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Participation at Older Americans Act Title III Funded Congregate Meal
is participation in the congregate meals programs important?
Participation in the congregate meals programs enhances
the daily nutrient intake, nutritional status, social interactions and
functionality of older adults. Improvements in these key factors for good
health and quality of life generates the necessary environment for older
adults to age successfully (1). The 1995 National Evaluation of the Elderly
Nutrition Program (ENP) (2) showed that participation in Title III congregate
meals has a very important role in the dietary intake of older adults.
Each congregate meal supplies a minimum of one-third of the daily RDAs.
For many nutrients consumed, congregate meals contribute 40 to 50 percent
of the RDAs. Congregate participants have significantly higher daily intakes
(than non-participants) of the nutrients that are usually low in the diets
of older adults including: calories, calcium, vitamin B6 and zinc. In
addition, 12 percent of congregate participants take either a full meal
or a snack home from the congregate site, which further increases their
overall daily nutrient intake. Many congregate programs also provide a
variety of nutrition-related services such as nutrition education, nutrition
screening and nutrition counseling that are otherwise not available to
non-institutionalized older adults.
Along with the nutritional benefits of consuming a congregate lunch, ENP
participants have increased opportunities for social interaction (2).
In March, 2000 the Chicago Suburban Area Agency on Aging (SAAA) held focus
groups at seven congregate sites conducted by Madelyn Iris, PhD, from
the Buehler Center on Aging, at Northwestern University. Participants
in the focus groups felt that they receive substantial social and recreational
benefits from the congregate program. Attending a meal site allows them
social interaction with other older adults promoting conversation, camaraderie,
support and friendship. The opportunity to connect with other older adults
provides relief from loneliness, social isolation and feelings of depression.
Participants spoke of having a reason to "get up and get going."
Participants also recognized their own need for cognitive stimulation
- they spoke of being "kept young and mentally active." Another
benefit these participants derive from social interaction at the congregate
site is through the opportunity to volunteer in the program. Volunteering
was seen as important in the success of the program as it gave participants
the feeling that they are "a part of the place." The third most
important benefit reported by SAAA congregate participants was access
to a variety of activities and social services. The National Evaluation2
showed that 70 percent of congregate participants engage in recreational
activities offered at congregate sites. In addition to improving nutrition
and social well being, these activities promote overall health and functionality
for older adults.
are the older adults that are being served at congregate meal sites?
Congregate meal programs serve people who are at greater health and nutritional
risk than their peers in the general older adult population. Participants
are older, poorer, more likely to be members of racial and ethnic minorities,
and more likely to be socially isolated and food insecure.
Although available to everyone age 60 and over, the average congregate
meal participant is 76 years old. About two-thirds (69%) of participants
are female. Overall racial and ethnic minorities constitute 27% of congregate
participants with 12% African-American and 12% Hispanic. One-third of
participants have incomes at or below the federal poverty level and participants
are more likely to be older adults who live alone. A significant number
of congregate participants have health problems and functional impairments.
The average participant has two to three diagnosed chronic health conditions.
About 1/4 have had a hospital or nursing home stay within a one-year period
and about 1/4 have functional difficulty doing everyday tasks. There is
also evidence that many participants are at nutrition risk, with 18-32%
having lost (or gained) 10 pounds within a six-month period prior to participation
in the ENP (2).
is the evidence that participation at congregate meal sites is declining?
the number of congregate participants and meals served has been steadily
declining nationwide for the past 12 years (4). In fiscal year (FY) 1988,
147.2 million meals were served under Title III-C at congregate meal sites.
By the close of FY 1998, the number of congregate meals served had dropped
to 114 million meals -- a 23% decrease. In FY 1998, there were about 511,000
less congregate participants than those attending congregate meal sites
in FY 1995.
In contrast, the number of meals being provided to older adults participating
in the Title III home-delivered meal programs has continually increased.
In FY 1988 there was 94.7 million home delivered meals served compared
to 130 million home delivered meals in FY 1998 -- a 27.2% increase. As
a result, home delivered meals now (1998 data) comprise 32% of total ENP
is participation declining at congregate meal sites?
Eligible older adults cite many reasons that they stop or do not participate
in congregate meals programs. Reasons for non-participation include: not
recognizing that they have a need for services, inadequate transportation,
impaired health, social discomfort with attending or applying for assistance,
dissatisfaction with foods served and lack of awareness that the program
In the SAAA focus groups (3) several barriers to attendance were identified.
The most common problem encountered by older adults who wished to attend
congregate lunch was lack of transportation. Getting to congregate sites
by public transportation was difficult, especially in bad weather. Several
participants who drive to sites complained about inadequate parking close
to the site. The biggest complaint was related to reliability and scheduling
of special transportation services - participants often arrive late for
meals or are too frail to wait for long periods of time to be picked up.
As in studies conducted in the 1980's of non-participation (5-7), lack
of awareness about the existence of the congregate meal program was another
reason cited for poor attendance. Participants in the SAAA focus groups
suggested increasing advertising in community newspapers, not only with
news announcements, but also by highlighting personal anecdotes from site
events. Other suggestions that were made were: develop an information
brochure describing the program, activities offered and benefits, and
ask banks and other community institutions to insert it in their mailings;
post flyers in churches, synagogues and other local gathering places;
and conduct door-to-door campaigns that target senior neighborhoods.
Lack of flexibility in choosing food items and serving times is another
obstacle for many older adults. The SAAA congregate program has piloted
a restaurant dining alternative where participants are offered the option
of either a combined restaurant dine-out plus congregate meal or a dine-out
only program. Participants contribute $3.00 to receive a coupon that covers
the cost of a meal in a local (cooperating) restaurant.
One of the key reasons SAAA participants enjoy the dine-out option is
the ability to make food choices, particularly of fruits, vegetables,
desserts and beverages. This issue is an extra concern for older adults
who are on restricted diets. Although 49% of congregate sites make meals
modified in sodium, fat and calories available2, a survey of 438
congregate participants conducted by Moran in 19938 showed that the 30%
of clients who were on "special diets" (most commonly low sodium,
low cholesterol or low fat) attended congregate sites less frequently
than those who did not have dietary restrictions.
Many of the SAAA participants who chose the dine-out option also explained
that choice is important to them because lunch is not their main meal
of the day, and some said they would prefer not to eat at noontime at
all. Additionally, SAAA participants commented that the variety and number
of activities offered at congregate sites needs to expand. For example,
at several sites participants stated their need for participating in a
regular exercise program. Other participants expressed the desire for
group activities that originate from the congregate site and go out to
area attractions, like visiting a museum or zoo.
While the dine-out alternative is able to address some of the concerns
that older adults have in regard to congregate meal participation (i.e.,
flexibility and choices), the program has not met other needs of older
adults targeted by the Older Americans Act. Because the dine-out program
has limited funds, requires participants to stand in line to obtain vouchers
and transport themselves to restaurants, and does not provide similar
opportunities for socialization and volunteering as the congregate sites
do, it has primarily served older adults who are least frail, and most
economically and socially advantaged.
can our program do to increase participation?
The 1999 Nutrition 2030 Grassroots Survey (9) of 478 Elderly Nutrition
Programs (ENP), Area Agencies on Aging (AAA) and State Units on Aging
(SUA) identified the need for expanding outreach and improving marketing
as key components of attracting participants to congregate sites. Other
avenues to increase participation seen as important by these survey respondents
were: providing transportation to sites, improving the variety of activities
at sites and providing linkages to other nutrition and social services
for older adults.
One final lesson to be learned for increasing congregate meal participation
from the SAAA focus groups is that dining in a restaurant removed the
stigmas of "charity" and "aging" often associated
with congregate site participation and made dine-out participants feel
"more valued", i.e. equal to other restaurant consumers. Dining
in an environment of people of mixed ages and the opportunity to see their
neighbors and friends made participants feel more socially acceptable.
of a Successful Program (3)
in menu, including cultural & dietary choices
Attractive presentation of food
Knowledgeable & friendly staff
Pleasant, welcoming, supportive environment
Participant input & volunteer opportunities
Adequate transportation & parking
Variety of programs, services & activities
Kahn RL and Rowe JW. Successful Aging. Delacorte Publishers, 1998.
2. Mathematica Policy Research. Serving Elders At Risk. The Older Americans
Act Nutrition Programs. National Evaluation of the Elderly Nutrition
Program, 1993-1995. US Department of Health and Human Services.
3. Evaluation of Dine-Out Programs. Prepared by Suburban Area Agency
on Aging (SAAA) and Community Nutrition Network. August 9, 2000. Contact:
Diane Slezak, Deputy Director, Suburban Area Agency on Aging: 708-383-0258,
4. AoA State Program Reports. Administration on Aging. Available at
5. Harris LJ et al. Comparing Participants' and Managers' Perception
of Services in a Congregate Meals Program. J Am Diet Assoc. 1987;87:190-5.
6. Waring ML et al. Morale and the Differential Use Among the Black
Elderly of Social Welfare Services Delivered by Volunteers. J Gerontol
Soc Work. 1984;6:81-94.
7. Burkhardt JE et al. Factors Affecting the Demand for Congregate Meals
at Nutrition Sites. J Gerontol. 1983;38:614-20.
8. Moran MB et al. Are Congregate Meals Meeting Clients' Needs for "Heart
Healthy" Menus? J Nutr Elder. 1993;13:3-10.
9. Wellman NS, Smith J, Alfonso M, Lloyd J. Nutrition 2030 Grassroots
Survey. October, 1999.
by Heidi J. Silver, MS, RD, CNSD, Doctoral Candidate and
Graduate Research Associate, and staff of the National
Policy and Resource Center on Nutrition and Aging, Florida International
University, Miami, FL. Contact: firstname.lastname@example.org
project is supported, in part, by a grant from the Administration on
Department of Health and Human Services (DHHS). Grantees undertaking
projects under government
sponsorship are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS
Posted on: 03/22/01