Clinical Geriatrics

Older adults’ health and well-being are a major focus for governments, communities, and for all who are involved in the care of this rapidly growing population. All indicators point to the significance of lifestyle interventions in successful aging, in both quality and quantity of life, as well as the potential cost-effectiveness of these strategies.

In 2008, there were approximately 38.7 million persons age 65 years and older living in the United States. This number is expected to increase to 88.5 million by 2050,¹ representing roughly 20% of the U.S. population. For many years now, healthcare costs have been increasing at double the rate of inflation, and reached $2.5 trillion in 2009.² National healthcare cost per U.S. resident in 1970 was $356, which rose to $2814 in 1990 and is projected to be $13,100 in 2018.³ The healthcare costs for older Americans is also on the rise, as noted in the trend from 1987 to 1999 ($157 billion to $386 billion).⁴

Increased need for long-term care (LTC) with advancing age has led to higher per capita and total LTC spending for older Americans⁴; annual Medicare LTC expenses per beneficiary grew from $5370 in 2002 to $7064 in 2005.⁵ In addition, Medicare spending for LTC as a percentage of national healthcare expenditure is projected to grow from 17.2% in 2005 to 20.7% in 2017.⁵ According to the Congressional Budget Office, the total LTC expenditure for seniors in 2000 was approximately $125.5 billion.⁶ The Office projected the expenditure trend to be $160.7 billion, $207.3 billion, $295.0 billion, and $346.1 billion for the years 2010, 2020, 2030, and 2040, respectively.7 Clearly, there is a need to evaluate all strategies, including preventive lifestyle interventions, that can help control the growing costs of LTC in the United States.

Government-sponsored programs have been instrumental in promoting healthy lifestyles among older people. The Older Americans Act (OAA) was enacted in 1965 to promote the well-being of older adults and to help them remain independent in their homes and communities. The OAA provides funding for the Elderly Nutrition Program (ENP), which oversees nutrition services (congregate meals and home-delivered meals) and Home and Community-Based Services (HCBS). The goals of these programs are to promote healthy lifestyles through nutrition education and routine physical activity. The federal funding for the ENP was maintained at a relatively constant level from 2005-2007: $719 million (2005), $715 million (2006), and $712 million (2007).⁸ Nonfederal resources from state, local, private, and community donations leverage the ENP funding. Every dollar in federal funding leverages $1.70 and $3.55 for congregate and home-delivered meals, respectively.⁹As a result of such resource utilization, the ENP was able to expand its services to at least two times the level that would be possible with ENP federal funding alone.⁹

The congregate meal program as a part of ENP is designed to combat not only poor nutrition but also to prevent social isolation among older adults. The program is often carried out in senior centers and coordinated with other social services providing health screenings, nutrition and physical education, and all types of fitness programs such as yoga, tai chi, aerobics, etc. These centers act as clearinghouses of health information and provide tools for healthy behaviors. The congregate meal program has been found effective in improving physical health, emotional health, and quality of life of the elderly population.^10,11 The study by Gitelson et al¹⁰ illustrated the important role of congregate meals in providing a social environment and a feeling of belonging, thus creating the improved perception of quality of life.