Hunger-Obesity Paradox and the

Community Resources Available to Assist

Nicolle Miller, MS, MPH, RD, LDN

NC Center for Health & Wellness at

UNC Asheville

Senior Nutrition Summit, Charlotte, NC

March 24, 2018

Mission:

Develop equitable opportunities that lead to

healthy North Carolina Communities.

NCCHW works to impact policy, build capacity,

and ignite community initiatives by working through

a web of cross sector relationships organized

around building healthier places throughout the

state.

A profile of North Carolinians:

NC is Aging

#Retirees

#Foreign-born population

(Immigrant and refugees)

#Life expectancy

#Baby boomers

#Lower birth rates

NC Ranks 9th in population age 65+

By 2019, there will be more people 60

and over than ages 0-17 in the state

2019

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

2015 2035

60+

0-17

Source: NC Office of State Budget and Management/demographicsRetrieved 11/1/2016

Counties with more people age 60 and

over than 0-17

2015

(66 counties)

2025

(87 counties)

By 2035, 94 counties will have more people 60 and over than under age 18. The 6 counties with more people 0-17 than 60 and over are Craven, Cumberland, Durham, Harnett, Hoke and Onslow.

Counties with more people ages 60+ than 0-17

Counties with more people ages 0-17 than 60+

Most older adults 65+ years

live in the community

▶Community

33.4 M; 93.5%

▶Nursing Homes

1.5 M; 4.5%

▶Assisted Living

1.0 M; 2.0%

US Census Bureau; Centers for Medicare & Medicaid, Medicare Current Beneficiary Survey

Poverty Rate Increases In Older Age

Source: American Community Survey 2009-2013. Table B17024

7

▪ 83% have at least one chronic disease. 52% have 2 or

more chronic diseases

▪ 68% reported exercising in the past month

▪ 29% reported that their health is fair or poor

▪ 93.5% live in the community

▪ 37% have at least one disability

American Community Survey 2011-2015 five year estimates, Table B18101BRFSS 2015 survey results, NC State Center for Health Statistics

Characteristics of Older Adults in

North Carolina

17%

21%63%

With one type of disability

With 2 or more types of disability

No disability

Seniors may have

unique nutrition

needs and

challengesIn 2015 9.7%

NC older adults

in poverty

Source: American Community Survey 2015 one year estimate. Table S0102 Population 60 years and over in the united states;

USDA - 33 percent of the census tract's population must reside more than one mile from a supermarket or large grocery store (for rural census tracts, the

distance is more than 10 miles).

Food Deserts

– lack access

to healthy food

Chronic

disease and

disability

Seniors’ Nutrition Challenge

• Food Insecurity is the more common, accurate,

and politically acceptable term

• Many reasons for food insecurity

30% of low income older adults choose

between food and medical care

35% of low income older choose between

food and paying for heat/utilities

• Less than half of older adults who are eligible for

SNAP (food stamps) are enrolled in the program

• Food Insecurity leads to Malnutrition = poor

nutrition

Hunger vs Food Insecurity

So What’s the Hunger-Obesity

Paradox?

▶ The common misconception that

obesity results from overeating

▶ Consider the types of foods that are

inexpensive

▶ Consider eating patterns when next

meal is not known

▶ What foods do you donate during

hunger relief efforts?

▶ Someone can be hungry,

malnourished and overweight

Malnourished Patients

Clinical studies have shown that:

• 53% of Medicare admits are suffering

malnutrition;

• 40-60% of patients discharged are

malnourished;

• Discharged patients that are malnourished

have poorer outcomes

Patients with Chronic Conditions -

Highest Risk for Admissions AND

Readmissions

• Congestive heart failure (CHF) patients

• Patients with 2 or more chronic conditions

● 20% of NC adults age 60+ are food insecure

● Malnutrition is often not screened● Over 50% of hospitalized older adults are

malnourished● Hospital stays are longer● Increases health costs● Access to food is one of the quickest

returns on investment among the social determinants of health

● Screening for food insecurity improves care

Identifying Patients Who Require

Nutrition Rx

Ref: UNC Hospital 2014 study; AARP Foundation ISSUE Brief Sept 2016 Addressing Food Insecurity in Primary Care; Defeat Malnutrition Today

NC FNS Statistics June 2017

●NC Participation Rate under 55 years

old: 69%

●NC Participation Rate 55y/o+: 57%

●NC monthly allotment average 55y/o+:

$118

●Robeson Co. 55+ Participation Rate:

63%

●Robeson Co. 55+ monthly allotment

average: $113

●Bladen Co. 55+ Participation Rate: 49%

●Bladen Co. 55+ monthly allotment avg:

$94

Good News!

North Carolina Supports for

Food Insecurity● Senior Nutrition Program

congregate nutrition programhome-delivered meals program

● Supplemental Nutrition Assistance Program SNAP or FNS or food stamps ○ $600,000 NC Pilot Program to increase access

to for dual eligible. The RFA for applications process is underway to partner with a not-for-profit firm.

● Food Banks and food pantries ● Farmers Markets, community gardens● Local food policy councils● Faith-based groups (NCBAM – Serving Hope)

Home Food Delivery for the Elderly

Strengthens Communities

States that invest more on home-delivered meals to seniors have lower rates of seniors in nursing homes.

Meals on Wheels America + AARP Foundation commissioned Brown University’s Center for Gerontology and Healthcare Research: investigate the impact of meal service delivery on the health and well-being of adults 60 years of age and older. 15 week study – waiting list for home delivered meals programs across US Design: Traditional home delivered meal delivery (hot lunch meal with daily visit); Once-weekly frozen meal delivery; or Continuance on the waiting list

The cost of 1 YEAR for a senior to receive

Meals on Wheels is less than 1 DAY in a

hospital.

2018 Malnutrition Quality

Improvement Initiative Academy

of Nutrition and Dietetics

●New quality measures to address

malnutrition in the hospital are being

evaluated

●Will create consistent standards of

practice

●Nutrition care plans are created after

assessment

Nutrition is clinically proven

intervention for many chronic

conditions

● Nutritional Interventions Substantially Improve Patient

Outcomes and Reduce Costs

● Reduction in length of stay 22%

● Reduction in lost hospital revenue per patient 71%

● Reduction in readmission costs 17%

● Reduction in readmission rate 5%

How Much Does the Nutrition Rx

Save?

● Nutrition is low cost versus hospitalization

○($18.95/day vs. $3500 for hospital stay).

● Nutrition is low cost compared to SNF

○($18.95/day vs. $222 – 278/day for SNF)

● Nutrition needs to be measured as a key intervention in reducing readmissions

●How are you making the case for nutrition services?

Gurvey et al., 2013 J. Primary Care and Com. Health 4(4):311

MOWA, ANDA, AARP F, NCOA & You

Call to Action

● Increase funding for the Older Americans Act

Meals and nutrition education

● Strengthen SNAP policies for older adults

Support SNAP-Ed, SNAP Outreach

● Encourage the Centers for Medicare and

Medicaid adopt Malnutrition e Clinical Quality

Measures

Screening and intervention for food insecurity

MOWA, ANDA, AARP F, NCOA & You

Call to Action

● Expand Medicare-covered medical nutrition

therapy/nutrition counseling to include diabetes

and other conditions

● Enhance Medicare Advantage by allowing doctor

to prescribe meals when needed

○implement Improve discharge planning so

health plans provide nutritious meals

● Support community partners

● Massachusetts’s governor signed S.2499, an act

to establish a commission on older adult

malnutrition prevention in 2016

AN INITIATIVE OF THE N.C. CENTER FOR

HEALTH & WELLNESS AT UNC ASHEVILLE

Healthy Aging NC Resource Center

Jeanne Dairaghi,

Chronic Disease

Self-Management

Project Manager

Janice Self,

Data Administrator

Nicolle Miller,

Director of State &

Community

Collaboration

Website:

www.healthyagingnc.com

Katie McDonald

Administrative

Support

Healthy Aging NC at NCCHW

Supports Sustainability of Value-

Based Care and Addresses Social

Determinants of Health

▶ Creating a falls prevention pathway between

an ACO and Evidence-Based Falls

Prevention Programs

▶ Area Agencies on Aging becoming Diabetes

Self-Management Education (DSME)

Medicare Providers

▶ Connecting Community-Based

Organizations with Healthcare

Organizations

Website:

www.healthyagingnc.com

AN INITIATIVE OF THE N.C. CENTER FOR HEALTH &

WELLNESS AT UNC ASHEVILLE

Contact Information

Nicolle Miller

Director of State and Community Collaboration

nmiller2@unca.edu

828-258-7711

Healthy Aging NC Resource Center

HealthyAgingNCInfo@gmail.com

Healthyagingnc.com

AN INITIATIVE OF THE N.C. CENTER FOR HEALTH

& WELLNESS AT UNC ASHEVILLE

Websites

●Meals on Wheels America -www.mealsonwheelsamerica.org/takeaction

●Academy Dietetics and Nutrition -http://www.eatrightpro.org/resources/practice/practice-resources/malnutrition

●National Council on Aging -www.NCOA.org/NutritionTools

●Defeat Malnutrition Today -www.DefeatMalnutrition.Today

●National Foundation to End Senior Hunger -http://www.nfesh.org/

●AARP Foundation - http://www.aarp.org/aarp-foundation/our-work/hunger.html