nutrition Program maintains high satisfaction rates amongst par-
ticipants, with nearly 75 percent reporting that the programs im-
proved their health.lix Further, 61 percent of home-delivered meal
participants and 42 percent of congregate meal participants indi-

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cated that without access to the programs, they would have to re-
duce their daily food intake.lx
Additionally, over half of all program participants indicate the
meals provided through the OAA Nutrition Program account for 50
percent or more of their daily food consumption.lxi States and local
agencies are required to prioritize addressing the needs of
marginalized populations, including low-income people and those of
racial and ethnic minorities.lxii In 2018, a national survey of OAA
Nutrition Program participants found that approximately 19 per-
cent of home-delivered meal participants and 11 percent of con-
gregate meal participants reported annual household incomes of
$10,000 or less.lxiii
Many older adults have limited incomes and face difficult finan-
cial decisions, such as choosing between purchasing their medica-
tion, paying their utilities, or buying groceries.lxiv In 2019, almost
one in ten adults ages 65 and older lived below the federal poverty
level, with older women of color, especially those living alone, expe-
riencing the highest rates of poverty.lxv The meals provided
through the OAA Nutrition Program can help those with limited
incomes bridge financial gaps in order to reduce their risk of food
insecurity and remain independent.
Serving Native American Communities: In 1978, the OAA
established support for Native Americans aging programs with the
inclusion of Title VI, which authorized grants to Tribal organiza-
tions to deliver supportive services, including nutrition services, to
older adults. Recent reauthorizations of the OAA continue to build
upon dedicated funding for Native Americans nutrition services.
Over time, these reauthorizations have provided additional path-
ways for American Indian, Alaska Native, and Native Hawaiian
communities to expand their reach and meet the needs of all older
adults, while allowing the flexibility to maintain culturally relevant
meals and practices.lxvi This is particularly important as this popu-
lation of older adults is expected to increase by 67 percent by
2040.lxvii
As an example, the Moenkopi Senior Center, located in the Hopi
Upper Village of Moenkopi in northern Arizona, serves older adults
in Moenkopi Village and the Hopi Reservation. The center provides
traditional home-delivered and congregate meals like hominy and
vegetable stew, socialization, recreational activities such as Yucca
basketweaving and quilting, and health and wellness services.
While the center had to close for two years during the COVID–19
pandemic to ensure the health and safety of all participants, they
serve as a vital community center for Hopi Elders. As their facility
remained unoccupied during that time, when the Moenkopi Senior
Center decided to reopen, several updates were required in order
to resume operations, including new kitchen equipment. Funding
from the OAA and community-based organizations as well as tech-
nical assistance from the Inter-Tribal Council of Arizona AAA and
the Hopi Office of Aging and Adult Services enabled the Moenkopi
Senior Center to reopen successfully and expand capacity. The re-
sources provided by the OAA to support Native Americans nutri-
tion services are essential to addressing food insecurity and im-
proving the health of Native American older adults, who continue
to be one of the most marginalized and economically disadvantaged
communities in the Nation.lxviii

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Section 2: Promoting Socialization and Reducing Isolation
The benefits of the OAA Nutrition Program go well beyond the
meals provided, as one of the statutory purposes is to promote the
socialization of older people.lxix Whether in congregate meal sites or
home-delivery services, these programs enhance socialization and
reduce social isolation among older Americans.
Social isolation refers to the objective absence or limitation in the
quantity of social interactions.lxx Conversely, loneliness is subjec-
tive and occurs when there is a perceived discrepancy between an
individual’s desired and achieved level of social interactions.lxxi
Compared to younger adults, older adults are more likely to experi-
ence isolation.lxxii Many homebound older adults may be isolated
due to physical or mental health conditions, living alone, or lack of
access to consistent and reliable transportation.lxxiii
The negative impacts of isolation are especially salient for older
adults. Studies have found that late-life isolation or loneliness is
associated with a 50 percent increased risk of developing dementia,
a 30 percent increased risk of developing incident coronary artery
disease or experiencing a stroke, and a 26 percent increased risk
of all-cause mortality.lxxiv The OAA Nutrition Program addresses
late life social isolation and loneliness by promoting positive social
experiences.
Older Americans Act: Fostering Connections
Congregate meal programs provide meals in senior centers,
schools, faith-based settings, churches, farmers’ markets, and other
community locations. Bringing older adults together to share a
meal fosters opportunities for recreation and social interaction.
Participants in these programs have routine contact with other
older adults, OAA Nutrition Program staff, and volunteers, culti-
vating a space to tell stories, ask questions, and share their lived
experiences.lxxv An evaluation of the OAA Nutrition Program found
that 93 percent of congregate meal participants were satisfied with
their opportunities to spend time with other people.lxxvi Benefits
from these interactions may include improvements in mood, oppor-
tunities for friendship, and a sense of belonging to the commu-
nity.lxxvii
In some cases, congregate meal programs also offer a pathway to
additional social activities such as exercise classes, arts and crafts,
cooking classes, discussion groups, and off-site trips. Participants
who attended congregate meal sites that offered social activities re-
ported higher levels of satisfaction with socialization opportunities
than participants who attended sites that did not offer these activi-
ties.lxxviii These findings underscore the value of congregate meal
programs in enhancing socialization among participants and the
importance of staying connected in late life.
Older adults in the community who receive home-delivered nutri-
tion services similarly benefit from social contact and support from
staff members and volunteers. Research has found that, compared
to older adults who were on a waiting list to receive home-delivered
meals, those receiving daily delivered meals were more likely to re-
port reductions in loneliness.lxxix Moreover, older adults receiving
daily delivered meals were three times more likely than those re-
ceiving frozen, once-weekly delivered meals to indicate that the
services received from the home-delivered meal program helped

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them feel less lonely.lxxx As one program provider shared ‘‘I feel
that socialization is just as important as the hot nutritious meal
they receive. Without the sites, they might go all day without leav-
ing their apartment or seeing anyone.’’ lxxxi
Combating Worsening Isolation Amidst a Global Pan-
demic: While addressing social isolation has been a long-standing
goal of the OAA Nutrition Program, this objective was of height-
ened urgency during the COVID–19 pandemic. Throughout the
pandemic, older adults had a higher risk of experiencing complica-
tions from the virus. Shelter-in-place restrictions and stay-at-home
orders led to increased isolation and loneliness among older
adults.lxxxii As a result of Congressional action, the OAA Nutrition
Program had additional flexibilities to offer grab-n-go services or
lunches in the park to safely connect with participants. Some pro-
grams also adapted by expanding services that provided regular
and trusted human interactions via telephone.
Mr. Rocky Duff from South Carolina, for example, became a vol-
unteer with the Meals on Wheels Telephone Reassurance Program
during the pandemic. He made daily calls with multiple home-de-
livered program participants, including a couple from Charleston
County who expressed appreciation for their daily interaction with
the volunteer, noting that they felt special because someone calls
to check on them.
The innovative models adopted by local programs during the
COVID–19 pandemic allowed older adults to maintain social con-
nections to their community, while also adhering to public health
guidelines. In particular, volunteers were central to ensuring con-
tinued socialization among older adults and strived to keep con-
sistent and meaningful interactions. As highlighted by the COVID–
19 pandemic, human connection is a hallmark of the home-deliv-
ered and congregate meal programs and helps to combat social iso-
lation among older adults.
Section 3: Promoting Healthy Aging
Adequate nutrition is critical to good health, physical ability, and
quality of life across the lifespan and contributes to healthy
aging.lxxxiii According to the Pan American Health Organization,
healthy aging is ‘‘the continuous process of optimizing opportunities
to maintain and improve physical and mental health, independ-
ence, and quality of life throughout the life course.’’ lxxxiv Eating
well supports older adults in maintaining a healthy weight and
having the nutrients their bodies need to stay active and engaged.
Healthy eating can also reduce the risk of certain chronic condi-
tions or lessen their symptoms. Further, eating nutritious foods
protects bones, joints, and muscles. As adults age, their caloric
needs will likely shift to account for changes in metabolism, the im-
pact of chronic conditions, and medication interactions.lxxxv
It is important that older adults receive nutritional counseling
and support to follow recommended dietary guidelines that promote
health. Yet, many older adults face barriers, such as lacking trans-
portation, fragmented systems of care, limited access to nutritional
services and counseling, and financial insecurity that inhibit their
ability to eat well. Additionally, the United States Government Ac-
countability Office (GAO) found that federal nutrition guidelines do
not address the varying nutritional needs of older adults of dif-

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ferent ages and with different health conditions.lxxxvi HHS plans to
address the unique nutritional needs of older adults in the 2025–
2030 Dietary Guidelines which will equip federal programs with
the guidance necessary to better promote healthy aging through
nutritional services. The nutrition needs of older adults can be
wide-ranging and person-centered dietary recommendations can
help promote healthy aging.
Older Americans Act: Supporting Health and Inde-
pendence
The OAA Nutrition Program promotes healthy aging among
older adults by recognizing that adequate nutrition is a core compo-
nent of overall health and by serving as a bridge to broader aging
services. ACL’s 2021 National Survey of Older Americans Act Par-
ticipants found that 90 percent of home-delivered meal participants
and 80 percent of congregate meal participants reported the pro-
grams help them to live independently.lxxxvii
The OAA Nutrition Program helps older Americans access a wide
array of other services, such as nutrition screenings, transpor-
tation, respite care, and evidence-based health programs, all of
which help support healthy aging. It is estimated that at least 43
percent of older adults receiving congregate meals receive one or
more additional service, like transportation or chronic disease self-
management classes. Additionally, nearly 60 percent of older adults
who receive home-delivered meals receive one or more supportive
service.lxxxviii
Delivering More than a Meal: The home-delivered meals pro-
gram is especially critical in promoting healthy aging, as it serves
homebound older adults who are often more socially isolated, in
poorer health with greater functional limitations, experience more
falls, and are more likely to be underweight than congregate meal
participants.lxxxix The program ensures that homebound older
adults are better able to meet their dietary needs, while providing
them with social interaction and a wellness check so they can safe-
ly remain at home and independent. In addition, home-delivered
meal drivers often provide a report on the well-being of program
participants so a care manager can follow up with additional sup-
port, if needed.
In Somerset County, Pennsylvania, Phil, an 82-year-old driver,
delivers nearly 300 meals a week to program participants and con-
ducts a wellness check with each delivery. During his regular
route, Phil encountered a program participant that had fallen. He
contacted a Somerset County AAA care manager, and with her as-
sistance, stayed with the participant for several hours until they
were able to locate her family. Phil returned for an additional meal
delivery and found that the participant had fallen again. He was
able to connect her to emergency services where she was treated
in the hospital and ultimately connected to more supportive serv-
ices. Without Phil and the support of the Somerset County AAA,
the participant may not have received the timely help she needed
to remain healthy. The OAA Nutrition Program is often the first
entry point to aging services for older adults and provides critical
support and referrals to additional services.

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Section 4: Delaying Adverse Outcomes Among Older Adults
An important part of the statutory purpose of the OAA Nutrition
Program in promoting the health and well-being of older adults in
gaining access to nutrition is to ‘‘delay the onset of adverse health
conditions resulting from poor nutritional health . . .’’ xc This pur-
pose is central to the program as older adults, particularly the old-
est segments of the United States population, are more likely to be
diagnosed with one or more chronic conditions and to experience
adverse health outcomes as a result, such as falls. In 2017, the av-
erage age for a congregate meal participant was 77, and the aver-
age age for a home-delivered meal participant was 82.xci
Many OAA Nutrition Program participants are at increased risk
for weight-related diseases and other health problems. In 2017, six
percent of home-delivered meal participants were underweight,
compared to less than one percent of congregate meal participants.
Moreover, 72 percent of congregate meal participants and 57 per-
cent of home-delivered meal participants had a Body Mass Index
(BMI) greater than 25, indicating they are overweight or obese and
at-risk for additional health problems.xcii
Poor nutrition can lead to muscle loss among older adults, which
may increase the risk of falling. Falls can result in serious injury,
such as broken bones or head injuries and may lead to higher rates
of hospitalization. In 2018, three million older adults were treated
for falls-related injuries in the emergency department (ED), caus-
ing more than 950,000 hospitalizations or transfers to another fa-
cility.xciii That same year, nearly 36 million falls were reported
among older adults in the past year, resulting in approximately
32,000 deaths.xciv
Older Americans Act: Reducing Barriers to Health and
Well-being
Growing bodies of research indicate the OAA Nutrition Program
can delay adverse health outcomes. In general, congregate meal
participants were less likely than nonparticipants to have a nurs-
ing home admission.xcv The OAA Nutrition Program serves as both
a primary prevention strategy and treatment intervention for older
adults who may be at risk of or who are currently navigating
chronic health conditions.xcvi A randomized-control trial, for exam-
ple, assigned eligible older Americans on a waiting list to a home-
delivered meal program. The study suggests that those receiving
daily delivered meals may experience a reduction in their risk of
falls but, according to the authors, further research is warranted
to fully understand the effect of meals on falls.xcvii Overall, the vast
majority of OAA Nutrition Program participants reported that the
program helped them eat more nutritious meals and control their
weight.xcviii These responses indicate the program’s positive impact
on the health of participants.
Long-term trends in adverse health experiences may also illus-
trate better outcomes for congregate meal members. According to
a recent evaluation, participation in the congregate meal program
may also be associated with a reduction in hospital readmissions
three years into the program. The study found that about two per-
cent of participants had a readmission, compared with eight per-
cent of program-eligible nonparticipants. Among low-income par-
ticipants and non-participants, the relative improvement was even

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11

starker: one percent versus 13 percent.xcix American Indian, Alaska
Native, and Native Hawaiian elders who participated in the OAA
Nutrition Program also experienced significantly fewer hospitaliza-
tions and falls per year in comparison with non-participating el-
ders.civ
Strengthening Partnerships to Support Healthy Aging
The health care system increasingly recognizes nutrition as a so-
cial determinant of health, defined as the conditions in the places
where people live, learn, work, and play that affect a wide range
of health risks and outcomes.ci As such, many AAAs are developing
partnerships with health care providers and broader community
stakeholders to more comprehensively address the nutritional
needs of older adults.
One potential example can be seen in the work of the Central
Midlands Council of Governments AAA in Columbia, South Caro-
lina. The Central Midlands Council of Governments AAA partnered
with Prisma Health and UnitedHealthcare to provide older adults
recently discharged from the hospital with nutritionally-balanced
meals to help prevent readmission and support long-term health
goals.xcii After one year, only 10 percent of discharged patients who
participated in the program were readmitted to the hospital,
whereas 28 percent of patients who declined to participate were re-
admitted.ciii
In some cases, AAAs and their volunteers are critical lifelines to
health care. Dave, a regular volunteer driver for SeniorsPlus in
Western Maine, found a woman in her 80s who had fallen in her
home. She had been on the floor without food or water for three
days when Dave delivered her meal. Dave immediately called 911
and stayed with her until the EMTs arrived and took her to the
hospital. SeniorsPlus received a call from the local fire chief com-
mending Dave for saving her life.civ
LOOKING AHEAD
In the 50 years since the OAA Nutrition Program was signed
into law, it has made substantial progress toward reducing hunger,
creating meaningful opportunities for engagement and social inter-
action, connecting older Americans to services to promote healthy
aging, and decreasing adverse health outcomes among older adults.
This landmark anniversary provided the Committee the oppor-
tunity to reflect on the significant impact these policies and pro-
grams have made on the lives of older Americans.
As the Nation’s population continues to age, addressing health
and nutrition will remain an important tool for ensuring greater
independence and enhanced well-being among older adults. The
COVID–19 pandemic exacerbated the painful realities of social iso-
lation and loneliness among many older Americans. The OAA Nu-
trition Program provides regular opportunities for older adults to
gather with one another and to be connected with additional re-
sources. As a result of the pandemic, many programs adopted new
methods to allow older adults to gather safely. As the Committee
considers the effects of the Nation’s changing demographics on the
OAA Nutrition Program, innovative approaches to foster new con-
nections and promote health offer a blueprint for the future.

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The Committee’s examination of these programs underscores the
critical importance of measuring outcomes and gathering data to
inform best practices in the field. The 2020 reauthorization of the
Older Americans Act established a Research, Demonstration, and
Evaluation Center for the Aging Network which would examine the
effectiveness of OAA programs, such as the Nutrition Program, and
assess innovative models conducted on the state and local level.
Additional research and evaluation will equip the aging network as
well as policymakers with needed information to address food inse-
curity among older adults.
As the Nation prepares for a rapidly aging population, older
adult hunger and food insecurity will remain a challenge. The
Committee recognizes the importance of leveraging partnerships
among all stakeholders to ensure all older adults have access to
healthy and affordable food. This report demonstrates the Commit-
tee’s commitment to combating hunger among older adults and pre-
serving essential nutrition programs.
END NOTES
i Administration for Community Living (ACL). (2022). Overview of Older Ameri-
cans Act Title III, VI, and VII Programs: 2020 Summary of Highlights and Accom-
plishments. U.S. Department of Health and Human Services (HHS). https://acl.gov/
sites/default/files/news%202022-09/2020%20OAA%20Report_Complete%20Product%2
09-1-22_508.pdf.
ii U.S. Census Bureau, American Community Survey. (2020). Retrieved from
https://data.census.gov/cedsci/table?q=american%20community%20survey. Note that
60+ data was determined through the addition of 60 to 64 data and 65 and over
data.
iii The Older Americans Act of 1965 (P.L. 89–73, as amended through P.L. 116–
141, the Supporting Older Americans Act of 2020). (2020, April 10). https://acl.gov/
sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20a
s%20amended%20by%20Public%20Law%20116-131%20on%203-25-2020.pdf.
iv P.L. 92–258, An Act to Amend The Older Americans Act of 1965. https://
www.congress.gov/92/statute/STATUTE-86/STATUTE-86-Pg88.pdf.
v Gunderson, C., Ziliak, J. (2022, May 11). The State of Senior Hunger in 2020.
Feeding America. https://www.feedingamerica.org/sites/default/files/2022-05/The%20
State%20of%20Senior%20Hunger%20in%202020_Full%20Report%20w%20Cover.pdf.
vi ACL. (2022, September 26). ‘‘Nutrition Services.’’ https://acl.gov/programs/health-
wellness/nutrition-services.
vii Id.
viii Centers for Disease Control and Prevention (CDC). (2021, April 29). ‘‘Loneliness
and Social Isolation Linked to Serious Health Conditions.’’ https://www.cdc.gov/
aging/publications/features/lonely-older-adults.html.
ix National Academies of Sciences, Engineering, and Medicine (NASEM). (2020).
Social isolation and loneliness in older adults: Opportunities for the health care sys-
tem. The National Academies Press. https://doi.org/10.17226/25663.
x Holt-Lunstad, J. (2017). The Potential Public Health Relevance of Social Isola-
tion and Loneliness: Prevalence, Epidemiology, and Risk Factors. Public Policy &
Aging Report, 27(4), 127–130. https://doi.org/10.1093/ppar/prx030.
xi Mabli, J., Gearan, E., Cohen, R., Niland, K., Redel, N., Panzarella, E., Carlson,
B. (2017, April 21). Evaluation of the Effect of the Older Americans Act Title III–
C Nutrition Services Program on Participants’ Food Security, Socialization, and Diet
Quality. Mathematica. https://acl.gov/sites/default/files/programs/2017-07/AoA_out
comesevaluation_final.pdf.
xii Id.
xiii ACL. (2022, September 26). ‘‘Nutrition Services.’’ https://acl.gov/programs/
health-wellness/nutrition-services.
xiv Kowlessar, N., Robinson, K., Schur, C. (2015, September). Older Americans
Benefit from Older Americans Act Nutrition Programs. Social & Scientific Systems,
Inc. https://acl.gov/sites/default/files/programs/2016-11/AoA-Research-Brief-8-
2015.pdf.
xv ACL. (2021). Overview of Older Americans Act Title III Programs: 2018 High-
lights and Accomplishments. Office of Performance and Evaluation. ACL. https://

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13
acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/OAA%20Titl
e%20III%20Report_2018_FINAL_WEB_VERSION_508.pdf.
xvi The Older Americans Act of 1965 (P.L. 89–73, as amended through P.L. 116–
141, the Supporting Older Americans Act of 2020). Title III, § 330 (2020, April 10).
https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of
%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-202
0.pdf.
xvii ACL. (2017, June 20) ‘‘Administration on Aging.’’ https://acl.gov/about-acl/
administration-aging.
xviii Eldercare Locator. (n.d.) ‘‘The Aging Network.’’ ACL. https://eldercare.acl.gov/
Public/About/Aging_Network/Index.aspx.
xix ACL. ‘‘State Units on Aging.’’ (2017, April 29). https://acl.gov/programs/aging-
and-disability-networks/state-units-aging.
xx Administration for Community Living (ACL). (2022). Overview of Older Ameri-
cans Act Title III, VI, and VII Programs: 2020 Summary of Highlights and Accom-
plishments. U.S. Department of Health and Human Services (HHS). https://acl.gov/
sites/default/files/news%202022-09/2020%20OAA%20Report_Complete%20Product%2
09-1-22_508.pdf.
xxi Id.
xxii Id.
xxiii ACL. (2021). Overview of Older Americans Act Title III Programs: 2018 High-
lights and Accomplishments. Office of Performance and Evaluation. ACL. https://
acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/OAA%20Titl
e%20III%20Report_2018_FINAL _WEB_VERSION_508.pdf.
xxiv Administration for Community Living (ACL). (2022). Overview of Older Ameri-
cans Act Title III, VI, and VII Programs: 2020 Summary of Highlights and Accom-
plishments. U.S. Department of Health and Human Services (HHS). https://acl.gov/
sites/default/files/news%202022-09/2020%20OAA%20Report_Complete%20Product%2
09-1-22_508.pdf.
xxv Id.
xxvi ACL. (2017, April 29). ‘‘State Units on Aging.’’ https://acl.gov/programs/aging-
and-disability-networks/state-units-aging.
xxvii Eldercare Locator. (n.d.) ‘‘The Aging Network.’’ ACL. https://eldercare.acl.gov/
Public/About/Aging_Network/Index.aspx.
xxviii ACL. (2021). Overview of Older Americans Act Title III Programs: 2018 High-
lights and Accomplishments. Office of Performance and Evaluation. ACL. https://
acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/OAA%20Titl
e%20III%20Report_2018_FINAL_WEB_VERSION_508.pdf.
xxix Administration for Community Living (ACL). (2022). Overview of Older Ameri-
cans Act Title III, VI, and VII Programs: 2020 Summary of Highlights and Accom-
plishments. U.S. Department of Health and Human Services (HHS). https://acl.gov/
sites/default/files/news%202022-09/2020%20OAA%20Report_Complete%20Product%2
09-1-22_508.pdf.
xxx ACL. (2022, September 26). ‘‘Nutrition Services.’’ https://acl.gov/programs/
health-wellness/nutrition-services.
xxxi Department of Health and Human Services Fiscal Year 2023 Administration
for Community Living. (2022). Justification of Estimates for Appropriations Commit-
tees. https://acl.gov/about-acl/budget.
xxxii ACL. (2022, September 26). ‘‘Nutrition Services.’’ https://acl.gov/programs/
health-wellness/nutrition-services.
xxxiii Department of Health and Human Services Fiscal Year 2023 Administration
for Community Living. (2022). Justification of Estimates for Appropriations Commit-
tees. https://acl.gov/about-acl/budget.
xxxiv Department of Health and Human Services Fiscal Year 2022 Administration
for Community Living. (2021). Justification of Estimates for Appropriations Commit-
tees. https://acl.gov/sites/default/files/about-acl/2021-06/FY%202022%20ACL%20Just
ification%20of%20Estimates%20for%20Appropriations%20Committees_Final.pdf.
xxxv ACL. (2021, August). The Economic Value of Volunteers: Key Results from ACL
Programs. Office of Performance and Evaluation. ACL. https://acl.gov/sites/default/
files/programs/2021-09/ACL%20Volunteerism%20Study_Infographic%20August%202
021.pdf.
xxxvi Colello, K.J., Napili, A. (2022, June 23). Older Americans Act: Overview and
Funding. Congressional Research Service (CRS). https://www.crs.gov/reports/pdf/
R43414.
xxxvii ADvancing States. (2020). Addressing Social Isolation for Older Adults Dur-
ing the COVID–19 Crisis. ADvancing States. http://www.advancingstates.org/sites/
nasuad/files/Social%20Isolation%20Resource_10142020.pdf.
xxxviii S. Res. 550, 117th Cong., 168 Cong. Rec. 1255 (2022) enacted. https://
www.congress.gov/117/bills/sres550/BILLS-117sres550ats.pdf.

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xxxix U.S. Government Accountability Office (GAO). (2019, November). Nutrition
Assistance Programs: Agencies Could Do More to Help Address the Nutritional Needs
of Older Adults. GAO. https://www.gao.gov/assets/gao-20-18.pdf.
xl Gunderson, C., Ziliak, J. (2022, May 11). The State of Senior Hunger in 2020.
Feeding America. https://www.feedingamerica.org/sites/default/files/2022-05/The%20
State%20of%20Senior%20Hunger%20in%202020_Full%20Report%20w%20Cover.pdf.
xli Whitmire, M., Arensberg, M.B., Ashbrook, A., Blancato, R. (2021). Nutrition-
Related Policy Fundamentals for Supporting Older Adults in the Community during
a Pandemic: Lessons from COVID–19. Journal of Elder Policy, 1(3), 223–260.
doi:10.18278/jep.1.3.9.
xlii U.S. Department of Agriculture. (2022, September 7). ‘‘Food Security in the
U.S.’’ https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-
s/measurement/.
xliii Food Research & Action Center (FRAC). (2019). Hunger is a Health Issue for
Older Adults: Food Security, Health, and the Federal Nutrition Programs. https://
frac.org/wp-content/uploads/hunger-is-a-health-issue-for-older-adults-1.pdf.
xliv Norman K., Haβ U., Pirlich M. (2021) Malnutrition in Older Adults-Recent Ad-
vances and Remaining Challenges. Nutrients. 13(8), 2764. doi:10.3390/nu13082764.
xlv Kellner Greuling, H. (2016, September 28). ‘‘Combatting Senior Malnutrition.’’
ACL Blog. https://acl.gov/news-and-events/acl-blog/combatting-senior-malnutrition.
xlvi Shlisky, J., Bloom, D.E., Beaudreault, A.R., Tucker, K.L., Keller, H.H., Freund-
Levi, Y., Fielding, R.A., Cheng, F.W., Jensen, G.L., Wu, D., Meydani, S.N. (2017)
Nutritional Considerations for Healthy Aging and Reduction in Age-Related Chronic
Disease. Advances in Nutrition, 8(1), 17–26. doi: 10.3945/an.116.013474.
xlvii Sadarangani, T.R., Beasley, J.M., Yi, S., Chodosh, J. (2020). Enriching Nutri-
tion Programs to Better Serve the Needs of a Diversifying Aging Population. Family
& Community Health, 43(2), 100–105 doi: 10.1097/FCH.0000000000000250.
xlviii Tucher E.L., Keeney T., Cohen A.J., Thomas K.S. (2021). Conceptualizing
Food Insecurity Among Older Adults: Development of a Summary Indicator in the
National Health and Aging Trends Study. The Journals of Gerontology: Series B.
76(10):2063–2072. doi: 10.1093/geronb/gbaa147.
xlix FRAC. (2019). Hunger is a Health Issue for Older Adults: Food Security,
Health, and the Federal Nutrition Programs. https://frac.org/wp-content/uploads/
hunger-is-a-health-issue-for-older-adults-1.pdf.
l Gunderson, C., Ziliak, J. (2022, May 11). The State of Senior Hunger in 2020.
Feeding America. https://www.feedingamerica.org/sites/default/files/2022-05/The%20
State%20of%20Senior%20Hunger%20in%202020_Full%20Report%20w%20Cover.pdf.
li Id.
lii Id.
liii Whitmire, M., Arensberg, M.B., Ashbrook, A., Blancato, R. (2021). Nutrition-Re-
lated Policy Fundamentals for Supporting Older Adults in the Community during
a Pandemic: Lessons from COVID–19. Journal of Elder Policy, 1(3), 223–260.
doi:10.18278/jep.1.3.9.
liv FRAC. (2019). Hunger is a Health Issue for Older Adults: Food Security, Health,
and the Federal Nutrition Programs. https://frac.org/wp-content/uploads/hunger-is-a-
health-issue-for-older-adults-1.pdf.
lv Ziliak, J.P., Gundersen, C. (2021 August, 18). The Health Consequences of Senior
Hunger in the United States: Evidence from the 1999–2016 NHANES. Feeding
America. https://www.feedingamerica.org/sites/default/files/2021-08/2021%20-%20
Health%20Consequences%20of%20Senior%20Hunger%201999-2016.pdf.
lvi Whitmire, M., Arensberg, M.B., Ashbrook, A., Blancato, R. (2021). Nutrition-Re-
lated Policy Fundamentals for Supporting Older Adults in the Community during
a Pandemic: Lessons from COVID–19. Journal of Elder Policy, 1(3), 223–260.
doi:10.18278/jep.1.3.9.
lvii Colello, K.J. (2020, May 4). Older Americans Act: Nutrition Services Program.
Congressional Research Service (CRS). https://www.crs.gov/Reports/IF10633.
lviii ACL. (2022, September 26). ‘‘Nutrition Services.’’ https://acl.gov/programs/
health-wellness/nutrition-services.
lix ACL. Data Source: 2021 National Survey on Older Americans Act Participants.
lx Mabli, J., Gearan, E., Cohen, R., Niland, K., Redel, N., Panzarella, E., Carlson,
B. (2017, April 21). Evaluation of the Effect of the Older Americans Act Title III–
C Nutrition Services Program on Participants’ Food Security, Socialization, and Diet
Quality. Mathematica. https://acl.gov/sites/default/files/programs/2017-07/AoA_out
comesevaluation_final.pdf.
lxi Colello, K.J. (2020, May 4). Older Americans Act: Nutrition Services Program.
Congressional Research Service (CRS). https://www.crs.gov/Reports/IF10633.
lxii Sadarangani, T.R., Beasley, J.M., Yi, S., Chodosh, J. (2020). Enriching Nutri-
tion Programs to Better Serve the Needs of a Diversifying Aging Population. Family
& Community Health, 43(2), 100–105. doi:10.1097/FCH.0000000000000250.

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lxiii Colello, K.J. (2020, May 4). Older Americans Act: Nutrition Services Program.
Congressional Research Service (CRS). https://www.crs.gov/Reports/IF10633.
lxiv Kowlessar, N., Robinson, K., Schur, C., et al. (2015). Older Americans Benefit
from Older Americans Act Nutrition Programs. ACL. https://acl.gov/sites/default/
files/programs/2016-11/AoA-Research-Brief-8-2015.pdf.
lxv ACL. (2021, May). 2020 Profile of Older Americans. ACL. https://acl.gov/sites/
default/files/Profile%20of%20OA/2020ProfileOlderAmericans_RevisedFinal.pdf.
lxvi ACL. (2020, October 19). ‘‘Services for Native Americans (OAA Title VI).’’
https://acl.gov/programs/services-native-americans-oaa-title-vi.
lxvii ACL. (2021, May). 2020 Profile of Older Americans. ACL. https://acl.gov/sites/
default/files/Profile%20of%20OA/2020ProfileOlderAmericans_RevisedFinal.pdf.
lxviii National Congress of American Indians. (n.d.) ‘‘Elders.’’ https://www.ncai.org/
policy-issues/education-health-human-services/elders.
lxix Older Americans Act of 1965 (P.L. 89–73, as amended through P.L. 116–141,
the Supporting Older Americans Act of 2020). Title III, § 330(2) (2020, April 10).
https://acl.gov/sites/default/files/about-acl/2020-04/Older%20Americans%20Act%20Of
%201965%20as%20amended%20by%20Public%20Law%20116-131%20on%203-25-202
0.pdf.
lxx De Long Gierveld, J., Van Tilburg, T., Dykstra, P. (2006). Loneliness and Social
Isolation. Cambridge Handbook of Personal Relationships. Cambridge University
Press, 485–500.
lxxi Id.
lxxii Mabli, J., Shenk, M. (2019). Older Americans Act Title III–C Nutrition Services
Program: An Examination of Social Activities at Congregate Meal Sites and Their
Role in Improving Socialization Outcomes of Participants. Mathematica. https://
acl.gov/sites/default/files/programs/2018-12/AoAevaluation_socialization.pdf.
lxxiii Kowlessar, N., Robinson, K., Schur, C. (2015). Older Americans Benefit from
Older Americans Act Nutrition Programs. Social & Scientific Systems, Inc. https://
acl.gov/sites/default/files/programs/2016-11/AoA-Research-Brief-8-2015.pdf.
lxxiv Donovan N.J., Blazer, D. (2020) Social Isolation and Loneliness in Older
Adults: Review and Commentary of a National Academies Report. American Journal
of Geriatric Psychiatry (12), 1233–1244.
lxxv ACL (2021). Evaluation of the ACL Title VI Programs. ACL. https://acl.gov/
sites/default/files/programs/2021-05/ACL_TitleVI_Evaluation_Final_Report_508.pdf.
lxxvi Mabli, J., Gearan, E., Cohen, R., Niland, K., Redel, N., Panzarella, E., Carl-
son, B. (2017, April 21). Evaluation of the Effect of the Older Americans Act Title
III–C Nutrition Services Program on Participants’ Food Security, Socialization, and
Diet Quality. Mathematica. https://acl.gov/sites/default/files/programs/2017-07/
AoA_outcomesevaluation_final.pdf.
lxxvii ACL (2021). Evaluation of the ACL Title VI Programs. ACL. https://acl.gov/
sites/default/files/programs/2021-05/ACL_TitleVI_Evaluation_Final_Report_508.pdf.
lxxviii Mabli, J., Shenk, M. (2019, January). Older Americans Act Title III–C Nutri-
tion Services Program: An Examination of Social Activities at Congregate Meal Sites
and Their Role in Improving Socialization Outcomes of Participants. Mathematica.
https://acl.gov/sites/default/files/programs/2018-12/AoAevaluation_socialization.pdf.
lxxix Thomas, K. S., Akobundu, U., & Dosa, D. (2016). More than a meal? A ran-
domized control trial comparing the effects of Home-delivered Meals Programs on
Participants’ feelings of Loneliness. Journals of Gerontology Series B: Psychological
Sciences and Social Science 71(6), 1049–1058.
lxxx Id.
lxxxi Blancato, R. (2017, July 24). Beyond the Meal: The Value of Socialization in
Older Americans Act Congregate Nutrition Programs. National Association of Nutri-
tion and Aging Services Programs. https://www.nanasp.org/sites/default/files/RRF%
20Grant%20%232016-081%20Beyond%20the%20Meal%20The%20Value%20of%20So
cialization%20in%20OAA%20Congregate%20Nutrition%20Programs_%207.24.17.pdf.
lxxxii Wu, B. (2020). Social Isolation and Loneliness among Older Adults in the con-
text of COVID–19: A Global Challenge. Global Health Research and Policy, 5(1), 1–
3.
lxxxiii National Institute on Aging. (2022, February 28). ‘‘How Much Should I Eat?
Quantity and Quality.’’ https://www.nia.nih.gov/health/how-much-should-i-eat-
quantity-and-quality.
lxxxiv Pan American Health Organization. (n.d.). ‘‘Healthy Aging.’’ https://
www.paho.org/en/healthy-aging.
lxxxv Whitmire, M., Arensberg, M.B., Ashbrook, A., Blancato, R. (2021). Nutrition-
Related Policy Fundamentals for Supporting Older Adults in the Community during
a Pandemic: Lessons from COVID–19. Journal of Elder Policy, 1(3), 223–260.
doi:10.18278/jep.1.3.9.

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