Live Long and Prosper: Optimal Nutrition for Today’s Aging Realities September 12, 2012 Presenter:...
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Transcript of Live Long and Prosper: Optimal Nutrition for Today’s Aging Realities September 12, 2012 Presenter:...
Live Long and Prosper: Optimal Nutrition for Today’s
Aging RealitiesSeptember 12, 2012
Presenter:
Nancy Wellman, PhD, RD
Adjunct Professor, Tufts University
Friedman School of Nutrition Science & PolicyModerator:
James M. Rippe, MD – Leading cardiologist, Founder and Director,
Rippe Lifestyle Institute
NUTRI-BITES®
Webinar Series
Approved for 1 CPE (Level 2) by the Academy of Nutrition and Dietetics Commission on Dietetic Registration and the American Culinary Federation
Live Long and Prosper: Optimal Nutrition for Today’s Aging Realities
This webinar covered:•
Nutri-Bites® Summary
• The beneficial effects of nutrition in health promotion, risk reduction and disease management of older Americans
• Federal and community food and nutrition programs available for older adults
• Access issues and opportunities to promote healthful aging and optimal nutrition status
• Strategies food and nutrition professionals can apply to integrate food and nutrition programs and services into home and community settings
• Approaches to help older adults meet their nutrition needs following hospital discharge
Demographics of Aging:Demographics of Aging:Dramatic ChangesDramatic Changes People age 65 + in the US
2010: 40 million = 13% = 1:8 2030: 72 million = 20% = 1:5
doubled compared to Yr 2000
Relatively few (1.3 M, ~3%) of 65+ in nursing homes Percentages increase dramatically w/ age:
1.1%, 65-74 yr; 3.5%, 75-84 yr; 13.2%, 85+ 1970s & 1980s: >21%, 85+
Older Americans 2012 Key Indicators of Well Being, http://agingstats.gov/
Nutrition Prevention Nutrition Prevention Spectrum in AgingSpectrum in Aging
NutritionPrimary
PreventionSecondary Prevention
Tertiary Prevention
Health Promotion Risk Reduction Treatment / Therapy
Definition
Prevent disease & disability by reducing or eliminating potential risk factors
Lessen health risks by screening & early treatment before observable symptoms
Treat or remediate those with diagnosed health conditions
Goals
Enhance/maintain wellness through behavioral or environmental changes
Maintain/improve nutritional status &/or avoid illness among those susceptible due to genetics, lifestyle, age, etc
Prevent/delay disease progression, disability, pain, premature death
Activities
Generalized education or facilitation of healthful diets
Anticipatory screening, detection, early intervention
Individualized nutrition TX for acute conditions & chronic diseases
Diet QualityDiet QualityINDICATOR 23
Impacts of Food & Nutrition on Health
Reduced Quality of Life Lessened Independence Increased Healthcare Costs
Without Adequate Healthy, Safe Food & Nutrition Services:Deafness; Blindness; Reduced Smell &Taste; Chewing & Swallowing Problems; Joint Destruction--Costly Replacements; Confusion, Forgetfulness, Memory Loss; Uncontrolled High Blood Pressure--Heart Attack,
Stroke; Uncontrolled Diabetes--Amputations, Blindness, Nerve Disorders, Dialysis; Osteoporosis--Weakened Bones, Decreased Mobility and Falls; Decreased Immune Response--Flu, Colds, Upper
Respiratory Infections, HIV/AIDS; Decreased Organ Function & Organ Failure; Wasting--“Dwindles” or “Failure to Thrive”; Involuntary Weight Loss: Body Mass Index, Muscle Mass;
Excessive Weight Gain--Obesity; Serum Albumin--Protein Malnutrition; Pressure Ulcers
Longer Hospital
StaysHospital
Re-Admission Premature NH Admission
Low Stamina
Poor Appetite
Depression Anxiety
Sleep
DisturbanceIncreased Morbidity & Mortality
Slower Recovery
CHRONIC DISEASES
Heart Disease; Hypertension; Diabetes; Osteoporosis;
Some Cancers: colon and breast; Arthritis; COPD;
Renal Disease
ACUTE CONDITIONS
Dehydration; Pressure Ulcers; Infections;
Pneumonia; Influenza; Fractures; Tooth Abscesses;
Gum Disease
AGE-RELATED CONDITIONS / DISEASES
Hearing Loss; Macular Degeneration; Destructive Joint
Disease: knees and hips; Loss of Muscle Mass: Sarcopenia; Cognition / Mental Health
POOR DIETSPOOR DIETS
Federally Funded Community Federally Funded Community Food & Nutrition ProgramsFood & Nutrition Programs
USDAUSDA SNAP (Food Stamps) SNAP-Education Commodity Supplemental
Food Program The Emergency Food
Assistance Program TEFAP Senior Farmers’ Market
Nutrition Program Child & Adult Care Food
Program
US DHHSUS DHHS Older Americans Act Nutrition
Program (“meals-on-wheels”)including Nutrition Services Incentive Program (NSIP)
Eldercare Locator: Connecting you to Community Services http://eldercare.gov/Eldercare.NET/Public/Index.aspx
Medicare & Medicaid
Disconnect between Hospital Disconnect between Hospital & Home& HomeHospital-based Health
Care System Hospital Discharge
Planners: “community nutrition services not readily available”
RDs: not involved in discharge planning; low awareness of community nutrition programs
Community-based Social Service System
Social Service Providers: low awareness of nutrition’s importance to health, independence, recovery, re-admissions, LOS, “aging in place”
RDs: too few within the Aging Network
Referrals to community nutrition programs, esp. OAA NUTRITION PROGRAM , in TRANSITION CARE is essential for at-risk older adults.
Care Transition: Problems AheadCare Transition: Problems Ahead Starting next month, Medicare will prod hospitals to
improve practices. Hospitals with high readmissions for 3 conditions (heart attack, pneumonia, heart failure) will be paid less than hospitals with fewer preventable readmissions. http://www.ahrq.gov/consumer/cc/cc090412.htm
*Transition from one care source to another: moment with high risk for communications failures, procedural errors & unimplemented plans.
*People with chronic conditions, organ system failure & frailty: at highest risk because their care is more complicated & they are less resilient when failures occur.
*Strong evidence: possible to significantly reduce hospital readmissions caused by flawed transitions.
*A Morgan, 8/24/12; Administration for Community Living
Nutrition isn’t considered Nutrition isn’t considered important for healthier agingimportant for healthier aging … be it food security, food safety, public health, health care,
hospital discharge planning, transition care, LTSS/LTC, Medicare, Medicaid, NH, ALFs, Board & Care homes.
Non-scientists & social service persons don’t think the evidence is there &/or find the science too complicated.
OR Food/nutrition is too simple – attitudinal challenge for many,
including MDs & PhDs. Health care & social science is embracing physical activity
better & faster.
Lip service only re importance of Lip service only re importance of nutrition for healthier agingnutrition for healthier aging
OpportunityOpportunity
Today RDs have a unique opportunity to make a differenceopportunity to make a difference in the lives of the growing number of older adults & the quality of programs & systems being developed for transition care & in the Affordable Care Act.
Affordable Care Act: State LedAffordable Care Act: State LedAcademy of Nutrition & Dietetics Step-by-Step Guide to include nutrition services by building
connections with state officials & being involved in state demonstration projects – what are you & your state doing?
Policy Initiatives & Advocacy Committees/Task Forces: State Regulatory Specialists, State Policy Reps, Public Policy Coordinators, Reimbursement Reps
Medicare & Medicaid now emphasize prevention – Incentivizing hospitals to make appropriate referrals by
linking reimbursement to preventable adverse events following discharge, eg, re-admissions, etc. – what are you & your hospital doing?
Affordable Care Act / Health Care Reformhttp://www.eatright.org/healthcarereform/ Rules & Programs Step-by-Step Guide for Success Resources Sample Affiliate (State Dietetic Association)
Plan of Action
Make a difference for RDs in your state! Make a difference for RDs in your state! Make a difference for public health in your state!Make a difference for public health in your state!
Roles for DietitiansRoles for DietitiansAdvocate forAdvocate for Inclusion of food & nutrition
services in transition care & HCBS
Establishment of screening & referral systems in HCBS
Adequate & sustained funding for meals & nutrition services
Comprehensive & coordinated community based nutrition services in transition care
Comprehensive nutrition services in Medicare & Medicaid via the Affordable Care Act
Position: Food & Nutrition Programs for Community Residing Older Adults. 2010.
Participate inParticipate in Service provision in HCBC & transition
care Documenting cost effectiveness &
efficiency Providing technical assistance &
training Developing & implementing evidence
based nutrition education
EducateEducate Physicians, Discharge Planners, Case
Managers, RNs, Administrators, Social Workers
Older Adults & Caregivers
Opportunities/Challenges for Home & Community Based Services
State programs vary: Get involved! Service system, structure Parallel system collaborations Funding Resources Capacity Expertise
Food & nutrition services are limited: Get involved! May not be perceived as essential Dietitians may not be valued
POSITION PAPERSPOSITION PAPERS Food & Nutrition for Older Adults: Promoting Health & Wellness.
J Acad Nutr Diet 2012;112:1255. www.eatright.org/About/Content.aspx?id=8374
Food & Nutrition Programs for Community-Residing Older Adults. J Am Diet Assoc 2010;110:46.
www.eatright.org/About/Content.aspx?id=6442451115 Individualized Nutrition Approaches for Older Adults in Health Care Communities.
J Am Diet Assoc 2010;110:1549. www.eatright.org/About/Content.aspx?id=8373
AFFORDABLE CARE ACT / HEALTH CARE REFORMAFFORDABLE CARE ACT / HEALTH CARE REFORMhttp://www.eatright.org/healthcarereform/ Rules & Programs Step-by-Step Guide for Success Resources Sample Affiliate (State Dietetic Association) Plan of Action