Nutrition Services Program Outcomes Evaluation

September 14, 2017

Responses to attendees questions posed during webinar:

Question Response

Are there any data available or collected on 

malnutrition?

The survey includes information on unintentional losses of weight and on food 

insecurity. The analyses conducted using the 24-hour dietary recall data can also 

provide insight into malnutrition and participants’ nutritional status. For example, the 

evaluation examined the percentage of participants whose usual diets met 

recommendations for key vitamins, minerals, and macronutrients (Table III.11). The 

evaluation also assessed how well participants’ diets conform to key 

recommendations of the Dietary Guidelines (using the Healthy Eating Index-2010; 

Table III.13). However, the survey did not include questions from malnutrition 

screening tools and did not formally measure malnutrition.

Was there a mix of rural and urban participants? 

Did you see any difference between these two 

groups?

Yes, there was a mix of urban and rural participants. 72 percent of congregate meal 

participants and 75 percent of home-delivered meal participants live in urban areas 

(Table III.1) We did not examine findings by urbanicity.

It has been reported that underutilization of these 

CM and HDM programs increases risk of 

malnutrition in the older adult population. Is there 

research being conducted on how we can increase 

utilization while the Federal funding of these 

programs are being reduced?

The evaluation examined program participation patterns and frequency of use of the 

program among congregate and home-delivered meal participants (Tables III.14-16). 

However, it did not assess how to increase program use.

How is activity levels considered in the study? The survey included a question asking whether participants took part in an exercise or 

fitness class offered by the meal site. However, the evaluation did not assess activity 

levels more generally.
I realize the survey numbers aren't huge, but it 

would be great to see some of this data broken out 

a bit more – e.g., by race/ethnicity, urban vs. rural, 

and maybe some other groupings. Any chance this 

will be possible?

The evaluation report presents program impacts separately for congregate meal 

participants and nonparticipants and for home-delivered meal participants and 

nonparticipants. The analyses of the effect of congregate and home-delivered meal 

participation on outcomes measuring food security, socialization, and diet quality

were also conducted separately for two important household and economic 

subgroups: by monthly household income relative to poverty and according to 

whether individuals lived alone or with other family members.

The design of the outcomes evaluation began with the design of the process and cost 

studies (which collected data from agencies such as SUAs, AAAs, and LSPs). This 

allowed the evaluation team to link the person-level data from the outcomes 

evaluation to the agency-level data from the process and cost studies. These findings 

are not available in the report, however. The agency-level data include the type of 

meal site (private/public), whether the LSP is a stand alone organization, whether the 

LSP offers special or therapeutic diets, whether various services are offered (such as 

nutrition education, nutrition counseling, transportation, and case management), 

types of social activities offered, number of volunteer hours, and the total and 

component costs of providing meals.

Did you get data on percent who had dietary 

intakes ABOVE recommended levels for fat and 

sodium? (vs non-participants)

Yes, the evaluation did estimate the percentage of participants and nonparticipants 

with usual intakes that exceeded recommendations for total fat and sodium (Table 

IV.7). For total fat, 46 percent of congregate meal participants exceeded the 

recommendation for total fat compared with 50 percent of nonparticipants. 40 

percent of home-delivered meal participants exceeded the recommendation for total 

fat compared with 52 percent of nonparticipants. For sodium, 94 percent of 

congregate meal participants and 63 percent of nonparticipants exceeded the 

recommendation. 69 percent of home-delivered meal participants and 62 percent of 

nonparticipants exceeded the recommendation for sodium.
When you looked at the number of meals delivered 

and the effect on loneliness, did you look at the 

number of individual deliveries? For example, did 

you compare daily hot meal delivery vs. a once a 

week delivery of 5 or more meals?

The survey collected information on the number of days in a typical week the 

participant received delivered meals from the nutrition program. It did not contain 

information on whether the meals were hot or frozen, or the number of meals 

provided in a single delivery.

How did you recruit nonparticipants, and how do 

you know they are equivalent in food news?

To estimate the effect of congregate or home-delivered meal participation on 

outcomes, we compared outcomes for participants with a matched comparison group 

of eligible nonparticipants. We surveyed participants, obtained their Social Security 

Number, obtained Medicare administrative records for them and obtained Medicare 

administrative records for all older adults in the same small geographic area (either 

the residential zip code or the service area in which the participant received meals). 

Using this information, we identified a long list of potential nonparticipants with 

similar demographic, economic, and health-related characteristics as the participant 

and that lived in the same small geographic area. We used a matching algorithm to 

rank the potential nonparticipants from best to worst match. We contacted the 

nonparticipants, confirmed they met the eligibility criteria and were not participating 

in the program, and administered the survey. Despite this rigorous matching 

technique, several differences remained between participants and nonparticipants, so 

we also used econometric and statistical methods to control for these differences 

when estimating program effects.

Regarding food security among CM and HDM 

participants, is there data broken out by some risk 

factors - i.e. poverty, isolation, marital status, etc.?

The report presents food security status for all program participants, separately by 

congregate and home-delivered meal participation status, and separately by income 

and age.
What is your hypothesis on why diabetes was 

reported as an issue for 1/3 of participants, yet 60 

percent of respondents reported being on a 

diabetic diet?

The percentage of participants that reported having been diagnosed with diabetes or 

high blood sugar was 33 percent for congregate meal participants and 36 percent for 

home-delivered meal participants (Table III.4). The percentage that reported being on 

a special diet for diabetes was 60 percent for each program group. However, the 

question about the specific type of diet was asked only of those participants that 

reported being on any special or therapeutic diet (27 percent of congregate meal 

participants and 34 percent of home-delivered meal participants reported being on 

any special or therapeutic diet). Thus, the percentage of all congregate meal 

participants that reported being on a diabetic diet was smaller than the percentage 

that reported ever being diagnosed with diabetes—16 percent (equal to 27%*60%) 

versus 33 percent. Similarly, the percentage of home-delivered meal participants that 

reported being on a diabetic diet was smaller than the percentage that reported ever 

being diagnosed with diabetes—20 percent (equal to 34%*60%) versus 36 percent.

We do not have information on why some participants that reported having been 

diagnosed with diabetes did not report being on a special diabetic diet.