Summary of findings
It is recommended that the findings and conclusions of many studies should be viewed with caution. Although any one particular study and its findings may be basically sound, its location in a different country with different meals programs means that results may not be replicated if the study were conducted in Australia.
Older people, food choices and nutritional status
• Older people are at higher risk of malnutrition and disease than their younger counterparts. Malnutrition is linked with poor health outcomes in the longer term. There is a strong link between physical disability and poor nutrition.
• Programs based on government policy and evidence-based practice guidelines will help to ensure better health outcomes for older people and will contribute to a reduction in burden on the health and aged care systems caused by poor nutrition.
• Older people typically eat less than the general population, although their requirements for vitamins and minerals remain the same or increase in some cases.
• The determinants of food choices and eating behaviours in community-dwelling older people are varied, complex and dynamic. Provision of meal services must take into account these factors and tailor services to meet the needs and preferences of their clients:
o Chronic problems with oral health and digestion, sensory loss, physical disability, the need for modified diets, disease states and multiple medications can all affect older people’s capacity to eat a healthy diet.
o Lower levels of economic resources are associated with increased risk of hunger and food insecurity and low income can affect the quality and quantity of food purchased.
o Access to transport to and from food retailers can be a barrier to obtaining adequate food and can act as a constraint to healthy eating for older people.
o Lack of motivation, knowledge and skills for meal preparation, particularly in older men, may result in less healthy food choices and more restricted diets.
• The continuing trend for individuals remaining in their home despite more advanced medical conditions implies that food services’ clients will require access to an integrated system that provides assessment and monitoring, to ensure optimal nutrition and health outcomes.
• A recent survey of Victorian HACC providers indicated that most providers encourage direct care staff to undertake tasks involved in meal preparation, and to use this contact with clients to monitor nutritional status and observe changes in clients’ weight. In addition, over half of the providers had direct care staff who intervened actively by encouraging strategies to improve nutrition, or demonstrating and teaching meal preparation techniques, equipment, and routines.
• The social objectives of meal delivery appear to be in conflict with the goal of providing an efficient delivery service. Some new delivery models are designed to provide meals in minimal time with maximum efficiency, to minimise risk of food-borne illness and facilitate less frequent delivery. Such efficiencies could reduce the time for volunteers to provide social contact—a balance may be needed.
• Dietitians play a key role in the provision of education, training and scientifically-based advice to providers, other health professionals, non-clinical community workers, clients and their carers.
• Motives for volunteering include finding a new sense of purpose, feeling like a valued member of the community, and gaining satisfaction from helping to keep a vital service in operation. Although the majority of meal service volunteers are older, innovative recruitment practices include approaching corporations and groups of younger people (known as trans-generational recruitment).
• Measures of nutrition risk and food security should be an integral component of meals program assessment.
• Some independent older people may benefit from being better informed about nutrient-dense food choices and accessing quick and easy recipes that meet the nutritional needs of their age group. Some recipients of prepared meals may benefit from receiving smaller, more nutrient-dense meals.
• Some research has shown that while providing home-delivered meals improves the nutritional intake of older people, receiving such meals does not necessarily prevent nutritional deficiencies.
• A link exists between functional disability and nutritional risk for those people receiving home-delivered meals.
• Meal preparation and delivery affect food safety, but an equally important consideration is the client’s own food handling and storage practices.
• Providing chilled or frozen meals to decrease the risk of food-borne illness needs to be weighed against the finding that these types of meals are not every client’s preference. In some studies, clients receiving hot meals reported higher satisfaction than those receiving frozen food.
• For most people, eating is not only about food and nutrition; it is also a social occasion. Some studies have shown that strong social networks have a positive effect on diet.
• Meals on Wheels services have at least a minimal impact on the social lives of clients, but there is a great deal of variability in the social impact of meal delivery across services, staff, and clients.
• Some studies have demonstrated the nutritional benefits of receiving meal services at home, and nutrient intake has been shown to be higher on days when clients eat with a group than when they eat at home.
• Nutrition standards for meal services funded by HACC are lacking, and a mechanism for appraising services against such standards is needed.
• Reviews of meal services have tended to focus on sustainability from the perspective of providers rather than that of clients.
• Winterton, Warburton, and Oppenheimer (2013) argued that evaluations of MOW services are needed that consider the views of staff, volunteers, and clients, with the aim of identifying alternative models of delivery to fulfil cost requirements, meal satisfaction, and social objectives.
• Very few reviews of costing or funding models for meal services have been reported. The Australian Meals on Wheels’ submission to the Productivity Commission discussed the level of user co-contributions so that they did not act as a disincentive for clients to eat adequately.
• The lack of literature on ‘Other Food Services’ represents a gap in knowledge and an opportunity for future studies.
• Further consultation with older people is required to develop a reliable approach to effective nutrition education campaigns in this age group.
• The CHSP meal service needs to incorporate better research and evaluation. Service providers should be resourced to carry out their own evaluations in situ.
• Some work suggests that more attention should be paid to the full supply chain, with emphasis on customer demand and satisfaction.
The social and nutritional benefits of meal services have been demonstrated. However, the challenges in ensuring future viability of meal services are strong, and innovative models are required across the whole process of producing meals, delivering them to clients, and assisting clients to consume them safely.