F INAL REPORT

Evaluation of the Effect of the Older 

Americans Act Title III-C Nutrition 

Services Program on Participants’ 

Food Security, Socialization, and 

Diet Quality

April 21, 2017

James Mabli

Elizabeth Gearan

Rhoda Cohen

Katherine Niland

Nicholas Redel

Erin Panzarella

Barbara Carlson

Submitted to:

Center for Disability and Aging Policy

Administration for Community Living

U.S. Department of Health and Human Services

1 Massachusetts Avenue, NW

Washington, DC 20201

Project Officer: Susan Jenkins, Director of Office of Performance and Evaluation

Contract Number: HHSP233201500035I/HHSP23337001T

Submitted by:

Mathematica Policy Research

955 Massachusetts Avenue, Suite 801

Cambridge, MA 02139

Telephone: (617) 491-7900

Facsimile: (617) 491-8044

Project Director: Rhoda Cohen

Reference Number: 50158.01.403.471.001
This page has been left blank for double-sided copying.
CONTENTS

INTRODUCTION BY THE ADMINISTRATION FOR COMMUNITY LIVING ..............................................vii

EXECUTIVE SUMMARY ..............................................................................................................................ix

I INTRODUCTION.............................................................................................................................. 1

A. Overview of the Title III-C Nutrition Services Program.............................................................. 2

1. Funding and administration................................................................................................. 2

2. Eligibility requirements ........................................................................................................ 3

3. Meals and services ............................................................................................................. 3

B. Nutrition Services Program evaluation objectives and research questions .............................. 3

C. Organization of the report.......................................................................................................... 5

II OVERVIEW OF DATA AND METHODOLOGY............................................................................... 7

A. Sampling design ........................................................................................................................ 7

B. Data collection ........................................................................................................................... 8

1. Instruments ......................................................................................................................... 8

2. Pretesting ............................................................................................................................ 8

3. Conducting interviews ......................................................................................................... 9

C. Additional data sources ............................................................................................................. 9

1. Neighborhood contextual data from the American Community Survey.............................. 9

2. Geographic address data for participants and food retailers.............................................. 9

D. Outcome measures ................................................................................................................. 10

1. Food security..................................................................................................................... 10

2. Socialization ...................................................................................................................... 10

3. Diet quality ........................................................................................................................ 11

E. Analytic methods ..................................................................................................................... 12

F. Analysis weights ...................................................................................................................... 14

G. Study limitations ...................................................................................................................... 14

III NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES ....................................... 17

A. Characteristics of participants ................................................................................................. 17

1. Demographic characteristics............................................................................................. 17

2. Income characteristics ...................................................................................................... 17

3. Health status, functional ability, and mobility .................................................................... 20

4. Diet and eating behaviors ................................................................................................. 24

5. Diet quality ........................................................................................................................ 26

6. Receipt of nutrition and supportive services ..................................................................... 36

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CONTENTS MATHEMATICA POLICY RESEARCH

7. Geographic access to food ............................................................................................... 42

8. Food security..................................................................................................................... 46

B. Impressions of the program and social interactions and activities .......................................... 51

1. Impression of the program ................................................................................................ 51

2. Social interactions and activities ....................................................................................... 55

IV. CONGREGATE AND HOME-DELIVERED MEAL PARTICIPATION AND 

PARTICIPANTS’ OUTCOMES ...................................................................................................... 57

A. Congregate and home-delivered meal participation and household food security ................. 57

1. Congregate meal participation .......................................................................................... 57

2. Home-delivered meal participation ................................................................................... 58

3. Differences by income and whether individuals live alone ............................................... 59

B. Congregate and home-delivered meal participation and socialization.................................... 60

1. Congregate meal participation .......................................................................................... 61

2. Home-delivered meal participation ................................................................................... 62

3. Differences by income and whether individuals live alone ............................................... 65

C. Congregate and home-delivered meal participation and diet quality ...................................... 66

1. Prevalence of adequate and excessive nutrient intakes................................................... 66

2. Healthy Eating Index-2010 scores .................................................................................... 71

V CONCLUSION ............................................................................................................................... 75

A. Comparison to findings from the 1995 NSP evaluation .......................................................... 75

B. Implications for future research and policy.............................................................................. 77

REFERENCES............................................................................................................................................ 81

APPENDIX A DATA AND METHODOLOGY...........................................................................................A.1

APPENDIX B USUAL NUTRIENT INTAKE DISTRIBUTIONS FOR NSP PARTICIPANTS....................B.1

APPENDIX C SUPPLEMENTARY TABLES OF NSP PROGRAM EFFECTS FOR INCOME AND 

FAMILY SUBGROUPS......................................................................................................C.1

APPENDIX D USUAL NUTRIENT INTAKE DISTRIBUTIONS FOR NSP NONPARTICIPANTS...........D.1

iv
TABLES

III.1 Selected demographic and household characteristics of Nutrition Services Program 

participants..................................................................................................................................... 19

III.2 Sources and distribution of income among Nutrition Services Program participants.................... 20

III.3 General health status of Nutrition Services Program participants ................................................. 21

III.4 Medical status and insurance characteristics of Nutrition Services Program participants ............ 22

III.5 Recent falls and fall-related injuries among Nutrition Services Program participants ................... 23

III.6 Presence of conditions that could affect independent living among Nutrition Services 

Program participants ...................................................................................................................... 24

III.7 Diet and eating behavior among Nutrition Services Program participants .................................... 25

III.8 Preparation of meals at home among Nutrition Services Program participants ............................ 26

III.9 Mean percentage of daily nutrient intakes obtained from program meals among Nutrition

Services Program participants ....................................................................................................... 28

III.10 Dietary Reference Intakes and 2015-2020 Dietary Guidelines’ recommendations....................... 29

III.11 Percentage of Nutrition Services Program participants with usual nutrient intakes above, 

below, or meeting recommendations ............................................................................................. 31

III.12 Healthy Eating Index-2010 components and standards for scoring .............................................. 34

III.13 Mean Healthy Eating Index-2010 scores and percentage of maximum scores for Nutrition 

Services Program participants ....................................................................................................... 35

III.14 Frequency of participation in congregate meal program ............................................................... 36

III.15 Frequency of participation in home-delivered meal program......................................................... 37

III.16 Changes in congregate meal program participation ...................................................................... 38

III.17 Initial connections to the Nutrition Services Program .................................................................... 39

III.18 Meal contribution characteristics among Nutrition Services Program participants........................ 40

III.19 Receipt of emergency meals among Nutrition Services Program participants.............................. 40

III.20 Use of other nutrition and supportive services in the past six months among Nutrition 

Services Program participants ....................................................................................................... 41

III.21 Information and referrals in the past year among Nutrition Services Program participants .......... 42

III.22 Median distance (in miles) to nearest retailer, by store type and urbanicity among 

Nutrition Services Program participants......................................................................................... 43

III.23 Quartiles of distribution of distances (in miles) to nearest supermarket, superstore, or 

large grocery store, by urbanicity, among Nutrition Services Program participants...................... 44

III.24 Median number of retailers within selected distance from Nutrition Services Program 

participants living in urban areas, by store type............................................................................. 45

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TABLES MATHEMATICA POLICY RESEARCH

III.25 Median number of retailers within selected distance from Nutrition Services Program 

participants living in rural areas, by store type............................................................................... 46

III.26 Food security among Nutrition Services Program participants...................................................... 47

III.27 Food security, by income as a percentage of poverty, among Nutrition Services Program 

participantsa.................................................................................................................................... 47

III.28 Food security, by age, among Nutrition Services Program participants........................................ 48

III.29 Adequacy of income among Nutrition Services Program participants........................................... 49

III.30 Participation in other programs among Nutrition Services Program participants .......................... 49

III.31 Coping strategies in the absence of NSP among Nutrition Services Program participants .......... 50

III.32 Impressions of the NSP among participants.................................................................................. 51

III.33 Impressions of meal delivery among Nutrition Services Program participants.............................. 52

III.34 Impressions of health benefits of the NSP among participants ..................................................... 53

III.35 Impressions of meals among Nutrition Services Program participants ......................................... 54

III.36 Socialization outcomes and opportunities among Nutrition Services Program participants.......... 55

III.37 Recreational, volunteer, and social activities among congregate meal participants ..................... 56

IV.1 Regression-adjusted percentages of individuals who live in households that are food 

insecure or have very low food security, by congregate meal participation status........................ 58

IV.2 Regression-adjusted percentages of individuals who live in households that are food 

insecure or have very low food security, by home-delivered meal participation status................. 59

IV.3 Regression-adjusted percentages of individuals who live in households that are food 

insecure or have very low food security, by home-delivered meal participation status and 

number of meals received per week .............................................................................................. 59

IV.4 Regression-adjusted socialization outcomes, by congregate meal participation status................ 61

IV.5 Regression-adjusted socialization outcomes, by home-delivered meal participation status......... 63

IV.7 Effects of congregate and home-delivered meal program participation on the percentage 

of people with adequate and excessive usual nutrient intakes, by participation status................. 68

IV.8 Effects of congregate and home-delivered meal program participation on mean Healthy 

Eating Index-2010 scores, by participation status ......................................................................... 72

vi
INTRODUCTION BY THE ADMINISTRATION FOR COMMUNITY LIVING

The 2017 evaluation of the Older Americans Act (OAA) Nutrition Program for the Elderly 

provides results and information on the impact of the program on the participants’ food security, 

socialization, and diet quality. Comparisons are drawn from the previous evaluation of the 

program conducted in 1995. This evaluation also serves to provide insight into areas needing 

further review. This evaluation’s results provide much support for the work of the Aging 

Network as it attempts to fulfill its core mission of reducing hunger and food insecurity, 

promoting socialization, and promoting the health and well-being of older individuals. For 

example:

• The majority of program participants had a positive impression of the program. Ninety-two

percent of congregate meal participants and 96 percent of home-delivered meal participants

rated the nutrition program overall as good, very good, or excellent. Similarly, nearly all

participants rated program staff positively overall and would recommend the program to

friends or relatives.

• Most participants (81 and 90 percent of congregate and home-delivered meal participants,

respectively) reported the program had helped them to eat healthier foods, and 68 to 78

percent indicated the program had improved their health and helped them to achieve or

maintain a healthy weight.

• The majority, 71 percent of congregate and 90 percent of home-delivered meal participants,

reported the program had helped them to live independently and remain in their own home.

In addition, the evaluation brought to light a few areas that warrant further exploration. For 

example, the research indicates that 46 percent of home-delivered meal participants felt the 

deliverer did not engage them. The percentage of those satisfied with the deliverer engagement 

had significantly increased from the 1995 survey. As the OAA Nutrition Program continues to 

strive to increase customer satisfaction, additional research may be warranted to evaluate the 

socialization and the informal safety-check benefits of a daily meal delivery.

Another area that may warrant further research is in response to the findings that suggest 

many home-delivered meal participants may not be receiving a sufficient number of meals per 

week to ameliorate their level of food insecurity. The research shows that among homedelivered meal participants who receive fewer than five meals per week (about 30 percent of 

participants), a significantly greater percentage of participants lived in households that had 

experienced very low food security, compared to non-participants (25.8 versus 15.9 percent). 

Part of the research involved assessing participants’ food consumption over a 24-hour period. 

This information was analyzed against current federal nutritional standards to evaluate the 

adequacy of the participant’s diet. The research found that congregate and home-delivered 

participants had healthier diets compared to nonparticipants, in terms of adequacy of their usual 

nutrient intakes and the overall quality of their diets. 

Finally, when nonparticipants were compared to participants in the congregate meal 

program, participants were more satisfied with their socialization opportunities. However, when 

high-income vs low-income congregate participants were questioned regarding their 

socialization opportunities at the congregate meal site, the low-income participants were less 

vii
satisfied. Further investigation may be warranted to ascertain why low-income participants are 

not as satisfied with the socialization opportunities presented at the meal sites. 

Overall, we find this report very informative. We plan to use the results of this evaluation to 

continue efforts to improve the health and well-being, address food insecurities, and meet the 

needs of OAA program participants. Further, we plan to use the results to highlight areas where 

States, Area Agencies on Aging and the local nutrition providers should assess their methods of 

service provision to ensure optimal benefit and responsiveness to the changing needs of the 

increasing number and increasingly diverse older population. 

 

viii
EXECUTIVE SUMMARY

In an effort to ensure that the health and social needs of older adults are adequately met and 

to rebalance long-term care provision away from institutionalization and toward home and 

community-based services, the Administration on Aging (AoA) within the Administration for 

Community Living of the U.S. Department of Health and Human Services (DHHS) administers

the Title III-C Nutrition Services Program (NSP) as part of the Older Americans Act (OAA). The 

NSP promotes access to nutritious meals, nutrition education, and nutrition counseling; 

facilitates social contact; and conducts health promotion activities all which help older adults 

maintain their independence in their homes and communities. 

Two core components of the program are the provision of congregate and home-delivered 

meals. NSP congregate meal participants can receive a nutritious meal at a senior center or other 

community location, where they can socialize with peers and may receive other services such as 

nutrition education, screening, and counseling. Non-nutrition services, including health 

promotion activities, transportation and case management services, may also be offered. 

Participants who are homebound receive nutritious home-delivered meals. Like congregate 

meal settings, home-delivered meals may offer an opportunity for socializing through 

interactions with meal delivery drivers and other volunteers. Homebound participants may also 

receive nutrition education, screening, and counseling. In this way, the NSP provides homebound 

participants with a primary access point for many home- and community-based services to help 

meet their health and nutrition needs. 

The mission of AoA is to develop a comprehensive, coordinated, and cost-effective system 

of long-term care that helps older adults maintain their independence in their homes and 

communities. As part of its ongoing efforts to support program planning, improve program 

efficiency, and strengthen program effectiveness, AoA contracted with Mathematica Policy 

Research to conduct the Title III-C NSP Evaluation. The three-part evaluation consists of a 

process evaluation of program administration and service delivery, a program cost analysis, and 

an evaluation of the effect of the program on participants’ outcomes. This report is the first of 

two reports about the NSP outcome evaluation. It summarizes findings from the outcomes 

evaluation using data collected from program participants and nonparticipants. 

Background

Organizations in the National Aging Network, an informal network of home- and 

community-based care providers, administer the NSP. AoA’s central and regional offices

provide overall federal coordination; however, the State Units on Aging (SUAs) and the Area 

Agencies on Aging (AAAs) both support key aspects of program operations. In turn, local 

service providers (LSPs) typically provide the direct nutrition services.

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EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

The NSP is authorized under Title III of the OAA.1 Under Title III, SUAs receive federal 

grants from AoA for provision of congregate nutrition services (authorized under Part C-1),

home-delivered nutrition services (authorized under Part C-2), meals (authorized under Part A) 

and support services (authorized under Part B). 

SUAs support the provision of daily meals and related nutrition services in either group 

(congregate) or home settings to adults ages 60 and older. The NSP does not have a financial 

means test, but services target older adults with the greatest economic or social need. Participants 

are not charged for meals but are encouraged to contribute toward the total cost of the meal

voluntarily. However, within site capacity, participants’ inability or unwillingness to contribute 

does not deny them of meals or other services. Congregate meals and support services are 

provided at LSPs’ meal sites (such as senior centers, religious facilities, and public or lowincome housing facilities). Home-delivered meals are provided to homebound individuals by the 

congregate meal sites, affiliated central kitchens, or nonaffiliated food service organizations. 

Congregate and home-delivered LSPs must provide meals that comply with the most recent 

Dietary Guidelines for Americans (“Dietary Guidelines”; DHSS and USDA 2015a) and provide 

a minimum of one-third of the Dietary Reference Intakes established by the Food and Nutrition 

Board of the Institute of Medicine of the National Academy of Science (2006). In addition to 

meals, LSPs also provide for nutrition education, nutrition screening and assessment, and 

nutrition counseling if appropriate.2

In fiscal year 2014, OAA Title III-C funding was $438 million for congregate nutrition 

services and $216 million for home-delivered nutrition services (ACL 2014). In that year, 

80 million meals were served to 1.6 million people at congregate sites and 138 million homedelivered meals were provided to 836,000 homebound older adults. 

Evaluation objectives and research approach

The objectives of the Title III-C NSP evaluation were to:

• Provide information to support program planning, including an analysis of program 

processes (referred to as the process study). 

• Develop information about program efficiency and cost issues (referred to as the cost study). 

• Assess program effectiveness, as measured by the program’s effects on a variety of 

important outcomes, including diet quality, socialization opportunities, health outcomes, 

and—ultimately—helping older adults avoid institutionalization (referred to as the outcomes 

evaluation). 

1 Similar nutrition and supportive services for elderly American Indians, Alaska Natives, and Native Hawaiians are 

authorized separately under Title VI. This report focusses on the Title III NSP.

2 Additional LSP requirements are available in Section 339 of the OAA.

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EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

The process study report (Mabli et al. 2015) and cost study report (Ziegler et al. 2015) shed 

light on the diversity and organizational structure of the National Aging Network and whether 

the system operates efficiently. However, policymakers and program administrators also need to 

know whether the NSP succeeds in delivering services of benefit to older adults. Thus, a third 

major objective of the NSP evaluation is to assess whether the program improves participants’ 

diet quality (and opportunities for socialization and health promotion activities) in the short run 

and, thereby, improves health outcomes in the longer run—outcomes that would allow 

participants to remain in their homes and communities aging in place and delaying or avoiding

institutionalization. 

This report summarizes findings from the NSP outcomes evaluation. The objectives of the 

evaluation are to:

1. Describe NSP participants’ demographic and household characteristics, health status, 

mobility, eating behaviors, diet quality, food security, socialization, and other 

characteristics.

2. Describe NSP participants’ experiences with and impressions of the NSP and their valuation 

of meals and supportive services received through the program. 

3. Determine the impact of NSP meals and related services on participants’ nutrition, food 

security, and diet quality (with a focus on nutrients linked to health of older adults) by 

comparing outcomes for NSP participants and nonparticipants. 

4. Determine the impact of NSP meals and nutrition services on overall wellness and wellbeing by comparing outcomes for NSP participants and nonparticipants. 

This report addresses the first three objectives and part of the fourth objective that assesses 

well-being based on loneliness, depression, and socialization opportunities. A separate report 

will further address the fourth objective which examines overall wellness measured using longerterm outcomes related to health and avoidance of institutionalization. 

The NSP outcomes evaluation draws on information obtained from comprehensive surveys 

of congregate and home-delivered meal participants and a matched comparison group of 

program-eligible nonparticipants. A comparison group of eligible nonparticipants represents 

what would happen to participants in the absence of the program. An NSP outcomes survey and 

a 24-hour dietary recall were administered to random samples of congregate and home-delivered 

meal participants, based on probability samples of AAAs and LSPs that were surveyed as part of 

the process study. The nonparticipant comparison group was formed by obtaining administrative 

lists of Medicare beneficiaries and using statistical matching techniques to identify older adults 

living in the same geographic area who had similar characteristics to those in the congregate 

meal and home-delivered meal samples. Descriptive, tabular analysis was used to characterize

NSP participants and multivariate analysis and matching methods were used to estimate the 

effect of congregate and home-delivered meal participation on NSP outcomes. 

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EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Study findings

Following are key findings of the evaluation. 

A. NSP participant characteristics and circumstances

1. Demographic characteristics and income

Congregate and home-delivered meal participants were similar in terms of gender, veteran 

status, and whether they live alone, but compared to congregate meal participants, homedelivered meal participants, on average, were older, had less education, and were more likely to 

be widowed. The average congregate meal participant was 77 years old, whereas the average 

home-delivered meal participant was 82 years old.3 More than two-thirds of congregate and 

home-delivered meal participants were women, and 15 to 17 percent were veterans. The 

percentage of participants who were married was similar across the two programs, though 52 

percent of home-delivered meal participants were widowed compared to 47 percent of 

congregate meal participants. About 60 percent of participants in both groups lived alone. 

Participants in each program were largely non-Hispanic white individuals (66 percent for 

congregate meal participants and 72 percent for home-delivered meal participants), but a sizable 

percentage of participants were members of racial and ethnic minority groups. Non-Hispanic 

blacks constituted approximately 14 percent of congregate meal participants and 18 percent of 

home-delivered meal participants. Hispanics made up another 13 percent and 9 percent of 

participants, respectively, in the two programs. 

Although financial means tests for participation in the NSP are prohibited, most participants 

were poor or near poor. Thirty-one percent of congregate meal participants and 35 percent of 

home-delivered meal participants had annual household incomes below 100 percent of the 

DHHS federal poverty guidelines. Most of the rest had annual household incomes between 100 

to 200 percent of the poverty guidelines. 

2. Health status, functional ability, and mobility

Compared to congregate meal participants, a greater percentage of home-delivered meal 

participants reported being in fair or poor health, being underweight, having trouble eating due to 

dental issues, and taking multiple medications. Nearly half (46 percent) of home-delivered meal 

participants reported being in fair or poor health, compared to 23 percent of congregate meal 

participants. Six percent of home-delivered meal participants were underweight, compared to 

less than 1 percent of congregate meal participants. One-quarter of home-delivered meal 

participants reported trouble eating due to a condition with their teeth or gums or had other 

dental issues. Many participants reported taking three or more prescription medications daily 

(68 percent of congregate meal participants and 82 percent of home-delivered meal participants).

3 The research team targeted participants who were at least age 67 at the time of the interview to ensure it would 

have at least one year of Medicare records for each participant for the purposes of identifying potential 

nonparticipants. This restriction made the average age of congregate and home-delivered meal participants greater 

than the average age in other surveys. For example, the average congregate meal participant was 76 years old and 

the average home-delivered meal participant was 79 years old in the 2014 National Survey of Older Americans Act 

Participants (NSOAAP).

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EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

The prevalence of doctor-diagnosed chronic health conditions was substantially higher for 

home-delivered meal participants than for congregate meal participants. The most common 

doctor-diagnosed health problems, reported by one-half to almost three-quarters of program 

participants, were high cholesterol, arthritis or rheumatism, eye conditions, and hypertension. 

The prevalence of arthritis, cancer, hearing impairments, stroke, and dementia were 8 to 15 

percentage points higher for home-delivered meal participants than for congregate meal 

participants. Forty-one percent of home-delivered meal participants and 35 percent of congregate 

meal participants also reported a history of heart disease.

The prevalence of recent falls and injuries from falls was much higher for home-delivered 

meal participants compared to congregate meal participants. Fourteen percent of home-delivered 

meal participants reported having had two or more falls during the past three months compared 

to 7 percent of congregate meal participants. Among those individuals who experienced a fall, 45 

percent of home-delivered meal participants reported a fall that had resulted in an injury, 

compared to 28 percent for congregate meal participants. 

Finally, a substantial proportion of home-delivered meal participants reported functional 

impairments and needed help performing one or more activities critical for them to remain in 

their homes. Twelve percent of home-delivered meal participants were not able to walk and 64 

percent had difficulty climbing stairs, compared to 1 and 33 percent, respectively, for congregate

meal participants. Home-delivered meal participants were also three to nine times more likely 

than congregate meal participants to have a condition that could affect independent living, 

including being unable to shop or having difficulty shopping for groceries or personal items 

without assistance; having difficulty bathing; and having difficulty dressing.

3. Diet and eating behaviors

Most congregate and home-delivered meal participants reported consuming about three 

meals a day. Eleven percent of congregate meal participants described their appetite as poor or 

fair, compared with 29 percent of home-delivered meal participants. More than one-quarter 

congregate (27 percent) and home-delivered meal participants (34 percent) were on special 

health-related diets, most commonly diets associated with diabetes or diets to reduce sodium 

intakes and lower blood cholesterol levels. Although most congregate meal participants could 

prepare hot meals if necessary, about one-third of home-delivered meal participants were unable 

to do so themselves. 

4. Diet quality 

The evaluation used 24-hour dietary recalls to measure contributions of congregate and 

home-delivered meals to participants’ total daily nutrient intakes and found that program meals 

contribute substantially to both congregate and home-delivered meal participants’ diets. On 

average, congregate meal participants obtained 41 percent of their daily calories from program 

meals, and home-delivered meal participants obtained 38 percent. In addition, congregate and 

home-delivered meals contributed more than one-third and up to 47 percent of participants’ daily 

intakes of all nutrients examined (ranging from 39 to 47 percent for congregate meal participants 

and 35 to 47 percent for home-delivered meal participants). 

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EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

To assess the adequacy of participants’ usual diets, the study examined participants’ usual 

daily intakes—including foods and beverages from congregate and home-delivered meals as well 

as foods and beverages obtained from other sources—to Dietary Reference Intakes for adults 51 

years and older. Findings indicate that the usual diets of more than 92 percent of congregate and 

home-delivered meal participants included adequate amounts of vitamin B12, niacin, riboflavin, 

iron, and phosphorus. In addition, the prevalence of adequate usual intakes of thiamin was high 

for both groups of participants (86 and 89 percent, respectively). The prevalence of adequate 

usual intakes was lower for both groups of participants for vitamin B6, folate, and zinc (72 to 78 

percent); vitamin A (76 and 65 percent, respectively); vitamin C (55 and 51 percent), magnesium 

(31 and 22 percent), and calcium (26 and 24 percent). 

The study also examined participants’ usual intakes of sodium and saturated fat. The 2015-

2020 Dietary Guidelines recommends that intakes of these nutrients be limited. The findings 

indicate that a majority of congregate and home-delivered meal participants had usual intakes of 

sodium that exceeded the Dietary Guidelines’ recommendation (94 and 69 percent, respectively). 

The same was true for saturated fat—89 percent of congregate meal participants and 72 percent 

of home-delivered meal participants had usual intakes of saturated fat that exceeded the 

recommended limit. 

Total Healthy Eating Index (HEI)-2010 scores, which measure overall diet quality relative to 

the 2010 Dietary Guidelines’ recommendations, were 66 and 61 of a possible 100 points for 

congregate and home-delivered meal participants, respectively. Both groups of participants 

achieved the maximum scores for whole fruit and total protein foods (5 of 5) and came close to 

achieving the maximum score for total fruit (4.8 and 4.6 of 5 for congregate and home-delivered 

meal participants, respectively). Congregate meal participants also came close to achieving the 

maximum score for seafood and plant proteins (4.6 of 5). Scores for total vegetables were 

slightly lower for both groups of participants but still more than 85 percent of the maximum 

possible score (4.5 and 4.3 of 5 for congregate and home-delivered meal participants, 

respectively). For both groups of participants, scores were less than 50 percent of the maximum 

for fatty acids (4.2 and 4.0 of 10, respectively) and whole grains (3.8 and 3.3 of 10, respectively) 

and less than 25 percent of the maximum for sodium (2.3 and 2.2 of 10, respectively). Higher 

scores for the adequacy components (including total fruit, whole fruit, total protein foods, 

seafood and plant protein, total vegetables, fatty acids, and whole grains) reflect greater 

consumption and higher diet quality. Higher scores for moderation components (including 

sodium) reflect lower consumption and higher diet quality. 

5. Receipt of nutrition and supportive services

Congregate meal participants attended congregate meal sites frequently, with 43 percent 

receiving five or more meals per week and 82 percent receiving three or more meals per week. 

Most congregate meal participants (79 percent) attended a single site for meals. Home-delivered 

meal participants also received meals frequently. Seventy-one percent received five or more 

meals per week, and 85 percent received three or more meals per week. 

The majority of participants have received meals and program services for more than a year. 

Eight-four percent of congregate meal participants and 70 percent of home-delivered meal 

participants first enrolled in the meal program one or more years before taking the survey. 

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EXECUTIVE SUMMARY MATHEMATICA POLICY RESEARCH

Fifteen percent of congregate meal participants and 27 percent of home-delivered meal 

participants enrolled within the preceding eight months. 

Many participants used nutrition and supportive services outside the scope of NSP. 

Compared to congregate meal participants, home-delivered meal participants were much more 

likely to use personal care services (41 versus 6 percent); home visits for physical, occupational, 

or speech therapy (43 versus 10 percent); case management services (61 versus 13 percent); and 

light housekeeping services (60 versus 17 percent), but less likely to have received nutrition 

counseling (12 versus 22 percent). 

6. Geographic access to food

Food access limitations are often characterized under the rubric of food deserts, defined in 

the 2008 Farm Bill as areas with limited access to affordable and nutritious food, particularly 

those composed of predominantly lower-income neighborhoods and communities. Food deserts 

are typically identified by having few or no retail food stores such as supermarkets and grocery 

stores in an area, in combination with other socioeconomic and transportation access criteria. 

Limited access to these types of stores may make it harder for congregate and home-delivered 

meal participants to eat a healthy diet. To measure participants’ geographic access to food, the 

research team examined the distance to the nearest retailer and the number of retailers within 

certain distances from participants’ homes for different types of stores. 

At least half of congregate meal participants in urban areas lived within 0.6 miles of a 

supermarket, superstore, or large grocery store and at least half of participants in rural areas lived 

within 2.3 miles of one. For home-delivered meal participants, these distances were 0.5 and 

3.1 miles, respectively.

In urban areas, at least half of congregate and home-delivered meal participants had one 

supermarket, superstore, or large grocery store within one mile of where they live. Convenience 

stores were more common, with participants having five to six stores within 1 mile. In rural 

areas, at least half of congregate and home-delivered meal participants had one supermarket, 

superstore, or large grocery store within 5 miles of where they live. As in urban areas, 

convenience stores were more common than supermarkets in rural areas. 

7. Food security and food coping strategies 

Although the majority of NSP participants were food secure, 16 percent of congregate meal 

participants and 23 percent of home-delivered meal participants had experienced food access 

limitations during the past month due to lack of money or other resources—they were food 

insecure. The rate of very low food security—a severe form of food insecurity—was also higher 

for home-delivered meal participants than congregate meal participants (7 versus 4 percent). For 

congregate and home-delivered meal participants, rates of food insecurity were lower for 

participants with more income: 32 percent of congregate meal participants with income in the 

lowest income quartile lived in a food insecure household, compared to 6 percent of participants 

with income in the highest income quartile. For home-delivered meal participants, these 

percentages were 35 and 13 percent, respectively. (The lowest income quartile consists of 

congregate meal participants with income below 92 percent of the federal poverty guidelines and

the highest income quartile consists of congregate meal participants with income above 

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188 percent of the poverty guidelines. The corresponding percentages for home-delivered meal 

participants are 84 and 173 percent, respectively.) 

Many participants reported that their income is sufficient to take care of their needs; 

however, a nontrivial percentage reported challenges in making ends meet and faced trade-offs in 

purchasing food each month. Specifically, fifteen percent of congregate meal participants and 23 

percent of home-delivered meal participants reported that their incomes do not cover their needs

and struggle to make ends meet. Some participants faced difficult choices of how to spend scarce 

household resources, such as whether to buy food or pay for rent, utility bills, or needed 

medications. About 4 to 9 percent of participants had to make these choices. 

NSP participants were asked about coping strategies they would use if their program were 

unavailable. Sizeable percentages of participants (42 percent of congregate meal participants and 

61 percent of home-delivered meal participants) indicated they would skip meals or eat less if the 

program were unavailable. 

B. Participants’ experiences with and impressions of the NSP

1. Impressions of the NSP

The majority of program participants had a positive impression of the program. Ninety-two 

percent of congregate meal participants and 96 percent of home-delivered meal participants rated

the nutrition program overall as good, very good, or excellent. Similarly, nearly all participants 

rated program staff positively overall and would recommend the program to friends or relatives. 

Most participants (81 and 90 percent of congregate and home-delivered meal participants, 

respectively) reported the program had helped them to eat healthier foods, and 68 to 78 percent 

indicated the program had improved their health and helped them to achieve or maintain a 

healthy weight. The majority, 71 percent of congregate and 90 percent of home-delivered meal 

participants, reported the program had helped them to live independently and remain in their own 

home. 

Most home-delivered meal participants reported that meals arrived at the scheduled time 

(91 percent) and that the delivery person was pleasant (96 percent); however, many participants 

(46 percent) reported that the delivery person seldom or never spent time talking to them as part 

of the delivery process. In the 1995 evaluation, 75 percent of home-delivered meal participants 

reported that the delivery person left immediately after delivering the food and did not spend 

time to talk with or check on the participant, suggesting that engagement of delivery staff has 

improved. 

More than 95 percent of congregate and home-delivered meal participants liked the meals 

they received from the nutrition program. Almost 80 percent of participants provided positive 

ratings on each element that measured their impression of the program meals, with homedelivered meal participants providing slightly lower ratings relative to congregate meal 

participants. In particular, about 25 percent of home-delivered meal participants reported they 

only sometimes, seldom, or never liked the taste or variety of food provided. 

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2. Social interactions and activities 

The vast majority (93 percent) of congregate meal participants were satisfied with their 

opportunities to spend time with other people; 77 percent indicated they had no difficulty getting 

in touch with others during the past two weeks; and 63 percent belonged to religious, social or 

special interest groups. Home-delivered meal participants were less satisfied with their 

opportunities to spend time with other people (81 percent reported they were satisfied), faced 

more difficulty getting in touch with others (66 percent), and were less likely to belong to 

religious, social, or special interest groups (48 percent). 

Congregate meal participants reported high levels of satisfaction with the opportunities for 

recreation and social interaction at the meal site. One-third reported spending a lot of time 

participating in activities or receiving services at the meal site, and 39 percent volunteered at the 

meal site. Almost all congregate meal program respondents (99 percent) reported being either 

very satisfied or somewhat satisfied with their opportunities to spend time with other people at 

the meal site.

C. The effect of congregate and home-delivered meal participation on food 

security, socialization, and diet quality

The effect of congregate and home-delivered meal participation on food security, 

socialization, and diet quality was estimated using data from program participants and a matched 

sample of nonparticipants. 

1. Congregate and home-delivered meal participation and household food security

The effect of program participation on household food security was estimated using two 

measures based on the six-item food security module: whether an individual lives in a food 

insecure household and whether an individual lives in a household that experiences very low 

food security. Congregate meal participants had a lower rate of food insecurity than did 

nonparticipants, but rates of very low food security were similar for the two groups. The 

percentage of congregate meal participants living in a food insecure household was 4.0 

percentage points lower than the percentage of nonparticipants (15.5 versus 19.5 percent). For 

lower-income individuals, the difference was nearly twice the size—7.8 percentage points (23.2 

versus 31.0 percent). 

Although home-delivered meal participants and nonparticipants had similar rates of food 

insecurity, the prevalence of very low food security was 4.2 percentage points higher among 

participants compared to nonparticipants (6.9 versus 2.7 percent). For the vast majority of 

participants who receive meals five days per week, however, the prevalence of very low food 

security among participants was similar to that among nonparticipants. For participants who

receive meals fewer than five days per week, home-delivered meal participants experienced 

greater rates of very low food security than did nonparticipants. 

2. Congregate and home-delivered meal participation and socialization 

The impact of program participation on socialization outcomes was assessed using three 

measures. First, individuals’ loneliness was measured using an abbreviated version of the 

Revised UCLA Loneliness Scale. The scale is based on responses to three questions related to 

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how often individuals feel they lack companionship, feel left out, and feel isolated from others. 

Higher scores indicate greater perceptions of loneliness. 

The second measure came from the Patient Health Questionnaire 2 (PHQ-2) which assesses 

the frequency of depressed mood over a two-week period. A raw score based on responses to 

two questions ranges from 0 to 6. Studies have identified thresholds above which respondents 

screen positively for depression by balancing sensitivity (the ability of the screener to correctly 

identify those with depression) and specificity (the ability of the screener to correctly identify 

those without depression). Because there is no agreed-upon threshold that positively identifies 

individuals with depression, thresholds of 2, 3, and 4 were used to define three measures of 

screening positively for depression. The raw score itself was also examined. 

As a third measure of socialization, two variables were constructed based on a single 

question measuring individuals’ self-reported satisfaction with the opportunities they have had to 

spend time with other people. One variable indicates whether a respondent was very satisfied 

compared to somewhat satisfied, not too satisfied, and not at all satisfied; the other variable 

indicates whether a respondent was either very satisfied or somewhat satisfied, compared to not 

too satisfied or not at all satisfied.

Congregate meal participants generally had greater socialization outcomes compared to 

nonparticipants. Although there was no significant difference in loneliness scores between 

participants and nonparticipants, congregate meal participants were less likely than 

nonparticipants to screen positively for depression on most of the measures examined. Based on 

the most conservative measure of depression screening used, the percentage of individuals who

screened positively for depression was lower for congregate meal participants than for 

nonparticipants (2.3 versus 6.5 percent). Participants also had greater satisfaction with their

socialization opportunities relative to nonparticipants. The percentage of individuals who were 

satisfied with their socialization opportunities was 8 percentage points greater for congregate 

meal participants than for nonparticipants (94.0 versus 85.8 percent), and the percentage of 

individuals who were very satisfied with their socialization opportunities was 12 percentage 

points greater for congregate meal participants than for nonparticipants (67.5 versus 55.5 

percent).

For home-delivered meal participants, the findings were mixed; for some socialization 

outcomes there were no significant differences between participants and nonparticipants, yet for 

other socialization outcomes, participants had less favorable outcomes than nonparticipants. The 

average loneliness score was higher for home-delivered meal participants compared to 

nonparticipants (4.5 versus 4.3, respectively), indicating slightly more loneliness among 

participants, and the percentage of individuals who were very satisfied with their socialization 

opportunities was 8.9 percentage points lower for home-delivered meal participants than for 

nonparticipants (44.5 versus 53.4 percent). However, there were no significant effects of homedelivered meal participation on the likelihood of screening positively for depression across any 

of the measures used and there was no statistical difference between the percentages of homedelivered meal participants and nonparticipants who were satisfied with the socialization 

opportunities they have had. Furthermore, examining the impact on socialization outcomes 

separately according to the number of days per week that participants receive meals showed that 

for the vast majority of participants who receive meals five days per week, there were no 

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differences in outcomes between participants and nonparticipants, but for participants who 

receive fewer than five meals per week, home-delivered meal participants experienced greater 

loneliness and were less likely to be satisfied with their socialization opportunities compared to 

nonparticipants. 

3. Congregate and home-delivered meal participation and diet quality

The effect of program participation on diet quality outcomes was estimated using two 

measures: (1) the prevalence of adequate and excessive nutrient intakes and (2) the HEI-2010, 

which assesses overall diet quality. Both of these measures were estimated based on participants’ 

and nonparticipants’ usual daily intakes. For participants, this includes foods and beverages from 

program meals as well as foods and beverages obtained from other sources. The findings indicate 

that congregate meal participants generally had healthier diets compared to nonparticipants, both 

in terms of the adequacy of their usual daily nutrient intakes and the overall quality of their diets. 

The percentages of congregate meal participants with adequate intakes of niacin, zinc, and 

vitamin B6 were 16.6 to 18.5 percentage points higher than nonparticipants; for riboflavin, 

phosphorus, and vitamin B12, percentages were 8.3 to 13.1 percentage points higher. While these 

vitamins and minerals are important for people of all ages, some are especially important for 

older adults. For example, vitamin B6 is important for numerous metabolic reactions in the body 

and inadequacies sometimes lead to impaired immune function. Inadequate intakes of vitamin B6 

have also been associated with declines in cognitive functioning and depression, both of which 

are common among older adults (Institute of Medicine 2010). Vitamin B12 is an important 

nutrient of concern because decreased levels of stomach acid and many commonly prescribed 

medications can hamper its absorption. Low serum concentrations of vitamin B12 can have 

consequences for mobility and quality of life due to peripheral neuropathy and disturbances in 

balance and cognitive functioning, and can also increase the risk of heart disease and the loss of 

bone density (Institute of Medicine 2010). 

Although participants were more likely than nonparticipants to have adequate intakes of 

many nutrients, they were also more likely to have excessive sodium intakes. The percentage of 

congregate meal participants with excessive sodium intakes was 30.6 percentage points higher 

compared to nonparticipants. 

There was a sizeable difference between congregate meal participants and nonparticipants in 

total HEI-2010 scores, which provide an overall measure of diet quality. The total score for 

participants was 6.1 points higher than for nonparticipants (65.5 versus 59.4 points of 100). The 

statistically significant effect observed for the total HEI-2010 score reflects differences in scores 

for a number of HEI-2010 components. Relative to nonparticipants, congregate meal participants 

received higher scores for three adequacy components (total fruit, dairy, and total vegetables) 

reflecting greater consumption and higher diet quality, and a higher score for one moderation 

component (refined grains) reflecting lower consumption and higher diet quality. Refined grains 

are found in products that do not contain all of the components of the grain kernel, which may 

include white bread, cookies, cakes, pastries, muffins, pasta, and cold cereals made with refined 

flour.

Overall, home-delivered meal participants were more likely than nonparticipants to have 

adequate nutrient intakes, but there were few differences in the overall quality of their diets. 

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Compared to nonparticipants, a greater percentage of home-delivered meal participants had 

adequate intakes of zinc (18.5 percentage points greater), vitamin B6 (12.7 percentage points 

greater), vitamin A (11.8 percentage points greater), and vitamin D (6.6 percentage points 

greater). There was no significant difference in the proportion of people with excessive sodium 

intakes. In addition, the percentage of home-delivered meal participants with usual intakes of 

total fat that were within the acceptable range was 11.5 percentage points higher than the 

percentage for nonparticipants. Conversely, the percentage of participants with usual intakes of 

alpha-linolenic acid that were within the acceptable range was 24.0 percentage points lower 

compared to nonparticipants. Alpha-linolenic acid is a fatty acid found mostly in nuts and seed 

oils such as walnuts, flaxseeds, canola oil and soybean oil and is essential in the diet because it 

cannot be produced in the body and must be obtained from food sources. 

Few significant differences existed between home-delivered meal participants and 

nonparticipants in HEI-2010 scores. Although scores for dairy and refined grains were 

significantly higher for participants than nonparticipants (indicating higher diet quality), there 

were no significant differences in scores for any of the other components or for the total score.

4. Discussion and implications for future research

The lower food insecurity rate among congregate meal participants, relative to 

nonparticipants, aligns with expectations about how receipt of nutritious meals can reduce food 

access limitations. However, although congregate meal participants had lower food insecurity 

rates than did nonparticipants, a nontrivial percentage of participants were still food insecure. 

This points to the need to examine the determinants of food insecurity among NSP participants 

in greater detail, including how food insecurity is related to food coping strategies among lowerincome participants. More generally, given that many participants reported that they experience 

challenges in making ends meet, it is important to learn more about the characteristics and 

circumstances of the participants who are forced to make difficult trade-offs between food and 

other goods and services. Exploring the extent to which family networks and food coping 

strategies complement the meals and services received through the NSP would be a fruitful area 

for future research. 

No difference in the food insecurity rate existed between participants and nonparticipants, 

and, for participants who received fewer than five meals per week, home-delivered meal 

participants experienced greater food insecurity than nonparticipants. This suggests that some 

home-delivered meal participants experiencing food access limitations may not be receiving a 

sufficient number of meals per week to ameliorate their level of food insecurity. Learning more 

about why participants receive varying amounts of program meals and how their food needs are 

assessed is an important step in improving their food security. It is essential to learn more about 

how the intensity of service receipt for both programs—measured by the number of congregate 

meals attended or home-delivered meals received per week as well as use of multiple sites—

depends on factors such as income, whether participants live alone, and functional impairments 

and, ultimately, how it affects participants’ outcomes. 

Congregate meal participants had more positive socialization outcomes compared to 

nonparticipants. For some outcomes, such as satisfaction with socialization opportunities, 

differences between participants and nonparticipants were particularly large. Additional research 

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could examine congregate meal sites’ provision of socialization activities to assess whether the 

number of social activities that sites offer influences the improvement in socialization outcomes.

For home-delivered meal participants, the findings related to socialization were mixed; for 

some socialization outcomes, there were no significant differences between participants and 

nonparticipants, whereas for other socialization outcomes, participants had less favorable 

outcomes than nonparticipants. A possible explanation is that findings from the descriptive 

analysis showed that nearly half of home-delivered meal participants reported the delivery 

person seldom or never spent time talking to them as part of the delivery process. This highlights 

the need to examine the characteristics of the home-delivered meal participants who reported 

limited engagement from the delivery person, and whether the negative effects observed in the 

outcomes analysis reflected differences in levels of program staff engagement. Another possible 

explanation is that the number of days per week that a participant receives meals affects the 

opportunities for socialization. The negative effects were observed only for participants that 

received meals fewer than five days per week, and not for the majority of participants that 

receive meals five or more days per week. Examining how program staff engagement may differ 

for participants that receive varying amounts of program meals could help to identify ways of 

improving socialization outcomes among home-delivered meal participants.

Program meals contributed substantially to both congregate and home-delivered meal 

participants’ diets, contributing between 35 and 47 percent of participants’ daily intakes of 

nutrients among participants who consumed a program meal on the interview day. This finding 

indicates that both congregate and home-delivered meals are important sources of nutrition for 

participants. Further examination of the meals offered to participants would provide useful 

information on how modifying meals could improve participants’ diet quality. More information 

is needed about the types of foods that programs frequently offer and the major food sources of 

nutrients and food groups in program meals. 

Finally, congregate and home-delivered meals had a positive effect on diet quality, 

particularly on the prevalence of adequate nutrient intakes. However, additional research is 

necessary to assess the effects of participation on participants’ food consumption patterns. 

Participants generally had healthier diets than nonparticipants, but participants’ diets still fell 

short of the Dietary Guidelines’ recommendations. To understand what is driving the differences 

in nutrition-related outcomes for participants and nonparticipants, additional analyses that 

examine differences in the food choices of participants and nonparticipants (outside of program 

meals) would be useful. Analyses that identify the key contributors to nutrient and food group 

intakes would also be useful. Both of these analyses would provide information that could be 

used to identify specific foods and/or consumption patterns to target in nutrition education 

efforts. It is also important to examine how the overall diets of home-delivered meal participants 

differ from those of congregate meal participants, given that participation had fewer effects on 

diet quality among home-delivered meal participants. More research is necessary to identify the 

differences in nutrient intakes and food choices between home-delivered meal and congregate 

meal participants, both at lunch (from program meals) and over 24 hours. 

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I. INTRODUCTION

In an effort to ensure that the health and social needs of older adults are adequately met and 

to rebalance the provision of long-term care away from institutionalization and toward home and 

community-based services, the Administration on Aging (AoA) within the Administration for 

Community Living (ACL) of the U.S. Department of Health and Human Services (DHHS) 

administers the Title III-C Nutrition Services Program (NSP) as part of the Older Americans Act 

(OAA). The NSP promotes access to nutritious meals, facilitates social contact, and helps older 

adults maintain their independence in their homes and communities. 

Two core components of the program are the provision of congregate and home-delivered 

meals. NSP congregate meal participants can receive a nutritious meal at a senior center or other 

congregate meal sites. Most sites serve lunch on one or more weekdays; however, in recent 

years, breakfast and dinner and meals offered on weekends have become more common (Mabli 

et al. 2015). Congregate meal sites offer an opportunity for participants to socialize with peers 

and receive other services such as nutrition education, screening, and counseling. These services 

help older adults identify their general and specific needs related to maintaining their health and 

managing individual nutrition-related diseases such as heart disease, hypertension, and diabetes. 

Participants may also receive non-nutrition services, including transportation and case 

management services. 

Participants who are homebound receive nutritious home-delivered meals, typically five 

days per week. Most deliveries consist of a single meal such as a hot lunch, but meals come in a 

variety of forms including hot, cold, frozen, dried, canned, or shelf-stable, and some participants 

receive breakfast and/or dinner as well (Mabli et al. 2015). Like congregate meal settings, homedelivered meals offer an opportunity for socializing. Home-delivered meal volunteers might be 

older adults as well and, in addition to delivering meals, might offer the opportunity for face-toface contact or conversation. This allows volunteers to relay important information about 

participants’ well-being and needs to service providers. Homebound participants also receive 

nutrition education, nutrition screening and assessment, and nutrition counseling. In this way, the 

NSP provides homebound participants with a primary access point for many home- and 

community-based services to help meet their health and nutrition needs. 

The mission of the AoA is to develop a comprehensive, coordinated, and cost-effective 

system of long-term care that helps older adults maintain their independence in their homes and 

communities. As part of its ongoing efforts to support program planning, improve program 

efficiency, and strengthen program effectiveness, AoA contracted with Mathematica Policy 

Research to conduct the Title III-C NSP Evaluation. The three-part evaluation consists of a 

process evaluation of program administration and service delivery, a program cost analysis, and 

an evaluation of the effect of the program on participants’ outcomes. This report summarizes 

findings from the outcomes evaluation using data collected from program participants and 

nonparticipants. Another report will be issued to finalize the outcome evaluation using longerterm health outcomes. The findings from the process and cost components of the evaluation are 

presented separately (see Mabli et al. [2015] and Ziegler et al. [2015], respectively). The 

remainder of this chapter provides an overview of the NSP, summarizes the research objectives 

of the evaluation, and describes the organization of the report. 

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I. INTRODUCTION MATHEMATICA POLICY RESEARCH

A. Overview of the Title III-C Nutrition Services Program

The NSP is authorized under Title III of the OAA. Through Title III, State Units on Aging 

(SUAs) implement a system of coordinated, community-based services targeted to older adults. 

Title III authorized the provision of nutrition and supportive services, such as meals, nutrition 

education, transportation, personal and homemaker services, and information and referrals.4 The 

OAA has been amended frequently since the creation of the NSP in 1972. These amendments 

have added new responsibilities for agencies in the aging network and clarified responsibilities 

previously performed under the original legislation.

Under Title III-C of the OAA, AoA provides grants to SUAs to support the provision of 

daily meals and related nutrition services in either group (congregate) or home settings to adults 

age 60 and older. In fiscal year (FY) 2014, the most recent year in which counts of meals and 

individuals served are available, 80 million meals were served to 1.6 million people at 

congregate sites and 138 million home-delivered meals were provided to 836,000 homebound 

older adults (ACL 2014). OAA Title III-C funding was $438 million for congregate nutrition 

services and $216 million for home-delivered nutrition services in FY 2014 (ACL 2015). 

1. Funding and administration

Organizations in the National Aging Network, one of the nation’s largest provider networks 

of home- and community-based care for older adults and their caregivers, administer the NSP.

AoA’s central and regional offices provide overall federal coordination; however, the SUAs and 

the Area Agencies on Aging (AAAs) both support key aspects of program operations. In turn, 

local service providers (LSPs) typically provide the direct nutrition services. 

Under Title III, SUAs receive federal grants from AoA for provision of congregate nutrition 

services (authorized under Part C-1), home-delivered nutrition services (authorized under Part C2), and supportive services (authorized under Part B). Funds are allocated to states and territories 

according to a formula that is largely based on the state’s or territory’s share of the population 

age 60 and older among all states and territories.

SUAs distribute the funds to AAAs, which administer the nutrition services program within 

their respective planning and service areas. AAAs receive funds from SUAs on the basis of statedetermined formulas that reflect the proportion of older adults in their planning and service areas

and other factors. AAAs award grants to and contract with LSPs to provide nutrition and 

supportive services in their planning areas. AAAs, with a waiver from their state, can be direct 

providers of nutrition services as well. In addition to receiving AoA funds, AAAs and LSPs 

receive financial support from state and local government, in-kind contributions, private 

donations, and voluntary contributions from participants. Congregate meals and supportive 

services are provided at LSPs’ meal sites (such as senior centers, religious facilities, and public 

or low-income housing facilities). Home-delivered meals are provided to homebound individuals 

through the congregate meal sites, affiliated central kitchens, or nonaffiliated food service 

organizations. 

4 Similar nutrition and supportive services for elderly American Indians, Alaska Natives, and Native Hawaiians are 

authorized separately under Title VI.

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I. INTRODUCTION MATHEMATICA POLICY RESEARCH

2. Eligibility requirements

Adults age 60 and older, and their spouses of any age, may participate in the NSP’s 

congregate meal program. In addition, the members of the following groups are eligible to 

receive congregate meals:

• Disabled people younger than age 60 who reside in housing facilities, occupied primarily by 

older adults where congregate meals are served. 

• Disabled people who reside at home with, and accompany, people age 60 and older to meal 

sites.

• Nutrition service volunteers. 

For home-delivered meals, people who are homebound because of disability, illness, or 

isolation and are age 60 and older are eligible, as are their spouses of any age. Disabled people 

younger than age 60 living with older adults are also eligible. 

The NSP is not an entitlement program. It also does not have a means test, but the program 

specifically targets older adults with the greatest economic or social need, with special attention 

given to low-income older adults, minorities, those living in rural areas, those with limited 

English proficiency, and those at risk of institutional care. Payment for meals is not mandatory, 

but participants are encouraged to make a voluntary contribution toward the total cost of the 

meal. However, within site capacity, participants’ inability or unwillingness to contribute does 

not deny them of meals or other services.

3. Meals and services

LSPs must provide congregate and home-delivered meals that comply with the most recent 

Dietary Guidelines for Americans (“Dietary Guidelines”; DHHS and USDA 2015a) and provide 

a minimum of one-third of the Dietary Reference Intakes (DRIs) established by the Food and 

Nutrition Board of the Institute of Medicine of the National Academy of Sciences (Institute of 

Medicine 2006). In addition to meals, LSPs also provide for nutrition education, nutrition 

screening and assessment, and nutrition counseling if appropriate.5

B. Nutrition Services Program evaluation objectives and research questions

The objectives of the Title III-C NSP evaluation were to:

• Provide information to support program planning, including an analysis of program 

processes (referred to as the process study). 

• Develop information about program efficiency and cost issues (referred to as the cost study). 

• Assess program effectiveness, as measured by the program’s effects on a variety of 

important outcomes, including diet quality, socialization opportunities, health outcomes, 

and—ultimately—helping older adults avoid institutionalization (referred to as the outcomes 

evaluation). 

5 Additional LSP requirements are available in Section 339 of the OAA.

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I. INTRODUCTION MATHEMATICA POLICY RESEARCH

Separate reports present findings from the process study (Mabli et al. 2015) and the cost 

study (Ziegler et al. 2015). The process study report used data collected from SUAs, AAAs, and 

LSPs to assess the ways in which the program operates to serve older adults. The process study 

analyzed NSP structure, administration, staffing, coordination, processes, and service delivery. It 

also described the nutrition and supportive services that agencies offer; differences in participant 

access to services, prioritization of services, and the use of waiting lists; and program resources. 

The cost study report estimated the average costs of a congregate and a home-delivered meal 

provided under the NSP and assessed whether these average costs vary by meal preparation 

method or by other program characteristics. The cost study report also examined program 

efficiency by generating unit cost estimates for individual LSPs and examining cost variation 

within the program by cost component, meal preparation method, program size, and other 

program characteristics. 

The process and cost studies shed light on the diversity and organizational structure of the 

National Aging Network and whether the system operates efficiently. However, policymakers 

and program administrators also need to know whether the NSP succeeds in delivering services 

of benefit to older adults. Thus, a third major objective of the NSP evaluation is to assess 

whether the program improves participants’ diet quality in the short run and, thereby, improves 

health outcomes in the longer run—outcomes that would allow participants to stay in their homes 

and communities and delay or avoid institutionalization. 

This report summarizes findings from the outcomes evaluation. Specifically, the objectives 

of the evaluation are to: 

1. Describe NSP participants’ demographic and household characteristics, health status, 

mobility, eating behaviors, diet quality, food security, socialization, and other characteristics. 

2. Describe NSP participants’ experiences with and impressions of the NSP and their valuation 

of meals and supportive services received through the program. 

3. Determine the impact of NSP meals and related services on participants’ nutrition, food 

security, and diet quality (with a focus on nutrients linked to health of older adults) by 

comparing outcomes for NSP participants and nonparticipants. 

4. Determine the impact of NSP meals and nutrition services on overall wellness and wellbeing by comparing outcomes for NSP participants and nonparticipants. 

This report addresses the first three objectives and part of the fourth objective that assesses 

well-being based on loneliness, depression, and socialization opportunities. A separate report 

will address the final portion of the fourth objective that examines overall wellness measured 

using longer-term outcomes related to health and avoidance of institutionalization based on 

Medicare claims data. That analysis will determine the impact of receiving program services on 

patterns of health care behavior and utilization (especially doctor visits, emergency room care, 

and hospital admission and readmission) by comparing outcomes for NSP participants and 

nonparticipants. It will also determine the impact of the NSP on older adults’ ability to age in 

place and maintain current quality of life. 

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I. INTRODUCTION MATHEMATICA POLICY RESEARCH

C. Organization of the report

The remaining chapters of this report discuss the methodology used in the analysis and 

present findings. Chapter II provides an overview of the study design and the data and 

methodology used in the analysis. Chapter III presents detailed tables describing NSP

participants’ characteristics. Chapter IV presents estimates of the effect of participating in 

congregate and home-delivered meal programs on food security, socialization, and diet quality

outcomes. Chapter V summarizes findings to inform policy and discusses implications for future 

research.

The appendices of the report provide supporting material and additional tables. Appendix A 

supplements Chapter II with a more detailed discussion of the data and methodology. Appendix 

B contains additional tables showing mean usual nutrient intakes and usual intake distributions 

for participants. Appendix C supplements the Chapter IV tables by presenting estimates of 

program effects on outcomes for income and family subgroups. Appendix D contains additional 

tables showing mean usual nutrient intakes and usual intake distributions for nonparticipants. 

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II. OVERVIEW OF DATA AND METHODOLOGY 

The outcomes evaluation draws primarily on information obtained from comprehensive 

surveys and 24-hour dietary recalls collected from samples of program participants and a 

matched comparison group of program-eligible nonparticipants. This chapter presents an 

overview of the sampling design, discusses the data collection, describes additional data sources 

used in the analysis, defines the evaluation’s outcome measures, and presents the analytic 

methods used to address the evaluation’s research objectives. 

A. Sampling design

The evaluation used a multistage clustered sample design. The stages of sampling were:

1. AAAs

2. LSPs within AAAs

3. Congregate meal sites and home-delivered meal distribution locations within LSPs

4. Home-delivered meal routes within home-delivered meal distribution locations 

5. Congregate meal participants within each congregate meal site and home-delivered meal 

participants within each home-delivered meal route 

In addition, the research team obtained a matched sample of congregate and home-delivered 

meal nonparticipants. Details are available in Appendix A. 

Data collection spanned one week for each randomly selected congregate meal site and 

home-delivered meal route. In congregate meals sites, field staff attended the main congregate 

meal (usually lunch) on the first day meals were provided. They randomly sampled congregate 

meal participants and conducted interviews. Similarly, on the first day of meal provision for each 

home-delivered meal distribution location, program staff provided a list of all home-delivered 

meal participants for the sampled route, participants were randomly sampled, and field staff 

conducted interviews in homes or another convenient location. 

Finally, in the same geographic area as the sampled congregate meal sites and homedelivered meal routes, the research team obtained a list of Medicare beneficiaries from the 

Centers for Medicare & Medicaid Services (CMS) and used statistical matching techniques to 

identify older adults with characteristics similar to those in the congregate and home-delivered 

meal samples to form the study’s comparison groups. The research team screened potential 

program-eligible nonparticipants by phone to exclude anyone who (1) participated in congregate 

or home-delivered meal programs in the past year; (2) lived in a nursing home, assisted living 

facility, group home, or rehabilitation facility; or (3) did not live in the same zip code as the 

participant to whom they were matched. Field staff interviewed nonparticipants in their homes 

or, for some congregate meal nonparticipants, a public location such as a local library. 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

B. Data collection 

Multiple instruments were used to collect data from NSP participants and nonparticipants. 

The instruments were pretested and pilot-tested, and interviews were conducted from October 

2015 to April 2016. 

1. Instruments

The research team collected data from NSP participants and nonparticipants in a computerassisted personal interview (CAPI) using two main instruments: an outcomes survey and a 24-

hour dietary recall. For nonparticipants, a short survey was also administered to screen and 

recruit individuals into the study. 

The outcomes survey collected information on a comprehensive set of topic areas including 

demographic characteristics, food security, health insurance coverage, health status and 

depression, and loneliness. In addition, all respondents were asked about their NSP participation 

history, and congregate and home-delivered meal participants were asked about the types of 

services they received, their impressions of the program and services, and monetary 

contributions for program meals. 

To describe NSP participants’ and nonparticipants’ diet quality and to assess the effect of 

the meal and related services on participant nutrition and diet quality, the research team 

conducted 24-hour dietary recalls with participants and nonparticipants. The Automated SelfAdministered 24-hour dietary recall system (ASA-24 Adult Version 2014) developed by the 

National Cancer Institute (2014) was used as an in-person interviewer-administered tool to 

collect the 24-hour dietary recall data. The research team collected a second day of dietary 

recalls from a subsample of participants and nonparticipants to estimate the distributions of usual 

intakes of key nutrients. The dietary recall data provide information on the nutrients and food 

group equivalents (amounts) participants and nonparticipants consumed over 24 hours. 

Finally, the research team used a short computer-assisted telephone interview (CATI) survey 

to screen and recruit meal program nonparticipants to participate in the study. The screener 

determined whether nonparticipants were eligible for the study using the criteria described in the 

sampling section. 

2. Pretesting

The research team pretested the outcomes survey with nine congregate and home-delivered 

meal participants (described in Appendix A). A small-scale pilot was also conducted to test the 

operational aspects of data collection. The pilot included conducting both the outcomes survey 

and the 24-hour dietary recall with 32 congregate and home-delivered meal participants from 

five meal program sites. As a result of the pilot test, the research team significantly reduced the 

length of the survey and incorporated “frail skips” that interviewers could use to bypass 

noncritical sections of the survey when respondents struggled to complete the survey due to 

length or fatigue. 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

3. Conducting interviews

The field data collection began in October 2015 and ended in April 2016. From late October 

2015 through early January 2016, field interviewers collected information from program 

participants. Data collection in each site spanned five days. Field interviewers randomly selected 

congregate and home-delivered meal participants to participate in the study on one day and, over 

the next four days, administered the outcomes survey and 24-hour dietary recall to sampled 

participants who agreed to participate in the study. The research team conducted a second dietary 

recall with a subsample of participants at least one day after their first dietary recall. From late 

January 2016 through early April 2016, field interviewers returned to the same geographic areas 

where they had interviewed program participants to interview a predetermined matched sample 

of nonparticipants identified through the nonparticipant screener. As with the participant 

samples, a second dietary recall was conducted with a subsample of nonparticipants at least one 

day after their first dietary recall. 

Response rates. The American Association for Public Opinion Research’s (APPOR) 

Standard Definitions, ninth edition, was used to calculate response rates (APPOR 2016). The 

outcomes survey response rates were 76.1 percent for congregate meal participants and 54.1 

percent for home-delivered meal participants (Appendix Table A.1). The outcomes survey 

completion rates for nonparticipants who were recruited from the telephone screener were 79.1 

percent for congregate meal nonparticipants and 76.6 percent for home-delivered meal 

nonparticipants (Appendix Table A.2).

C. Additional data sources

To address the research objectives, the research team linked the outcomes survey data to 

several other data sources. 

1. Neighborhood contextual data from the American Community Survey

Data from the American Community Survey was used to obtain local-area population 

characteristics. To obtain characteristics for small census geographies, such as census tracts, the 

Census Bureau aggregates data over five years. The 2010 to 2014 American Community Survey 

summary file was used to obtain tract-level measures of population, the percentage of families 

with income below 200 percent of the federal poverty threshold, the percentage of the total 

population that is non-white, the percentage of the total population that is Hispanic, and the 

percentage of housing units without access to a vehicle. 

2. Geographic address data for participants and food retailers

To describe NSP participants’ geographic access to food, the research team used participant 

address information for each respondent in the outcomes survey, data from the Census Bureau, 

and address data for food retailers from the U.S. Department of Agriculture (USDA). The 

research team geocoded the address information and calculated measures of geographic access to 

food based on (1) distances from each participant to the nearest store in the area and (2) the 

number of retailers, by type, within three distances from each participant’s residential address. In 

urban areas, the distances are less than 0.5 miles, 0.5 to less than 1 mile, and 1 to 2 miles. In rural 

areas, the distances are less than 5 miles, 5 to less than 10 miles, and 10 to 20 miles. 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

D. Outcome measures

Outcomes in three different domains were analyzed: food security, socialization, and diet 

quality. 

1. Food security

Food security is having access at all times to enough food for an active, healthy life for all 

household members (Coleman-Jensen et al. 2015). Evaluations of the effectiveness of nutrition 

assistance programs in improving food security typically measure whether participating in the 

program reduces food insecurity, defined as whether a household experiences food access 

limitations due to lack of money or other resources. The research team used the six-item food 

security module (Bickel et al. 2000) to create a binary variable indicating whether an individual 

lived in a household that was food insecure in the past 30 days and a second variable indicating

whether a household experienced a particularly severe level of food insecurity—referred to as

“very low food security.” 

2. Socialization 

The research team assessed socialization using three measures. First, individuals’ loneliness 

was measured using an abbreviated version of the Revised UCLA Loneliness Scale (R-UCLA; 

Russell et al. 1980; Hughes et al. 2004). The scale is based on responses to three questions 

related to how often respondents feels they lack companionship, feel left out, and feel isolated 

from others. Higher scores indicate greater perceptions of loneliness. 

The second measure came from the Patient Health Questionnaire 2 (PHQ-2), an abbreviated 

version of the nine-question PHQ used to diagnose depression. The PHQ-2 assesses the 

frequency of depressed mood over the past two weeks; however, because it consists of only two 

of the nine questions, the PHQ-2 can be used for depression screening but not diagnosis. A raw 

score based on the responses to questions ranges from 0 to 6. Studies have identified thresholds 

above which respondents screen positively for depression by balancing sensitivity (the ability of 

the screener to correctly identify those with depression) and specificity (the ability of the 

screener to correctly identify those without depression). Research comparing the PHQ-2 to 

patients with depression diagnoses found that a score of 3 or greater was best to achieve this 

balance (Li et al. 2007; Lowe et al. 2005). However, researchers have recommended that further 

research evaluate validity and cutoff scores for older adults (Sheeran et al. 2010). Because there 

is no agreed-upon threshold that positively identifies individuals with depression, the research 

team used thresholds of 2, 3, and 4 to define three measures of screening positively for 

depression. The raw score itself was also examined. Thus, when considering this outcome, the 

research team looked for consistency in findings across these depression screening measures. 

As a third measure of socialization, two variables were constructed based on a single 

question measuring individuals’ self-reported satisfaction with the opportunities they have had to 

spend time with other people. One variable indicates whether a respondent was “very satisfied”

compared to “somewhat satisfied,” “not too satisfied,” and “not at all satisfied”; the other 

variable indicates whether a respondent was either “very satisfied” or “somewhat satisfied,” 

compared to “not too satisfied” or “not at all satisfied.” 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

3. Diet quality

The research team used several measures to examine the quality of participants’ diets and 

assess the effects of participating in the NSP on diet quality. First, the contribution program 

meals made to participants’ daily intakes of calories and nutrients was examined. The research 

team also estimated usual nutrient intakes to assess the prevalence of adequate and excessive 

nutrient intakes among participants and nonparticipants. To assess the overall quality of the diets 

consumed by participants and nonparticipants, the Healthy Eating Index (HEI)-2010 was used, 

which assesses conformance to key recommendations of the 2010 Dietary Guidelines. 

For the first measure of diet quality, the research team estimated the percentage contribution 

that program meals made to NSP participants’ daily calorie and nutrient intakes. To help the 

research team identify foods obtained from program meals, participants reported the source of 

each food reported in the 24-hour dietary recall. Because some participants do not receive meals 

every day, not all participants consumed a program meal on the day referenced in the 24-hour 

dietary recall (the intake day). The percentage contribution of program meals to participants’ 

daily nutrient intakes was computed as the sum of the nutrients from all foods obtained from 

program meals divided by total daily nutrient intakes. The mean percentage contribution was 

estimated two ways: (1) for all participants, including those who did not consume a program 

meal (where the contribution is zero for non-consumers); and (2) for only participants who 

consumed a program meal on their intake day. The first measure provides information on the 

contribution of program meals to participants’ intakes on an average day. The second measure 

provides information on the relative contribution of program meals on days where participants 

consume meals. 

To assess the prevalence of adequate and excessive nutrient intakes among NSP participants

and nonparticipants, the research team estimated usual intakes of vitamins, minerals, 

macronutrients, and other dietary components relative to the DRIs and select recommendations 

from the 2015-2020 Dietary Guidelines. The DRIs are the most up-to-date scientific standards 

for determining whether diets provide enough nutrients to meet requirements, without being 

excessive. (The DRIs are defined in Chapter III and Appendix A.) The research team used the 

method developed by the National Cancer Institute to estimate usual intake distributions, mean 

usual intakes, and the percentages of participants and nonparticipants with usual intakes that 

were above, below, or within DRI standards or 2015-2020 Dietary Guidelines recommendations. 

The National Cancer Institute method applies an econometric model to dietary recalls to estimate 

the distribution of usual intakes for the full population and any subpopulations of interest (Tooze 

et al. 2010; Freedman et al. 2010). Estimating usual nutrient intakes requires both the first 24-

hour recall and, for a subsample of participants and nonparticipants, the second day 24-hour 

recall.

For the third measure, the research team used the HEI-2010 to assess the overall quality of 

the diets consumed by NSP participants and nonparticipants. The HEI-2010 is a measure of diet 

quality that assesses conformance to key recommendations of the 2010 Dietary Guidelines

(Guenther et al. 2013). The USDA has adopted it as a tool to monitor the quality of foods 

consumed by the U.S. population overall, as well as progress toward healthier eating habits 

among food assistance program participants (Guenther et al. 2007). The HEI-2010 is a scoring 

metric made up of 12 components, each reflecting a key aspect of diet quality, and a total score 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

that measures overall diet quality. The standards used to assign HEI-2010 component scores are 

expressed on a density basis (that is, amounts per 1,000 calories or a percentage of calories), 

rather than absolute amounts of foods consumed. The use of such standards in assessing diet 

quality reflects the recommendation that individuals should strive to meet food group and 

nutrient guidelines while maintaining calorie balance, rather than meeting these guidelines 

simply by consuming large quantities of food. 

The HEI-2010 consists of nine adequacy components, which are dietary components 

individuals are recommended to consume to ensure adequate nutrient intakes, and include the 

following: 

• Total fruit, including juice 

• Whole fruit 

• Total vegetables

• Greens and beans

• Whole grains 

• Dairy

• Total protein foods 

• Seafood and plant proteins 

• Fatty acids

The remaining three components, referred to as moderation components, measure dietary 

components that individuals are recommended to limit, and include the following: 

• Refined grains

• Sodium 

• Empty calories

Maximum component scores for the various components range from 5 to 20. Higher scores 

for the adequacy components reflect greater consumption and higher diet quality, whereas higher 

scores for the moderation components reflect lower consumption and higher diet quality. Scores 

for each of the 12 components are summed to create a total HEI-2010 score, which ranges from 0 

to 100. Two HEI-2010–related outcomes were estimated: (1) mean total and component HEI2010 scores, and (2) percentages of the maximum possible component and total scores. 

Additional details on scoring are available in Chapter III and Appendix A. 

E. Analytic methods

Descriptive, tabular analysis was used to describe the characteristics of older adults who 

participate in the NSP, participants’ impressions of the program, and their valuation of meals and 

supportive services received through the program. For categorical variables, the percentage of 

participants who responded in each category was estimated. For continuous variables, the mean 

and median values of the distribution among participants and the percentages of participants with 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

values in different ranges of the distribution are presented. (The median, or 50th percentile of the 

distribution, is the value for which 50 percent of the observations are less than or equal to.) All 

analyses were conducted separately for congregate and home-delivered meal participants. 

To estimate the effect of receiving a congregate meal or home-delivered meal on food 

security, socialization, and diet quality, the research team compared outcomes for participants 

and a matched comparison group of program-eligible nonparticipants. The purpose of a

comparison group of eligible nonparticipants is to represent what would happen to participants in 

the absence of the program. The comparison group of nonparticipants should ideally be as 

similar as possible to the sample of participants, except for program participation and random 

variation. Despite efforts to use Medicare administrative data to identify a group of 

nonparticipants who were comparable to participants across several critical individual 

characteristics related to outcomes (that is, demographics, Medicare eligibility, chronic 

conditions including depression, and health care service utilization and expenditures [see 

Appendix A]), the characteristics of the two samples differed. Consequently, the analyses used 

statistical methods and the outcomes survey data to control for differences in the characteristics 

of participants and nonparticipants that affect both outcomes and program participation

decisions. 

The methods used differed depending on the outcome measure examined. For individuallevel outcomes in the domains of food security and socialization, the research team estimated 

multivariate regressions to estimate the effect of NSP participation on the outcomes, controlling 

for characteristics that could be related to both program participation and the outcomes studied. 

(These regressions are described in detail in Appendix A.) The research team also used weights 

for nonparticipants generated using a propensity-score matching algorithm based on machine 

learning called boosting (Ridgeway and McCaffrey 2007; Lee et al. 2010), that, when used in the 

analyses, made the characteristics of participants and nonparticipants similar in terms of all of 

the characteristics the model includes. The research team could not use multivariate regression, 

however, to estimate the effect of NSP participation on HEI-2010 scores and usual nutrient 

intakes relative to national standards because they are population-based estimates computed at 

the group level rather than the individual level. Thus, the analyses of those outcomes solely use 

the propensity-score weights to make the groups more comparable. 

All multivariate analyses were conducted 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 HEI-2010 scores were also conducted separately for two important 

household and economic subgroups. The research team reestimated the analyses by monthly 

household income relative to poverty, dividing the sample roughly in half into lower-income and 

higher-income groups. The research team also reestimated the models according to whether 

individuals lived alone or with other family members. 

The multistage sampling design of the outcomes evaluation was accounted for when 

estimating standard errors. This is described in detail in Appendix A. 

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II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

F. Analysis weights

Analysis weights allow unbiased estimates to be computed based on sample survey 

responses from the study population. Weights take into account both the probability of selection 

into the sample and the differential response patterns that may exist in the respondent sample.

Because not all respondents from the outcomes survey completed the 24-hour dietary recalls, the 

research team constructed one set of weights for analyses using data from the outcomes survey 

and a second set of weights for analyses using data from both the outcomes survey and the 24-

hour dietary recall data. For each set, weights were constructed separately for congregate meal

participants and nonparticipants and home-delivered meal participants and nonparticipants. 

Based on weighted data, the congregate and home-delivered meal participant findings in 

Chapter III of this report are nationally representative of the population of congregate and homedelivered meal participants. This is not true for the nonparticipants who completed interviews, 

however, because, by design, they were not sampled from a frame of nonparticipating older 

adults. Instead, the estimates of the effects of congregate and home-delivered meal participation 

on outcomes that use weighted participant and nonparticipant data are representative of the 

effects for the population of congregate and home-delivered meal participants; that is, the study 

is meant to assess the effect of the programs on those who choose to participate in the program, 

not on the entire population. 

G. Study limitations

This report represents the most comprehensive assessment in 20 years of the effectiveness of 

the Title III-C NSP in improving participants’ outcomes. When interpreting the report’s findings, 

it is important to consider two limitations.

Item nonresponse. Although interviewers administered the surveys, respondents were able 

to respond “don’t know” or refuse to answer questions. The percentages and estimates presented 

in Chapter III of this report are based on responses that exclude both types of missing data. As a 

result, item nonresponse bias is possible for those estimates. Item nonresponse bias occurs when 

individuals who respond to a question differ in meaningful ways from those who do not respond. 

This was not a serious problem for most survey questions, however, as all of the estimates 

presented in the tables either had no item nonresponse or had a particularly low percentage of 

item nonresponse, which was defined as at least an 80 percent response rate. 

Causality. Both the propensity-score matching procedure and regression analysis can adjust 

for differences only in observable characteristics, whereas program participants might also differ 

from nonparticipants in unobservable ways that could influence the estimates of program impacts 

on outcomes. Therefore, the findings based on either approach cannot be definitively interpreted 

as causal effects of the extent to which program participation affects food security, socialization, 

and diet quality. Instead, these procedures adjust—to the extent possible—for observable 

differences likely to be correlated with the outcome measures. This allows similar groups of 

participants and nonparticipants to be compared, while still acknowledging that unobservable 

factors might influence differences in outcome measures. The research team attempted to 

minimize this possibility, however, by using a powerful research design that (1) matched 

participants and nonparticipants based on a comprehensive set of demographic and health 

14
II. OVERVIEW OF DATA AND METHODOLOGY MATHEMATICA POLICY RESEARCH

characteristics in Medicare administrative records and (2) identified matched nonparticipants 

within small, local geographic areas (zip codes) in which participants lived.

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES

This chapter describes congregate and home-delivered meal participants’ characteristics and 

circumstances; nutrition and well-being outcomes; and overall impressions of the congregate and 

home-delivered meal programs. Information is presented separately for each program and 

describe differences and similarities between congregate and home-delivered meal participants. 

Section A describes participants’ demographic characteristics, including income; health status, 

functional ability, and mobility; as well as food and dietary behaviors, diet quality, receipt of 

nutrition and supportive services, geographic access to food, food security, and food coping 

strategies and participation in food assistance programs. Section B describes participants’ 

impressions of the NSP, their valuation of meals and supportive services received through the 

program, and opportunities for social interactions. 

A. Characteristics of participants

1. Demographic characteristics

Congregate and home-delivered meal participants were similar in terms of gender, veteran 

status, and whether they live alone, but compared to congregate meal participants, homedelivered meal participants, on average, were older, had less education, and were more likely to 

be widowed. The average congregate meal participant was 77 years old; the average homedelivered participant was age 82 (Table III.1). Fifty-nine percent of congregate and 79 percent of 

home-delivered meal participants were 75 and older. More than two-thirds of congregate and 

home-delivered meal participants were women and 15 to 17 percent were veterans. The 

percentage of participants who were married was similar across the two programs, although 

52 percent of home-delivered meal participants were widowed compared to 47 percent of 

congregate meal participants. Many participants lived alone (60 percent of congregate meal 

participants and 59 percent of home-delivered meal participants). Twenty-eight percent of 

congregate meal participants and 25 percent of home-delivered meal participants resided in rural 

areas.

Participants in each program were largely non-Hispanic white individuals, but a sizable 

percentage of participants were members of racial and ethnic minority groups. Non-Hispanic 

blacks constituted approximately 14 percent of congregate meal participants and 18 percent of 

home-delivered meal participants (Table III.1). Hispanics accounted for another 13 percent and 9 

percent, respectively, of participants in the two programs. 

2. Income characteristics

Although the OAA prohibits financial means tests for participation in the NSP, most 

participants were poor or near poor. Thirty-one percent of congregate meal participants and 

35 percent of home-delivered meal participants had annual household incomes below 100 

percent of the DHHS federal poverty guidelines (Table III.2). (For a 1-person household, this 

corresponds to $11,770.) Most of the rest had annual household incomes between 100 and 200 

percent of the poverty guidelines. Only about one-quarter of congregate and 20 percent of homedelivered meal participants had annual household incomes above 200 percent of the poverty 

guidelines. 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Sources of income were similar for congregate and home-delivered meal participants. 

Virtually all participants received income from Social Security (97 percent); and approximately 

half of both groups (49 percent of congregate meal participants and 47 percent of home-delivered 

meal participants) received income from pensions or a retirement fund (Table III.2). Reflecting 

their younger age and better health, nearly 20 percent of congregate meal participants had 

income from employment (full- or part-time work) compared to just 5 percent of home-delivered 

meal participants. 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.1. Selected demographic and household characteristics of Nutrition 

Services Program participants

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Age 

70 and younger 22.2 11.4

71 to 74 19.0 9.6

75 to 84 41.2 36.0

85 and older 17.6 43.1

Average age (years) 77.1 81.8

Gender 

Male 33.1 31.5

Female 66.9 68.5

Military service 

Veteran 16.6 14.7

Nonveteran 83.4 85.3

Highest grade level completed 

8th grade or less 9.5 24.6

9th to 12th grade (no diploma) 14.0 15.7

High school graduate, GED, or equivalent 30.5 27.8

Some college (no degree) 20.3 11.7

Associate’s degree, occupational, or technical degree 12.8 7.1

Bachelor’s degree 9.8 7.8

Master’s degree or higher 3.1 5.3

Race/ethnicity 

Non-Hispanic 

White 66.2 71.8

Black 13.8 17.7

 Asian 3.9 0.3

American Indian 4.0 4.6

Other 0.9 0.4

Hispanic 

White 10.0 8.7

Black 0.8 0.0

 Asian 1.5 0.0

American Indian 0.2 0.1

Other 0.6 0.3

Marital status 

Married or living with partner 24.9 24.0

Widowed 46.5 52.0

Divorced 16.1 17.3

Separated 4.8 0.6

Never married 7.7 6.0

Number of other people living in household 

Live alone 60.2 59.1

1 29.3 27.3

2 4.8 6.2

3 or more 5.7 7.4

Urbanicity 

Urban 72.3 74.9

Rural 27.7 25.1

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.2. Sources and distribution of income among Nutrition Services 

Program participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

Monthly income-to-poverty ratioa 

0 2.0 0.0 

1 to 50 3.5 6.3

51 to 100 25.7 28.3

101 to 150 28.1 26.7 

151 to 200 17.6 19.2

201 to 300 14.3 12.7 

301 and above 8.8 6.8

Annual income-to-poverty ratio 

0 1.8 0.0 

1 to 50 5.0 7.7 

51 to 100 23.5 27.6

101 to 150 28.2 24.6

151 to 200 13.8 18.7 

201 to 300 15.8 13.7

301 and above 12.0 7.7

Sources of income 

Full-time or part-time work 16.9 5.0

Social Security 96.9 96.8

Unemployment compensation 0.5 0.3

SSDI or workers’ compensation 8.4 5.1

SSI 12.3 12.2

Pension or retirement fund 49.0 46.6

General assistance 2.7 4.8

Money from relatives 3.8 2.6

Other sources 7.9 3.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

a Income-to-poverty ratio based on DHHS’ poverty guidelines (https://aspe.hhs.gov/2015-poverty-guidelines). 

SSDI = Social Security Disability Insurance; SSI = Supplemental Security Income.

3. Health status, functional ability, and mobility

Compared to congregate meal participants, a greater percentage of home-delivered meal 

participants reported being in fair or poor health, being underweight, having trouble eating due to 

dental issues, and taking multiple medications. Nearly half (46 percent) of home-delivered meal 

participants reported being in fair or poor health, compared to 23 percent of congregate meal 

participants (Table III.3); home-delivered meal participants were about half as likely to report 

being in excellent health (6 versus 13 percent). 

Twenty-seven percent of congregate meal participants and 38 percent of home-delivered 

meal participants had an estimated body mass index (BMI) in the normal range (Table III.3). 

Most participants were either over- or underweight, placing them at increased risk for weightrelated diseases and other health problems. Six percent of home-delivered meal participants were 

underweight, compared to 1 percent of congregate meal participants. Seventy-two percent of 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

congregate meal participants and 57 percent of home-delivered meal participants had a BMI 

greater than 25, indicating they are overweight or obese and at risk for developing certain 

diseases such as heart disease, diabetes, high blood pressure, and some types of cancer.

Unintentional changes in body weight have been associated with an increased risk of poor 

nutritional status and adverse health problems (Nutrition Screening Initiative 1991), and 

24 percent of congregate meal participants and 30 percent of home-delivered meal participants 

reported that they had recently lost or gained 10 pounds unintentionally. 

Many older adults take multiple medications concurrently, which increases the potential for 

adverse drug-nutrient interactions, and adverse effects of malnutrition on drug absorption, 

metabolism, or utilization (Boullata and Armenti 2004). Sixty-eight percent of congregate meal 

participants and 82 percent of home-delivered meal participants reported taking three or more 

prescription medications daily (Table III.3).

Table III.3. General health status of Nutrition Services Program participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

General health 

Excellent 12.8 6.4

Very good 27.5 12.5

Good 36.7 35.3

Fair 18.6 30.4

Poor 4.4 15.4

Body mass index 

Below 18.5 (underweight) 0.8 5.6

18.5 to 24.9 (normal) 27.0 37.7

25.0 to 29.9 (overweight) 33.8 27.6

30.0 and above (obese) 38.4 29.1

Unintentional gain or loss of 10 pounds in past six months 23.9 30.3

Trouble eating due to condition of teeth, gums, or other 

dental issue

 

Yes 11.5 25.7

No 88.5 74.3

Number of prescription medications taken every day 

0 11.2 2.5

1 or 2 21.2 15.4

3 to 5 39.1 34.3

6 to 9 20.7 30.7

10 or more 7.8 17.1

Average 4.3 6.0

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

The prevalence of doctor-diagnosed chronic health conditions were substantially higher for 

home-delivered meal participants than for congregate meal participants. The most common 

doctor-diagnosed health problems, reported by one-half to almost three-quarters of program 

participants, consisted of high cholesterol, arthritis or rheumatism, eye conditions, and 

21
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

hypertension (Table III.4). The prevalence of arthritis, cancer, hearing impairments, stroke, and 

dementia were 8 to 15 percentage points higher for home-delivered meal participants than for 

congregate meal participants. Thirty-five percent of congregate meal participants and 41 percent 

of home-delivered meal participants also reported a history of heart disease.

Nearly all participants had health insurance coverage; only one percent of congregate meal 

participants reported not having any medical insurance (Table III.4). Ninety-four percent of 

congregate and home-delivered meal participants had prescription drug coverage.

Table III.4. Medical status and insurance characteristics of Nutrition 

Services Program participants

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Medical doctor has diagnosed 

Anemia 16.6 23.3

Arthritis or rheumatism 60.3 69.2

Breathing or lung problems 39.3 43.9

Cancer (excluding minor skin cancer) 20.2 28.2

Dementia or Alzheimer’s disease 3.0 10.9

Diabetes or high blood sugar 32.6 36.3

Hearing impairment 26.3 41.7

Heart disease 34.9 41.0

High blood pressure (hypertension) 70.0 73.8

High cholesterol 57.2 53.0

Kidney disease 10.6 10.5

Medical conditions of the eye 67.7 69.4

Osteoporosis 19.4 23.5

Stroke 9.6 22.3

Type of medical insurance 

Private health insurance 97.6 95.4

Medicare 8.7 9.5

Medi-Gap 48.1 43.1

Medicaid 18.0 18.8

Military health care 5.7 9.1

Indian health service 0.2 0.3

State-sponsored health plan 3.9 5.0

Other government program 1.1 0.9

No coverage 1.1 0.0

Has prescription drug coverage 93.6 94.0

Has dental care coverage 34.9 26.1

Has vision care coverage 53.5 52.2

Has long-term care or nursing home care coverage 21.1 25.6

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

The prevalence of recent falls, injuries from falls, and fear of fall-related injuries was much 

higher for home-delivered meal participants compared to congregate meal participants. Fourteen 

percent of home-delivered meal participants reported having had two or more falls during the 

past three months compared to 7 percent of congregate meal participants. Among those 

22
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

individuals who experienced a fall, 45 percent of home-delivered meal participants reported a 

fall that had resulted in an injury, compared to 28 percent for congregate meal participants (Table 

III.5). Home-delivered meal participants were also more likely to report a fear of falling

(76 versus 67 percent). 

A substantial proportion of home-delivered meal participants reported functional 

impairments and needed help performing one or more activities critical for them to remain in 

their homes. One percent of congregate meal participants were not able to walk and 33 percent 

had difficulty climbing stairs; this compares to 12 percent of home-delivered meal participants 

who could not walk and 64 percent who had difficulty climbing stairs (Table III.6). Homedelivered meal participants were also three to nine times more likely than congregate meal 

participants to have a condition that could affect independent living. For example, 47 percent of 

home-delivered meal participants were unable to shop or had difficulty shopping for groceries or 

personal items without assistance, compared with 6 percent of congregate meal participants; 

43 percent of home-delivered meal participants had difficulty bathing, compared with 6 percent 

of congregate meal participants; and 29 percent of home-delivered meal participants had 

difficulty dressing, compared with 4 percent of congregate meal participants. 

Table III.5. Recent falls and fall-related injuries among Nutrition Services 

Program participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

Number of falls in the past three months 

0 77.3 66.9

1 15.7 19.2

2 4.2 5.2

3 or more 2.9 8.8

Number of falls in the past three months that caused an 

injury

 

0 72.1 55.4

1 24.4 33.9

2 1.4 7.3

3 or more 2.0 3.4

Fearful of falling 

Not at all 32.9 24.0

A little 35.6 27.7

Somewhat 18.7 22.2

A lot 12.8 26.0

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.6. Presence of conditions that could affect independent living

among Nutrition Services Program participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

Mobility 

Able to walk 99.0 88.5

Able to walk, but has difficulty walking or climbing stairs 32.9 64.2

Bedbound 0.0 2.2

Chairbound or in a wheelchair 1.0 9.3

Has serious difficulty concentrating, remembering, or making 

decisions because of a physical, mental, or emotional condition

13.4 30.8

Has difficulty performing the following activities: 

Shopping for groceries or personal items, such as toiletries or 

medicine

5.9 47.0

Getting to a store to buy groceries or personal items 8.7 49.0

Using the telephone 3.0 20.9

Doing light housework 9.0 45.4

Using public transportation or riding in a private automobile 4.7 31.4

Taking medications 1.6 10.3

Managing money or balancing a checkbook 7.8 20.8

Taking a bath or shower 5.7 43.3

Dressing 4.2 29.1

Getting in or out of a bed or chair 8.1 27.6

Eating 1.0 9.0

Using the toilet 1.4 13.2

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

4. Diet and eating behaviors 

Only two thirds of congregate and home-delivered meal participants reported consuming 

about three meals a day (Table III.7). About half of congregate meal participants and nearly 

70 percent of home-delivered meal participants usually ate alone. Eleven percent of congregate 

meal participants described their appetite as poor or fair, compared with 29 percent of homedelivered meal participants. More than one-quarter of congregate (27 percent) and homedelivered meal participants (34 percent) were on special diets for health, medication, religious, or 

cultural reasons. The most common were diets associated with diabetes (about 60 percent of 

those on special diets from each program) and diets to reduce sodium intakes and lower blood 

cholesterol levels.

Congregate and home-delivered meal participants differed in their ability to prepare meals at 

home. Relative to congregate meal participants, home-delivered meal participants were twice as 

likely not to cook (19 and 42 percent, respectively) (Table III.8). The vast majority (95 percent) 

of congregate meal participants and the majority (68 percent) of home-delivered meal 

participants were able to prepare hot meals if necessary. Nearly all participants had access to a 

refrigerator, freezer, stove or toaster oven, or microwave; home-delivered meal participants had 

slightly greater access to this equipment compared to congregate meal participants. 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.7. Diet and eating behavior among Nutrition Services Program

participants

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Number of meals per day 

0 to 1 3.6 6.9

2 23.5 27.9

3 68.4 61.8

4 or more 4.6 3.4

Mean 2.8 2.6

Median 3.0 3.0

Currently on a special diet for health, medication, religious, or 

cultural reasons

27.3 34.1

Type of special diet 

Diabetic 59.6 60.2

Low-sodium 43.8 40.9

Low-cholesterol 21.4 16.0

Low-calorie 9.3 9.5

Low-sugar 27.4 23.5

Low-fat 18.1 15.2

Low-fiber 1.7 0.2

High-fiber 5.6 5.4

Ground or pureed 2.6 0.1

Vegetarian 1.3 1.7

Lactose-free 0.4 5.0

Kosher 0.0 3.8

Halal 0.0 0.0

Other 8.3 9.1

Appetite 

Excellent 38.9 24.9

Good 50.1 46.1

Fair 10.0 23.2

Poor 1.0 5.8

Eats alone most of the time 52.6 69.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.8. Preparation of meals at home among Nutrition Services Program

participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

Meal preparation responsibilities 

Participant prepares own meals 74.1 50.7

Participant helps someone else cook 6.9 7.6

Participant does not cook 19.0 41.7

Participant can prepare hot meals if necessary 95.4 67.6

Access to food preparation equipment 

Refrigerator 97.1 99.5

Freezer 95.4 97.2

Stove or toaster oven 95.7 97.3

Microwave 95.4 97.6

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

5. Diet quality 

The congregate and home-delivered meal programs authorized under Title III-C of the OAA 

strive to reduce hunger and food insecurity, promote health and well-being, and delay adverse 

health conditions by providing older adults with nutritionally balanced meals (AoA 2016). Title 

III-C specifies that nutrition programs are to provide at least one meal per day to participants for 

five or more days per week (however, programs in rural areas may provide meals on fewer days 

if approved by the SUA). Program meals must comply with the most recent Dietary Guidelines 

and meet standards based on the DRIs developed by the Institute of Medicine. Specifically, if a 

program offers one meal per day, the program meal must provide a minimum of one-third of the 

Recommended Daily Allowance for selected nutrients (AoA 2016). 

This section provides information on the quality of congregate and home-delivered meal 

participants’ diets. All findings are based on analysis of the 24-hour dietary recall data (see 

Chapter II and Appendix A). The following measures were used to examine diet quality:

• Proportion of participants’ daily nutrient intakes provided by program meals to assess the 

contribution of meals to participants’ diets. 

• Usual nutrient intakes to assess the proportions of participants with adequate and excessive 

nutrient intakes. 

• HEI-2010 scores to assess the overall quality of the diets consumed by participants. 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

a. Contribution of program meals to NSP participants’ daily nutrient intakes

This section provides information on the percentage contribution of program meals to NSP 

participants’ daily nutrient intakes. Congregate and home-delivered meal participants reported 

the source of each food reported in the 24-hour dietary recall so that the research team could 

identify foods obtained from program meals. Because some participants do not receive meals on 

every day, not all participants consumed a program meal on the day referenced in the 24-hour 

dietary recall (the intake day). Overall, 79 percent of congregate meal participants and 86 percent 

of home-delivered meal participants consumed a program meal on their intake day. 

To calculate the percentage contribution of program meals to participants’ daily nutrient 

intakes, the research team computed the sum of the nutrients from all foods obtained from 

program meals divided by total daily nutrient intakes. If a participant did not consume a program 

meal on his or her intake day, the percentage contribution was zero. The mean percentage 

contribution was estimated two ways: (1) for all participants, including those who did not 

consume a program meal (where the contribution of program meals is zero for non-consumers); 

and (2) for participants who consumed a program meal on their intake day. The first measure 

provides information on the contribution of program meals to participants’ intakes on an average 

day. The second measure provides information on the relative contribution of program meals on 

days when participants consume program meals. The findings in this section focus on estimates 

for participants who consumed a program meal on their intake day, referred to as “consumers 

only” in the table below. 

Program meals contributed substantially to both congregate and home-delivered meal 

participants’ diets. Among NSP participants who consumed a program meal on their intake day, 

the average contribution of program meals to participants’ daily nutrient intakes ranged, across 

the nutrients examined, from 39 to 47 percent for congregate meal participants and 35 to 47 

percent for home-delivered meal participants (Table III.9). On average, congregate meal 

participants who consumed a program meal on their intake day obtained 41 percent of their daily 

calories from program meals, and home-delivered meal participants obtained 38 percent. Among 

congregate meal participants, program meals made the largest contributions to participants’ daily 

intakes of niacin, vitamin C, alpha-linolenic acid, vitamin A, protein, and sodium. Among homedelivered meal participants, program meals made the largest contributions to participants’ daily 

intakes of alpha-linolenic acid, vitamin A, dietary fiber, vitamin C, sodium, and protein. 

b. Prevalence of adequate and excessive nutrient intakes among NSP participants

To assess the prevalence of adequate and excessive nutrient intakes among congregate and 

home-delivered meal participants, the research team estimated usual nutrient intakes and 

compared them to the DRIs and 2015-2020 Dietary Guidelines. The DRIs, established by the 

Food and Nutrition Board of the Institute of Medicine, provide standards for the amounts of 

nutrients healthy individuals should consume, based on age, gender, and life stage (Institute of 

Medicine 2006). The DRIs are the most up-to-date scientific standards for determining whether 

diets provide sufficient nutrients to meet requirements without being excessive. The DRIs 

include four types of standards for various nutrients, as Table III.10 lists. The 2015-2020 Dietary 

Guidelines provide quantitative recommendations for intakes of saturated fat (as a percentage of 

total calories) and sodium (DHHS and USDA 2015a). The research team used the method 

developed by the National Cancer Institute to estimate usual intake distributions, mean usual 

27
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

intakes, and the percentages of participants with usual intakes that were above, below, or within 

DRI standards or 2015-2020 Dietary Guidelines’ recommendations. 

Table III.9. Mean percentage of daily nutrient intakes obtained from program 

meals among Nutrition Services Program participants

 Congregate meal participants

Home-delivered meal 

participants

 All participants

Consumers 

only All participants

Consumers 

only

 Mean percentage of daily intake

Calories 32.3 40.6 33.3 38.3

Macronutrients

Total fat 33.1 41.7 34.0 39.1

Saturated fat 32.9 41.4 33.5 38.5

Linoleic acid 34.0 42.8 34.0 39.1

Alpha-linolenic acid 35.7 44.9 38.2 43.9

Carbohydrate 31.1 39.2 30.7 35.3

Protein 36.7 46.2 41.1 47.3

Vitamins 

Vitamin A 36.2 45.5 38.4 44.2

Vitamin C 35.2 44.3 40.0 46.0

Vitamin D 33.6 42.2 36.2 41.6

Vitamin E 34.3 43.2 36.5 42.0

Vitamin B6 34.0 42.8 37.7 43.4

Vitamin B12 34.4 43.3 37.6 43.2

Folate 31.2 39.2 30.8 35.4

Niacin 35.2 44.3 37.2 42.7

Riboflavin 31.6 39.8 30.9 35.5

Thiamin 32.2 40.6 31.8 36.6

Minerals

Calcium 31.1 39.2 31.4 36.2

Iron 31.1 39.1 30.7 35.3

Magnesium 31.2 39.3 32.6 37.5

Phosphorus 33.6 42.3 35.8 41.2

Potassium 34.1 42.9 36.5 42.0

Sodium 36.9 46.5 40.0 46.0

Zinc 34.4 43.3 37.0 42.6

Other dietary components

Dietary fiber 34.2 43.0 39.4 45.3

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Notes: Not all participants consumed a program meal on the intake day for the 24-hour recall. In this tabulation, 

consumers are defined as participants who did consume a program meal on their intake day. Tabulations 

for all participants are based on unweighted sample sizes of 591 congregate meal participants and 502

home-delivered meal participants. Tabulations for consumers only are based on unweighted sample sizes 

of 468 congregate meal participants and 433 home-delivered meal participants.

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.10. Dietary Reference Intakes and 2015-2020 Dietary Guidelines’

recommendations 

Estimated Average 

Requirement (EAR)

The EAR is the average daily nutrient intake level estimated to meet the 

requirement of half of the healthy individuals in a particular life stage and gender 

group. The proportion of a group with usual intakes greater than or equal to the 

EAR provides an estimate of the prevalence of adequate usual intakes for that 

group. The prevalence of adequate usual intakes was estimated for the following 

nutrients with defined EARs: vitamin A, vitamin C, vitamin D, vitamin E, vitamin B6, 

vitamin B12, folate, niacin, riboflavin, thiamin, calcium, iron, magnesium, 

phosphorus, and zinc. 

Adequate Intake (AI) The AI is the recommended average intake level assumed to be adequate for 

healthy individuals in a life stage and gender group, based on observed or 

experimentally determined estimates of intake. An AI is defined when the data 

available for a particular nutrient are insufficient to estimate requirements and 

establish an EAR. Unlike an EAR, the AI cannot be used to estimate the 

prevalence of adequate nutrient intakes. Instead, assessment focuses on 

comparing mean usual intakes to the AI. Populations with mean usual intakes that 

meet or exceed AI levels can be assumed to have high levels of nutrient adequacy. 

However, when mean usual intakes fall below the AI, no firm conclusions can be 

drawn about the adequacy of usual intakes. Mean usual intakes were estimated as 

a percentage of the AI for potassium, dietary fiber, and sodium. 

Tolerable Upper Intake 

Level (UL)

The UL is the maximum level of daily nutrient intake that is likely to pose no risk of 

adverse health effects for nearly all individuals in a population group. As intake 

increases above the UL, the potential risk of adverse effects may increase. The 

prevalence of excessive usual intakes was estimated relative to the UL for sodium. 

Acceptable Macronutrient 

Distribution Ranges 

(AMDRs)

The AMDRs define ranges of usual macronutrient intakes that are associated with 

reduced risk of chronic disease, while providing adequate intakes of other essential 

nutrients. The DRIs define AMDRs for intakes of macronutrients as percentages of 

total calorie intake. Usual intakes that fall below or exceed the AMDR may 

increase risk of chronic diseases. The percentages of individuals with usual intakes 

of total fat, linoleic acid, alpha-linolenic acid, carbohydrate, and protein that were 

above, below, and within the AMDRs were estimated. 

2015-2020 Dietary 

Guidelines’

recommendations 

The 2015-2020 Dietary Guidelines provide quantitative recommendations for 

intakes of saturated fat (as a percentage of total calories) and sodium. The Dietary 

Guidelines’ recommended limit on sodium is the same as the UL for sodium. The 

prevalence of excessive nutrient intakes was estimated relative to the Dietary 

Guidelines’ recommendations for saturated fat and sodium. 

Sources: Institute of Medicine (2006); U.S. Department of Health and Human Services and U.S. Department of 

Agriculture (2015). 

Usual intakes of vitamins and minerals with defined Estimated Average Requirements. 

The proportion of a group of individuals with usual intakes greater than or equal to the Estimated 

Average Requirement (EAR) provides an estimate of the prevalence of adequate intakes in that 

group. The prevalence of adequate usual intakes among congregate and home-delivered meal 

participants was 86 percent or more for vitamin B12, niacin, riboflavin, thiamin, iron, and 

phosphorus (Table III.11).6 The prevalence of adequate usual intakes was lower for vitamin B6, 

folate, and zinc for both groups of participants (72 to 78 percent). Three-quarters (76 percent) of 

congregate meal participants and two-thirds (65 percent) of home-delivered meal participants 

6 Appendix B provides detailed data for each nutrient, including mean usual intakes and usual intake distributions by 

DRI age and gender groups.

29

 
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

had adequate usual intakes of vitamin A. Just more than half of congregate and home-delivered 

meal participants had adequate usual intakes of vitamin C (55 percent and 51 percent, 

respectively). 

Less than one-third of congregate and home-delivered meal participants had adequate usual 

intakes of calcium and magnesium (26 and 24 percent, respectively, for calcium, and 31 and 

22 percent, respectively, for magnesium). The prevalence of adequate usual intakes was less than 

10 percent in both groups of participants for vitamin D (4 and 7 percent) and vitamin E (5 and 3 

percent).7 The 2015-2020 Dietary Guidelines Advisory Committee has classified calcium and 

vitamin D as nutrients of public health concern for the U.S. population because 

underconsumption has been linked in the scientific literature to adverse health outcomes (DHHS 

and USDA 2015b). 

Usual intakes of potassium, dietary fiber, and sodium. Potassium, dietary fiber, and 

sodium do not have defined EARs, so it is not possible to assess the prevalence of adequate 

intakes for these nutrients. Instead, mean usual intakes can be compared to the AI. Groups of 

individuals with usual intakes that meet or exceed the AI can be assumed to have high levels of 

nutrient adequacy. However, when mean usual intakes fall below the AI, a firm conclusion about 

nutrient adequacy cannot be made. 

Usual intakes of potassium were 53 percent of the AI for congregate meal participants and 

48 percent of the AI for home-delivered meal participants (Table III.11). Usual intakes of dietary 

fiber, relative to the AI, were slightly higher than those observed for potassium—65 and 57 

percent of the AI for congregate and home-delivered meal participants, respectively. The 2015-

2020 Dietary Guidelines Advisory Committee has also classified potassium and dietary fiber as 

nutrients of public health concern, given that underconsumption may pose health risks (DHHS 

and USDA 2015b). 

Usual intakes of sodium were more than twice the AI for both congregate and homedelivered meal participants (242 and 223 percent of the AI, respectively). Usual intakes of 

sodium were also compared to the Tolerable Upper Intake Level (UL) and the 2015-2020 

Dietary Guidelines’ recommended limit on sodium. Most congregate meal participants (94 

percent) had usual intakes of sodium that exceeded the UL and 2015-2020 Dietary Guidelines’

limit. In comparison, 69 percent of home-delivered meal participants had excessive intakes of 

sodium relative to the UL and 2015 Dietary Guidelines’ limit. Sodium is overconsumed by the 

U.S. population in general and may pose a public health concern (DHHS and USDA 2015b). 

7

 Findings for vitamins D and E should be interpreted with caution. The data used in this analysis includes only 

vitamin D consumed in the diet, and most Americans synthesize some additional vitamin D in the skin after 

inadvertent or intentional sun exposure. Current dietary assessment methods tend to underestimate vitamin E, and 

many believe the EAR for vitamin E was set too high (Devaney et al. 2007)

30

 
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.11. Percentage of Nutrition Services Program participants with 

usual nutrient intakes above, below, or meeting recommendations

 

Congregate meal 

participants

Home-delivered 

meal participants

Vitamins and minerals with EARs (percentage with usual intakes ≥ EAR)

Vitamin A 75.5 64.5

Vitamin Ca 54.9 50.6

Vitamin D 4.1 7.0

Vitamin E 4.7 2.6

Vitamin B6 77.4 73.1

Vitamin B12 94.4 93.0

Folate 72.1 73.1

Niacinb 95.4 95.1

Riboflavin 97.6 95.8

Thiamin 85.5 88.7

Calcium 26.3 24.1

Iron 99.3 98.0

Magnesium 31.3 22.4

Phosphorus 98.8 94.5

Zinc 78.2 77.5

Potassium, dietary fiber, and sodium

Potassium (mean % of AI) 53.0 47.6

Dietary fiber (mean % of AI) 65.3 56.9

Sodium (mean % of AI) 241.5 223.4

Sodium (% > UL/DG) 93.7 69.2

Macronutrients

Protein 

% within AMDR 99.9 99.6

% < AMDR 0.1 0.4

% > AMDR 0.0 0.0

Carbohydrate 

% within AMDR 75.6 72.8

% < AMDR 24.2 24.2

% > AMDR 0.2 3.0

Total fat 

% within AMDR 53.9 59.3

% < AMDR 0.0 0.6

% > AMDR 46.1 40.1

Linoleic acid 

% within AMDR 84.8 75.7

% < AMDR 11.3 23.7

% > AMDR 3.9 0.6

Alpha-linolenic acid 

% within AMDR 74.5 50.8

% < AMDR 22.3 48.9

% > AMDR 3.2 0.2

Saturated fat 

% > DG 89.0 71.5

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data. 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.11. (continued)

Note: Not all participants consumed a program meal on the intake day for the 24-hour recall. Tabulations are 

based on unweighted sample sizes of 591 congregate meal participants and 502 home-delivered meal 

participants.

aThe EAR for vitamin C is 35 mg greater for smokers than nonsmokers. In this analysis, EARs were used for 

nonsmokers.

bNiacin intakes include preformed niacin only. EARs for niacin are expressed as niacin equivalents, including 

contributions from tryptophan. Therefore, prevalence of adequate niacin intakes may be underestimated. 

AI = Adequate Intake; AMDR = Acceptable Macronutrient Distribution Range; DG = 2015-2020 Dietary Guidelines; 

EAR = Estimated Average Requirement; UL = Tolerable Upper Intake Level.

Usual intakes of macronutrients. The DRIs define Acceptable Macronutrient Distribution 

Ranges (AMDRs) for intakes of macronutrients, as percentages of total calorie intake. Usual 

intakes that fall below or exceed the AMDR may increase risk of chronic diseases.

Nearly all congregate and home-delivered meal participants had usual intakes of protein that 

were within with the AMDR (Table III.11). Roughly three-quarters of congregate and homedelivered meal participants (76 and 73 percent, respectively) had usual intakes of carbohydrate 

that were within with the AMDR. The majority of participants with intakes of carbohydrate that 

were not consistent with the AMDR were more likely to exceed the recommended range (24 

percent for both groups of participants) than fall below it (less than 1 percent of congregate meal 

participants and 3 percent of home-delivered meal participants). 

Just more than half of participants had usual intakes of total fat that were within with the 

AMDR (54 percent of congregate meal participants and 59 percent of home-delivered meal 

participants). Among those with intakes of total fat that were not consistent with the AMDR, the 

majority consumed more calories from total fat than recommended (46 percent of congregate 

meal participants and 40 percent of home-delivered meal participants). 

Nearly 85 percent of congregate meal participants and 76 percent of home-delivered meal 

participants had usual intakes of linoleic acid that were within the AMDR. Most participants 

with intakes of linoleic acid that were not consistent with the AMDR had intakes that fell below 

the recommended range. Smaller percentages of participants had usual intakes of alpha-linolenic 

acid that were consistent with the AMDR, especially among home-delivered meal participants 

(75 percent of congregate meal participants and 51 percent of home-delivered meal participants). 

Usual intakes of alpha-linolenic acid were more likely to fall below the recommended range than 

to exceed it. Alpha-linolenic acid is a fatty acid found mostly in nuts and seed oils such as 

walnuts, flaxseeds, canola oil and soybean oil and is essential in the diet because it cannot be 

produced in the body and must be obtained from food sources. 

Among congregate meal participants, 89 percent had usual intakes of saturated fat that 

exceeded the 2015-2020 Dietary Guidelines’ recommended limit. Slightly less than threequarters (72 percent) of home-delivered meal participants had usual saturated fat intakes that 

exceeded this limit. Saturated fat is also a nutrient of public health concern, given that is it 

overconsumed by the U.S. population (DHHS and USDA 2015b). 

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III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

c. Healthy Eating Index-2010 scores of NSP participants 

This section presents information on the overall diet quality of congregate and homedelivered meal participants based on HEI-2010 scores. The HEI-2010 is a measure of diet quality 

that assesses conformance to key recommendations of the 2010 Dietary Guidelines (Guenther et 

al. 2013). It is a scoring metric made up of 12 components, each reflecting a key aspect of diet 

quality, and a total score that measures overall diet quality. The standards used to assign HEI2010 component scores are expressed on a density basis (that is, amounts per 1,000 calories or a 

percentage of calories) rather than absolute amounts of foods consumed. The use of such 

standards in assessing diet quality reflects the recommendation that individuals should strive to 

meet food group and nutrient guidelines while maintaining calorie balance, rather than meeting 

these guidelines simply by consuming large quantities of food. 

Table III.12 lists the HEI-2010 components. Nine of the 12 components included in the 

HEI-2010 are adequacy components, which assess intakes of dietary components individuals are 

recommended to consume to ensure adequate nutrient intakes. The adequacy components include 

the following: (1) total fruit, including juice; (2) whole fruit; (3) total vegetables; (4) greens and 

beans; (5) whole grains; (6) dairy; (7) total protein foods; (8) seafood and plant proteins; and 

(9) fatty acids. The remaining three components, referred to as moderation components, measure 

dietary components that individuals are recommended to limit, including refined grains, sodium, 

and empty calories.

Table III.12 also shows the maximum score for each component, along with the intake 

criteria corresponding to minimum and maximum scores for each component. Maximum scores 

for the various components range from 5 to 20. Scores for intakes between the minimum and 

maximum standards are scored proportionately. For example, an intake that is halfway between 

the criteria for the maximum and minimum scores yields a score that is half the maximum score. 

Higher scores for the adequacy components reflect greater consumption and higher diet quality, 

whereas higher scores for the moderation components reflect lower consumption and higher diet 

quality. Scores for each of the 12 components are summed to create a total HEI-2010 score, with 

a range from 0 to 100. 

The research team estimated HEI-2010 total and component scores for congregate and 

home-delivered meal participants at the population level, using the population ratio method 

(Guenther et al. 2013). This method involves calculating mean intakes of calories, nutrients, and 

food groups for the population, and then calculating the ratios of the means with calories in the 

denominator, and comparing ratios with HEI standards for scoring. 

33
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.12. Healthy Eating Index-2010 components and standards for 

scoring 

HEI-2010 componenta

Maximum 

score

Standard for maximum

score

Standard for minimum score of 

zero

Adequacy components (higher score indicates higher consumption)

Total fruitb 5 ≥ 0.8 cup equiv. / 1,000 kcal No fruit

Whole fruitc 5 ≥ 0.4 cup equiv. / 1,000 kcal No whole fruit

Total vegetablesd 5 ≥ 1.1 cup equiv. / 1,000 kcal No vegetables

Greens and beansd 5 ≥ 0.2 cup equiv. / 1,000 kcal No dark green vegetables, beans, 

or peas

Whole grains 10 ≥ 1.5 ounce equiv. / 1,000 kcal No whole grains

Dairye 10 ≥ 1.3 cup equiv. / 1,000 kcal No dairy

Total protein foodsf 5 ≥ 2.5 ounce equiv. / 1,000 kcal No protein foods

Seafood and plant proteinsf,g 5 ≥ 0.8 ounce equiv. / 1,000 kcal No seafood or plant proteins

Fatty acidsh 10 (PUFAs + MUFAs) / SF > 2.5 (PUFAs + MUFAs) / SF < 1.2

Moderation components (higher score indicates lower consumption)

Refined grains 10 ≤ 1.8 ounce equiv. / 1,000 kcal ≥ 4.3 ounce equiv. / 1,000 kcal

Sodium 10 ≤ 1.1 gram / 1,000 kcal ≥ 2.0 grams / 1,000 kcal

Empty caloriesi 20 ≤ 19% of energy ≥ 50% of energy

Total score 100 

Source: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion (2013). 

aIntakes between the minimum and maximum standard are scored proportionately. 

bIncludes 100 percent fruit juice. 

cIncludes all forms except juice. 

dIncludes any beans and peas not counted as total protein foods. 

eIncludes all milk products, such as fluid milk, yogurt, cheese, and fortified soy beverages. 

f

Beans and peas are included here (and not with vegetables) when the total protein foods standard is otherwise not 

met. 

gIncludes seafood, nuts, seeds, soy products (other than beverages) as well as beans and peas counted toward total 

protein foods. 

hRatio of PUFAs and MUFAs to SF.

i

Calories from solid fats, alcohol, and added sugars; threshold for counting alcohol is > 13 grams/1,000 kcal. 

Equiv = equivalent; HEI = Healthy Eating Index; kcal = calories; MUFA = monounsaturated fatty acid; PUFA = 

polyunsaturated fatty acid; SF = saturated fat. 

Total HEI-2010 scores. The total HEI-2010 score for congregate meal participants was 

65.5 of a possible 100 (Table III.13). The total HEI-2010 score for home-delivered meal 

participants was lower, at 61.4. This indicates that the diets of both congregate and homedelivered meal participants fell short of the 2010 Dietary Guidelines’ recommendations but were 

similar to average scores for the U.S. population of older adults. The total scores for congregate 

and home-delivered meal participants are consistent with data from the National Health and 

Nutrition Examination Survey, which found that average total HEI-2010 scores were 61.6 for 

adults ages 51 to 70 and 65.8 for adults age 71 and older (DHHS and USDA 2015b). 

34
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.13. Mean Healthy Eating Index-2010 scores and percentage of 

maximum scores for Nutrition Services Program participants

 

Congregate meal 

participants

Home-delivered meal 

participants

HEI-2010 component

Maximum 

score

Mean 

score

Percentage 

of maximum 

score

Mean 

score

Percentage 

of maximum 

score

Adequacy (higher score indicates higher consumption)

Total fruit 5 4.8 96.6 4.6 92.0

Whole fruit 5 5.0 100.0 5.0 100.0

Total vegetables 5 4.5 89.9 4.3 86.7

Greens and beans 5 3.8 75.8 2.6 52.9

Whole grains 10 3.8 37.8 3.3 33.0

Dairy 10 6.9 69.1 7.2 71.8

Total protein foods 5 5.0 100.0 5.0 100.0

Seafood and plant proteins 5 4.6 91.6 3.8 75.0

Fatty acids 10 4.2 42.3 4.0 39.5

Moderation (higher score indicates lower consumption)

Refined grains 10 7.8 78.0 7.4 74.1

Sodium 10 2.3 23.2 2.2 22.0

Empty calories 20 12.8 64.0 12.0 60.1

Total score 100 65.5 65.5 61.4 61.4

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Note: Not all participants consumed a program meal on the intake day for the 24-hour recall. Tabulations are 

based on unweighted sample sizes of 591 congregate meal participants and 502 home-delivered meal 

participants.

HEI = Healthy Eating Index.

HEI-2010 component scores. Both congregate and home-delivered meal participants 

achieved the maximum scores for whole fruit and total protein foods (5 of 5) and came close to 

achieving the maximum score for total fruit (4.8 and 4.6 of 5 for congregate and home-delivered 

meal participants, respectively; Table III.13). Congregate meal participants also came close to 

achieving the maximum score for seafood and plant proteins (4.6 of 5). For both groups of 

participants, scores for total vegetables were slightly lower, but still more than 85 percent of the 

maximum possible score (4.5 and 4.3 of 5 for congregate and home-delivered meal participants, 

respectively). 

Scores for dairy were roughly 70 percent of the maximum possible score for both 

congregate and home-delivered meal participants (6.9 and 7.2 of 10, respectively). For greens 

and beans, congregate meal participants achieved a score that was 76 percent of the maximum 

score (3.8 of 5), whereas the score for home-delivered meal participants was 53 percent of the 

maximum score (2.6 of 5). For both congregate and home-delivered meal participants, scores 

were less than 50 percent of the maximum for fatty acids (4.2 and 4.0 of 10, respectively) and 

whole grains (3.8 and 3.3 of 10, respectively). 

35
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

For the moderation components (where higher scores indicate lower consumption), scores 

for refined grains and empty calories ranged from 60 to 78 percent of the maximum possible 

score for congregate and home-delivered meal participants. For both groups of participants, 

scores for sodium were less than 25 percent of the maximum score (2.3 and 2.2 of 10, 

respectively). The lower scores for sodium indicate that consumption of sodium was high for 

both groups of participants relative to the 2010 Dietary Guidelines’ recommendation.

6. Receipt of nutrition and supportive services

Congregate meal participants received meals frequently. Forty-three percent received five or 

more meals per week, and 82 percent received three or more meals per week (Table III.14). Most 

congregate meal participants (79 percent) attended a single site for meals. Seventeen percent of 

congregate meal participants indicated that they had used special transportation to and from the 

meal site in the past 30 days, and 58 percent indicated that if special transposition were not 

available, they would not visit the site as often. 

Table III.14. Frequency of participation in congregate meal program 

Characteristic

Congregate meal 

participants

Number of days in a typical week participant ate a meal at the congregate meal site 

1 6.4

2 12.0

3 18.1

4 20.4

5 42.1

6 0.0

7 1.0

Number of congregate sites the participant usually visits for meals, excluding interview site 

0 79.4

1 11.8

2 or more 8.9

Percentage of participants who used special transportation to and from meal site in the past 

30 days

17.3

If special transportation was not available, participants would go to meal site 

About as often as now 41.9

Somewhat less often 17.5

A lot less often 22.6

Wouldn’t go at all 18.0

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

Home-delivered meal participants also received meals frequently. Seventy-one percent 

received five or more meals per week, and 85 percent received three or more meals per week 

(Table III.15). Most participants (83 percent) had received a delivered meal within the past two 

days. Nearly all home-delivered meal participants (97 percent) received meals from a single site. 

36
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.15. Frequency of participation in home-delivered meal program 

Characteristic

Home-delivered 

meal participants

Number of days in a typical week participant received a delivered meal from the nutrition 

program

 

1 14.3

2 0.7

3 8.4

4 5.7

5 69.2

6 0.0

7 1.4

Number of home-delivered meal sites that deliver meals to the participant excluding the 

interview site

 

0 97.4

1 2.5

2 or more 0.1

Last time participant received a delivered meal from the nutrition program 

0 to 2 days ago 83.1

3 to 4 days ago 5.9

5 to 6 days ago 3.1

7 days ago or more 7.7

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

Approximately three-quarters of congregate meal participants had not changed the 

frequency with which they ate at program sites during the previous six months (Table III.16). Of 

the 12 percent who visited more often during the past six months, 20 percent indicated they had 

done so because they had made friends at the meal site, and 11 percent indicated they had done 

so because they had no one at home with whom to eat. Of the 14 percent of participants who 

visited the site less often during the past six months, 12 percent indicated they had done so 

because they did not always like the food. 

37
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.16. Changes in congregate meal program participation

Characteristic

Congregate meal 

participants

In the previous six months, participant ate meals at nutrition program site 

More often 12.2

Less often 14.1

About as often 73.8

Reasons for eating at the nutrition program site more often 

No one at home to eat with 11.1

Made friends at the meal site 20.1

Got involved in activities at the meal site 9.9

Costs less to eat at meal site than elsewhere 6.3

Meal site is warm and inviting 9.2

No longer have a place to prepare meals 0.0

Physically difficult to make own meals 1.1

Like the foods served 11.0

Recently joined program 12.8

Recently moved 11.8

Other 34.6

Reasons for eating at the nutrition program site less often 

Few or no friends at the meal site 5.6

Have other places to eat 7.3

Haven’t gotten involved in or not interested in activities at the meal site 6.0

Can’t afford to donate at meal site 0.2

Difficult to get to the meal site 3.0

Don’t always like the foods served 12.4

Still able to prepare own meals 3.1

Other 70.6

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

The majority of participants have received meals and program services for more than a year. 

Eight-four percent of congregate meal participants and 70 percent of home-delivered meal 

participants first enrolled in the meal program more than one year before taking the survey 

(Table III.17). Fifteen percent of congregate meal participants and 27 percent of home-delivered 

meal participants enrolled within the preceding eight months.

Congregate and home-delivered meal participants learned about the program in several 

ways. Fifteen percent of home-delivered meal participants reported they first heard about the 

program through a social worker, and 16 percent first heard about the program from a hospital or 

community-based agency or organization (Table III.17). Most of the rest (55 percent) heard 

about the program through family, friends, or another person. In contrast, 74 percent of 

congregate meal participants heard about the program from family, friends, or another person, 

and fewer than 8 percent of congregate meal participants were referred to the program by social 

workers or from hospitals or community-based organizations. 

38
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.17. Initial connections to the Nutrition Services Program

Characteristic

Congregate meal

participants

Home-delivered meal

participants 

How long ago did you first go to a congregate meal site, 

senior center, or senior lunch program for a meal (or first 

receive a home-delivered meal)?

 

0 to 1 month 3.0 6.2

2 to 4 months 6.2 10.2

5 to 8 months 5.8 10.9

9 to 11 months 0.6 2.9

1 to 5 years 42.9 58.5

6 to 10 years 21.9 10.6

More than 10 years 19.7 0.7

First heard of the nutrition program from 

Another person 23.0 20.3

Medical doctor 1.1 4.8

Medical personnel other than a doctor 0.3 7.3

Social worker 4.2 14.9

Family member 15.3 15.9

Friend 35.4 19.1

Newspaper, TV, radio, Internet 5.6 3.2

Posters, something in the mail 1.6 0.4

Announcement in club or church 1.6 1.3

Referred by a community-based agency (hospital, social 

services agency, etc.)

3.8 15.6

Other 18.5 8.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Although participants are not charged for meals, they are encouraged to make a voluntary 

contribution toward the meal costs. However, the program cannot deny participants of meals or 

other services because of an inability or an unwillingness to contribute. Eighty-one percent of 

congregate meal participants indicated they had contributed for the meals they consumed; 

84 percent indicated the program had a suggested contribution amount and few (3 percent) 

indicated they felt pressured to contribute (Table III.18). A smaller percentage (58 percent) of 

home-delivered meal participants indicated they contributed. Seventy percent indicated the 

program had a suggested contribution amount and very few participants (1 percent) indicated 

they felt pressured to contribute. 

39
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.18. Meal contribution characteristics among Nutrition Services 

Program participants

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Participant makes a contribution 80.5 58.2

Program has a suggested contribution amount 84.0 70.0

Participant feels pressured to contribute to each meal 3.1 1.4

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Seven percent of congregate meal participants indicated the nutrition program had provided 

emergency meals at home for them. This compares to 38 percent of home-delivered meal 

participants (Table III.19). 

Table III.19. Receipt of emergency meals among Nutrition Services Program

participants

Characteristic

Congregate meal

participants

Home-delivered meal

participants

Percentage of participants for whom the nutrition program 

has provided any emergency meals at home

7.2 38.0

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Many participants use nutrition and supportive services outside the scope of NSP, yet there 

are differences in service uptake between congregate and home-delivered meal participants. 

Home-delivered meal participants were much more likely than congregate meal participants to 

use personal care services (41 versus 6 percent); home visits for physical, occupational, or 

speech therapy (43 versus 10 percent); case management services (61 versus 13 percent); and 

light housekeeping services (60 versus 17 percent) (Table III.20). Congregate meal participants, 

however, were more likely to have received nutrition counseling (22 versus 12 percent); 

38 percent of congregate meal participants attended a class or lecture on nutrition and healthy 

eating habits, and 39 percent participated in an exercise or fitness class.

40
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.20. Use of other nutrition and supportive services in the past six 

months among Nutrition Services Program participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

Help or services received 

Adult day care services 5.0 1.6

Personal care services for help with dressing or bathing 6.4 41.3

Home visit from nurse or therapist visit to provide physical, 

occupational, or speech therapy

10.2 43.3

Nutrition counseling 21.8 11.7

Case management services 13.1 61.4

Free or discounted housing 17.0 15.3

Support group 16.4 16.3

Light housekeeping services 17.0 59.9

Chore services for heavier housecleaning or yard work 16.2 23.1

Attended a class or lecture about: 

A specific chronic disease 25.2 NA

Nutrition or healthy eating habits 38.1 NA

Safety issues, such as falls prevention 31.4 NA

Health insurance or Medicare Part D 29.9 NA

How to manage medications 15.0 NA

How to manage finances 11.3 NA

Other activities 

Participated in an exercise or fitness class 38.6 NA

Received assistance in finding employment 2.6 NA

Received legal services 11.9 NA

Received counseling about housing situation 6.6 NA

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

NA = not applicable.

In addition to receiving nutrition and supportive services, home-delivered meal participants 

were more likely to seek information or referrals for the services they used more often, such as 

personal care services, home visits, case management services, and light housekeeping services. 

Congregate meal participants were more likely to seek referrals for support groups (21 versus 

7 percent), nutrition counseling (25 versus 19 percent), and housing assistance (12 versus 

2 percent) (Table III.21).

41
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.21. Information and referrals in the past year among Nutrition 

Services Program participants

Characteristic

Congregate meal

participants

Home-delivered meal

participants

Sought information or referral for places that provide 

information on financial, social, or health services available to 

participant

 

 Adult day care program 5.8 3.9

 Personal care services 3.8 25.9

 Home visiting nurse or therapist 11.0 21.3

 Nutrition counseling 25.1 18.9

 Case management services 4.7 36.7

 Support group 20.6 7.4

 Light housekeeping services 14.9 34.2

 Heavier housekeeping services or yard work 10.1 28.2

 Housing assistance 12.3 2.3

 Transportation services 11.1 28.9

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

7. Geographic access to food 

At least half of congregate and home-delivered meal participants lived within 0.7 miles of a 

supermarket, superstore, or large grocery store (Table III.22). Among all store types, participants 

lived closest to convenience stores, with the nearest store within 0.4 miles from home, on 

average. Other grocery stores and specialty stores were 1.7 to 2.9 miles from participants, on 

average. The median distance to retailers differed according to whether a participant lived in an 

urban or rural area. For congregate meal participants, the median distance to a supermarket, 

superstore, or large grocery store was 0.6 miles for those in urban areas and about 2.3 miles for 

those in rural areas. For home-delivered meal participants, these distances were 0.5 and 

3.1 miles, respectively. 

42
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.22. Median distance (in miles) to nearest retailer, by store type and 

urbanicity among Nutrition Services Program participants

Characteristic

Congregate meal

participants

Home-delivered 

meal participants

All participants 

All retailers 0.3 0.3

Supermarkets, superstores, and large grocery stores 0.7 0.7

Medium grocery stores 2.2 1.9

Small grocery stores 2.1 1.7

Convenience stores 0.4 0.4

Specialty stores 2.9 1.9

Other outlets 0.5 0.5

Participants living in urban areas 

All retailers 0.3 0.2

Supermarkets, superstores, and large grocery stores 0.6 0.5

Medium grocery stores 1.3 1.4

Small grocery stores 1.3 1.0

Convenience stores 0.3 0.3

Specialty stores 1.6 1.3

Other outlets 0.5 0.5

Participants living in rural areas 

All retailers 0.6 0.5

Supermarkets, superstores, and large grocery stores 2.3 3.1

Medium grocery stores 10.4 8.7

Small grocery stores 14.7 13.0

Convenience stores 1.1 1.6

Specialty stores 16.7 12.9

Other outlets 1.4 1.1

Sources: AoA NSP outcomes survey, 2015-2016, and Store Tracking and Redemption System, 2015, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Specialty food stores comprise stores classified as selling one of the following specialized items: baked 

goods/bread, fruits/vegetables, meat/poultry products, or seafood products.

Other outlets comprise stores classified as a combination grocery/other store, delivery route, farmers’ 

market, direct marketing farmer, military commissary, nonprofit food buying cooperative, wholesaler, or 

meal service provider.

Table III.23 presents the distribution of distances to the nearest supermarket, superstore, or 

large grocery store for all participants, and according to whether the participant lived in an urban 

or rural area. A quarter of congregate meal participants lived within 0.4 miles of a store, and 

another quarter lived at least 1.5 miles from a store. These distances are 0.3 and 0.9 miles in 

urban areas and 0.8 and 9.2 miles in rural areas. The distances for home-delivered meal 

participants were generally similar to those for congregate meal participants.

43
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.23. Quartiles of distribution of distances (in miles) to nearest 

supermarket, superstore, or large grocery store, by urbanicity, among 

Nutrition Services Program participants

Characteristic

Congregate meal

participants

Home-delivered

meal participants

All participants 

25th percentile 0.4 0.4

50th percentile 0.7 0.7

75th percentile 1.5 1.2

Participants living in urban areas 

25th percentile 0.3 0.3

50th percentile 0.6 0.5

75th percentile 0.9 0.9

Participants living in rural areas 

25th percentile 0.8 0.9

50th percentile 2.3 3.1

75th percentile 9.2 7.3

Sources: AoA NSP outcomes survey, 2015-2016, and Store Tracking and Redemption System, 2015, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Specialty food stores comprise stores classified as selling one of the following specialized items: baked 

goods/bread, fruits/vegetables, meat/poultry products, or seafood products.

Other outlets comprise stores classified as a combination grocery/other store, delivery route, farmers’ 

market, direct marketing farmer, military commissary, nonprofit food buying cooperative, wholesaler, or 

meal service provider.

In urban areas, at least half of congregate meal participants had no supermarkets, 

superstores, or large grocery stores within 0.5 miles of their residence, one store in 0.5 miles to 

less than 1 mile, and three stores in 1 to 2 miles (Table III.24). Convenience stores were more 

common, with two stores within 0.5 miles of participants’ residence and five stores within 

1 mile. The numbers of stores were generally similar for home-delivered meal participants. 

44
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.24. Median number of retailers within selected distance from 

Nutrition Services Program participants living in urban areas, by store type

Characteristic

Congregate meal

participants

Home-delivered 

meal participants

Supermarkets, superstores, and large grocery stores 

Less than 0.5 mile 0 0 

0.5 to less than 1 mile 1 1 

1 to 2 miles 3 4 

Medium grocery stores 

Less than 0.5 mile 0 0 

0.5 to less than 1 mile 0 0 

1 to 2 miles 0 1 

Small grocery stores 

Less than 0.5 mile 0 0 

0.5 to less than 1 mile 0 0 

1 to 2 miles 1 1 

Convenience stores 

Less than 0.5 mile 2 2 

0.5 to less than 1 mile 3 4 

1 to 2 miles 8 10

Specialty stores 

Less than 0.5 mile 0 0 

0.5 to less than 1 mile 0 0 

1 to 2 miles 0 0 

Other outlets 

Less than 0.5 mile 1 1 

0.5 to less than 1 mile 2 2 

1 to 2 miles 4 4 

Source: AoA NSP outcomes survey, 2015-2016, and Store Tracking and Redemption System, 2015, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Specialty food stores comprise stores classified as selling one of the following specialized items: baked 

goods/bread, fruits/vegetables, meat/poultry products, or seafood products.

Other outlets comprise stores classified as a combination grocery/other store, delivery route, farmers’ 

market, direct marketing farmer, military commissary, nonprofit food buying cooperative, wholesaler, or 

meal service provider.

In rural areas, at least half of congregate meal participants had one supermarket, superstore, 

or large grocery store within 5 miles of their residence, no stores in 5 to less than 10 miles, and 

five stores in 10 to 20 miles (Table III.25). At least half of home-delivered meal participants had 

one supermarket, superstore, or large grocery store within 5 miles of their residence, one store in 

5 to less than 10 miles, and eight stores in 10 to 20 miles. As in urban areas, convenience stores 

were more common than supermarkets. 

45
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.25. Median number of retailers within selected distance from 

Nutrition Services Program participants living in rural areas, by store type

Characteristic

Congregate meal

participants

Home-delivered 

meal participants

Supermarkets, superstores, and large grocery stores 

Less than 5 miles 1 1 

5 to less than 10 miles 0 1 

10 to 20 miles 5 8 

Medium grocery stores 

Less than 5 miles 0 0 

5 to less than 10 miles 0 0 

10 to 20 miles 1 2 

Small grocery stores 

Less than 5 miles 0 0 

5 to less than 10 miles 0 0 

10 to 20 miles 1 2 

Convenience stores 

Less than 5 miles 2 2 

5 to less than 10 miles 2 4 

10 to 20 miles 17 28

Specialty stores 

Less than 5 miles 0 0 

5 to less than 10 miles 0 0 

10 to 20 miles 1 2 

Other outlets 

Less than 5 miles 2 2 

5 to less than 10 miles 1 2 

10 to 20 miles 9 19

Source: AoA NSP outcomes survey, 2015-2016, and Store Tracking and Redemption System, 2015, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Specialty food stores comprise stores classified as selling one of the following specialized items: baked 

goods/bread, fruits/vegetables, meat/poultry products, or seafood products.

Other outlets comprise stores classified as a combination grocery/other store, delivery route, farmers’ 

market, direct marketing farmer, military commissary, nonprofit food buying cooperative, wholesaler, or 

meal service provider.

8. Food security

Although the majority of NSP participants were food secure, 16 percent of congregate meal 

participants and 23 percent of home-delivered meal participants had experienced food access 

limitations during the past month due to lack of money or other resources—they were food 

insecure (Table III.26). The rate of very low food security was also higher for home-delivered 

meal participants than congregate meal participants (7 percent versus 4 percent). 

46
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

The patterns of food insecurity by income as a percentage of poverty mostly correspond 

with conventional wisdom. For congregate and home-delivered meal participants, rates of food 

insecurity decreased as the household income-to-poverty ratio increased (Table III.27). This was 

generally true for congregate meal participants’ very low food security as well; for homedelivered meal participants, there was no clear pattern. 

In general, food insecurity decreased with age for congregate and home-delivered meal 

participants. For both groups, individuals age 74 and younger experienced the highest rates of 

food insecurity (24 percent for congregate and 44 percent for home-delivered meal participants) 

and individuals age 85 and older experienced the lowest rates (5 and 16 percent, respectively) 

(Table III.28). Food insecurity rates that decline with age, even among older adults, is consistent 

with findings from studies that use national data such as the Current Population Survey Food 

Security Supplement (Ziliak and Gundersen 2013). 

Table III.26. Food security among Nutrition Services Program participants

Food security

Congregate meal 

participants

Home-delivered 

meal participants

Food secure 83.6 77.5

Food insecure 16.4 22.5

Food insecure with low food security 12.1 15.8

Food insecure with very low food security 4.3 6.7

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Table III.27. Food security, by income as a percentage of poverty, among 

Nutrition Services Program participantsa

Food security

First income 

quartile

Second income 

quartile

Third income 

quartile

Fourth income 

quartile

Congregate meal participants 

Food secure 67.6 82.2 90.3 93.9

Food insecure 32.4 17.8 9.7 6.1

Food insecure with low food security 23.8 13.9 8.3 2.7

Food insecure with very low food security 8.5 3.9 1.4 3.4

Home-delivered meal participants 

Food secure 64.7 78.5 79.6 86.9

Food insecure 35.3 21.5 20.4 13.1

Food insecure with low food security 29.4 16.4 10.1 7.8

Food insecure with very low food security 5.9 5.2 10.3 5.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

a Income-to-poverty ratio based on the poverty guidelines from DHHS (https://aspe.hhs.gov/2015-poverty-guidelines). 

47
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.28. Food security, by age, among Nutrition Services Program

participants

Food security 74 and younger 75 to 84 85 and older

Congregate meal participants 

Food secure 75.6 86.5 95.2

Food insecure 24.4 13.5 4.8

Food insecure with low food security 16.4 11.2 4.7

Food insecure with very low food security 8.1 2.4 0.1

Home-delivered meal participants 

Food secure 55.9 81.6 83.8

Food insecure 44.1 18.4 16.2

Food insecure with low food security 29.0 15.9 10.0

Food insecure with very low food security 15.2 2.4 6.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

9. Food coping strategies and participation in food assistance programs

Although many participants reported that their income is sufficient to take care of their 

needs, a nontrivial percentage reported challenges in making ends meet and faced trade-offs in 

purchasing food each month. Eighty-five percent of congregate meal participants reported that 

their incomes take care of their needs very or fairly well; 15 percent reported that their incomes 

do not cover their needs (Table III.29). A greater percentage of home-delivered meal participants 

struggle to make ends meet—23 percent reported that their incomes do not cover their needs.

Some participants faced difficult choices of how to spend scarce household resources—

whether to buy food or pay for rent, utility bills, or needed medications. Nine percent of homedelivered meal participants said they had to choose between buying food and paying utility bills 

during the past month; 5 percent also reported having to choose between buying food and paying 

rent and 4 percent had to choose between buying food and buying medications (Table III.29). 

The percentages for congregate meal participants were lower when facing the trade-off between 

buying food and paying rent or utility bills (4 and 7 percent, respectively), but were higher when 

facing the trade-off between buying food and buying medications (7 percent). 

48
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.29. Adequacy of income among Nutrition Services Program

participants

Characteristic

Congregate meal

participants

Home-delivered meal 

participants

Extent to which income takes care of needs 

Very well 35.7 30.5

Fairly well 48.9 46.9

Poorly 15.3 22.6

Trade-offs in purchasing food in past month 

Buying food and buying medications 7.0 3.9

Buying food and paying utility bills 6.7 8.8

Buying food and paying rent 3.8 4.9

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

A variety of federal, state, and local food assistance programs are available to help older 

adults meet their food and nutritional needs. Congregate and home-delivered meal participants 

receive assistance to purchase food through the Supplemental Nutrition Assistance Program 

(SNAP) and directly receive food through other food and nutrition assistance programs, such as 

food pantries and soup kitchens; they also receive energy assistance. Twenty-seven percent of 

congregate meal participants and 30 percent of home-delivered meal participants reported 

participating in SNAP (Table III.30). Smaller percentages received food from food pantries 

(17 and 14 percent, respectively) and received meals provided by churches or in soup kitchens in 

the past 30 days (11 and 3 percent, respectively). 

Table III.30. Participation in other programs among Nutrition Services 

Program participants

Program participation

Congregate meal

participants

Home-delivered meal 

participants

Currently receiving SNAP benefits 26.7 29.9

Received food from a food pantry or food bank in the past 

30 days

17.3 14.0

Received any meals provided by churches, soup kitchens,

or emergency kitchens in the past 30 days

10.7 3.0

Received emergency assistance to help with heating and 

cooling in the past 30 days

10.2 13.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

SNAP = Supplemental Nutrition Assistance Program.

49
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

NSP participants were asked about coping strategies they would use if their program were 

unavailable. Most congregate meal participants indicated in the absence of the program they 

would cook for themselves (86 percent), make meals that are easy to fix (88 percent), obtain 

meals from restaurants more often (71 percent), and eat foods saved from other meals when 

possible (85 percent) (Table III.31). A sizeable percentage (42 percent) indicated they would 

skip meals or eat less if the program was unavailable. Coping strategies for home-delivered meal 

participants were similar; however, relative to congregate meal participants, home-delivered 

meal participants were more likely to rely on friends and family for meals (73 percent), less 

likely to cook for themselves (72 percent), less likely to obtain meals from restaurants 

(48 percent), and more likely to skip meals or eat less (61 percent). 

Table III.31. Coping strategies in the absence of NSP among Nutrition 

Services Program participants

Characteristic

Congregate meal

participants

Home-delivered 

meal participants

Participant would cook for self 

Most of the time 56.5 33.5

Sometimes 29.6 38.6

Never 13.9 27.9

Family or friends would provide participant with meals 

Most of the time 14.5 27.5

Sometimes 33.4 45.3

Never 52.1 27.2

Participant would eat at restaurants or have food delivered from 

restaurants

 

Most of the time 6.8 4.5

Sometimes 64.2 43.5

Never 29.0 52.0

Participant would eat meals that were easy to fix 

Most of the time 41.3 47.1

Sometimes 46.9 47.6

Never 11.8 5.3

Participant would eat meals that were ready to eat right out of the 

package

 

Most of the time 6.9 19.0

Sometimes 51.1 58.7

Never 42.0 22.2

Participant would skip meals or eat less 

Most of the time 5.6 12.4

Sometimes 36.3 48.2

Never 58.1 39.4

Participant would eat foods saved from other meals 

Most of the time 23.5 22.6

Sometimes 61.9 66.1

Never 14.6 11.3

Participant would get food in some other way 

Most of the time 6.2 6.7

Sometimes 12.2 9.9

Never 81.6 83.4

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

50
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

B. Impressions of the program and social interactions and activities

1. Impression of the program 

This section examines congregate and home-delivered meal participants’ experiences with 

the program. It describes their overall impressions of the program, their impressions of the 

meals, their experience with meal delivery (for home-delivered meal participants), their 

valuation of supportive services received through the program, and the perceived health benefits 

of program participation.

The majority of program participants had a positive impression of the program. Ninety-two 

percent of congregate meal participants and 96 percent of home-delivered meal participants rated

the nutrition program overall as good, very good, or excellent (Table III.32). Similarly, 

97 percent of congregate meal participants and 98 percent of home-delivered meal participants 

rated program staff positive overall, and almost all participants would recommend the program to 

friends or relatives. Most home-delivered meal participants reported that meals arrived at the 

scheduled time (91 percent) and the delivery person was pleasant (96 percent) (Table III.33). 

However, a sizeable percentage of home-delivered meal participants (46 percent) reported the 

delivery person seldom or never spent time talking to them as part of the delivery process. 

Table III.32. Impressions of the NSP among participants

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

Overall rating of the nutrition program 

Excellent 42.2 44.3

Very good 36.9 32.5

Good 12.5 19.3

Fair 7.2 2.6

Poor 1.3 1.3

Overall rating of the nutrition program staff 

Excellent 62.4 60.1

Very good 28.1 25.3

Good 6.8 12.8

Fair 2.2 0.6

Poor 0.5 1.1

Recommend nutrition program to friends or relatives 

Yes 95.1 97.0

No 4.9 3.0

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

51
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.33. Impressions of meal delivery among Nutrition Services Program

participants

Characteristic Home-delivered meal participants

Meal arrives at the scheduled time 

Always 58.5

Usually 32.1

Sometimes 6.4

Seldom 0.4

Never 2.6

Delivery person spends time talking 

Always 15.7

Usually 14.0

Sometimes 24.8

Seldom 22.5

Never 23.0

Delivery person is pleasant 

Always 91.8

Usually 4.6

Sometimes 2.3

Seldom 0.0

Never 1.2

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on an unweighted sample size of 504 home-delivered meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

Ninety-seven percent of congregate meal participants and 99 percent of home-delivered 

meal participants indicated the nutrition program had been helpful, with 68 percent of congregate 

and 83 percent of home-delivered meal participants indicating that the program had “helped a 

lot” (Table III.34). Eighty-one percent of congregate meal participants reported the program had 

helped them to eat healthier foods and 68 percent indicated that the program had improved their 

health and helped them to achieve or maintain a healthy weight (Table III.34).

52
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.34. Impressions of health benefits of the NSP among participants

Characteristic

Congregate meal 

participants

Home-delivered meal 

participants

How helpful has the nutrition program been? 

Helped a lot 67.6 82.7

Helped somewhat 24.0 12.6

Helped a little 5.6 3.3

Did not help 2.3 1.4

Made things worse 0.5 0.0

Has the nutrition program helped participant eat healthier foods? 

Yes 81.1 89.7

No 18.9 10.3

Has the nutrition program improved participant’s health? 

Yes 67.9 77.8

No 32.1 22.2

Has the nutrition program helped participant follow special diet 

prescribed by doctor/dietician?

 

Yes 37.3 38.8

No 62.7 61.2

Has the nutrition program helped participant achieve or maintain 

a healthy weight?

 

Yes 67.7 72.0

No 32.3 28.0

Has the nutrition program helped participant live independently 

and stay in own home?

 

Yes 70.6 89.7

No 29.4 10.3

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions.

Ninety percent of home-delivered meal participants reported the program had helped them 

to eat healthier foods, and most indicated the program had improved their health (78 percent) and 

helped them to achieve or maintain a healthy weight (72 percent) (Table III.34). The majority, 

71 percent of congregate and 90 percent of home-delivered meal participants, reported the 

program had helped them to live independently and stay in their own home. 

The vast majority of congregate (95 percent) and home-delivered meal participants 

(96 percent) liked the meals they received from the nutrition program (Table III.35). Almost 

80 percent of congregate meal participants provided positive ratings on each element that 

measured their impression of the program meals; 79 percent liked the foods provided, 81 percent 

liked the way the food tastes, 84 percent were satisfied with the variety of foods, and 91 percent 

were satisfied with the amount of food. Home-delivered meal participants were also satisfied 

with the meals, but fewer people reported that they liked the foods provided (72 percent), liked 

the way the food tastes (75 percent), and were satisfied with the variety of foods provided 

(76 percent).

53
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.35. Impressions of meals among Nutrition Services Program

participants

Characteristic

Congregate meal 

participants

Home-delivered 

meal participants

Like meals from nutrition program 

Yes 94.9 95.6

No 5.1 4.4

Like the foods provided 

Always 34.4 36.1

Usually 44.4 35.4

Sometimes 19.2 24.4

Seldom 1.0 2.5

Never 1.1 1.6

Satisfied with the way food tastes 

Always 34.7 33.5

Usually 45.8 41.4

Sometimes 16.3 22.0

Seldom 2.1 1.2

Never 1.1 1.9

Satisfied with the way food smells 

Always 46.0 52.2

Usually 38.8 33.1

Sometimes 12.6 12.2

Seldom 1.5 1.2

Never 1.2 1.3

Satisfied with the way food looks 

Always 46.9 55.0

Usually 38.8 28.7

Sometimes 12.4 14.0

Seldom 0.9 0.7

Never 1.0 1.6

Satisfied with the variety of food 

Always 43.7 47.1

Usually 40.5 28.5

Sometimes 12.6 19.6

Seldom 1.7 3.2

Never 1.4 1.6

Satisfied with the amount of food 

Always 61.8 61.8

Usually 29.3 25.6

Sometimes 5.2 8.4

Seldom 2.7 1.9

Never 1.0 2.3

Satisfied with the attractiveness of the dining area 

Always 68.9 NA

Usually 27.0 NA

Sometimes 3.2 NA

Seldom 0.5 NA

Never 0.4 NA

Satisfied that food meets special dietary needs or restrictions 

Always 50.1 50.5

Usually 22.4 22.1

Sometimes 11.4 12.2

Seldom 2.3 2.4

Never 13.9 12.8

Food is the proper temperature 

Always 59.3 59.2

Usually 31.8 27.2

Sometimes 8.4 8.4

Seldom 0.2 2.0

Never 0.3 3.2

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

54
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Table III.35. (continued)

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 home-delivered 

meal participants. Individual estimates within the table may have slightly fewer observations due to item 

nonresponse to individual questions.

NA = not applicable.

2. Social interactions and activities

The survey included several questions about the types, frequency, and perceived quality of 

participants’ social interactions and activities. Congregate meal participants were socially active: 

the vast majority (93 percent) were satisfied with their opportunities to spend time with other 

people; 77 percent indicated they had no difficulty getting in touch with others during the past 

two weeks; and 63 percent belonged to religious, social or special interest groups (Table III.36). 

On a scale of 3 to 9, the average Revised-UCLA loneliness score was a 4.1, indicating that the 

typical congregate meal participant does not experience loneliness. In addition, only a small 

percentage of congregate meal participants (7 percent) screened positively for depression. 

Patterns of responses are similar for home-delivered meal participants, but as a whole the group 

was less satisfied with their opportunities to spend time with other people (81 percent reported 

being somewhat satisfied or very satisfied); they were less likely to belong to religious, social, or 

special interest groups (48 percent); and they were much more likely to screen positively for 

depression (19 percent). 

Table III.36. Socialization outcomes and opportunities among Nutrition 

Services Program participants

Characteristic

Congregate meal

participants

Home-delivered meal

participants

Satisfaction with the opportunities to spend time with other 

people

 

Very satisfied 66.9 42.8

Somewhat satisfied 26.5 37.8

Not too satisfied 5.8 11.1

Not at all satisfied 0.8 8.3

Percentage of participants who belong to religious or 

social groups, book clubs, special interest groups, or other 

organizations

62.6 47.6

R-UCLA Loneliness Scale mean scorea 4.1 4.6

Percentage of participants who screen positively for 

depression based on the Patient Health Questionnaire 2

6.9 19.2

During past two weeks, frequency with which participant 

found it difficult to get in touch with others

 

Almost always 2.9 5.6

Most of the time 2.5 3.8

About half the time 4.6 5.6

Occasionally 13.4 18.9

Not at all 76.7 66.0

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on unweighted sample sizes of 596 congregate meal participants and 504 homedelivered meal participants. Individual estimates within the table may have slightly fewer observations due 

to item nonresponse to individual questions. a Revised UCLA loneliness scale ranges from 3 to 9. 

R-UCLA = Revised UCLA three-item Loneliness Scale.

55
III. NSP PARTICIPANTS’ CHARACTERISTICS AND CIRCUMSTANCES MATHEMATICA POLICY RESEARCH

Congregate meal participants reported high levels of satisfaction with the opportunities for 

recreation and social interaction at the meal site. One-third reported spending a lot of time 

participating in activities or receiving services at the nutrition site, and 39 percent volunteered at 

the nutrition site (Table III.37). Almost all congregate meal participants (99 percent) reported 

being either very satisfied or somewhat satisfied with their opportunities to spend time with other 

people at the meal site.

Table III.37. Recreational, volunteer, and social activities among congregate 

meal participants

Characteristic Congregate meal participants

Satisfaction with the opportunities to spend time with other people at the 

nutrition site

 

Very satisfied 82.1

Somewhat satisfied 16.6

Not too satisfied 0.4

Not at all satisfied 0.9

Amount of time participating in activities or receiving services at the nutrition 

site

 

A lot of time 32.6

Some time 39.7

Just a little time 13.6

No time 14.2

Volunteer at the nutrition site 

Yes 38.5

No 61.5

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Tabulations are based on an unweighted sample size of 596 congregate meal participants. Individual 

estimates within the table may have slightly fewer observations due to item nonresponse to individual 

questions.

56
IV. CONGREGATE AND HOME-DELIVERED MEAL PARTICIPATION AND 

PARTICIPANTS’ OUTCOMES

This chapter presents estimates of the effects of congregate and home-delivered meal

participation on participants’ outcomes. The descriptive tabulations of food security, 

socialization, and diet quality outcomes presented in the previous chapter characterize the 

population of congregate and home-delivered meal participants. The findings presented in this 

chapter describe how participation in congregate and home-delivered meal programs affects 

these outcomes. The findings are based on multivariate analyses that account for observed 

differences between participants and matched nonparticipants. These findings are referred to as 

regression-adjusted findings.8

 

Findings are presented about the impact of program participation on food security (Section 

A), socialization (Section B), and diet quality (Section C). Unless stated otherwise, all 

differences between participants and nonparticipants are statistically significant at the 0.10, 0.05, 

or 0.01 levels (specified in the tables). 

A. Congregate and home-delivered meal participation and household food 

security

The impact of program participation on household food security was assessed using two 

measures: (1) whether an individual lives in a food insecure household and (2) whether an 

individual lives in a household that experienced very low food security. Overall, congregate meal 

participants had a lower rate of food insecurity than nonparticipants, but rates of very low food 

security were similar for the two groups. Home-delivered meal participants had a food insecurity 

rate similar to nonparticipants and, for the vast majority of participants who receive meals five 

days per week, a similar rate of very low food security. However, for home-delivered meal 

participants who receive fewer than five meals per week, the rate of very low food security was 

significantly greater for participants than nonparticipants. 

1. Congregate meal participation 

The percentage of congregate meal participants living in a food insecure household was 

4.0 percentage points lower than the percentage of nonparticipants (15.5 versus 19.5 percent; 

Table IV.1). However, there was no statistically significant difference between the percentages 

of congregate meal participants and nonparticipants living in households that experienced very 

low food security. 

8 Appendix A describes the regression-adjustment process.

57

 
IV. CONGREGATE AND HOME-DELIVERED MEAL MATHEMATICA POLICY RESEARCH

PARTICIPATION AND PARTICIPANTS’ OUTCOMES

Table IV.1. Regression-adjusted percentages of individuals who live in 

households that are food insecure or have very low food security, by 

congregate meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

Food insecurity 15.5 (2.1) 19.5 (2.1) -4.0* (2.4) 

Very low food security 4.2 (0.8) 4.0 (1.0) 0.2 (1.0) 

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,226 congregate meal participants and 

nonparticipants. 

*Significantly different from zero at the .10 level, two-tailed test.

2. Home-delivered meal participation

There was no statistically significant difference between home-delivered meal participants 

and nonparticipants in the percentage of individuals living in a food insecure household (Table 

IV.2). However, the prevalence of very low food security was 4.2 percentage points higher 

among participants than nonparticipants (6.9 versus 2.7 percent). Because this is a 

counterintuitive finding, the research team conducted auxiliary analyses to assess whether the 

effect differed depending on the intensity of participating in the program, measured by the 

number of days per week participants receive home-delivered meals. Among home-delivered 

meal participants who receive meals five or more days per week (about 70 percent of 

participants), there was no difference between participants and nonparticipants in the percentage 

of individuals who live in households that experienced very low food security (Table IV.3).

Among home-delivered meal participants who receive fewer than five meals per week (about 30 

percent of participants), a significantly greater percentage of participants lived in households that 

had experienced very low food security, compared to nonparticipants (25.8 versus 15.9 percent).

There were similar findings for food insecurity. This suggests that some home-delivered meal 

participants experiencing food access limitations may not be receiving a sufficient number of 

meals per week to ameliorate their severe level of food insecurity. As discussed in the next 

chapter, learning more about the reasons participants receive varying amounts of program meals 

and how their food needs are assessed is an important step in improving their food security. 

58
IV. CONGREGATE AND HOME-DELIVERED MEAL MATHEMATICA POLICY RESEARCH

PARTICIPATION AND PARTICIPANTS’ OUTCOMES

Table IV.2. Regression-adjusted percentages of individuals who live in 

households that are food insecure or have very low food security, by homedelivered meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

Food insecurity 22.0 (2.1) 17.0 (2.1) 5.0 (3.2) 

Very low food security 6.9 (1.1) 2.7 (0.7) 4.2*** (1.5) 

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants. 

***Significantly different from zero at the .01 level, two-tailed test.

Table IV.3. Regression-adjusted percentages of individuals who live in 

households that are food insecure or have very low food security, by homedelivered meal participation status and number of meals received per week

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

Food insecurity 22.0 (2.1) 17.0 (2.1) 5.0 (3.2) 

Receive fewer than 5 

delivered meals per week 13.6 (3.1) 3.5 (1.0) 10.1*** (3.6)

Receive 5 or more 

delivered meals per week 4.6 (1.3) 2.4 (0.6) 2.2 (1.6)

Very low food security 6.9 (1.1) 2.7 (0.7) 4.2*** (1.5) 

Receive fewer than 5 

delivered meals per week 25.8 (3.4) 15.9 (1.7) 9.9** (4.1)

Receive 5 or more 

delivered meals per week

20.4 (2.4) 17.7 (2.2) 2.7 (3.5)

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants. 

**Significantly different from zero at the .05 level, two-tailed test.

***Significantly different from zero at the .01 level, two-tailed test.

3. Differences by income and whether individuals live alone

As described in Chapter II, the research team assessed whether program impacts varied by 

household income and whether individuals lived alone. These findings are summarized below. 

59
IV. CONGREGATE AND HOME-DELIVERED MEAL MATHEMATICA POLICY RESEARCH

PARTICIPATION AND PARTICIPANTS’ OUTCOMES

Congregate meal participants and nonparticipants. Among lower-income individuals, 

the percentage of congregate meal participants living in a food insecure household was 

7.8 percentage points lower than the percentage of nonparticipants (23.2 versus 31.0 percent); 

Appendix Table C.1). Similar to the full sample, there was no significant difference between 

participants and nonparticipants in the percentage of individuals living in households that 

experienced very low food security. 

Among higher-income individuals, there were no statistically significant differences 

between participants and nonparticipants in either of the food security outcomes (Appendix 

Table C.1). This is expected, given that food insecurity and very low food security are measures 

of economic access to food—whether a household experiences food access limitations due to 

lack of money or other resources. 

Because food insecurity is a household-level measure, it measures food access limitations 

for all household members, including those who live with congregate meal participants but do 

not participate in the program themselves. To assess whether the effect of participation in 

congregate meal programs on food insecurity partially reflected food access limitations for 

household members other than the program participant, program impacts were examined for 

individuals who live with other people and individuals who live alone. There were no significant 

differences for either group (Appendix Table C.1).9

 This was also true for very low food 

security.

Home-delivered meal participants and nonparticipants. There were no significant 

differences in the rates of food insecurity and very low food security for lower-income 

individuals (Appendix Table C.2). For higher-income individuals, however, the rates of food 

insecurity and very low food security were each greater for participants than nonparticipants. 

Because this is a counterintuitive finding, a similar auxiliary analysis was conducted to assess 

whether the effect differed depending on the number of days per week participants receive homedelivered meals. Participants experienced greater food insecurity and very low food security than 

nonparticipants regardless of the number of meals per week they received.

B. Congregate and home-delivered meal participation and socialization

The impact of program participation on socialization outcomes was assessed using three 

measures: (1) a measure of perceived loneliness, (2) a depression screener, and (3) a measure of 

satisfaction with the opportunities one has to spend time with other people. Congregate meal 

participants generally had more positive socialization outcomes than nonparticipants. For homedelivered meal participants, the findings were mixed. For some socialization outcomes, there 

were no significant differences between participants and nonparticipants; for other socialization 

outcomes, there were no significant differences between participants who receive meals five or 

more days per week and nonparticipants, but home-delivered meal participants that receive fewer 

than five meals per week had less favorable outcomes than nonparticipants. 

9 Among individuals living in lower-income households, however, there was a larger and statistically significant 

reduction in food insecurity for individuals living alone (−11.0 percentage points) and no significant reduction for 

individuals living with others (−0.9 percentage points) (not shown).

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1. Congregate meal participation 

There was no statistically significant difference between congregate meal participants and 

nonparticipants in the average R-UCLA loneliness score (equal to 4.1) (Table IV.4). Based on a 

scale that ranges from 3 to 9, each group scored an average of 4.1, indicating there was no 

difference in the extent to which participants and nonparticipants feel a lack companionship, left 

out, or isolated from others. 

Table IV.4. Regression-adjusted socialization outcomes, by congregate meal 

participation status

 Participants Nonparticipants Difference

Outcome Estimate 

Standard 

error Estimate 

Standard 

error Estimate 

Standard 

error

R-UCLA loneliness scale 

Loneliness score (mean)a 4.1 (0.1) 4.1 (0.1) 0.0 (0.1) 

PHQ-2 depression screener 

Percentage of individuals who 

affirmed at least 2 of 6 questions

18.1 (2.1) 24.3 (2.8) -6.2* (3.7) 

Percentage of individuals who

affirmed at least 3 of 6 questions

6.5 (1.2) 9.3 (1.8) -2.8 (2.4)

Percentage of individuals who

affirmed at least 4 of 6 questions

2.3 (0.7) 6.5 (1.7) -4.2** (1.9) 

Number of questions individuals 

affirmed (mean)

0.6 (0.1) 0.8 (0.1) -0.2** (0.1) 

Satisfaction with socialization 

opportunities

 

Percentage of individuals satisfied 

with socialization opportunities

94.0 (1.4) 85.8 (2.1) 8.2*** (2.4) 

Percentage of individuals very 

satisfied with socialization 

opportunities

67.5 (3.3) 55.5 (2.5) 12.0*** (4.3) 

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,226 congregate meal participants and 

nonparticipants.

 *Significantly different from zero at the .10 level, two-tailed test.

 **Significantly different from zero at the .05 level, two-tailed test.

 ***Significantly different from zero at the .01 level, two-tailed test.

a R-UCLA loneliness scale ranges from 3 to 9.

PHQ-2 = Patient Health Questionnaire 2; R-UCLA = Revised UCLA Three-Item Loneliness Scale. 

As described in Chapter II, the second socialization measure is based on the PHQ-2, which 

assesses the frequency of depressed mood over the past two weeks to indicate whether an 

individual screens positively for depression. Because there is no agreed-upon threshold that 

positively identifies individuals with depression, the research team compared the PHQ-2 raw 

score to thresholds of 2, 3, and 4 to define three measures of screening positively for depression. 

The raw score itself was also examined. 

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Congregate meal participants were less likely to screen positively for depression in three of 

the four measures examined. The percentage of individuals who screened positively for 

depression was lower for congregate meal participants than for nonparticipants (18.1 versus 24.3 

percent) when using the PHQ-2 screener with a threshold of 2 affirmative answers (Table IV.4). 

The percentage of individuals who screened positively for depression was also lower for 

congregate meal participants than for nonparticipants (2.3 versus 6.5 percent) when using the 

PHQ-2 screener with a threshold of 4 affirmative answers. In addition, the PHQ-2 screener raw 

score was lower among participants than nonparticipants, indicating a lower average likelihood 

of participants screening positively for depression. There was no statistically significant 

difference between participants and nonparticipants in the percentage of individuals who screen 

positively for depression using the PHQ-2 screener with a threshold of 3 affirmative answers. 

Because the findings are consistent for three of the four measures, the research team concludes 

that congregate meal participants were less likely than nonparticipants to screen positively for 

depression. 

The third measure of socialization is based on two variables measuring individuals’ selfreported satisfaction with the opportunities they have had to spend time with other people. 

Compared to nonparticipants, congregate meal participants had greater satisfaction with their

socialization opportunities. The percentage of individuals who were satisfied with their 

socialization opportunities was 8.2 percentage points higher for congregate meal participants 

than for nonparticipants (94.0 versus 85.8 percent) (Table IV.4). Similarly, the percentage of 

individuals who were very satisfied with their socialization opportunities was 12.0 percentage 

points higher for congregate meal participants than for nonparticipants (67.5 versus 55.5 

percent). 

2. Home-delivered meal participation

The findings were mixed for home-delivered meal participation. The average R-UCLA 

loneliness score was slightly higher for home-delivered meal participants compared to 

nonparticipants (4.5 versus 4.3) (Table IV.5), indicating relatively greater levels of loneliness 

among participants. However, there were no statistically significant differences between 

participants and nonparticipants in the likelihood of screening positively for depression. The 

percentage of home-delivered meal participants who screened positively for depression was not 

statistically different from the percentage of nonparticipants for the PHQ-2 screener with a 

threshold of 2, 3, and 4. This was also true for the PHQ-2 raw score. Finally, there was no 

statistical difference between the percentages of home-delivered meal participants and 

nonparticipants who were satisfied with the socialization opportunities they have had. However, 

the percentage of individuals who were very satisfied with their socialization opportunities was 

8.9 percentage points lower for home-delivered meal participants than for nonparticipants (44.5 

versus 53.4 percent). 

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Table IV.5. Regression-adjusted socialization outcomes, by home-delivered

meal participation status

 Participants Nonparticipants Difference

Outcome Estimate 

Standard 

error Estimate 

Standard 

error Estimate 

Standard 

error

R-UCLA loneliness scale 

Loneliness score (mean)a 4.5 (0.1) 4.3 (0.1) 0.2* (0.1) 

PHQ-2 depression screener 

Percentage of individuals who 

affirmed at least 2 of 6 questions

18.0 (2.8) 15.1 (1.7) 2.9 (3.7) 

Percentage of individuals who

affirmed at least 3 of 6 questions

29.2 (2.6) 27.6 (2.9) 1.6 (4.3)

Percentage of individuals who

affirmed at least 4 of 6 questions

11.5 (2.1) 11.6 (1.7) -0.1 (2.9)

Number of questions individuals 

affirmed (mean)

1.1 (0.1) 1.1 (0.1) 0.1 (0.2) 

Satisfaction with socialization 

opportunities

 

Percentage of individuals satisfied 

with socialization opportunities

82.3 (1.6) 85.7 (2.1) -3.3 (2.7) 

Percentage of individuals very 

satisfied with socialization 

opportunities

44.5 (2.4) 53.4 (2.4) -8.9** (3.6) 

Source: AoA NSP outcomes survey, 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants. 

 *Significantly different from zero at the .10 level, two-tailed test.

 **Significantly different from zero at the .05 level, two-tailed test.

a Revised UCLA loneliness scale ranges from 3 to 9.

PHQ-2 = Patient Health Questionnaire 2; R-UCLA = Revised UCLA Three-Item Loneliness Scale. 

The research team conducted auxiliary analyses to assess whether the effect differed 

depending on the intensity of participating in the program, measured by the number of days per 

week participants receive home-delivered meals. Among home-delivered meal participants who 

receive meals five or more days per week, there were no statistically significant differences 

between participants and nonparticipants in any of the socialization outcomes (Table IV.6). 

Among home-delivered meal participants who receive fewer than five meals per week, the 

average R-UCLA loneliness score was slightly higher for participants than nonparticipants (4.6 

versus 4.2), the percentage of individuals who were satisfied with their socialization 

opportunities was lower for participants than for nonparticipants (79.7 versus 87.2 percent), and 

the percentage of individuals who were very satisfied with their socialization opportunities was 

lower for participants than for nonparticipants (34.5 versus 55.0 percent).

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Table IV.6. Regression-adjusted socialization outcomes, by home-delivered 

meal participation status and number of meals received per week

 Participants Nonparticipants Difference

Outcome

Estimat

e 

Standard 

error Estimate

Standard 

error Estimate

Standard 

error

R-UCLA loneliness scale 

Loneliness score (mean)a 4.5 (0.1) 4.3 (0.1) 0.2* (0.1)

Receive fewer than 5 delivered meals per 

week

4.6 (0.2) 4.2 (0.1) 0.4* (0.2)

Receive 5 or more delivered meals per week 4.5 (0.1) 4.3 (0.1) 0.2 (0.1)

PHQ-2 depression screener 

Percentage of individuals who affirmed at 

least 2 of 6 questions

29.2 (2.6) 27.6 (2.9) 1.6 (4.3)

Receive fewer than 5 delivered meals per 

week

28.6 (4.9) 27.7 (2.7) 0.8 (5.8)

Receive 5 or more delivered meals per week 28.2 (3.0) 27.4 (2.9) 0.8 (4.4)

Percentage of individuals who affirmed at 

least 3 of 6 questions

18.0 (2.8) 15.1 (1.7) 2.9 (3.7)

Receive fewer than 5 delivered meals per 

week

19.4 (4.8) 15.4 (1.7) 4.0 (5.5)

Receive 5 or more delivered meals per week 15.7 (2.8) 14.9 (1.7) 0.8 (3.6)

Percentage of individuals who affirmed at 

least 4 of 6 questions

11.5 (2.1) 11.6 (1.7) -0.1 (2.9)

Receive fewer than 5 delivered meals per 

week

5.3 (2.1) 11.7 (1.5) -6.4** (2.7)

Receive 5 or more delivered meals per week 13.2 (2.5) 11.5 (1.7) 1.7 (3.2)

Number of questions individuals affirmed 

(mean)

1.1 (0.1) 1.1 (0.1) 0.1 (0.2)

Receive fewer than 5 delivered meals per 

week

1.1 (0.2) 1.0 (0.1) 0.1 (0.3)

Receive 5 or more delivered meals per week 1.1 (0.1) 1.0 (0.1) 0.1 (0.2)

Satisfaction with socialization opportunities 

Percentage of individuals satisfied with 

socialization opportunities

82.3 (1.6) 85.7 (2.1) -3.3 (2.7)

Receive fewer than 5 delivered meals per 

week

79.7 (3.1) 87.2 (1.8) -7.6** (3.6)

Receive 5 or more delivered meals per week 84.1 (1.8) 85.2 (2.0) -1.1 (3.0)

Percentage of individuals very satisfied with 

socialization opportunities

44.5 (2.4) 53.4 (2.4) -8.9** (3.6)

Receive fewer than 5 delivered meals per 

week

34.5 (4.3) 55.0 (2.2) -20.5*** (5.2)

Receive 5 or more delivered meals per week 49.7 (2.7) 53.0 (2.4) -3.4 (3.7)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants.

 *Significantly different from zero at the .10 level, two-tailed test.

 **Significantly different from zero at the .05 level, two-tailed test.

 ***Significantly different from zero at the .01 level, two-tailed test.

a Revised UCLA loneliness scale ranges from 3 to 9.

PHQ-2 = Patient Health Questionnaire 2; R-UCLA = Revised UCLA Three-Item Loneliness Scale.

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3. Differences by income and whether individuals live alone

The research team assessed whether program impacts on socialization outcomes varied by 

household income and whether individuals lived alone. These findings are summarized below. 

Congregate meal participants and nonparticipants. There was no statistically significant 

difference between congregate meal participants and nonparticipants in the average R-UCLA 

loneliness score for lower-income individuals, individuals living with others, and individuals 

living alone. Among higher-income individuals, however, the average loneliness score was lower 

for congregate meal participants compared to nonparticipants (3.8 versus 4.1 percent) (Appendix 

Table C.3).

Relative to nonparticipants, congregate meal participants were less likely to screen positively 

for depression for individuals who lived alone, but not for individuals that lived with other 

people. Among individuals who lived alone, congregate meal participants were less likely to 

screen positively for depression in three of the four measures examined; for those who lived with 

other people, there were no significant differences between participants and nonparticipants 

(Appendix Table C.4). There also were generally no differences by income group.

Compared to nonparticipants, congregate meal participants had greater satisfaction with the 

socialization opportunities they have had. This was true for higher-income individuals, however, 

but not for lower-income individuals. Among higher-income individuals, for example, the 

percentage of individuals who were very satisfied with the socialization opportunities they have 

had was 15.1 percentage points greater for congregate meal participants than for nonparticipants 

(71.2 versus 56.1 percent) (Appendix Table C.5). Congregate meal participants had greater 

satisfaction with socialization opportunities relative to nonparticipants regardless of whether they 

lived alone or with other people. 

Home-delivered meal participants and nonparticipants. The home-delivered meal 

program analyses were also reestimated by household income and whether individuals live 

alone. Among individuals in higher-income households, the average R-UCLA loneliness score 

was higher for home-delivered meal participants compared to nonparticipants (Appendix Table 

C.6); however, there were no significant differences for individuals living in lower-income 

households, individuals living with other people, and individuals living alone (Appendix Table 

C.7). There were no significant effects of the home-delivered meal program on the likelihood of 

screening positively for depression across all four outcomes measures regardless of income and 

whether individuals live alone. Finally, the findings were mixed across subgroups for the 

percentage of individuals who were satisfied or very satisfied with the socialization opportunities 

they have had. For example, the percentage of higher-income individuals who were very 

satisfied with their socialization opportunities was lower for home-delivered meal participants 

than for nonparticipants (Appendix Table C.8). However, for lower-income individuals, there 

was no statistical difference between home-delivered participants and nonparticipants. In 

contrast, for lower-income individuals, there was a significant difference between participants 

and nonparticipants in the percentage of individuals who were either satisfied or very satisfied 

with their socialization opportunities and no effect for higher-income individuals. 

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C. Congregate and home-delivered meal participation and diet quality 

The research team estimated the impact of program participation on diet quality outcomes 

using two measures: (1) the prevalence of adequate and excessive nutrient intakes and (2) the 

HEI-2010, which assesses overall diet quality. Congregate meal participants generally had 

healthier diets compared to nonparticipants, both in terms of the adequacy of their usual nutrient 

intakes and the overall quality of their diets. However, congregate meal participants were more 

likely than nonparticipants to have excessive intakes of sodium. Overall, home-delivered meal 

participants were more likely than nonparticipants to have adequate nutrient intakes, but there 

were few differences in the overall quality of their diets. 

1. Prevalence of adequate and excessive nutrient intakes 

Congregate meal participation. There were a number of significant differences between 

congregate meal participants and nonparticipants in the percentage of individuals with adequate 

intakes for vitamins and minerals (Table IV.7). The percentages of congregate meal participants 

with adequate intakes for niacin, zinc, and vitamin B6 were 16.6 to 18.5 percentage points higher 

than nonparticipants; for riboflavin, phosphorus, and vitamin B12, percentages were 8.3 to 

13.1 percentage points higher. While these vitamins and minerals are important for people of all 

ages, some are especially important for older adults. For example, vitamin B6 is important for 

numerous metabolic reactions in the body and inadequacies sometimes lead to impaired immune 

function. Inadequate intakes of vitamin B6 have also been associated with declines in cognitive 

functioning and depression, both of which are common among older adults (Institute of Medicine 

2010). Vitamin B12 is an important nutrient of concern because decreased levels of stomach acid 

and many commonly prescribed medications can hamper its absorption. Low serum 

concentrations of vitamin B12 can have consequences for mobility and quality of life due to 

peripheral neuropathy and disturbances in balance and cognitive functioning and can also 

increase risk of heart disease and increase loss of bone density (Institute of Medicine 2010). 

Congregate meal participants also had higher mean intakes of potassium and dietary fiber, 

relative to the AI, than nonparticipants (a difference of 8.2 and 6.9 percentage points for 

potassium and dietary fiber, respectively). The AI is the recommended average intake level 

assumed to be adequate for healthy individuals in a life stage and gender group, based on 

observed or experimentally determined estimates of intake. It is important to note that when 

mean usual intakes fall below the AI, firm conclusions cannot be made about the adequacy of 

intakes. Thus, given the limitation of the AI standard, the differences observed for potassium and 

dietary fiber do not necessarily imply that participants were more likely than nonparticipants to 

have adequate usual intakes of these nutrients. 

Although congregate meal participants were more likely than nonparticipants to have 

adequate intakes of many nutrients, they were also more likely to have excessive sodium intakes. 

The percentage of congregate meal participants with excessive sodium intakes was 30.6 

percentage points higher compared to nonparticipants (93.7 versus 63.1 percent). As reported in 

Chapter III, congregate meal participants obtained, on average, 47 percent of their daily sodium 

intakes from program meals. 

Home-delivered meal participation. There were a number of statistically significant 

differences between home-delivered meal participants and nonparticipants in the percentage of 

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individuals with adequate nutrient intakes. Compared to nonparticipants, a greater percentage of 

home-delivered meal participants had adequate intakes of zinc (18.5 percentage points greater), 

vitamin B6 (12.7 percentage points greater), vitamin A (11.8 percentage points greater), and 

vitamin D (6.6 percentage points greater) (Table IV.7). There were no statistically significant 

differences between home-delivered meal participants and nonparticipants in mean usual intakes 

of potassium or dietary fiber relative to the AI, or in the proportions with excessive sodium 

intakes. The percentage of home-delivered meal participants with usual intakes of total fat that 

were within the AMDR was 11.5 percentage points higher compared to nonparticipants. 

Conversely, the percentage of participants with usual intakes of alpha-linolenic acid that were 

within the AMDR was 24.0 percentage points lower compared to nonparticipants. Alphalinolenic acid is a fatty acid found mostly in nuts and seed oils such as walnuts, flaxseeds, canola 

oil and soybean oil and is essential in the diet because it cannot be produced in the body and 

must be obtained from food sources. 

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IV. CONGREGATE AND HOME-DELIVERED MEAL PARTICIPATION AND PARTICIPANTS’ OUTCOMES MATHEMATICA POLICY RESEARCH

Table IV.7. Effects of congregate and home-delivered meal program participation on the percentage of 

people with adequate and excessive usual nutrient intakes, by participation status 

 Congregate meal program Home-delivered meal program

 Participants Nonparticipants Difference Participants Nonparticipants Difference

Nutrient Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error

Vitamins and minerals with EARs (percentage with usual intakes ≥ EAR)

Vitamin A 75.5 24.74 47.4 3.98 28.1 25.06 64.5 4.80 52.7 4.25 11.8* 6.41

Vitamin Ca 54.9 4.07 46.8 3.03 8.1 5.08 50.6 4.58 49.1 3.12 1.5 5.54

Vitamin D 4.1 3.50 2.6 1.27 1.5 3.73 7.0 2.26 0.4 0.83 6.6*** 2.41

Vitamin E 4.7 1.70 4.7 1.56 0.0 2.31 2.6 1.70 0.6 1.23 1.9 2.10

Vitamin B6 77.4 7.39 58.9 3.42 18.5** 8.14 73.1 5.85 60.4 2.78 12.7* 6.47

Vitamin B12 94.4 3.23 81.3 4.80 13.1** 5.78 93.0 8.13 91.1 4.79 1.9 9.44

Folate 72.1 4.97 76.4 6.28 -4.3 8.01 73.1 8.64 63.2 3.38 9.8 9.28

Niacinb 95.4 4.18 78.8 3.25 16.6*** 5.30 95.1 6.87 83.8 4.41 11.3 8.16

Riboflavin 97.6 1.53 89.3 3.13 8.3** 3.48 95.8 3.30 91.8 1.87 4.0 3.79

Thiamin 85.5 5.45 79.9 4.38 5.6 7.00 88.7 7.28 78.5 4.31 10.2 8.46

Calcium 26.3 4.58 17.6 3.30 8.7 5.64 24.1 3.55 17.1 2.76 7.1 4.50

Iron 99.3 0.59 97.8 2.13 1.5 2.21 98.0 2.20 95.5 1.63 2.5 2.74

Magnesium 31.3 3.15 25.4 3.19 6.0 4.48 22.4 3.54 20.6 3.35 1.8 4.87

Phosphorus 98.8 1.52 88.5 2.70 10.3*** 3.10 94.5 2.74 91.4 3.05 3.1 4.10

Zinc 78.2 5.15 60.6 3.90 17.6*** 6.46 77.5 7.05 58.9 3.41 18.5** 7.83

Potassium, dietary fiber, and sodium

Potassium 

(mean % of 

AI) 

53.0 1.71 44.9 1.50 8.2*** 2.28 47.6 1.21 45.9 1.38 1.8 1.84

Dietary fiber 

(mean % of 

AI) 

65.3 2.15 58.3 2.60 6.9** 3.37 56.9 2.22 58.0 2.41 -1.0 3.27

Sodium 

(mean % of 

AI) 

241.5 8.75 224.5 6.85 17.1 11.11 223.4 5.08 222.7 6.79 0.7 8.48

Sodium (% > 

UL/DG)

93.7 18.02 63.1 3.92 30.6* 18.44 69.2 4.29 61.8 3.66 7.4 5.64

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Table IV.7. (continued) 

 Congregate meal program Home-delivered meal program

 Participants Nonparticipants Difference Participants Nonparticipants Difference

Nutrient Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error Percent

Standard 

error

Macronutrients

Protein 

% within 

AMDR

99.9 0.42 99.1 1.35 0.8 1.41 99.6 0.79 99.1 0.75 0.6 1.09

% < AMDR 0.1 0.40 0.9 1.35 -0.8 1.41 0.4 0.79 0.9 0.75 -0.6 1.09

% > AMDR 0.0 0.02 0.0 0.01 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00

Carbohydrate 

% within 

AMDR

75.6 5.52 69.0 4.15 6.5 6.90 72.8 4.14 70.4 3.60 2.5 5.49

% < AMDR 24.2 5.27 29.5 3.39 -5.3 6.26 24.2 3.66 27.7 3.10 -3.5 4.80

% > AMDR 0.2 0.30 1.5 1.42 -1.2 1.45 3.0 1.58 2.0 1.27 1.0 2.03

Total fat 

% within 

AMDR

53.9 5.87 49.5 3.56 4.4 6.87 59.3 5.40 47.8 3.62 11.5* 6.50

% < AMDR 0.0 0.01 0.4 0.47 -0.4 0.47 0.6 0.63 0.5 0.46 0.1 0.78

% > AMDR 46.1 5.87 50.1 3.67 -4.0 6.92 40.1 5.36 51.7 3.71 -11.6* 6.52

Linoleic acid 

% within 

AMDR

84.8 8.17 79.8 7.40 5.0 11.02 75.7 6.58 86.7 10.84 -11.0 12.68

% < AMDR 11.3 5.66 15.7 5.29 -4.3 7.75 23.7 5.35 10.9 7.91 12.9 9.55

% > AMDR 3.9 3.11 4.5 2.41 -0.6 3.94 0.6 1.53 2.4 3.29 -1.8 3.63

Alphalinolenic acid 

% within 

AMDR

74.5 10.66 58.2 5.20 16.3 11.86 50.8 5.67 74.8 13.57 -24.0 14.71

% < AMDR 22.3 8.09 36.5 4.09 -14.1 9.06 48.9 5.65 24.9 12.58 24.1* 13.79

% > AMDR 3.2 3.29 5.3 2.19 -2.1 3.95 0.2 0.53 0.3 1.22 0.0 1.33

Saturated fat 

% > DG 89.0 17.80 72.7 5.81 16.3 18.72 71.5 6.77 70.9 4.29 0.7 8.02

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data. 

Note: Not all participants consumed a program meal on the intake day for the 24-hour recall. Estimates are based on an unweighted sample size of 1,210

congregate meal participants and nonparticipants and 1,016 home-delivered meal participants and nonparticipants.

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IV. CONGREGATE AND HOME-DELIVERED MEAL PARTICIPATION AND PARTICIPANTS’ OUTCOMES MATHEMATICA POLICY RESEARCH

Table IV.7. (continued) 

aThe EAR for vitamin C is 35 mg greater for smokers than nonsmokers. EARs were used for nonsmokers in this analysis.

bNiacin intakes include preformed niacin only. EARs for niacin are expressed as niacin equivalents, including contributions from tryptophan. Therefore, prevalence 

of adequate niacin intakes may be underestimated. 

 * Difference between participants and nonparticipants is significantly different from zero at the .10 level, two-tailed test.

 ** Difference between participants and nonparticipants is significantly different from zero at the .05 level, two-tailed test.

*** Difference between participants and nonparticipants is significantly different from zero at the .01 level, two-tailed test.

AI = Adequate Intake; AMDR = Acceptable Macronutrient Distribution Range; DG = 2015-2020 Dietary Guidelines; EAR = Estimated Average Requirement; UL = 

Tolerable Upper Intake Level.

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PARTICIPATION AND PARTICIPANTS’ OUTCOMES

2. Healthy Eating Index-2010 scores 

Congregate meal participation. There was a sizeable difference between congregate meal 

participants and nonparticipants in total HEI-2010 scores. The total score for participants was 6.1 

points higher than for nonparticipants (65.5 versus 59.4 points of 100) (Table IV.8). The 

statistically significant effect observed for the total HEI-2010 score reflects differences in scores 

for a number of HEI-2010 components. Relative to nonparticipants, congregate meal participants 

received higher scores for refined grains (1.8 points), total fruit (1.2 points), dairy (1.2 points), 

and total vegetables (0.6 points). Refined grains are found in products that do not contain all of 

the components of the grain kernel, which may include white bread, cookies, cakes, pastries, 

muffins, pasta, and cold cereals made with refined flour. 

Home-delivered meal participation. There were few statistically significant differences 

between home-delivered meal participants and nonparticipants in HEI-2010 scores (Table IV.8).

Scores for dairy and refined grains were significantly higher (1.3 points and 1.0 point, 

respectively) for participants than nonparticipants. There were no significant differences between 

home-delivered meal participants and nonparticipants, however, in scores for any of the other 

components or for the total score. 

Differences by income and whether individuals live alone. The research team examined

differences among participants and nonparticipants’ HEI-2010 scores by household income and 

whether individuals live alone. 

Congregate meal participants and nonparticipants. Relative to nonparticipants, total 

HEI-2010 scores were significantly higher for congregate meal participants among both lowerand higher-income individuals (7.1 points and 5.6 points, respectively) (Appendix Table C.9). 

For individuals in both income groups, scores for total fruit and refined grains were significantly 

higher for congregate meal participants than for nonparticipants (for total fruit, a difference of 

1.6 and 0.8 points for lower-income and higher-income participants, respectively; and for refined 

grains, a difference of 1.8 and 1.9 points, respectively). Among lower-income individuals, the 

score for total vegetables was 0.9 points higher for congregate meal participants than for 

nonparticipants, but there was no difference among higher-income individuals for this 

component. Conversely, among higher-income individuals, the score for dairy was 1.5 points 

higher for congregate meal participants than nonparticipants, but no effect was observed for this 

component for lower-income individuals. 

The total HEI-2010 score for individuals living with other people was 8.7 points higher for 

congregate meal participants than nonparticipants, but there was no statistically significant 

difference in the total HEI-2010 score among individuals living alone (Appendix Table C.10). 

Among individuals living alone, congregate meal participants had significantly higher scores for 

refined grains (1.6 points) and total fruit (1.0 points) than nonparticipants. Higher scores for 

these components were also observed among individuals living with others (2.1 points higher for 

refined grains and 1.4 points higher for total fruit). Congregate meal participants living with 

others also had significantly higher scores than nonparticipants for dairy (1.1 points), sodium 

(1.5 points), and empty calories (1.4 points). 

71
Table IV.8. Effects of congregate and home-delivered meal program participation on mean Healthy Eating 

Index-2010 scores, by participation status 

 Congregate meal program Home-delivered meal program

HEI-2010 

component

Maximum 

score

Participants Nonparticipants Difference Participants Nonparticipants Difference

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Adequacy (higher score indicates higher consumption)

Total fruit 5 4.8 0.19 3.6 0.20 1.2*** 0.27 4.6 0.26 4.3 0.26 0.3 0.37

Whole fruit 5 5.0 0.00 4.9 0.14 0.1 0.14 5.0 0.01 5.0 0.02 0.0 0.02

Total vegetables 5 4.5 0.24 3.9 0.17 0.6** 0.29 4.3 0.20 4.4 0.21 0.0 0.29

Greens and beans 5 3.8 0.36 3.5 0.35 0.3 0.50 2.6 0.29 2.8 0.29 -0.2 0.41

Whole grains 10 3.8 0.39 3.7 0.28 0.0 0.48 3.3 0.37 3.5 0.29 -0.2 0.47

Dairy 10 6.9 0.42 5.7 0.27 1.2** 0.50 7.2 0.33 5.8 0.28 1.3*** 0.43

Total protein foods 5 5.0 0.00 5.0 0.00 0.0 0.00 5.0 0.00 5.0 0.00 0.0 0.00

Seafood and plant 

proteins

5 4.6 0.51 4.5 0.37 0.1 0.63 3.8 0.66 4.2 0.43 -0.4 0.78

Fatty acids 10 4.2 0.44 4.3 0.26 -0.1 0.51 4.0 0.31 4.2 0.27 -0.2 0.41

Moderation (higher score indicates lower consumption)

Refined grains 10 7.8 0.25 6.0 0.41 1.8*** 0.48 7.4 0.38 6.4 0.45 1.0* 0.59

Sodium 10 2.3 0.47 2.2 0.37 0.2 0.59 2.2 0.44 1.9 0.29 0.3 0.53

Empty calories 20 12.8 0.52 12.1 0.45 0.7 0.69 12.0 0.41 11.9 0.37 0.1 0.55

Total score 100 65.5 1.41 59.4 1.44 6.1*** 2.01 61.4 1.66 59.3 1.34 2.1 2.14

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,210 congregate meal participants and nonparticipants and 1,016 home-delivered meal participants and 

nonparticipants.

 * Difference between participants and nonparticipants is significantly different from zero at the .10 level, two-tailed test.

 ** Difference between participants and nonparticipants is significantly different from zero at the .05 level, two-tailed test.

*** Difference between participants and nonparticipants is significantly different from zero at the .01 level, two-tailed test.

HEI = Healthy Eating Index.

72
IV. CONGREGATE AND HOME-DELIVERED MEAL MATHEMATICA POLICY RESEARCH

PARTICIPATION AND PARTICIPANTS’ OUTCOMES

Home-delivered meal participants and nonparticipants. The research team also 

examined HEI-2010 scores by household income and whether individuals live alone for homedelivered meal participants and nonparticipants. Among lower-income individuals, the score for 

dairy was 1.9 points higher for home-delivered meal participants than nonparticipants (Appendix 

Table C.11). Conversely, the score for greens and beans was 1.2 points lower for participants 

than nonparticipants. These effects were not observed among higher-income individuals. Among 

higher-income individuals, the score for refined grains and the total HEI-2010 score were 

significantly higher for participants compared to nonparticipants (1.3 points for refined grains 

and 4.1 points for the total HEI-2010 score). 

Among individuals living alone, the score for seafood and plant proteins was significantly 

lower for home-delivered meal participants than nonparticipants (−1.4 points), but there was no 

effect for this component among individuals living with others (Appendix Table C.12). There 

were no other significant differences in scores among individuals living alone. Relative to 

nonparticipants, scores for dairy and refined grains were significantly higher (2.0 points and 

1.8 points, respectively) among home-delivered meal participants who live with others. 

However, the score for greens and beans was lower for participants than nonparticipants (−1.1 

points).

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V. CONCLUSION

This chapter compares select findings to those in the last NSP evaluation conducted from 

1993 to 1995, here referred to as the 1995 evaluation (Ponza et al. 1996). It also presents 

recommendations for additional research motivated by the evaluation findings, including 

analyses that explain some of the counterintuitive findings observed for home-delivered meal 

participants related to food security and socialization. 

A. Comparison to findings from the 1995 NSP evaluation

This is the first national evaluation of the Title III-C NSP in 20 years. Compared to the 1995 

evaluation, the overall makeup of NSP participants has remained similar over time, with a few 

differences highlighted here: 

• The demographic composition of congregate and home-delivered meal participants has 

remained fairly stable over time. A larger percentage of home-delivered meal participants 

were Hispanic (9 percent in the current evaluation versus 5 percent in 1995); for congregate 

meal participants, these percentages were roughly the same (13 and 12 percent, 

respectively). In addition, a larger percentage of congregate meal participants lived alone in 

the current evaluation compared to in the 1995 evaluation (60 versus 57 percent); the 

percentage of home-delivered meal participants who lived alone was similar over time 

(59 versus 60 percent, respectively). 

• NSP participants continue to have significant economic needs, though the percentage of 

poor participants has decreased over time. In the current evaluation, 31 percent of 

congregate meal participants and 35 percent of home-delivered meal participants had 

incomes below 100 percent of the DHHS federal poverty guideline, compared to 34 and 

48 percent, respectively, in 1995.

• Most NSP participants continue to be satisfied with the services the program provides. The 

percentages of participants who were satisfied with the way the food tastes and looks, and 

with the variety of the food, have remained high (above 95 percent) over time. The 

percentage of home-delivered meal participants who reported the meal arrived at the 

scheduled time and the delivery person was pleasant also remained high (above 98 percent). 

• Participants continue to have a significant number of health problems, though the percentage 

of participants with doctor-diagnosed chronic health conditions has increased. Compared to 

the 1995 evaluation, greater percentages of congregate meal participants in the current 

evaluation had high cholesterol (57 versus 28 percent), heart disease (35 versus 28 percent), 

diabetes (33 versus 18 percent), and breathing or lung problems (39 versus 13 percent). This 

was also true for home-delivered meal participants with the exception of heart disease, 

which was less common in the current evaluation. Compared to the 1995 evaluation, greater 

percentages of home-delivered meal participants in the current evaluation had high 

cholesterol (53 versus 20 percent), diabetes (36 versus 25 percent), and breathing or lung 

problems (44 versus 16 percent). Forty-one percent of home-delivered meal participants 

reported having heart disease compared to 44 percent in the 1995 evaluation. 

75
V. CONCLUSION MATHEMATICA POLICY RESEARCH

• The percentage of home-delivered meal participants who have participated in the program 

for one or more years has increased, whereas this percentage for congregate meal 

participants has remained the same over time. Seventy percent of home-delivered meal 

participants in the current evaluation had participated for one or more years, compared to 

65 percent in the 1995 evaluation. Most of the change reflects an increase in the percentage 

of home-delivered meal participants who have participated in the program for one to five 

years. Eighty-four percent of congregate meal participants in the current evaluation had 

participated in the NSP for one or more years, the same as in the 1995 evaluation. 

Comparisons of evaluations’ findings on key outcomes. Both evaluations also estimated 

the effects of congregate and home-delivered meal participation on participants’ outcomes. The 

current evaluation was similar to the 1995 evaluation in its study design in terms of using a 

matched comparison group of nonparticipants based on Medicare administrative records. Both 

evaluations also examined the domains of socialization and diet quality (the food security 

domain was assessed only in the current evaluation). Despite similarities across the evaluations 

in the domains of outcomes used, the evaluations used different outcome measures within the 

domains. These differences, described below, are important to consider when comparing findings 

across studies. 

Both evaluations measured the effect of NSP participation on socialization outcomes. The 

1995 evaluation measured socialization using a single variable counting the number of social 

contacts older adults had over the previous month, and the current evaluation measured 

socialization using three outcomes: a measure of loneliness, a depression screener, and a measure 

of satisfaction with the opportunities one has to spend time with other people.10 Both evaluations 

found positive effects of congregate meal participation on socialization. However, whereas in the 

1995 evaluation home-delivered meal participants had a greater number of social contacts than 

nonparticipants, the findings in the current evaluation were mixed, pointing to either no effect or, 

for participants who receive meals fewer than five days per week, even lower levels of 

socialization among program participants relative to nonparticipants. Given the differences in the 

socialization outcome measures used in each study, it is not possible to determine whether 

differences in the findings for home-delivered meal participants are due to differences in the 

measurement of outcomes or to changes in the program’s effectiveness over time. However, 

descriptive information on delivery staff engagement suggests that engagement of program staff, 

namely delivery drivers, has improved over time. In the 1995 evaluation, 75 percent of homedelivered meal participants reported that the delivery person left immediately after delivering the 

food and did not spend time to talk with or check on the participant, whereas in the current 

evaluation, 46 percent of participants reported that the delivery person seldom or never spent 

time talking to them as part of the delivery process. This suggests that although engagement has 

improved, it may not be translating into improvements in socialization as participants perceive it. 

10 In the 1995 evaluation, “social contacts” included talking on the telephone; visiting friends, relatives, or 

neighbors; attending religious services; attending clubs; attending congregate meal sites; having contact with 

providers of personal care, home health, homemaker, and adult day care services; and, for home-delivered meal 

participants, having contact with the program person who delivers the meal.

76

 
V. CONCLUSION MATHEMATICA POLICY RESEARCH

Program meals continue to make substantial contributions to both congregate and homedelivered meal participants’ diets. Findings on the average contribution program meals made to 

participants’ daily nutrient intakes were comparable across the two studies. Program meals 

contributed 37 to 50 percent of participants’ daily intakes of nutrients in the previous evaluation 

and, among participants who consumed a program meal on the interview day, between 35 and 

47 percent in the current study. Similarly, participants obtained 41 to 44 percent of their daily 

calories from program meals in the previous evaluation and 38 to 41 percent in the current study. 

These findings indicate that both congregate and home-delivered meals have remained important 

sources of nutrition for participants over time. 

Because the two evaluations used different measures of diet quality and different nutrient 

standards, it is difficult to assess how the effects of program participation on diet quality have 

changed over time. The previous study found that participants had higher mean daily nutrient 

intakes, as a percentage of the Recommended Dietary Allowance (RDA), than nonparticipants 

for most nutrients analyzed.11 In the current study, the research team found that the prevalence of 

adequate nutrient intakes, relative to Estimated Average Requirements (EARs), was higher for a 

number of nutrients among participants than nonparticipants. Despite the limitations of this 

comparison, in general, participation has continued to have positive effects on diet quality over 

time. 

B. Implications for future research and policy

The descriptive study findings suggest several substantive research directions. These 

include: 

• Examine the reasons why some home-delivered meal participants do not like the taste 

or variety of food provided. Overall, nearly all home-delivered meal participants had a 

positive impression of the program and its staff, and most participants reported that meals 

arrived on schedule and the delivery person was pleasant. However, with about one-quarter 

of participants reporting concerns about the taste and variety of the food, more research is 

needed to understand their food preferences, special diets, and types of meals received (fresh

or frozen).

• Examine nutritional characteristics of the meals offered to participants. Congregate and 

home-delivered meals contributed substantially to participants’ daily intakes of calories and 

nutrients. Further examination of the meals offered to participants would provide useful 

information on how modifying meals could improve participants’ diet quality. Analyses 

could examine the types of foods the program frequently offers and the major food sources 

of nutrients and food groups in program meals. 

11 The RDA is an estimate of the daily average intake that meets the nutrient needs of nearly all healthy individuals 

in a life stage and gender group. It has limited use in assessing the adequacy of nutrient intakes. The EAR is the 

average daily nutrient intake level that is estimated to meet the nutrient needs of half of the healthy individuals in a 

life stage or gender group and is now the primary reference point for assessing the adequacy of nutrient intakes 

(IOM 2006). 

77

 
V. CONCLUSION MATHEMATICA POLICY RESEARCH

• Examine the challenges that congregate and home-delivered meal participants 

experience in making ends meet. With 15 percent of congregate meal participants and 

nearly 25 percent of home-delivered meal participants reporting that they experience 

challenges making ends meet, it is important to learn more about the characteristics and 

circumstances of the participants who must make difficult trade-offs between food and other 

goods and services such as paying utility bills or rent. A related analysis could study the 

difference between the 42 percent of congregate meal participants and 61 percent of homedelivered meal participants who indicated they would skip meals or eat less if the program 

were unavailable and those participants who would make other arrangements in the absence 

of the program. Such an analysis would help to understand the extent to which family 

networks and food coping strategies complement the meals and services received through 

the NSP. 

• Describe the types of congregate and home-delivered meal participants who

participate in the NSP more intensively. Analyses could assess the ways in which the 

43 percent of participants who attend congregate meal sites five or more times per week 

differ from those who attend more seldom; describe the characteristics of congregate meal 

participants who attend multiple sites each week; and describe how frequency of congregate 

meal participation depends on factors such as income, whether participants live alone, and 

functional impairments. Similar analyses could assess why 15 percent of home-delivered 

meal participants receive fewer than three meals per week.

• Examine the factors associated with receiving other forms of food assistance and using 

nutrition and supportive services outside the NSP. This could include analyzing the 

factors associated with receiving personal care services; home visits for physical, 

occupational, or speech therapy; and case management services. It could also include 

analyzing decisions to participate in federal food assistance programs such as SNAP in 

addition to congregate and home-delivered meal program participation, as well as the factors 

associated with congregate and home-delivered meal participants receiving food from local 

emergency pantries. 

The study of the effects of congregate and home-delivered meal participation on food 

security, socialization, and diet quality suggests the following substantive research directions: 

• Examine the determinants of food insecurity and very low food security among 

congregate meal participants. The lower food insecurity rate among congregate meal 

participants, relative to nonparticipants, aligns with expectations about how receipt of 

nutritious meals can reduce food access limitations. However, although congregate meal 

participants had lower food insecurity rates than did nonparticipants, a nontrivial percentage 

of participants were still food insecure. This highlights the need to examine the determinants 

of food insecurity among NSP participants in greater detail, including how food insecurity is 

related to food coping strategies among lower-income participants. More generally, given 

that many participants reported they experience challenges in making ends meet, it is 

important to learn more about the characteristics and circumstances of the participants who

must make difficult trade-offs between food and other goods and services. Exploring the 

extent to which family networks and food coping strategies complement the meals and 

services received through the NSP would be a fruitful direction for future research. 

78
V. CONCLUSION MATHEMATICA POLICY RESEARCH

• Examine the determinants of food insecurity and very low food security among homedelivered meal participants. Unlike for congregate meal participants, the findings for 

home-delivered meal participants were counterintuitive. There was no difference between 

participants and nonparticipants in the food insecurity rate and, for participants who

received fewer than five meals per week, home-delivered meal participants experienced 

greater food insecurity than nonparticipants. This suggests that some home-delivered meal 

participants experiencing food access limitations may not be receiving a sufficient number 

of meals per week to ameliorate their level of food insecurity. Learning more about why 

participants receive varying amounts of program meals and how they assess their food needs 

is an important step in improving their food security. It is essential to learn more about how 

the intensity of service receipt for both programs—measured by the number of congregate 

meals attended or home-delivered meals received per week as well as use of multiple sites—

depends on factors such as income, whether participants live alone, and functional 

impairments and, ultimately, how it affects participants’ outcomes.

• Assess how provision of socialization services at congregate meal sites affects the 

magnitude of the effect of congregate meal participation on socialization outcomes.

Congregate meal participants had more positive socialization outcomes compared to 

nonparticipants. For some outcomes, such as satisfaction with socialization opportunities, 

differences between participants and nonparticipants were particularly large. Additional 

research could examine congregate meal sites’ provision of socialization activities to assess 

whether the number and type of social activities that sites offer influences the improvement 

in socialization outcomes.

• Examine in more detail the effects of home-delivered meal participation on 

socialization outcomes. For home-delivered meal participants, the findings related to 

socialization were mixed; for some socialization outcomes there were no significant 

differences between participants and nonparticipants, whereas for other socialization 

outcomes, participants had less favorable outcomes than nonparticipants. A possible 

explanation is that findings from the descriptive analysis showed that nearly half of homedelivered meal participants reported the delivery person seldom or never spent time talking 

to them as part of the delivery process. This highlights the need to examine the 

characteristics of nearly half of all home-delivered meal participants who reported limited 

engagement from the delivery person and whether the negative effects observed in the 

outcomes analysis reflected differences in levels of program staff engagement. Another 

possible explanation is that the number of days per week that a participant receives meals 

affects the opportunities for socialization. The negative effects were observed only for 

participants that received meals fewer than five days per week, and not for the majority of 

participants that receive meals five or more days per week. Examining how program staff 

engagement may differ for participants that receive varying amounts of program meals 

could help to identify ways of improving socialization outcomes among program 

participants.

• Assess the effects of participation on food consumption patterns. Participants generally 

had healthier diets relative to nonparticipants, but participants’ diets still fell short of the 

Dietary Guidelines’ recommendations. Analyses examining differences in food choices and 

key sources of nutrients and food groups would provide useful information on foods to 

target through nutrition education. 

79
V. CONCLUSION MATHEMATICA POLICY RESEARCH

• Examine how the diets of home-delivered meal participants differ from those of 

congregate meal participants, given that participation had fewer effects on diet quality 

among home-delivered meal participants. More research could help identify the 

differences in nutrient intakes and food choices between home-delivered meal and 

congregate meal participants, both at lunch (from program meals) and over 24 hours. 

80
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Guenther, Susan Krebs-Smith, Amy Subar, and Kevin Dodd. “A Mixed-Effects Model 

Approach for Estimating the Distribution of Usual Intake of Nutrients: The NCI Method.” 

Statistics in Medicine, vol. 29, no. 27, 2010, pp. 2857–2868. 

U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. “Healthy Eating 

Index-2010 Fact Sheet.” February 2013. Available at https://www.cnpp.usda.gov/sites/ 

default/files/healthy_eating_index/CNPPFactSheetNo2.pdf Accessed December 7, 2016. 

U.S. Department of Health and Human Services, and U.S. Department of Agriculture. “Dietary 

Guidelines for Americans 2015–2020 (8th Edition).” December 2015a. Available at 

http://health.gov/dietaryguidelines/2015/guidelines. Accessed December 6, 2016. 

83
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U.S. Department of Health and Human Services, and U.S. Department of Agriculture. “Scientific 

Report of the 2015 Dietary Guidelines Advisory Committee.” February 2015b. Available at 

https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the2015-Dietary-Guidelines-Advisory-Committee.pdf. Accessed December 6, 2016. 

Ziegler, Jessica, Nicholas Redel, Linda Rosenberg, and Barbara Carlson. “Older Americans Act 

Nutrition Programs Evaluation: Meal Cost Analysis.” Washington, DC: U.S. Department of 

Health and Human Services, Administration for Community Living, September 30, 2015. 

Ziliak, James P., and Craig C. Gundersen. “Spotlight on Food Insecurity among Senior 

Americans: 2011.” National Foundation to End Senior Hunger Report. April 2013. 

Available at http://www.nfesh.org/wp-content/uploads/2013/03/Spotlight-on-FoodInsecurity-among-Senior-Americans-2011.pdf. Accessed November 1, 2016. 

84
APPENDIX A

DATA AND METHODOLOGY
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TABLES

A.1 Final disposition and response rates for participants ....................................................................A.9

A.2 Completion rates for screened nonparticipants ............................................................................A.9

A.3 Outcome measures and data sources ........................................................................................A.12

A.4 Definitions of Dietary Reference Intakes and 2015-2020 Dietary Guidelines’

recommendations........................................................................................................................A.15

A.5 Dietary Reference Intakes and select 2015-2020 Dietary Guidelines’ recommendations, 

by age and gender groups ..........................................................................................................A.16

A.6 Healthy Eating Index-2010 components and standards for scoring ...........................................A.18

A.7 Nonresponse bias analysis for outcomes survey .......................................................................A.28
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APPENDIX A MATHEMATICA POLICY RESEARCH

The Title III-C Nutrition Services Program (NSP) outcomes evaluation draws primarily on 

information obtained from comprehensive surveys and 24-hour dietary recalls collected from 

samples of program participants and a matched comparison group of program-eligible 

nonparticipants. This appendix presents an overview of the sampling design for the data 

collection and describes topics covered in the survey. It describes additional data sources used in 

the analysis and defines the evaluation’s outcome measures. Next, the chapter presents the 

analytic methods used to address the evaluation’s research objectives, including how sampling 

weights were constructed to allow findings from the sample to be representative of the 

population of congregate and home-delivered meal participants (and the group of matched 

nonparticipants). A final section discusses study limitations.

A. Sampling design

The evaluation used a multistage clustered sample design. The stages of sampling were:

1. Area Agencies on Aging (AAAs) 

2. Local service providers (LSPs) within AAAs

3. Congregate meal sites and home-delivered meal distribution locations within LSPs

4. Home-delivered meal routes within home-delivered meal distribution locations

5. Congregate meal participants within each congregate meal site and home-delivered meal 

participants within each home-delivered meal route 

In addition, the research team obtained a matched sample of congregate and home-delivered 

meal nonparticipants. 

In the process study, the research team administered the AAA survey to a probability sample 

of AAAs. An equal-probability random sample was used to select most of the AAAs, although 

the six largest AAAs were selected with certainty.12 For LSPs, the research team administered 

the survey to a probability sample of LSPs from the sampled and participating AAAs. The 

sample frame was formed using lists of LSPs obtained from these AAAs. LSPs were selected 

within AAAs using sequential sampling with probability proportional to size, with the measure 

of size being a composite measure incorporating both congregate and home-delivered meals. The 

research team also asked LSPs to provide a list of their congregate and home-delivered meal 

sites, which were then used as sample frames to select sites for the cost evaluation.

Among those LSPs that participated in the process and cost studies, the research team used 

the lists of congregate meal sites at each LSP to select the congregate meal sites for the outcomes 

evaluation. One congregate meal site was randomly selected among all of the LSP’s sites using 

probability proportional to size sampling. On the first day of meal provision in the data collection 

12 Size was defined using a composite measure based on information provided by State Units on Aging (SUAs) and 

by the National Association of States United for Aging and Disabilities on the total, unduplicated number of people 

who received NSP congregate nutrition services and home-delivered nutrition services during the most recently 

completed fiscal year in each of the AAAs. The six AAAs selected with certainty were the Chicago Department of 

Family and Support Services, New York City Department for the Aging, New Hampshire Bureau of Elderly and 

Adult Services, Los Angeles County Community and Senior Services, New Mexico Non-metro Area Agency on 

Aging, and the Greater Wisconsin Agency on Aging Resources, Inc. 

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week for each selected site, field staff attended the main congregate meal that day (usually lunch) 

and randomly sampled congregate meal participants and conducted interviews. 

The research team selected the home-delivered meal distribution location at the congregate 

meal site location or in its service area, obtained a list of each distribution location’s routes, and 

randomly sampled one route. On the first day of meal provision in the data collection week for 

each selected home-delivered meal distribution location, the research team obtained a list of all 

home-delivered meal participants for the sampled route, randomly sampled participants, and 

conducted interviews in their homes or in another convenient location. 

Finally, in the same geographic area as the sampled congregate meal sites and homedelivered meal routes, the research team obtained a list of Medicare beneficiaries from the 

Centers for Medicare & Medicaid Services (CMS) and used statistical matching techniques to 

identify older adults with characteristics similar to those in the congregate and home-delivered 

meal samples to form the study’s comparison groups. Potential program-eligible nonparticipants 

were screened by phone to exclude anyone who (1) participated in the congregate meal or homedelivered meal programs in the past year; (2) lived in a nursing home, assisted living facility, 

group home, or rehabilitation facility; or (3) did not live in the same zip code as the participant to 

whom they were matched. Field staff conducted interviews with nonparticipants in their homes 

or, for some congregate meal nonparticipants, a public location such as a local library. 

B. Data collection

The research team used multiple instruments to collect data from NSP participants and 

nonparticipants. The instruments were pretested and pilot-tested, and interviews were conducted 

from October 2015 to April 2016. 

1. Instruments

The research team collected data from NSP participants and nonparticipants in a 75-minute 

computer-assisted personal interview using two main instruments: an outcomes survey and a 24-

hour dietary recall. For nonparticipants, a short survey was also administered to screen and 

recruit individuals into the study. 

The outcomes survey collected information on a comprehensive set of topic areas including 

demographic characteristics, food security, health insurance coverage, health status and 

depression, and loneliness. In addition, all respondents were asked about their NSP participation 

history, and congregate and home-delivered meal participants were asked about the types of 

services they received, their impressions of the program and services, and monetary 

contributions for program meals. 

To describe NSP participants’ and nonparticipants’ diet quality and assess the effect of the 

meal and related services on participants’ nutrition and diet quality, the research team conducted 

24-hour dietary recalls with participants and nonparticipants. The Automated Self-Administered 

24-hour dietary recall system (ASA24 Adult Version 2014), developed by the National Cancer 

Institute (2014), was used as an in-person interviewer-administered tool to collect the 24-hour 

dietary recall data. The ASA24 is a web-based dietary intake data collection system that is 

modeled closely on the Automated Multiple Pass Method and uses the same general 

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methodology as the National Health and Nutrition Examination Survey. ASA24 provides 

nutrient and MyPyramid (“food group”) equivalents values from the Food and Nutrient Database 

for Dietary Studies, version 4.1, and the MyPyramid Equivalents Database, version 1.0, 

respectively.

13 The research team created supplemental forms and scripts for field interviewers to 

use for collecting the 24-hour recalls for this study. A second day of dietary recalls were 

collected from a subsample of participants and nonparticipants to estimate the distributions of 

usual intakes of key nutrients. 

Finally, a short computer-assisted telephone interview survey was used to screen and recruit 

meal program nonparticipants to participate in the study. The screener determined whether 

nonparticipants were eligible for the study using the criteria described in the sampling section. 

2. Pretesting

The research team pretested questions from the outcomes survey by phone with nine 

respondents: two congregate meal participants, three home-delivered meal participants, and four

nonparticipants. Most pretest participants thought the questions were easy to understand. As a 

result of the pretest, minor modifications were made to some of the terminology in the survey, 

such as referring to home-delivered meals as “meals-on-wheels.”

The research team also conducted a small-scale pilot to test the operational aspects of data 

collection. The pilot included conducting both the outcomes survey and the 24-hour dietary 

recall with 32 individuals (12 congregate meal participants and 20 home-delivered meal 

participants) from five meal program sites. The purpose of pilot-testing these instruments was to 

gauge respondent burden, ASA24 administration and features, and the usefulness of 

supplemental forms and scripts in collecting the 24-hour recall data. 

As a result of the pilot test, the research team significantly reduced the number of items in 

the outcomes survey. A “frail skip” was also incorporated into the outcomes survey so

interviewers could bypass noncritical sections of the survey to significantly reduce its length 

when respondents struggled to complete the survey due to length or fatigue. Finally, additional 

procedures were developed to help interviewers identify when a proxy was needed.

3. Conducting interviews

The field data collection began in October 2015 and ended in April 2016. In the first half of 

the field period, from late October 2015 through early January 2016, field interviewers visited 

92 LSPs during a prescheduled one-week period (the target week) to select a random sample of 

congregate and home-delivered meal participants and collect information from them. 

Data collection in each site spanned five days. On the first day of the target week, field 

interviewers randomly selected congregate and home-delivered meal participants to participate in 

the study. If necessary, field interviewers attempted to identify a proxy at the time of sampling. 

The research team targeted participants who were at least age 67 at the time of the interview to 

ensure it would have at least one year of Medicare records for each participant for the purposes 

13 The food group data were used in estimating the HEI-2010. The food groups included in the MyPyramid database 

are consistent with the food groups included in the HEI-2010. 

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of identifying potential nonparticipants. Over the next four days, field interviewers administered 

the outcomes survey and 24-hour dietary recall to sampled participants who agreed to participate 

in the study. Interviews with congregate and home-delivered meal participants took place at the 

meal site, in their homes, or in another convenient location such as a public library. A second 

dietary recall was conducted with a subsample of participants at least one day after their first 

dietary recall. 

A nonparticipant screener was conducted from December 2015 through March 2016 by 

trained telephone interviewers. For each congregate and home-delivered meal participant, the 

research team selected a sample of up to 50 potential nonparticipants from the same geographic 

area using propensity score matching and a list of Medicare beneficiaries from CMS. 

Potential nonparticipants were ranked in numerical order based on the strength of the match 

to the participant. On the first dialing attempt, interviewers started with the nonparticipant ranked 

as the best match for each participant and continued down the list of ranked potential 

nonparticipants in descending order. If the interviewer reached the end of the list and at least one 

nonparticipant match had not been recruited to participate in the study, the interviewer went back 

to the top of the list (the best match) and dialed cases that had not received a final status a second 

time in ranked order. This process continued until the research team recruited up to two 

nonparticipants for each participant or had exhausted efforts to recruit a nonparticipant match for 

a participant.14

Nonparticipants who were eligible for the study based on the criteria described in the 

sampling section and agreed to participate were scheduled a time for an in-person interview to 

complete the 24-hour dietary recall and outcomes survey in person with a field interviewer. 

These in-person interviewers were typically scheduled about four weeks in advance. 

From late January 2016 through early April 2016, field interviewers returned to the same 

geographic areas where they had interviewed congregate and home-delivered meal participants 

and for one week interviewed the predetermined matched sample of nonparticipants identified 

through the nonparticipant screener. Field interviewers administered the 24-hour dietary recall 

and outcomes survey to nonparticipants in nonparticipants’ homes or another convenient 

location. A second dietary recall took place with a subsample of nonparticipants at least one day 

after the first dietary recall was completed. 

4. Response rates. 

The research team used the American Association for Public Opinion Research’s Standard 

Definitions, ninth edition (2016), to calculate unweighted response rates for participants.15 The 

14 For half of the program participants from each LSP (randomly selected), the research team aimed to recruit two 

nonparticipant matches to participate in the study. For the other half of participants, the research team aimed to 

recruit one nonparticipant match. This ensured that the number of nonparticipants who completed the 24-hour 

dietary recall and outcomes survey would be comparable to the sample of meal participants, as it was known that 

some recruited nonparticipants would not complete the field interview.

15 American Association of Public Opinion Research, Standard Definitions: Final Dispositions of Case Codes and 

Outcome Rates for Surveys, revised April 2015. https://www.aapor.org/AAPOR_Main/media/publications/StandardDefinitions2015_8theditionwithchanges_April2015_logo.pdf.

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response rate (RR3) was defined as response rate = I / ( I + P + R + NC + O+ e(UH + UO) )

where I = complete interviews, P = partial interviews, R = refusal and break off, NC = noncontact, O = other, UH = unknown if housing unit was occupied, UO = unknown other, and e = 

proportion of cases with unknown eligibility estimated to be eligible. The eligibility rate for 

unknown cases was estimated based on the observed eligibility rate. The outcomes survey 

response rates were 76.1 percent for congregate meal participants and 54.1 percent for homedelivered meal participants (Table A.1). The outcomes survey completion rates for 

nonparticipants who were recruited from the telephone screener were 79.1 percent for congregate 

meal nonparticipants and 76.6 percent for home-delivered meal nonparticipants (Table A.2).

Table A.1. Final disposition and response rates for participants 

. 

Initial 

sample

Studyineligible

Studyeligible 

noncomplete

Study 

eligibility 

undetermined Complete

Response 

rate

Outcomes survey 

Congregate meal

participant

980 151 29 198 602 76.1%

Home-delivered 

meal participant

1,306 216 43 539 508 54.1%

24-hour dietary 

recall

 

Congregate meal

participant

980 151 31 198 600 75.9%

Home-delivered 

meal participant

1,306 216 39 539 512 54.6%

Table A.2. Completion rates for screened nonparticipantsa

. Screened and 

eligible

Study-eligible 

noncomplete Complete

Completion 

rate

Outcomes survey 

Congregate meal

nonparticipant

808 169 639 79.1%

Home-delivered meal

nonparticipant

691 162 529 76.6%

24-hour dietary recall 

Congregate meal

nonparticipant

808 179 629 77.8%

Home-delivered meal

nonparticipant

691 172 519 75.1%

a Because each potential nonparticipant sample member was likely attempted only once before going to the next 

person on the list, rather than making a full attempt to reach each one (as was done for the probability sample of 

program participants), neither a screener completion rate nor an actual response rate that accounts for all potential 

sample members ever attempted is presented for them. Instead, the completion rates among those nonparticipants 

who were recruited from the telephone screener are presented. 

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C. Additional data sources

To address the research objectives the research team linked the outcomes survey data to 

several other data sources. 

1. Neighborhood contextual data from the American Community Survey 

The research team used data from the American Community Survey to obtain local-area 

population characteristics. To obtain characteristics for small census geographies, such as census 

tracts, the Census Bureau aggregates data over five years. The 2010 to 2014 American Community 

Survey summary file was used to obtain tract-level measures of population, the percentage of 

families with income below 200 percent of the federal poverty threshold, the percentage of the 

total population that is non-white, the percentage of the total population that is Hispanic, and the 

percentage of housing units without access to a vehicle. 

2. Geographic address data for participants and food retailers

To describe NSP participants’ geographic access to food, the research team used residential 

address information for each respondent in the outcomes survey, data from the Census Bureau, 

and address data for food retailers from the U.S. Department of Agriculture (USDA). Using this 

information, the research team calculated measures of geographic access to food and determined 

whether a respondent lives in an urban or rural area.

The outcomes survey collected street address information for each respondent. The 

addresses were located using the geocoding tool in Google Maps API software. This process 

converted the address information to latitude and longitude coordinates and stored them in a 

newly created file. Next, data were obtained from the Store Tracking and Redemption System 

(STARS), which contains the name, street address, and type of store for all of the retailers in the 

country authorized to accept Supplemental Nutrition Assistance Program (SNAP) benefits. This 

set of stores make up most of the food retailers in the country, especially among supermarkets, 

superstores, and large grocery stores (Economic Research Service [ERS] 2009). The STARS’ 

data contained any store SNAP-authorized from October 2015 to April 2016, which aligns with 

the NSP evaluation data collection period. Using these data, the research team overlaid the map 

of individuals’ residential locations with the map of SNAP retailers and calculated distances 

from each individual to each store in the area. For each individual, the minimum distance to each 

store type was calculated and then recorded on the individual-level data file. As a second 

measure of geographic access to food, the number of retailers was calculated, by type, within 

three distances from each individual’s residential address. In urban areas, the distances are less 

than 0.5 miles, 0.5 to less than 1 mile, and 1 to 2 miles. In rural areas, the distances are less than 

5 miles, 5 to less than 10 miles, and 10 to 20 miles. 

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The research team determined whether an individual lived in an urban or rural area by 

overlaying the map of respondents’ residential locations with a U.S. Census Bureau geographic 

boundaries file and identifying the census tract in which each respondent was located.16 A binary 

indicator of urban/rural status was created using the census tract identification number. Using the 

ERS food environment atlas (ERS 2016), the research team obtained a variable that indicates 

whether the population-weighted centroid of a census tract is in an urban or rural area. According 

to ERS (2016): “urban and rural are defined in the Census Bureau’s urbanized area definitions, 

where rural areas are sparsely populated areas with fewer than 2,500 people, and urban areas are 

areas with more than 2,500 people. A census tract is urban if the geographic centroid of the tract 

is in an area with more than 2,500 people; all other tracts are rural.” Urban/rural status in ERS 

(2016) is based on the 2010 census. 

D. Outcome measures

The research team analyzed outcomes in three domains— food security, socialization, and 

diet quality (Table A.3). 

1. Food security

Food security is having access at all times to enough food for an active, healthy life for all 

household members (Coleman-Jensen et al. 2015). Evaluations of the effectiveness of nutrition 

assistance programs in improving food security typically measure whether participating in the 

program reduces food insecurity, defined as whether a household experiences food access 

limitations due to lack of money or other resources. A binary variable was created indicating 

whether an individual lived in a household that was food insecure in the past 30 days using 

responses to six questions related to food access and available income (Bickel et al. 2000). 

Households that affirmed two or more items of the six were classified as “food insecure.” A 

second binary variable was created indicating whether a household experienced a particularly 

severe level of food insecurity—referred to as “very low food security.” Households that 

affirmed five or more items were classified as having very low food security. 

2. Socialization 

The research team assessed socialization using three measures. First, individuals’ loneliness 

was measured using an abbreviated version of the Revised UCLA Loneliness Scale (R-UCLA; 

Russell et al. 1980; Hughes et al. 2004). The scale is based on responses to three questions 

related to how often respondents feel they lack companionship, feel left out, and feel isolated 

from others. Response options of hardly ever, some of the time, and often were coded to values 

of 1, 2, and 3, respectively, and the values were summed for each respondent across the three 

questions. Higher scores indicate greater perceptions of loneliness. 

16 Census tracts are geographic boundaries developed by the U.S. Census Bureau. They are drawn to encompass 

similar population sizes and, thus, vary in spatial size depending on whether they are in a metropolitan or 

nonmetropolitan area. Census tracts are the largest subcounty geographies defined by the Census Bureau and 

generally contain 1,500 to 8,000 people and have a target size of 4,000. In 2010, the United States was divided into 

more than 73,000 census tracts.

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APPENDIX A MATHEMATICA POLICY RESEARCH

Table A.3. Outcome measures and data sources

Domain of 

outcome 

measure Data source Outcome measures Description

Food security Outcomes

survey

Whether an individual lives in a 

household that was food insecure in 

the past 30 days

Based on responses to six questions 

about the food eaten in the past 30 

days and whether the respondent’s 

household was able to afford enough 

food

Food security Outcomes

survey

Whether an individual lives in a 

household that experienced very low 

food security in the past 30 days

Based on responses to six questions 

about the food eaten in the past 30 

days and whether the respondent’s 

household was able to afford enough 

food

Socialization Outcomes

survey

Revised UCLA Loneliness Scale Based on responses to an 

abbreviated version of the Revised 

UCLA Loneliness Scale to measure 

individuals’ loneliness

Socialization Outcomes

survey

PHQ-2 depression screener Based on responses to a twoquestion Patient Health 

Questionnaire (PHQ) screener for 

depression

Socialization Outcomes

survey

Whether an individual is very satisfied 

with the opportunities he or she has 

had to spend time with other people

Whether an individual is satisfied with 

the opportunities he or she has had 

to spend time with other people

Based on responses to a question 

asking how satisfied respondents are 

with the opportunities they have had 

to spend time with other people

Diet quality 24-hour 

dietary recall

Percentage contribution of program 

meals to participants’ total daily 

nutrient intakes

Estimate the proportion of 

participants’ daily nutrient intakes 

provided by program meals to assess 

the contribution of meals to 

participants’ diets

Diet quality 24-hour 

dietary recall

Usual nutrient intakes relative to 

national standards

Usual nutrient intakes relative to 

Dietary Reference Intake (DRI) 

standards and select 

recommendations of the 2015-2020

Dietary Guidelines to assess the 

proportion of participants and 

nonparticipants with adequate or 

excessive nutrient intakes 

Diet quality 24-hour 

dietary recall

Healthy Eating Index (HEI)-2010 

scores 

HEI-2010 scores estimated to provide 

an overall measure of diet quality 

relative to the 2010 Dietary 

Guidelines’ recommendations 

The second measure came from the Patient Health Questionnaire 2 (PHQ-2), an abbreviated 

version of the nine-question PHQ used to diagnose depression. The PHQ-2 assesses the 

frequency of depressed mood over the past two weeks; however, because it consists of only two 

of the nine questions, the PHQ-2 can be used for depression screening, but not diagnosis. People 

who screen positive for depression should receive further evaluation with the PHQ-9 to 

determine whether they meet criteria for a depressive disorder (Kroenke et al. 2003). The 

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APPENDIX A MATHEMATICA POLICY RESEARCH

outcomes survey contained the two questions in the PHQ-2, not the full set of nine PHQ-9 

questions. The two questions asked how often the respondent had little interest or pleasure in 

doing things and how often he or she felt down, depressed, or hopeless. The response options of 

not at all, several days, more than half of the days, and nearly every day were coded as 0, 1, 2, 

and 3, respectively. The values were summed for each respondent across the two questions, 

resulting in a raw score ranging from 0 to 6. 

Studies have identified thresholds above which respondents screen positively for depression 

by balancing sensitivity (the ability of the screener to correctly identify those with depression) 

and specificity (the ability of the screener to correctly identify those without depression). 

Research comparing the PHQ-2 to patients with depression diagnoses found that a score of 3 or 

greater was best to achieve this balance (Li et al., 2007; Lowe et al., 2005). However, researchers 

have recommended that further research evaluate validity and cutoff scores for older adults 

(Sheeran et al. 2010). Because there is no agreed-upon threshold that positively identifies 

individuals with depression, thresholds of 2, 3, and 4 were used to define three measures of 

screening positively for depression. The raw score itself was also examined. Thus, when 

considering this outcome, the research team looked for consistency in findings across these 

depression-screening measures. 

As a third measure of socialization, two variables were constructed from a single question 

measuring respondents’ self-reported satisfaction with the opportunities they have had to spend 

time with other people. Response options consisted of very satisfied, somewhat satisfied, not too 

satisfied, and not at all satisfied. A binary variable was created equal to 1 if an individual 

reported being very satisfied and equal to 0 otherwise. A second binary variable was created 

equal to 1 if an individual reported being satisfied (either very satisfied or somewhat satisfied) 

and equal to 0 otherwise. 

3. Diet quality

The research team used the 24-hour dietary recall data to analyze diet quality outcomes. 

Three measures were used to examine the quality of participants’ diets and assess the effects of 

participating in the NSP on diet quality. First, the contribution program meals made to 

participants’ daily intakes of calories and nutrients was examined. The research team also 

estimated usual nutrient intakes to assess the prevalence of adequate and excessive nutrient 

intakes among participants and nonparticipants. To assess the overall quality of participants’ and 

nonparticipants’ diets, the Healthy Eating Index (HEI)-2010 was used, which assesses 

conformance to key recommendations of the 2010 Dietary Guidelines (DHHS and USDA 

2015a). 

Contributions of program meals to daily nutrient intakes. The research team estimated 

the percentage contribution program meals made to participants’ daily intakes of calories and 

nutrients. To identify foods obtained from program meals, participants reported the source of 

each food reported in the 24-hour dietary recall. Because some participants do not receive 

program meals every day, not all participants consumed a program meal on the day referenced in 

the 24-hour dietary recall (the intake day). The percentage contribution of program meals to 

participants’ daily nutrient intakes was computed as the sum of the nutrients from all foods 

obtained from program meals divided by total daily nutrient intakes. If a participant did not 

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APPENDIX A MATHEMATICA POLICY RESEARCH

consume a program meal on his or her intake day, the percentage contribution was zero. The 

mean percentage contribution was estimated two ways: (1) for all participants, including those 

who did not consume a program meal (where the contribution is zero for non-consumers); and 

(2) for only participants who consumed a program meal on their intake day. The first measure 

provides information on the contribution of program meals to participants’ intakes on an average 

day. The second measure provides information on the relative contribution of program meals on 

days where participants consume meals. 

Usual nutrient intakes. To assess the prevalence of adequate and excessive nutrient intakes 

among participants and nonparticipants, the research team estimated usual intakes of vitamins, 

minerals, macronutrients, and other dietary components relative to the Dietary Reference Intakes 

(DRIs) and select recommendations from the 2015-2020 Dietary Guidelines. The DRIs are the 

most up-to-date scientific standards for determining whether diets provide enough nutrients to 

meet requirements, without being excessive. The DRIs are intended to be applied to measures of 

long-run or usual intakes. Therefore, both the mean and the distribution of usual daily intakes 

were estimated. 

Experts in diet assessment have found that data from single 24-hour recalls will lead to 

biased estimates of the distribution of usual intakes, as well as the proportion of a group with 

usual intakes above or below a standard (Beaton et al. 1983). This is due to individuals’ dietary 

intakes varying from day to day. Statistical modeling has mitigated some of the limitations of 24-

hour recalls by estimating and removing the within-person variation in dietary intake (Dodd et al. 

2006). The research team used the method developed by the National Cancer Institute to 

generate estimates of usual nutrient intakes. The National Cancer Institute method applies an 

econometric model to dietary recalls to estimate the distribution of usual intakes for the full 

population and any subpopulations of interest (Tooze et al. 2010; Freedman et al. 2010). 

Estimating usual nutrient intakes requires both the first 24-hour recall and, for a subsample of 

participants and nonparticipants, the second 24-hour recall. 

The research team used the SAS macros developed by the National Cancer Institute to 

estimate usual intake distributions, mean usual intakes, and the percentage of people with usual 

intakes that were above, below, or within DRI standards or select recommendations from the 

2015-2020 Dietary Guidelines. The DRIs include four types of standards for various nutrients 

(Table A.4). Estimated Average Requirements (EARs) were used as the cutpoint to assess 

adequacy for most vitamins and minerals. For potassium, dietary fiber, and sodium, which do not 

have established EARs, usual intakes were compared to the Adequate Intake (AI) level. Usual 

intakes of macronutrients (for example, total fat and carbohydrate) were compared to the 

Acceptable Macronutrient Distribution Ranges (AMDRs), which are expressed as percentages of 

total calorie intake. Usual intakes of sodium were also compared to the Tolerable Upper Intake 

Level (UL) (Institute of Medicine 2006). The 2015-2020 Dietary Guidelines include quantitative 

recommendations for intakes of saturated fat (as a percentage of total calories) and sodium that 

encourage reduced intakes of these nutrients (DHHS and USDA 2015a). Usual daily intakes of 

saturated fat and sodium were compared to these recommendations. Table A.5 shows the DRI 

standards and Dietary Guidelines’ recommendations for the nutrients included in the analysis, by 

DRI age and gender groups.

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Table A.4. Definitions of Dietary Reference Intakes and 2015-2020 Dietary 

Guidelines’ recommendations

Estimated Average 

Requirement (EAR)

The EAR is the average daily nutrient intake level estimated to meet the 

requirement of half of the healthy individuals in a particular life stage and gender 

group. The proportion of a group with usual intakes greater than or equal to the 

EAR provides an estimate of the prevalence of adequate usual intakes for that 

group. The prevalence of adequate usual intakes was estimated for the following 

nutrients with defined EARs: vitamin A, vitamin C, vitamin D, vitamin E, vitamin B6, 

vitamin B12, folate, niacin, riboflavin, thiamin, calcium, iron, magnesium, 

phosphorus, and zinc. 

Adequate Intake (AI) The AI is the recommended average intake level assumed to be adequate for 

healthy individuals in a life stage and gender group, based on observed or 

experimentally determined estimates of intake. An AI is defined when the data 

available for a particular nutrient are insufficient to estimate requirements and 

establish an EAR. Unlike an EAR, the AI cannot be used to estimate the 

prevalence of adequate nutrient intakes. Instead, assessment focuses on 

comparing mean usual intakes to the AI. Populations with mean usual intakes that 

meet or exceed AI levels can be assumed to have high levels of nutrient adequacy. 

However, when mean usual intakes fall below the AI, no firm conclusions can be 

drawn about the adequacy of usual intakes. Mean usual intakes were estimated as

a percentage of the AI for potassium, dietary fiber, and sodium. 

Tolerable Upper Intake 

Level (UL)

The UL is the maximum level of daily nutrient intake that is likely to pose no risk of 

adverse health effects for nearly all individuals in a population group. As intake 

increases above the UL, the potential risk of adverse effects may increase. The 

prevalence of excessive usual intakes was estimated relative to the UL for sodium. 

Acceptable Macronutrient 

Distribution Ranges 

(AMDRs)

The AMDRs define ranges of usual macronutrient intakes that are associated with 

reduced risk of chronic disease, while providing adequate intakes of other essential 

nutrients. The DRIs define AMDRs for intakes of macronutrients as percentages of

total calorie intake. Usual intakes that fall below or exceed the AMDR may 

increase risk of chronic diseases. The percentages of individuals with usual intakes 

of total fat, linoleic acid, alpha-linolenic acid, carbohydrate, and protein that were 

above, below, and within the AMDRs were estimated. 

2015-2020 Dietary 

Guidelines’

recommendations 

The 2015-2020 Dietary Guidelines provide quantitative recommendations for 

intakes of saturated fat (as a percentage of total calories) and sodium. The Dietary 

Guidelines’ recommended limit on sodium is the same as the UL for sodium. The 

prevalence of excessive nutrient intakes was estimated relative to the Dietary 

Guidelines’ recommendations for saturated fat and sodium. 

Sources: Institute of Medicine (2006); U.S. Department of Health and Human Services and U.S. Department of 

Agriculture (2015a). 

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Table A.5. Dietary Reference Intakes and select 2015-2020 Dietary 

Guidelines’ recommendations, by age and gender groups 

 Estimated Average Requirement (EAR)

 

Vitamin 

A (mcg 

RAE)

Vitamin 

C (mg)

Vitamin 

D (mcg)

Vitamin 

B6 (mg) 

Vitamin 

B12 (mcg)

Vitamin E 

(mcg)

Folate 

(mcg 

DFE)

Niacin 

(mg) 

Phosphorus 

(mg) 

Males 

51–71+ years 625 75 10 1.4 2.0 12 320 12 580

Females 

51–71+ years 500 60 10 1.3 2.0 12 320 12 580

Estimated Average Requirement (EAR)

 Riboflavin 

(mg) Thiamin (mg) Calcium (mg) Iron (mg)

Magnesium 

(mg) Zinc (mg)

Males 

51–70 years 1.1 1.0 800 6.0 350 9.4

71+ years 1.1 1.0 1,000 6.0 350 9.4

Females 

51–70 years 0.9 0.9 1,000 5.0 265 6.8

71+ years 0.9 0.9 1,000 5.0 265 6.8

 Adequate Intake (AI)

 Potassium (mg) Sodium (mg) Dietary Fiber (g)

Males 

51–70 years 4,700 1,300 30

71+ years 4,700 1,200 30

Females 

51–70 years 4,700 1,300 21

71+ years 4,700 1,200 21

Upper Tolerable Intake Level (UL)a 

 Sodium (mg)

Adults 51+ years 2,300 

 Acceptable Macronutrient Distribution Range (AMDR)

 

Total fat

Linoleic 

acid

Alphalinolenic 

acid Carbohydrate Protein 

 Percentage of total calories

Adults 51+ years 20–35 5–10 0.6–1.2 45–65 10–35

2015 Dietary Guidelines’ recommendationsa 

 Saturated fat (percentage of total calories)

Adults 51+ years < 10

Sources: Institute of Medicine (2006); U.S. Department of Health and Human Services and U.S. Department of 

Agriculture (2015a). 

a The UL and the 2015-2020 Dietary Guidelines’ recommendation for sodium are the same.

DFE = dietary folate equivalent; RAE = retinol activity equivalent.

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HEI-2010 scores. The HEI-2010 is a measure of diet quality that assesses conformance to 

key recommendations of the 2010 Dietary Guidelines (Guenther et al. 2013). The USDA has 

adopted it as a tool to monitor the quality of foods consumed by the U.S. population overall, as 

well as progress toward healthier eating habits among food assistance program participants 

(Guenther et al. 2007). The HEI-2010 is a scoring metric made up of 12 components, each 

reflecting a key aspect of diet quality, and a total score that measures overall diet quality. The 

standards used to assign HEI-2010 component scores are expressed on a density basis (that is, 

amounts per 1,000 calories or a percentage of calories), rather than absolute amounts of foods 

consumed. The use of such standards in assessing diet quality reflects the recommendation that 

individuals should strive to meet food group and nutrient guidelines while maintaining calorie

balance, rather than meeting these guidelines simply by consuming large quantities of food. 

Table A.6 lists the HEI-2010 components and standards for scoring. The HEI-2010 consists 

of nine adequacy components, which are dietary components individuals are recommended to 

consume to ensure adequate nutrient intakes, and include (1) total fruit, including juice; (2) 

whole fruit; (3) total vegetables; (4) greens and beans; (5) whole grains; (6) dairy; (7) total 

protein foods; (8) seafood and plant proteins; and (9) fatty acids. The remaining three 

components, referred to as moderation components, measure dietary components that individuals 

are recommended to limit and include refined grains, sodium, and empty calories. 

Table A.6 also shows the maximum score for each component, along with the intake criteria 

corresponding to minimum and maximum scores for each component. Maximum component 

scores for the various components range from 5 to 20. Scores for intakes between the minimum 

and the maximum standards are scored proportionately. For example, an intake that is halfway 

between the criteria for the maximum and minimum scores yields a score half the maximum 

score. Higher scores for each of the adequacy components reflect greater consumption and 

higher diet quality, whereas higher scores for each of the moderation components reflect lower 

consumption and higher diet quality. Scores for each of the 12 components are summed to create 

a total HEI-2010 score, with a range from 0 to 100. 

SAS macros developed by the National Cancer Institute were used to estimate mean HEI2010 scores using data from the single 24-hour recall available for all participants and 

nonparticipants. The National Cancer Institute programs produce estimates at the population 

level, using the population ratio method (Guenther et al. 2013). This method involves calculating 

mean intakes of calories, nutrients, and food groups for the population, and then calculating the 

ratios of the means with calories in the denominator, and comparing ratios with HEI standards 

for scoring. Two HEI-2010 related outcomes were estimated: (1) mean total and component 

HEI-2010 scores, and (2) percentages of the maximum possible component and total scores. 

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Table A.6. Healthy Eating Index-2010 components and standards for scoring 

HEI-2010 componenta

Maximum 

score

Standard for maximum

score

Standard for minimum score of 

zero

Adequacy components (higher score indicates higher consumption)

Total fruitb 5 ≥ 0.8 cup equiv. / 1,000 kcal No fruit

Whole fruitc 5 ≥ 0.4 cup equiv. / 1,000 kcal No whole fruit

Total vegetablesd 5 ≥ 1.1 cup equiv. / 1,000 kcal No vegetables

Greens and beansd 5 ≥ 0.2 cup equiv. / 1,000 kcal No dark green vegetables, beans, 

or peas

Whole grains 10 ≥ 1.5 ounce equiv. / 1,000 kcal No whole grains

Dairye 10 ≥ 1.3 cup equiv. / 1,000 kcal No dairy

Total protein foodsf 5 ≥ 2.5 ounce equiv. / 1,000 kcal No protein foods

Seafood and plant proteinsf,g 5 ≥ 0.8 ounce equiv. / 1,000 kcal No seafood or plant proteins

Fatty acidsh 10 (PUFAs + MUFAs) / SF > 2.5 (PUFAs + MUFAs) / SF < 1.2

Moderation components (higher score indicates lower consumption)

Refined grains 10 ≤ 1.8 ounce equiv. / 1,000 kcal ≥ 4.3 ounce equiv. / 1,000 kcal

Sodium 10 ≤ 1.1 gram / 1,000 kcal ≥ 2.0 grams / 1,000 kcal

Empty caloriesi 20 ≤ 19% of energy ≥ 50% of energy

Total score 100 

Source: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion (2013).

aIntakes between the minimum and maximum standard are scored proportionately. 

bIncludes 100 percent fruit juice. 

cIncludes all forms except juice. 

dIncludes any beans and peas not counted as total protein foods. 

eIncludes all milk products, such as fluid milk, yogurt, cheese, and fortified soy beverages. 

f

Beans and peas are included here (and not with vegetables) when the total protein foods standard is otherwise not 

met. 

gIncludes seafood, nuts, seeds, soy products (other than beverages) as well as beans and peas counted toward total 

protein foods. 

hRatio of PUFAs and MUFAs to SF.

i

Calories from solid fats, alcohol, and added sugars; threshold for counting alcohol is > 13 grams/1,000 kcal. 

Equiv = equivalent; HEI = Healthy Eating Index; kcal = calories; MUFA = monounsaturated fatty acid; PUFA = 

polyunsaturated fatty acid; SF = saturated fat. 

E. Analytic methods

The research team used both descriptive and multivariate analysis methods to address the 

research objectives in the evaluation. 

1. Descriptive analysis

Descriptive, tabular analysis was used to describe the characteristics of older adults who 

participate in the NSP, participants’ impressions of the program, and their valuation of meals and 

supportive services received through the program. For categorical variables, the percentage of 

individuals who responded in each category was estimated. For example, the responses to a 

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question that asks participants for their overall impression of the nutrition program were 

tabulated, with the options of excellent, very good, good, fair, and poor. For continuous 

variables, the mean and median values of the distribution among individuals and the percentages 

of individuals with values in different ranges of the distribution are presented. (The median, or 

50th percentile of the distribution, is the value for which 50 percent of the observations are less 

than or equal to.) For example, the mean and median number of meals participants report eating 

per day and the percentages of participants who report eating 0 to 1, 2 to 3, or 4 to 5 meals per 

day are presented. All analyses were conducted separately for congregate and home-delivered 

meal participants. In several cases, cross-tabulations were performed using variables other than 

program type. For example, the prevalence of food insecurity by income and age is presented. 

2. Multivariate analysis 

To estimate the effect of receiving a congregate meal or home-delivered meal on food 

security, socialization, and diet quality, the research team compared outcomes for participants 

and a matched comparison group of program-eligible nonparticipants. The purpose of a 

comparison group of eligible nonparticipants is to represent what would happen to participants in 

the absence of the program. The comparison group of nonparticipants should ideally be as 

similar as possible to the sample of participants, except for program participation and random 

variation. After NSP participants completed the survey and provided their Social Security 

number, the research team selected a group of potential nonparticipants from the Medicare 

Beneficiary Summary File of nonparticipants who lived in the same geographic area as 

participants and who were similar to participants on a set of demographic, economic, and healthrelated variables. For each NSP participant, propensity score matching was used to identify the 

best potential nonparticipant matches based on observable characteristics,17 contacted them and 

confirmed they met the eligibility criteria described in the sampling section (including that they 

were not participating in the congregate meal or home-delivered meal programs), and 

administered the outcomes survey and dietary recall. Despite efforts to use Medicare 

administrative data to identify a group of nonparticipants who were comparable to participants 

across several critical individual characteristics related to outcomes, the characteristics of the two 

samples differed. Consequently, the research team used statistical methods and the outcomes 

survey data in the analyses to control for differences in the characteristics of participants and 

nonparticipants that affect both outcomes and program participation decisions. 

The methods used differed depending on the outcome measure examined. For individuallevel outcomes in the domains of food security and socialization, multivariate regressions were 

used to estimate the effect of NSP participation on the outcomes, controlling for characteristics 

that could be related to both program participation and the outcomes studied. The regressions are 

described in greater detail below. The research team also used weights for nonparticipants that 

17 The research team estimated a logistic regression model of NSP participation as a function of age; gender; race 

and ethnicity; Medicare eligibility; whether the beneficiary was dually eligible for both Medicare and Medicaid 

(which served as a proxy for socioeconomic status); indicators for cancer conditions (breast, colon, prostate, lung, 

endometrial); indicators for and counts of chronic conditions for some of the 27 chronic conditions on the file 

including cataract, chronic kidney, glaucoma, hip fracture, depression, stroke, diabetes, and asthma; Medicare 

service utilization indicators including inpatient and emergency department visits and skilled nursing facility and 

home health visits; and total Part A and Part B Medicare expenditures.

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were generated using a propensity-score matching algorithm based on machine learning called 

boosting (Ridgeway and McCaffrey, 2007 and Lee et al. 2010), that when used in the analyses 

make the characteristics of participants and nonparticipants similar in terms of all of the 

characteristics the model includes. (The weight construction procedure is described in greater 

detail in the weighting section below.) Multivariate regression analysis could not be used, 

however, to estimate the effect of NSP participation on HEI-2010 scores and usual nutrient 

intakes relative to national standards because they are population-based estimates computed at 

the group level rather than the individual level. Thus, the analyses of those outcomes solely use 

the propensity score weights to make the groups more comparable. 

Regression analysis. For individual-level outcomes in the domains of food security and 

socialization, the research team estimated multivariate regressions to estimate the effect of NSP 

participation on the outcomes, controlling for characteristics that could be related to both 

program participation and the outcomes studied. Ordinary least squares (OLS) regression 

analysis was used for outcome measures that are continuous variables: the R-UCLA raw score 

and the PHQ-2 depression screener raw score. Logistic regression analysis was used for binary 

variables: food insecurity, very low food security, PHQ-2 depression screener indicators, and 

respondents’ report of being very satisfied or satisfied with their socialization opportunities. The 

full sample findings were robust to whether OLS or logistic regression models were used for 

binary outcomes in that the program effects were similar in magnitude and statistical 

significance.18 

All multivariate analyses were conducted separately for congregate meal participants and 

nonparticipants and for home-delivered meal participants and nonparticipants. The regression 

models differed across the congregate and home-delivered meal samples only in terms of the set 

of independent variables. The independent variables used in the congregate meal regressions

consisted of: 

• Individual-level demographic and economic variables (gender; age; veteran status; 

educational attainment; whether the individual was white, non-Hispanic; whether the 

individual was Hispanic; whether the individual was married or had a partner; whether the 

individual lived with other people in the household; monthly household income relative to 

the federal poverty DHHS guidelines;19 and whether anyone in the household received 

Social Security benefits or Supplemental Security Income [SSI])

• Health variables (whether the individual had ever been diagnosed with high blood pressure 

or hypertension, whether the individual had ever been diagnosed with diabetes or high blood 

sugar, and the number of falls in the past three months) 

18 For several subgroup analyses for the binary outcome of very low food security, the research team used OLS in 

place of logistic regression analyses due to lack of convergence of the nonlinear model likely attributed to the 

smaller sample sizes and limited variation in the dependent variable.

19 https://aspe.hhs.gov/2015-poverty-guidelines. 

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• Local-area population characteristics of the census tract in which the individual lived (total 

population, percentage of families with income below 200 percent of the federal poverty 

threshold, percentage of the total population that is non-white, percentage of the total 

population that is Hispanic, percentage of housing units without access to a vehicle, and 

urbanicity). 

The independent variables used in the home-delivered meal regressions consisted of this 

same set of variables plus indicators of (1) whether the individual was able to walk, was bed 

bound, or was chair bound or in a wheelchair and (2) whether the individual had serious 

difficulty concentrating, remembering, or making decisions because of a physical, mental, or 

emotional condition. To determine the set of variables to include in each model, the research 

team started with the variables included in similar models from the 1995 NSP outcomes 

evaluation (Ponza et al. 1996) and both dropped variables and added new variables to maximize 

the fit of the model to the data. 

The results of regression analyses are presented using regression-adjusted tables of estimates 

of program effects that resemble descriptive tables (see Chapter IV). For example, a regressionadjusted table compares the rates of food insecurity for congregate meal participants and 

nonparticipants after accounting or adjusting for compositional differences across groups. To 

examine binary outcome measures using logistic regression analysis, the regression-adjusted 

estimates were obtained by estimating the regression, using the regression coefficients and 

variable values for each person in the sample to obtain a predicted probability of being food 

insecure, and averaging the predicted probabilities to obtain the adjusted (predicted) rate of food 

insecurity in the sample. By performing these steps assuming all sample members are 

participants, then repeating the procedure assuming all sample members are nonparticipants, two 

averaged values were obtained. The difference between these values is the regression-adjusted 

estimate of the effect of program participation on food insecurity. The procedure is identical for 

continuous outcome measures, except that the tables contain regression-adjusted mean values of 

the R-UCLA raw score and the PHQ-2 raw score.

The research team analyzed the effect of congregate and home-delivered meal participation 

on outcomes measuring food security, socialization, and diet quality (HEI-2010 scores) 

separately for two important household and economic subgroups. The models were reestimated 

by monthly household income relative to poverty by dividing the sample into those individuals 

with income-to-poverty ratios less than the median value in the sample and those with ratios 

greater than or equal to the median value. Median income as a percentage of poverty was equal 

to 128 percent for congregate meal participants and nonparticipants and 122 percent for homedelivered meal participants and nonparticipants. These groups are referred to as lower-income 

and higher-income groups. The models were also reestimated according to whether individuals 

lived alone or with other family members. 

F. Accounting for item nonresponse

Missing data are a potential source of bias in the regression analysis of the effects of 

program participation on food security and socialization outcomes. The research team used three 

sequential methods to impute missing data for specific survey items to help reduce this bias. 

First, imputations of demographic and household information were used based on the empirical 

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distributions of variables to correct for incomplete responses to survey items that were included 

as covariates in the regression model. Next, a simple imputation method was used to fill in 

specific numeric values for categorical data for monthly and annual income variables in which 

individuals were asked to provide a range of values when they believed they could not provide a 

specific number. Finally, predictive mean matching was used to fill in any remaining missing 

income information. 

Imputation of demographic and household variables. Item nonresponse was low for the 

demographic and household variables included in the regression models. Nonresponse ranged 

from 2 individuals for veteran status to 31 individuals for whether anyone in the household 

receives SSI (of a total sample size of 2,255 individuals). Simple random imputation was used to 

impute missing values of the following variables (the number of imputed cases for each variable 

is in parentheses): educational attainment (24); veteran status (2); whether the individual was 

white, non-Hispanic (10); whether the individual was Hispanic (5); whether the individual was 

married or had a partner (7); whether the individual had ever been diagnosed with high 

hypertension (14); the number of falls in the past three months (8); whether the individual had 

serious difficulty concentrating, remembering, or making decisions because of a physical, 

mental, or emotional condition (14); whether anyone in the household received Social Security 

benefits (19); and whether anyone in the household received SSI (31). 

Imputation of categorical income data. For the monthly and annual household income 

variables in the outcomes survey, the research team asked respondents who were not able or 

refused to provide a specific dollar value to provide a categorical response. A simple imputation 

method was used to fill in values for these variables while maintaining the patterns observed for 

the group of individuals who provided numerical responses. For each individual providing a 

categorical response to a survey item, the research team randomly selected an individual in the 

same participation status group (congregate meal participant, congregate meal nonparticipant, 

home-delivered meal participant, or home-delivered meal nonparticipant) and the same 

educational attainment group (less than high school, high school, some college, or college) with 

income in the same category who provided an exact dollar response; this was called the donor 

observation. The individual with missing monthly income data inherited the donor’s exact 

monthly income. This was repeated for annual income for individuals with missing annual 

income data.

To define monthly income in the regression analysis, reported monthly income was used for 

those individuals with a nonmissing value. There were 607 individuals missing a numerical value 

of monthly income. The research team imputed 325 cases using the categorical monthly income 

data imputation procedure described previously. Annual income (both reported and imputed 

based on categorical annual income data) divided by 12 was used to impute monthly income for 

another 24 cases. Predictive mean matching (described below) was used to impute monthly 

income values for the remaining 258 cases with missing monthly and annual income. 

Predictive mean matching. The imputation process was conducted based on predictive 

mean matching using five steps. First, an imputation model was estimated in which the reported 

monthly income was modeled as a linear function of program participation status, age, and 

educational attainment. The imputation model was estimated using only individuals who 

reported a nonmissing monthly income amount. Second, the estimated coefficients and standard 

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errors from the imputation model were used to form a posterior distribution for the true 

coefficients of the imputation model. A random draw was obtained from this posterior distribution, 

producing a specific set of coefficients. Third, the specific set of coefficients drawn in the previous 

step was used to generate predicted values of monthly income for individuals who responded to the 

question about monthly income and those who did not respond. Fourth, for each person who did not 

respond to the monthly income question, the five respondents who had the closest predicted values to 

that of the nonrespondent were identified. Finally, one of these five respondents was randomly 

selected, and the reported monthly income of the selected respondent served as the imputed value for 

the nonrespondent.

G. Standard errors

For all regression-based analyses, standard errors were estimated using a variance estimator 

based on a first-order Taylor series approximation. The research team accounted for the 

multistage sampling design of the outcomes survey when estimating standard errors by using the 

Stata 14.1 software’s “svy” commands and identifying the strata and primary sampling unit 

identifiers. For the estimation of HEI-2010 total and component scores, standard errors were 

estimated using the National Cancer Institute’s SAS macros that account for the complex survey 

design in a similar way. Finally, for the usual nutrient intake analyses, the National Cancer 

Institute’s SAS macros only allow standard error estimation using replicate weights. Sixty-nine 

replicate weights were constructed using a jackknife method and included them in the estimation 

procedure. 

H. Analysis weights

Analysis weights allow unbiased estimates to be computed based on sample survey 

responses from the study population. Weights take into account both the probability of selection 

into the sample and the differential response patterns that may exist in the respondent sample.

Because not all respondents from the outcomes survey completed the 24-hour dietary 

recalls, one set of weights was constructed for analyses using data from the outcomes survey and 

a second set of weights was constructed for analyses using data from both the outcomes survey 

and the 24-hour dietary recall data. For each set, weights were constructed separately for 

congregate meal participants and nonparticipants and home-delivered meal participants and 

nonparticipants. 

Because the sample design incorporated multiple stages of selection (AAA, LSP, congregate 

meal site, home-delivered meal route, congregate meal participant, and home-delivered meal 

participant), the weights had to account for selection and response at each stage. The analysis 

weights were the product of sampling weights and nonresponse adjustments to those weights 

across all stages of sampling. The first step of weighting in each stage consisted of calculating 

the sampling weight (the inverse of its selection probability) for each unit sampled and released. 

These sampling weights were by-products of the sampling procedures and had already been 

constructed for AAAs and LSPs for the process and cost studies (Mabli et al. 2015; Ziegler et al. 

2015). 

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For congregate meal participants, the sampling weight was calculated for the selection of: 

• Each AAA

• Each LSP selected within the AAA

• The congregate meal site selected within each LSP, and its associated home-delivered meal 

site

• Each congregate meal participant selected within each congregate meal site

For home-delivered meal participants, the sampling weight was calculated for the selection 

of:

• Each AAA

• Each LSP selected within the AAA

• The congregate meal site selected within each LSP that is associated with the homedelivered meal site

• The home-delivered meal route selected within the associated home-delivered meal site20 

• Each home-delivered meal participant selected within each home-delivered meal route

Because of the way they were selected, home-delivered meal sites were assigned the 

sampling weight of their associated congregate meal site. The only exceptions to this were in the 

four LSPs containing only one home-delivered meal site and no congregate meal sites—these 

home-delivered meal sites received a sampling weight equal to one. 

The sampling weights were adjusted to compensate for nonresponse and to help ensure 

accurate representation of the population at each stage of selection and data collection in the 

evaluation results. This included: 

• Adjusting the AAA weight for process study nonresponse with respect to provision of its 

LSP list

• Adjusting the LSP weight for process study and cost study nonresponse 

• Adjusting the LSP weight for outcomes evaluation nonparticipation 

• Adjusting the home-delivered meal site–level sampling weights for one site that did not 

participate (no congregate meal sites within participating LSPs declined to participate)

The research team made the remaining nonresponse adjustments to the weights at the 

participant level, separately, for congregate and home-delivered meal participants. This was done 

in two stages: (1) adjusting for whether the screener obtained sufficient information so that the 

participant’s study eligibility status was determined, and (2) adjusting for nonresponse among 

participants determined to be eligible. Due to the lack of any specific information about sampled 

20 The research team did not randomly select a home-delivered meal site within each LSP. Instead, the homedelivered meal site associated with each sampled congregate meal site was included in the study.

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APPENDIX A MATHEMATICA POLICY RESEARCH

participants who did not respond to the survey, participant sampling weights were adjusted for 

participant-level nonresponse within weighting cells defined by the AAA in which the LSP and 

its sites were operating.21 The inverse of the weighted response rate within the weighting cell 

was used as the nonresponse adjustment factor to the prevailing cumulative weight. 

After applying the adjustments to the sampling weights for the responding sample members, 

the research team examined the weight distribution for outliers. Weight trimming and 

redistribution were then used to address outliers that were unduly increasing the design effect or 

could potentially give any one participant too much influence on an estimate.22 

This entire process was carried out for response to the outcomes survey and for response to 

both the outcomes survey and the dietary recall instrument.

Weights for congregate and home-delivered meal nonparticipants. Despite efforts to 

identify a group of nonparticipants from Medicare beneficiaries within the same geographic 

areas who were comparable to participants across several critical individual characteristics 

related to outcomes, the characteristics of the two samples differed, both for the congregate and 

home-delivered meal samples. Consequently, the research team did not assign the matched 

comparison cases the sampling weight of their associated program participant. Instead, a 

propensity score matching algorithm was estimated based on a machine learning process called 

boosting, using the R package TWANG (Ridgeway et al. 2016), described below. Recent studies 

have concluded that propensity score estimation using boosting has consistently superior 

performance (Ridgeway and McCaffrey 2007; Lee et al. 2010). 

The model used data from participants and nonparticipants and defined the dependent 

variable to measure whether the respondent was a participant. The matching algorithm, which 

was separately run for congregate and home-delivered meal participants, used the following 

information from the outcomes survey that was not available in the Medicare administrative 

records used in the initial matching performed to identify a comparison group of nonparticipants 

age, gender, race, ethnicity, veteran status, education, monthly household income, monthly 

household income-to-poverty ratio, employment status, marital status, and household size. 

Among this set of potential candidate variables, the matching algorithm identified monthly 

household income, monthly household income-to-poverty ratio, race, ethnicity, and age as the 

variables that would achieve the best balance between participants of both types and their 

21 In cases where the use of the AAA as the weighting cell was thought to be problematic (either due to a small 

number of respondents per cell or a large nonresponse adjustment per cell), the research team instead used census 

region crossed with a four-category LSP size variable (quartile for number of congregate or home-delivered meals) 

as the weighting cell.

22 The congregate and home-delivered meal participants in one LSP ended up with extremely high weights due to a 

combination of factors, including expected size measures at the time of sampling that did not match actual size 

measures, and high nonresponse adjustment factors. These extremely high weights significantly increased the design 

effect, meaning that the participants in that LSP would have represented a substantial proportion of the estimated 

population, as well as imposed a risk that participants in that LSP would have an undue influence on the study 

findings. The research team tried various ways of trimming their weights but found no way to do so without risking 

the introduction of bias. Because the research team believed it did not have sufficient information about the LSP and 

its components to adequately describe the population it represented, the research team ultimately excluded the 

participants from this LSP from the analysis.

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APPENDIX A MATHEMATICA POLICY RESEARCH

corresponding nonparticipants. The algorithm produced propensity score weights for 

nonparticipants that, when used in the analyses, make the characteristics of participants and 

nonparticipants similar in terms of all of the characteristics included in the model. This process 

was carried out for response to the outcomes survey and then again for response to both the 

outcomes survey and the dietary recall.

Representativeness of weights. Based on weighted data, the congregate and homedelivered meal participant findings in Chapter III of this report are nationally representative of 

the population of congregate and home-delivered meal participants. However, this is not true for 

the nonparticipants who completed interviews because, by design, they were not sampled from a 

frame of nonparticipating older adults. Instead, the estimates of the effects of congregate and 

home-delivered meal participation on outcomes that use weighted participant and nonparticipant 

data are representative of the effects for the population of congregate and home-delivered meal 

participants. In other words, the study intends to assess the effect of the programs on those who 

choose to participate in the program, not on the entire population. 

Replicate weights. To estimate the effect of program participation on usual nutrient intakes, 

the research team could not estimate standard errors using a Taylor series approach based on the 

full sample weights along with design variables. Instead, eight sets of replicate weights were 

created, with each set having 69 replicates. These were constructed separately for congregate 

meal participants and nonparticipants and home-delivered meal participants and nonparticipants, 

and separately for analyses using data from the outcomes survey and analyses using data from 

both the outcomes survey and the 24-hour dietary recall data. To construct these weights, the 

research team used a jackknife approach in which one primary sampling unit (usually the AAA) 

was removed at a time and, using the final full-sample weights described above, re-weighted 

within the impacted stratum to account for the individuals in the dropped unit. 

Nonresponse bias analysis. Because the response rates for both the outcomes survey and 

dietary recall were less than 80 percent for both congregate and home-delivered meal

participants, the research team analyzed the potential for nonresponse bias—bias that results 

when respondents differ in meaningful ways from nonrespondents. As response rates decrease, 

the risk for nonresponse bias increases if nonrespondents respond differently from respondents. 

The goal was to assess the potential risk for nonresponse bias and whether nonresponse could be 

properly accounted for using the nonresponse-adjusted analysis weights, thereby mitigating any 

significant differences between the respondents and the sample as a whole. Nonresponse bias 

cannot usually be directly measured. However, the research team can look for indications of the 

risk for nonresponse bias on key outcomes and examine whether the nonresponse-adjusted 

weights mitigate this risk. 

Because the research team had little to no information about the sampled but nonresponding 

individuals, information was used on the census region for each participant and the size (number 

of meals served) of the LSP from which the research team sampled the participant’s site. 

Because census region and LSP size could be related to key study outcomes, whether differences 

existed in response patterns with respect to these variables was examined. Table A.7 presents the 

findings. Because the findings were nearly identical for the analysis of nonresponse to the dietary 

recall, only the findings for the analysis of nonresponse to the outcomes survey are presented 

here. 

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APPENDIX A MATHEMATICA POLICY RESEARCH

The second column of Table A.7 contains the weighted response rates for each census 

region and LSP size. The next column contains the weighted distribution of census region and 

LSP size for all sample members.23 This column is the standard for comparison and is a best 

guess as to what the distribution of individuals looks like across regions and size. The next 

column shows what the distribution would be like among respondents and ineligible sample 

members had the research team not adjusted for nonresponse, and the last column shows the 

distribution after nonresponse adjustments and weight trimming. 

The weighted response rates differed by census region. Congregate meal participants were 

more likely to respond if they lived in the Northeast (83.9 percent) and less likely to respond if 

they lived in the Midwest (74.6 percent). This is evident by comparing the census region 

distribution for the entire sample and for the responding (plus ineligible) sample. For the entire 

sample, the Midwest represents 21.5 percent, but among the respondents, the Midwest represents 

20.2 percent. After nonresponse adjustments to the weights, the Midwest represents 21.6 percent 

of the population. For the home-delivered meal participants, the South had the highest weighted 

response rate (57.6 percent) and the West had the lowest (48.7 percent). The census region 

distribution before weighting adjustments overrepresented participants in the South by less than 

2 percentage points, but this discrepancy narrowed after weighting. The corresponding 

discrepancy for the West did not resolve after weighting, but all discrepancies, both before and 

after nonresponse adjustments, were minor. 

The weighted response rates differed slightly by the size of LSP (as measured by either 

number of congregate meals served or number of home-delivered meals served). Congregate 

meal participants were more likely to respond if they attended a site in a small LSP (84.3 

percent) and less likely to respond if they attended a medium LSP (76.3 percent). This is evident 

by comparing the size distribution for the entire sample and for the responding (plus ineligible) 

sample. For the entire sample, participants in medium LSPs represent 43.4 percent, but among 

the respondents, they represent 41.9 percent. After nonresponse adjustments to the weights, they 

represent 43.0 percent of the population. For the home-delivered meal participants, small LSPs 

once again had the highest weighted response rate (55.9 percent) and large LSPs had the lowest 

(48.1 percent). The size distribution before weighting adjustments overrepresented participants in 

small LSPs by less than 2 percentage points, but this discrepancy narrowed after weighting. The 

corresponding discrepancies for medium and large LSPs did not resolve after weighting, but 

again, all discrepancies, both before and after nonresponse adjustments, were minor. 

23 The weighted response rate accounts for each participant’s sampling weight, which incorporates prior sample 

selection stages.

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APPENDIX A MATHEMATICA POLICY RESEARCH

Table A.7. Nonresponse bias analysis for outcomes survey

Characteristic

Weighted response 

rate

(percentage) 

Selected sample 

(weighted by 

sampling weight)

(percentage) 

Respondents plus 

ineligible sample 

(weighted by 

sampling weight) 

(percentage) 

Respondents plus 

ineligible sample 

(weighted by 

nonresponseadjusted weight) 

(percentage) 

Congregate meal 

program

 

Census region 

Midwest 74.6 21.5 20.2 21.6

Northeast 83.9 24.6 26.0 24.7

South 80.5 19.1 19.4 19.2

West 77.6 34.8 34.3 34.4

LSP sizea 

Small 84.3 23.4 24.8 23.6

Medium 76.3 43.4 41.9 43.0

Large 79.0 33.2 33.3 33.5

Home-delivered 

meal program

 

Census region 

Midwest 51.6 23.9 23.7 25.1

Northeast 54.5 15.7 16.1 16.6

South 57.6 17.4 18.8 18.3

West 48.7 43.0 41.3 40.0

LSP sizea 

Small 55.9 20.3 21.3 20.7

Medium 52.5 48.4 50.2 46.8

Large 48.1 31.3 28.5 32.5

Source: AoA NSP outcomes survey, 2015-2016.

aFor congregate meals, the categories were 1 to 168 meals, 169 to 532 meals, and more than 532 meals. For homedelivered meals, the categories were 1 to 135 meals, 136 to 406 meals, and more than 406 meals. These were 

based on LSP size distributions (tertiles among non-zero values).

Although there is no rule of thumb for how large of a relative bias is acceptable, the larger it 

is, the more caution it merits in analysis. In this study, for the two high-level variables that were 

available for analysis, respondent distributions differed from those of the full sample by less than 

2 or 3 percentage points even before nonresponse weighting adjustments. In most cases, those 

small differences narrowed after adjustments. This is a good indication that the nonresponse 

adjustment reduces the potential bias that results from interview nonresponse. 

I. Study limitations

This report represents the most comprehensive assessment in 20 years of the effectiveness of 

the Title III-C NSP in improving participant outcomes. When interpreting the report’s findings, it 

is important to consider two limitations.

Item nonresponse. Although interviewers administered the surveys, respondents were able 

to respond “don’t know” or refuse to answer questions. The percentages and estimates presented 

in Chapter III of this report are based on responses that exclude both types of missing data. As a 

result, item nonresponse bias is possible for those estimates. Item nonresponse bias occurs when 

individuals who respond to a question differ in meaningful ways from those who do not respond. 

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APPENDIX A MATHEMATICA POLICY RESEARCH

This was not a serious problem for most survey questions, however, as all of the estimates 

presented in the tables either had no item nonresponse or very little item nonresponse, which the 

research team defined as at least an 80 percent response rate. 

Causality. Both the propensity score matching procedure and regression analysis can adjust 

for differences only in observable characteristics, whereas program participants might also differ 

from nonparticipants in unobservable ways that could influence the estimates of program impacts 

on outcomes. Therefore, the findings based on either approach cannot be definitively interpreted 

as causal effects of the extent to which program participation affects food security, socialization, 

and diet quality. Instead, these procedures adjust—to the extent possible—for observable 

differences likely to be correlated with the outcome measures. This allows similar groups of 

participants and nonparticipants to be compared, while still acknowledging that unobservable 

factors might influence differences in outcome measures. The research team attempted to 

minimize this possibility, however, by using a powerful research design that (1) matched 

participants and nonparticipants based on a comprehensive set of demographic and health 

characteristics in Medicare administrative records and (2) identified matched nonparticipants 

within small, local geographic areas (zip codes) in which participants lived.

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APPENDIX B

USUAL NUTRIENT INTAKE DISTRIBUTIONS FOR NSP PARTICIPANTS
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APPENDIX B MATHEMATICA POLICY RESEARCH

TABLES

B.1 Vitamin A (mcg RAE): Usual nutrient intakes of congregate and home-delivered meal 

program participants .....................................................................................................................B.5

B.2 Vitamin C (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants....................................................................................................................................B.6

B.3 Vitamin D (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

participants....................................................................................................................................B.7

B.4 Vitamin E (mg AT): Usual nutrient intakes of congregate and home-delivered meal 

program participants .....................................................................................................................B.8

B.5 Vitamin B6 (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants ....................................................................................................................................B.9

B.6 Vitamin B12 (mcg): Usual nutrient intakes of congregate and home-delivered meal 

program participants ...................................................................................................................B.10

B.7 Folate (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.11

B.8 Niacina (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.12

B.9 Riboflavin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.13

B.10 Thiamin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.14

B.11 Calcium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.15

B.12 Iron (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.16

B.13 Magnesium (mg): Usual nutrient intakes of congregate and home-delivered meal 

program participants ...................................................................................................................B.17

B.14 Phosphorus (mg): Usual nutrient intakes of congregate and home-delivered meal 

program participants ...................................................................................................................B.18

B.15 Zinc (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.19

B.16 Potassium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.20

B.17 Dietary fiber (g): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.21

B.18 Sodium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants..................................................................................................................................B.22

B.19 Protein (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program participants...........................................................................................B.23

B.3 
APPENDIX B MATHEMATICA POLICY RESEARCH

B.20 Carbohydrate (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program participants.................................................................................B.24

B.21 Total fat (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program participants...........................................................................................B.25

B.22 Linoleic acid (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program participants.................................................................................B.26

B.23 Alpha-linolenic acid (as a percentage of calories): Usual nutrient intakes of congregate 

and home-delivered meal program participants .........................................................................B.27

B.24 Saturated fat (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program participants.................................................................................B.28

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APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.1. Vitamin A (mcg RAE): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 774 44.5 368 427 548 719 933 1,186 1,371

Males 183 870 109.1 359 427 574 791 1,076 1,408 1,676

51–70 years 40 722 195.8 414 470 574 702 853 1,000 1,100

71+ years 143 917 100.6 362 433 581 813 1,127 1,533 1,839

Females 408 724 44.7 383 438 543 687 864 1,056 1,192

51–70 years 77 750 99.5 374 430 542 701 904 1,135 1,280

71+ years 331 714 56.1 387 440 539 679 846 1,038 1,169

All home-delivered meal program 

participants

502 773 70.8 227 295 444 673 988 1,375 1,660

Males 156 910 148.9 228 295 448 719 1,138 1,719 2,244

51–70 years 22 693 157.5 312 376 489 667 863 1,037 1,181

71+ years 134 939 179.5 248 317 481 750 1,158 1,767 2,249

Females 346 690 29.0 299 361 485 652 851 1,070 1,217

51–70 years 35 722 99.3 224 304 468 670 924 1,209 1,382

71+ years 311 685 34.4 321 383 498 653 837 1,037 1,161

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

RAE = retinol activity equivalent; SE = standard error.

B.5 
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.2. Vitamin Ca (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 78 4.1 22 29 46 70 101 138 164

Males 183 92 14.1 15 23 42 76 124 182 229

51–70 years 40 91 22.0 15 24 45 78 123 174 211

71+ years 143 94 13.4 16 24 44 78 125 187 232

Females 408 71 4.4 35 42 53 68 86 104 117

51–70 years 77 71 4.6 35 41 53 68 86 103 116

71+ years 331 69 4.6 28 35 48 65 86 109 124

All home-delivered meal 

program participants

502 72 3.7 21 28 43 65 92 124 146

Males 156 69 5.0 18 24 39 61 89 122 148

51–70 years 22 60 6.9 – – – – – – – 

71+ years 134 70 6.1 16 22 37 60 91 131 158

Females 346 73 4.2 23 30 45 66 94 126 148

51–70 years 35 111 17.8 24 36 61 97 146 206 245

71+ years 311 69 4.2 22 29 42 63 88 117 136

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

aThe EAR for vitamin C is 35 mg greater for smokers than nonsmokers. In this analysis, EARs were used for nonsmokers.

– The usual intake distribution could not be reliably estimated for this subgroup. 

B.6 
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.3. Vitamin D (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 5.2 0.27 2.1 2.6 3.5 4.8 6.4 8.3 9.6

Males 183 6.5 0.66 2.0 2.5 3.8 5.7 8.3 11.4 13.9

51–70 years 40 6.7 2.25 0.9 1.3 2.4 4.4 8.3 14.3 20.0

71+ years 143 6.6 0.61 2.6 3.2 4.4 6.1 8.3 10.7 12.5

Females 408 4.6 0.26 2.5 2.9 3.6 4.4 5.4 6.5 7.1

51–70 years 77 4.6 0.26 2.5 2.9 3.5 4.4 5.4 6.4 7.1

71+ years 331 4.3 0.26 1.7 2.1 2.9 4.0 5.3 6.9 7.9

All home-delivered meal 

program participants

502 5.1 0.36 1.3 1.8 2.9 4.5 6.7 9.1 10.8

Males 156 6.4 0.71 1.6 2.2 3.5 5.6 8.4 11.7 14.4

51–70 years 22 6.0 1.94 0.7 1.1 2.1 4.4 8.1 12.4 16.7

71+ years 134 6.6 0.77 1.8 2.3 3.7 5.7 8.4 12.0 14.4

Females 346 4.5 0.38 1.3 1.8 2.7 4.1 5.8 7.7 8.9

51–70 years 35 4.7 0.55 3.0 3.3 3.9 4.6 5.4 6.2 6.7

71+ years 311 4.4 0.43 1.1 1.6 2.5 4.0 5.8 7.9 9.2

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.7 
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.4. Vitamin E (mg AT): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 6.4 0.24 2.9 3.4 4.4 5.9 7.8 10.1 11.8

Males 183 7.3 0.38 2.5 3.1 4.3 6.3 9.1 12.6 15.7

51–70 years 40 9.3 1.34 2.5 3.2 4.8 7.5 11.8 17.5 22.3

71+ years 143 6.6 0.51 2.7 3.2 4.3 6.0 8.2 10.9 13.0

Females 408 6.0 0.36 3.1 3.5 4.4 5.7 7.2 8.8 9.9

51–70 years 77 6.5 0.81 4.2 4.6 5.3 6.3 7.4 8.7 9.4

71+ years 331 5.8 0.35 2.8 3.3 4.2 5.5 7.0 8.8 10.0

All home-delivered meal 

program participants

502 6.0 0.30 2.5 3.1 4.2 5.6 7.4 9.4 10.7

Males 156 6.3 0.36 2.7 3.3 4.4 6.0 7.8 9.8 11.3

51–70 years 22 6.3 0.38 2.6 3.2 4.4 6.0 7.8 9.7 11.2

71+ years 134 6.3 0.38 2.5 3.1 4.3 5.9 7.8 10.1 11.5

Females 346 5.8 0.38 2.5 3.0 4.0 5.4 7.2 9.2 10.6

51–70 years 35 7.0 1.75 2.1 2.6 4.0 5.8 8.7 12.8 15.6

71+ years 311 5.7 0.38 2.5 3.0 4.0 5.3 7.0 9.0 10.2

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

AT = alpha-tocopherol; SE = standard error.

B.8 
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.5. Vitamin B6 (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 1.8 0.06 1.0 1.1 1.4 1.7 2.1 2.6 2.9

Males 183 2.0 0.22 0.9 1.0 1.4 1.9 2.5 3.3 3.9

51–70 years 40 2.2 0.73 0.6 0.8 1.2 1.8 2.8 4.1 5.2

71+ years 143 2.0 0.13 1.1 1.3 1.5 1.9 2.4 2.8 3.1

Females 408 1.7 0.07 1.1 1.2 1.4 1.6 1.9 2.2 2.4

51–70 years 77 1.8 0.12 0.9 1.0 1.3 1.7 2.2 2.7 3.0

71+ years 331 1.7 0.07 1.1 1.2 1.4 1.6 1.9 2.1 2.3

All home-delivered meal 

program participants

502 1.7 0.06 0.9 1.1 1.3 1.6 2.0 2.4 2.7

Males 156 1.9 0.09 1.2 1.3 1.5 1.8 2.1 2.5 2.7

51–70 years 22 1.9 0.29 1.0 1.1 1.4 1.8 2.3 2.6 2.9

71+ years 134 1.9 0.12 1.2 1.3 1.6 1.8 2.1 2.5 2.7

Females 346 1.6 0.08 0.9 1.0 1.2 1.5 1.9 2.4 2.6

51–70 years 35 1.8 0.27 0.9 1.0 1.3 1.7 2.1 2.6 3.0

71+ years 311 1.6 0.07 0.8 1.0 1.2 1.5 1.9 2.3 2.6

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.9 
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.6. Vitamin B12 (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5ths 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 5.2 0.31 1.9 2.3 3.2 4.6 6.4 8.8 10.6

Males 183 6.4 0.80 1.9 2.4 3.5 5.3 8.0 11.5 14.7

51–70 years 40 6.4 2.45 1.0 1.3 2.4 4.3 8.0 13.5 18.6

71+ years 143 6.5 0.75 2.5 3.0 4.0 5.7 8.0 11.0 13.3

Females 408 4.6 0.26 2.0 2.4 3.2 4.2 5.7 7.3 8.5

51–70 years 77 5.0 0.70 1.9 2.3 3.1 4.4 6.2 8.4 9.8

71+ years 331 4.5 0.29 2.0 2.4 3.1 4.1 5.5 7.1 8.3

All home-delivered meal 

program participants

502 5.5 0.45 1.8 2.3 3.3 4.8 6.9 9.4 11.2

Males 156 7.3 1.15 2.3 2.9 4.1 6.2 9.1 12.9 16.1

51–70 years 22 5.7 1.51 1.9 2.4 3.4 5.2 7.4 9.5 11.4

71+ years 134 7.5 1.40 2.5 3.0 4.4 6.4 9.3 13.4 16.5

Females 346 4.5 0.22 2.3 2.7 3.4 4.3 5.3 6.4 7.1

51–70 years 35 4.6 0.69 3.4 3.6 4.1 4.6 5.1 5.7 6.1

71+ years 311 4.4 0.22 2.1 2.5 3.2 4.2 5.4 6.6 7.4

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.10
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.7. Folate (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 442 14.8 207 239 308 407 532 685 798

Males 183 539 39.8 192 236 332 479 678 916 1,111

51–70 years 40 661 165.3 149 198 313 511 840 1,286 1,674

71+ years 143 503 28.1 260 299 374 478 603 744 841

Females 408 395 16.0 224 252 305 377 465 560 627

51–70 years 77 457 49.7 264 294 354 435 537 649 718

71+ years 331 379 14.0 215 242 292 362 445 540 605

All home-delivered meal 

program participants

502 406 15.6 226 256 314 390 479 576 641

Males 156 448 26.2 274 303 358 432 519 612 681

51–70 years 22 446 26.2 268 300 355 433 517 607 681

71+ years 134 458 32.3 264 295 357 437 534 649 725

Females 346 386 14.9 216 245 300 371 455 546 606

51–70 years 35 435 72.4 244 276 339 414 510 622 693

71+ years 311 378 16.1 197 229 286 363 453 550 611

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.11 
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.8. Niacina (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 20 0.5 12 13 16 19 23 27 30

Males 183 24 1.8 14 16 19 23 28 33 37

51–70 years 40 27 6.4 10 13 18 25 34 43 50

71+ years 143 23 1.2 17 18 20 23 25 28 30

Females 408 18 0.6 12 13 15 18 21 24 25

51–70 years 77 20 0.9 13 14 17 20 23 26 28

71+ years 331 18 0.7 11 13 15 17 20 23 25

All home-delivered meal 

program participants

502 19 0.5 12 13 16 18 21 24 26

Males 156 20 0.9 14 15 17 20 23 26 28

51–70 years 22 23 2.4 13 16 19 23 27 29 31

71+ years 134 20 1.1 14 15 17 20 23 26 28

Females 346 18 0.7 12 13 15 18 20 23 24

51–70 years 35 19 2.3 11 12 15 18 22 26 29

71+ years 311 18 0.7 11 13 15 17 20 23 24

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

aNiacin intakes include preformed niacin only. EARs for niacin are expressed as niacin equivalents, including contributions from tryptophan. Therefore, prevalence 

of adequate niacin intakes may be underestimated. 

B.12
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.9. Riboflavin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 2.0 0.06 1.1 1.2 1.5 1.9 2.3 2.8 3.2

Males 183 2.4 0.22 1.3 1.4 1.8 2.2 2.8 3.4 3.9

51–70 years 40 2.4 0.62 1.2 1.4 1.8 2.2 2.9 3.5 4.0

71+ years 143 2.4 0.14 1.3 1.5 1.8 2.3 2.8 3.4 3.9

Females 408 1.8 0.06 1.1 1.2 1.4 1.7 2.1 2.4 2.7

51–70 years 77 1.8 0.10 1.3 1.4 1.6 1.8 2.0 2.2 2.3

71+ years 331 1.7 0.06 1.0 1.2 1.4 1.7 2.0 2.4 2.7

All home-delivered meal 

program participants

502 1.9 0.05 1.0 1.2 1.4 1.8 2.3 2.8 3.1

Males 156 2.2 0.10 1.3 1.4 1.7 2.1 2.6 3.1 3.5

51–70 years 22 2.1 0.29 1.2 1.3 1.6 2.0 2.5 3.0 3.4

71+ years 134 2.2 0.13 1.3 1.4 1.7 2.1 2.6 3.2 3.6

Females 346 1.8 0.06 1.0 1.1 1.4 1.7 2.1 2.4 2.7

51–70 years 35 2.0 0.22 1.2 1.3 1.6 1.9 2.3 2.7 2.9

71+ years 311 1.7 0.06 0.9 1.1 1.3 1.7 2.1 2.5 2.7

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.13
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.10. Thiamin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 1.4 0.04 0.8 0.9 1.1 1.3 1.7 2.0 2.3

Males 183 1.7 0.16 0.7 0.8 1.1 1.5 2.1 2.8 3.4

51–70 years 40 1.9 0.58 0.6 0.7 1.1 1.6 2.4 3.4 4.3

71+ years 143 1.6 0.10 0.8 0.9 1.2 1.6 2.0 2.5 2.8

Females 408 1.3 0.04 0.8 0.9 1.1 1.2 1.4 1.6 1.8

51–70 years 77 1.5 0.08 1.1 1.2 1.3 1.5 1.7 1.8 1.9

71+ years 331 1.2 0.04 0.8 0.9 1.0 1.2 1.4 1.6 1.7

All home-delivered meal 

program participants

502 1.3 0.05 0.8 0.9 1.1 1.3 1.5 1.8 1.9

Males 156 1.5 0.06 1.0 1.1 1.3 1.4 1.7 1.9 2.0

51–70 years 22 1.5 0.27 0.9 1.0 1.2 1.5 1.8 2.1 2.4

71+ years 134 1.5 0.07 1.0 1.1 1.3 1.4 1.6 1.9 2.0

Females 346 1.3 0.05 0.8 0.9 1.0 1.2 1.5 1.7 1.9

51–70 years 35 1.3 0.17 0.9 0.9 1.1 1.3 1.5 1.8 1.9

71+ years 311 1.3 0.05 0.7 0.8 1.0 1.2 1.5 1.7 1.9

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.14
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.11. Calcium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 826 34.6 428 489 614 782 984 1,215 1,378

Males 183 975 90.1 455 537 702 926 1,193 1,474 1,683

51–70 years 40 946 237.1 397 478 643 872 1,175 1,505 1,749

71+ years 143 997 65.1 516 598 752 959 1,196 1,452 1,621

Females 408 751 39.0 421 476 580 719 887 1,065 1,188

51–70 years 77 696 35.3 511 547 611 689 774 856 902

71+ years 331 756 44.5 403 460 567 718 898 1,105 1,247

All home-delivered meal 

program participants

502 784 35.7 307 382 532 734 980 1,249 1,430

Males 156 869 70.6 371 440 579 789 1,064 1,391 1,654

51–70 years 22 772 152.0 312 375 493 704 970 1,239 1,487

71+ years 134 891 76.8 376 445 592 804 1,082 1,442 1,699

Females 346 746 31.6 295 367 512 705 933 1,180 1,344

51–70 years 35 945 125.5 284 371 565 828 1,200 1,671 1,985

71+ years 311 721 31.1 302 376 512 691 898 1,113 1,244

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.15
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.12. Iron (mg): Usual nutrient intakes of congregate and home-delivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 12.6 0.37 7.1 8.0 9.7 12.0 14.8 18.0 20.3

Males 183 15.2 1.39 7.7 8.8 11.0 14.2 18.2 22.8 26.3

51–70 years 40 18.3 5.06 6.1 7.6 10.8 15.7 23.0 31.9 39.1

71+ years 143 14.2 0.84 9.3 10.1 11.8 13.9 16.2 18.8 20.5

Females 408 11.4 0.36 7.0 7.8 9.3 11.1 13.2 15.4 16.9

51–70 years 77 12.4 0.80 6.8 7.7 9.4 11.7 14.7 18.1 20.2

71+ years 331 11.2 0.35 7.1 7.8 9.1 10.9 12.8 14.9 16.3

All home-delivered meal 

program participants

502 12.6 0.38 6.4 7.5 9.5 12.1 15.1 18.3 20.3

Males 156 13.5 0.73 8.5 9.4 11.0 13.1 15.6 18.3 20.2

51–70 years 22 12.2 2.51 5.2 6.2 7.9 11.1 15.1 19.2 23.1

71+ years 134 13.8 0.78 8.9 9.7 11.3 13.4 15.7 18.4 20.2

Females 346 12.1 0.45 5.9 7.0 9.0 11.6 14.7 18.0 20.2

51–70 years 35 12.8 2.09 6.5 7.5 9.5 12.0 15.2 19.1 21.6

71+ years 311 12.0 0.51 5.2 6.4 8.6 11.5 14.9 18.4 20.6

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.16
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.13. Magnesium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 257.1 6.02 146.7 164.6 200.0 246.8 301.4 362.2 404.3

Males 183 293.8 23.04 154.5 175.4 217.8 277.1 350.6 432.4 496.3

51–70 years 40 329.2 70.25 129.9 156.2 211.8 293.3 408.9 544.4 650.5

71+ years 143 284.1 17.43 169.6 188.5 224.4 273.3 330.7 395.1 438.8

Females 408 237.9 7.27 145.7 164.2 196.4 234.9 276.2 315.2 340.0

51–70 years 77 247.2 13.69 150.3 168.8 202.2 243.1 288.0 332.0 356.6

71+ years 331 234.7 6.92 144.9 162.8 193.8 231.8 271.4 311.3 335.8

All home-delivered meal 

program participants

502 232.0 8.42 123.9 142.3 177.6 222.9 276.1 332.8 370.6

Males 156 252.2 10.88 146.5 163.8 196.5 241.5 295.2 353.6 397.5

51–70 years 22 251.7 34.50 153.6 169.8 197.9 243.0 294.6 342.6 384.6

71+ years 134 253.0 11.60 143.5 160.9 195.5 241.0 295.6 360.7 404.2

Females 346 222.4 11.04 119.9 137.3 170.7 214.0 264.4 318.8 355.0

51–70 years 35 221.9 17.68 101.3 122.3 163.1 211.2 270.4 336.1 376.0

71+ years 311 221.9 12.00 122.4 140.1 171.8 213.7 263.2 316.3 349.5

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.17
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.14. Phosphorus (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 1,169 35.0 695 773 926 1,127 1,359 1,616 1,793

Males 183 1,373 101.1 824 913 1,088 1,321 1,599 1,894 2,117

51–70 years 40 1,426 308.1 704 813 1,031 1,329 1,723 2,155 2,477

71+ years 143 1,361 65.6 868 958 1,122 1,332 1,565 1,809 1,966

Females 408 1,068 45.1 668 739 870 1,038 1,233 1,432 1,567

51–70 years 77 1,072 44.7 689 760 891 1,053 1,234 1,413 1,515

71+ years 331 1,061 52.0 657 727 856 1,028 1,225 1,441 1,584

All home-delivered meal 

program participants

502 1,068 32.3 568 661 832 1,041 1,274 1,509 1,660

Males 156 1,217 49.9 722 804 959 1,169 1,419 1,689 1,890

51–70 years 22 1,213 51.8 706 796 951 1,173 1,413 1,673 1,890

71+ years 134 1,214 53.0 715 797 956 1,163 1,409 1,698 1,889

Females 346 1,000 35.6 540 627 786 980 1,190 1,402 1,535

51–70 years 35 1,086 99.7 541 644 837 1,053 1,306 1,574 1,731

71+ years 311 987 38.2 532 622 777 968 1,177 1,385 1,508

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.18
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.15. Zinc (mg): Usual nutrient intakes of congregate and home-delivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 10.2 0.31 6.1 6.7 8.1 9.8 11.9 14.1 15.7

Males 183 12.0 1.07 6.3 7.2 8.9 11.3 14.3 17.6 20.1

51–70 years 40 12.7 3.49 4.5 5.5 7.7 11.0 15.9 21.8 26.5

71+ years 143 11.8 0.61 7.1 8.0 9.5 11.5 13.8 16.3 17.9

Females 408 9.3 0.23 6.3 6.9 7.9 9.2 10.6 12.0 12.9

51–70 years 77 9.9 0.62 5.5 6.2 7.6 9.4 11.7 14.0 15.5

71+ years 331 9.2 0.26 6.5 7.0 7.9 9.1 10.3 11.6 12.4

All home-delivered meal 

program participants

502 10.1 0.35 5.8 6.5 8.0 9.8 11.8 14.0 15.3

Males 156 11.5 0.64 5.9 6.8 8.4 10.8 13.7 17.1 19.6

51–70 years 22 11.5 0.68 5.8 6.7 8.4 10.8 13.7 16.9 19.6

71+ years 134 11.2 0.57 5.5 6.3 8.1 10.5 13.5 17.0 19.3

Females 346 9.4 0.37 6.1 6.7 7.8 9.2 10.8 12.4 13.5

51–70 years 35 9.3 0.39 6.1 6.7 7.7 9.2 10.7 12.2 13.2

71+ years 311 9.3 0.43 5.1 5.9 7.2 9.0 11.1 13.3 14.6

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.19
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.16. Potassium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 2,493 80.5 1,344 1,537 1,915 2,404 2,959 3,559 3,965

Males 183 2,826 295.7 1,416 1,640 2,087 2,692 3,413 4,175 4,746

51–70 years 40 2,755 711.7 1,171 1,395 1,858 2,512 3,405 4,409 5,171

71+ years 143 2,885 191.6 1,610 1,832 2,246 2,793 3,412 4,078 4,513

Females 408 2,326 77.4 1,349 1,536 1,871 2,282 2,733 3,169 3,451

51–70 years 77 2,377 110.4 1,325 1,515 1,868 2,314 2,822 3,333 3,625

71+ years 331 2,303 82.5 1,357 1,539 1,859 2,262 2,691 3,133 3,408

All home-delivered meal 

program participants

502 2,238 56.5 1,281 1,458 1,785 2,185 2,631 3,082 3,372

Males 156 2,471 89.5 1,427 1,597 1,920 2,363 2,894 3,473 3,909

51–70 years 22 2,508 356.4 1,596 1,751 2,015 2,435 2,908 3,342 3,718

71+ years 134 2,471 85.5 1,402 1,572 1,909 2,353 2,885 3,521 3,945

Females 346 2,127 64.2 1,308 1,461 1,741 2,086 2,464 2,852 3,100

51–70 years 35 2,271 263.4 980 1,195 1,623 2,139 2,788 3,525 3,978

71+ years 311 2,110 68.6 1,366 1,515 1,769 2,079 2,418 2,756 2,956

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.20
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.17. Dietary fiber (g): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 15 0.4 7 8 11 15 19 23 26

Males 183 17 1.5 6 7 11 16 22 28 32

51–70 years 40 18 3.6 7 8 11 16 22 30 36

71+ years 143 16 1.3 6 8 11 16 21 26 30

Females 408 15 0.6 8 9 12 14 17 20 22

51–70 years 77 14 1.0 6 7 10 14 18 22 24

71+ years 331 15 0.6 9 10 12 14 17 20 21

All home-delivered meal 

program participants

502 13 0.5 7 8 10 13 16 19 21

Males 156 14 0.6 8 9 11 13 17 20 22

51–70 years 22 14 1.8 11 12 13 14 15 17 17

71+ years 134 14 0.6 8 9 11 13 17 20 23

Females 346 13 0.6 7 8 10 12 15 18 20

51–70 years 35 14 1.3 6 7 10 13 17 22 25

71+ years 311 13 0.7 7 8 10 12 15 18 20

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.21
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.18. Sodium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 2,948 104.3 2,261 2,392 2,632 2,920 3,226 3,538 3,741

Males 183 3,309 237.2 2,474 2,630 2,919 3,273 3,657 4,032 4,297

51–70 years 40 3,203 617.8 1,635 1,881 2,364 3,014 3,854 4,756 5,417

71+ years 143 3,310 236.1 2,469 2,626 2,913 3,276 3,658 4,036 4,304

Females 408 2,767 129.4 2,280 2,380 2,551 2,753 2,967 3,169 3,298

51–70 years 77 2,843 134.0 1,774 1,974 2,340 2,792 3,294 3,791 4,072

71+ years 331 2,768 128.5 2,280 2,382 2,553 2,755 2,968 3,172 3,299

All home-delivered meal 

program participants

502 2,708 62.4 1,508 1,748 2,174 2,672 3,199 3,709 4,025

Males 156 3,027 111.1 2,152 2,319 2,614 2,985 3,388 3,789 4,069

51–70 years 22 3,019 120.7 2,118 2,302 2,601 2,991 3,379 3,767 4,069

71+ years 134 3,022 103.2 2,162 2,318 2,611 2,968 3,363 3,800 4,074

Females 346 2,568 71.3 1,313 1,560 2,004 2,530 3,084 3,628 3,966

51–70 years 35 2,945 254.1 1,406 1,664 2,172 2,784 3,557 4,442 4,991

71+ years 311 2,519 81.2 1,297 1,554 1,980 2,489 3,026 3,543 3,841

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.22
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.19. Protein (as a percentage of calories): Usual nutrient intakes of congregate and home-delivered 

meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 17.5 0.38 13.2 14.0 15.5 17.4 19.3 21.3 22.6

Males 183 18.5 0.70 15.8 16.3 17.3 18.4 19.6 20.7 21.5

51–70 years 40 19.0 1.04 12.6 13.8 15.9 18.5 21.7 24.8 27.0

71+ years 143 18.5 0.71 15.8 16.3 17.3 18.4 19.6 20.7 21.5

Females 408 17.0 0.34 12.2 13.2 14.8 16.8 19.0 21.1 22.5

51–70 years 77 18.0 1.04 11.5 12.7 14.9 17.6 20.7 23.8 25.5

71+ years 331 16.7 0.39 12.3 13.2 14.7 16.6 18.6 20.6 21.9

All home-delivered meal 

program participants

502 17.4 0.35 12.5 13.5 15.3 17.3 19.4 21.4 22.6

Males 156 17.6 0.51 – – – – – – – 

51–70 years 22 21.4 2.02 13.1 15.1 18.1 21.7 24.9 27.3 29.1

71+ years 134 17.6 0.51 – – – – – – – 

Females 346 17.3 0.45 11.9 13.0 14.9 17.1 19.5 21.8 23.2

51–70 years 35 16.7 1.13 13.9 14.5 15.5 16.6 17.8 19.0 19.7

71+ years 311 17.3 0.47 11.6 12.8 14.7 17.1 19.7 22.2 23.6

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

– The usual intake distribution could not be reliably estimated for this subgroup. 

B.23
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.20. Carbohydrate (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 49.0 0.50 39.2 41.4 45.1 49.1 52.9 56.3 58.4

Males 183 47.2 1.20 35.6 38.5 43.0 47.6 51.9 55.5 57.7

51–70 years 40 47.1 1.87 36.2 38.8 42.9 47.2 51.5 55.1 57.4

71+ years 143 47.5 1.66 36.0 39.0 43.4 47.9 52.1 55.7 57.8

Females 408 49.8 0.78 40.6 42.7 46.1 49.9 53.5 56.7 58.7

51–70 years 77 49.0 1.98 35.8 38.6 43.3 48.8 54.5 59.7 62.6

71+ years 331 49.9 0.83 42.3 44.1 46.8 50.0 53.0 55.8 57.4

All home-delivered meal 

program participants

502 50.3 0.77 38.9 41.2 45.2 49.9 54.9 59.8 62.9

Males 156 48.3 0.88 39.5 41.3 44.5 48.2 52.0 55.5 57.8

51–70 years 22 48.2 0.88 39.1 41.2 44.4 48.3 51.9 55.3 57.8

71+ years 134 49.1 1.16 39.1 41.2 44.9 49.0 53.1 57.3 59.7

Females 346 51.2 0.87 39.2 41.5 45.6 50.7 56.1 61.7 65.3

51–70 years 35 50.8 3.04 38.1 40.9 45.7 50.6 55.8 61.0 63.9

71+ years 311 51.2 0.90 39.0 41.4 45.5 50.6 56.2 61.9 65.4

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.24
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.21. Total fat (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 34.7 0.44 29.1 30.3 32.4 34.7 36.9 39.0 40.3

Males 183 34.6 0.43 29.1 30.3 32.4 34.6 36.8 38.9 40.2

51–70 years 40 34.6 0.43 29.2 30.4 32.5 34.7 36.6 38.6 40.0

71+ years 143 34.6 0.43 29.1 30.2 32.3 34.6 37.0 39.1 40.4

Females 408 34.6 0.66 27.1 28.8 31.6 34.6 37.7 40.4 42.1

51–70 years 77 34.7 1.83 23.8 26.1 30.0 34.6 39.3 43.8 46.2

71+ years 331 34.5 0.66 28.2 29.6 31.9 34.5 37.1 39.5 41.0

All home-delivered meal 

program participants

502 33.6 0.66 24.7 26.8 30.1 33.7 37.2 40.3 42.1

Males 156 34.4 0.83 29.3 30.4 32.2 34.4 36.5 38.4 39.7

51–70 years 22 34.3 0.84 29.1 30.3 32.2 34.4 36.4 38.3 39.7

71+ years 134 34.2 0.92 28.0 29.4 31.7 34.2 36.6 39.0 40.3

Females 346 33.2 0.73 23.3 25.6 29.4 33.4 37.2 40.6 42.7

51–70 years 35 34.2 2.44 24.4 26.9 30.8 34.4 38.0 41.2 43.0

71+ years 311 33.0 0.78 23.1 25.5 29.2 33.2 37.1 40.6 42.5

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.25
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.22. Linoleic acid (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 6.8 0.22 4.5 4.9 5.7 6.7 7.8 8.9 9.7

Males 183 6.8 0.37 4.8 5.2 5.8 6.7 7.6 8.4 9.1

51–70 years 40 7.7 0.30 6.7 6.9 7.3 7.7 8.1 8.4 8.7

71+ years 143 6.4 0.38 4.3 4.6 5.3 6.2 7.3 8.4 9.1

Females 408 6.9 0.28 4.4 4.8 5.6 6.7 7.9 9.1 10.0

51–70 years 77 7.0 0.78 5.1 5.5 6.1 6.9 7.9 8.8 9.4

71+ years 331 6.8 0.31 4.3 4.7 5.5 6.6 7.8 9.1 9.9

All home-delivered meal 

program participants

502 6.0 0.17 3.9 4.3 5.1 5.9 6.9 7.8 8.4

Males 156 6.2 0.26 4.7 5.0 5.5 6.1 6.8 7.4 7.8

51–70 years 22 6.2 0.26 4.6 5.0 5.5 6.1 6.8 7.4 7.8

71+ years 134 6.3 0.26 4.4 4.8 5.4 6.2 7.0 7.8 8.3

Females 346 5.9 0.21 3.6 4.0 4.8 5.8 6.9 8.1 8.8

51–70 years 35 6.5 0.58 3.9 4.4 5.3 6.4 7.6 8.8 9.5

71+ years 311 5.9 0.20 3.6 4.0 4.8 5.7 6.8 7.9 8.6

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.26
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.23. Alpha-linolenic acid (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 0.8 0.03 0.5 0.5 0.6 0.7 0.9 1.0 1.1

Males 183 0.7 0.04 0.5 0.6 0.6 0.7 0.8 0.9 0.9

51–70 years 40 0.7 0.05 0.5 0.5 0.6 0.7 0.8 0.9 1.0

71+ years 143 0.7 0.05 0.5 0.6 0.6 0.7 0.8 0.8 0.9

Females 408 0.8 0.05 0.5 0.5 0.6 0.8 0.9 1.1 1.2

51–70 years 77 0.7 0.09 0.3 0.4 0.5 0.7 0.9 1.1 1.3

71+ years 331 0.8 0.05 0.5 0.5 0.6 0.8 0.9 1.1 1.2

All home-delivered meal 

program participants

502 0.6 0.02 0.4 0.4 0.5 0.6 0.7 0.8 0.9

Males 156 0.6 0.04 0.5 0.5 0.6 0.6 0.7 0.8 0.9

51–70 years 22 0.6 0.13 0.4 0.5 0.5 0.6 0.7 0.8 0.9

71+ years 134 0.6 0.04 0.5 0.5 0.6 0.6 0.7 0.8 0.8

Females 346 0.6 0.02 0.4 0.4 0.5 0.6 0.7 0.8 0.9

51–70 years 35 0.7 0.09 0.3 0.4 0.5 0.7 0.8 1.0 1.0

71+ years 311 0.6 0.02 0.4 0.4 0.5 0.6 0.7 0.8 0.9

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

B.27
APPENDIX B MATHEMATICA POLICY RESEARCH

Table B.24. Saturated fat (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program participants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

participants

591 11.4 0.30 9.6 9.9 10.6 11.4 12.2 12.9 13.4

Males 183 11.4 0.36 9.1 9.6 10.4 11.4 12.4 13.4 14.1

51–70 years 40 11.4 0.38 9.1 9.6 10.4 11.4 12.4 13.3 14.0

71+ years 143 12.0 0.42 8.2 9.0 10.3 11.8 13.5 15.2 16.2

Females 408 11.4 0.38 9.9 10.2 10.7 11.4 12.0 12.6 13.0

51–70 years 77 11.2 0.66 7.3 8.0 9.4 11.0 12.8 14.6 15.6

71+ years 331 11.5 0.43 – – – – – – – 

All home-delivered meal 

program participants

502 11.3 0.28 7.8 8.5 9.8 11.2 12.7 14.0 14.9

Males 156 11.4 0.23 10.3 10.6 11.0 11.4 11.9 12.3 12.6

51–70 years 22 11.4 0.24 10.3 10.5 10.9 11.4 11.9 12.3 12.6

71+ years 134 11.3 0.25 9.9 10.2 10.7 11.3 11.9 12.5 12.8

Females 346 11.2 0.36 7.1 7.9 9.4 11.1 12.8 14.5 15.5

51–70 years 35 11.3 0.66 9.1 9.7 10.5 11.4 12.2 13.0 13.5

71+ years 311 11.1 0.41 6.8 7.7 9.2 11.0 12.9 14.7 15.8

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015, weighted data.

SE = standard error.

– The usual intake distribution could not be reliably estimated for this subgroup. 

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APPENDIX C

SUPPLEMENTARY TABLES OF NSP PROGRAM EFFECTS FOR INCOME AND 

FAMILY SUBGROUPS
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APPENDIX C MATHEMATICA POLICY RESEARCH

TABLES

C.1 Regression-adjusted percentages of individuals who live in households that are food 

insecure or have very low food security, by congregate meal participation status.......................C.5

C.2 Regression-adjusted percentages of individuals who live in households that are food 

insecure or have very low food security, by home-delivered meal participation status................C.6

C.3 Regression-adjusted percentages of individuals who experience social isolation, by 

congregate meal participation status ............................................................................................C.7

C.4 Regression-adjusted percentages of individuals who screen positively for depression, by 

congregate meal participation status ............................................................................................C.8

C.5 Regression-adjusted percentages of individuals who are satisfied with socialization 

opportunities, by congregate meal participation status.................................................................C.9

C.6 Regression-adjusted percentages of individuals who experience social isolation, by 

home-delivered meal participation status ...................................................................................C.10

C.7 Regression-adjusted percentages of individuals who screen positively for depression, by 

home-delivered meal participation status ...................................................................................C.11

C.8 Regression-adjusted percentages of individuals who are satisfied with socialization 

opportunities, by home-delivered meal participation status........................................................C.12

C.9 Effects of congregate meal program participation on mean Healthy Eating Index-2010 

scores, by participation status and household income ...............................................................C.13

C.10 Effects of congregate meal program participation on mean Healthy Eating Index-2010 

scores, by participation status and whether participant lives alone............................................C.14

C.11 Effects of home-delivered meal program participation on mean Healthy Eating Index2010 scores, by participation status and household income ......................................................C.15

C.12 Effects of home-delivered meal program participation on mean Healthy Eating Index2010 scores, by participation status and whether participant lives alone....................................C.16

C.3 
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APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.1. Regression-adjusted percentages of individuals who live in 

households that are food insecure or have very low food security, by 

congregate meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

Food insecurity 

Full sample 15.5 (2.1) 19.5 (2.1) -4.0* (2.4)

Individuals in lowerincome households 23.2 (3.1) 31.0 (3.5) -7.8** (3.9)

Individuals in higherincome households 8.0 (1.8) 7.8 (1.7) 0.2 (2.0)

Individuals who live with 

other family members 14.7 (2.5) 17.7 (2.4) -3.0 (3.0)

Individuals who live alone 16.6 (2.6) 20.0 (3.1) -3.4 (3.9)

Very low food security 

Full sample 4.2 (0.8) 4.0 (1.0) 0.2 (1.0)

Individuals in lowerincome households5.8 (1.2) 5.9 (1.5) -0.1 (1.9)

Individuals in higherincome householdsa 2.1 (1.1) 2.5 (1.3) -0.4 (1.7)

Individuals who live with 

other family members 

2.7 (0.7) 3.3 (1.3) -0.6 (1.2)

Individuals who live alone 5.3 (1.2) 4.5 (1.4) 0.8 (1.9)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,226 congregate meal participants and 

nonparticipants.

a Estimated using ordinary linear squares regression model.

*Significantly different from zero at the .10 level, two-tailed test.

**Significantly different from zero at the .05 level, two-tailed test.

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APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.2. Regression-adjusted percentages of individuals who live in 

households that are food insecure or have very low food security, by homedelivered meal participation status

 Participants Nonparticipants Difference

Outcome Estimate 

Standard 

error Estimate 

Standard 

error Estimate 

Standard 

error

Food insecurity 

Full sample 22.0 (2.1) 17.0 (2.1) 5.0 (3.2)

Individuals in lowerincome households28.3 (3.6) 29.2 (4.1) -0.8 (6.1)

Individuals in 

higher-income 

households

16.7 (3.1) 4.0 (1.7) 12.7*** (4.1)

Individuals who live 

with other family 

members 

24.0 (3.1) 20.1 (3.0) 3.8 (4.5)

Individuals who live 

alone

19.8 (2.1) 15.6 (2.8) 4.2 (3.5)

Very low food security 

Full sample 6.9 (1.1) 2.7 (0.7) 4.2*** (1.5)

Individuals in lowerincome households7.1 (1.7) 4.8 (1.3) 2.4 (2.4)

Individuals in 

higher-income 

households

8.6 (1.7) 0.2 (0.2) 8.4*** (1.8)

Individuals who live 

with other family 

members 

7.8 (2.5) 2.4 (1.3) 5.4 (3.3)

Individuals who live 

alone

8.1 (1.7) 3.1 (1.1) 5.0*** (1.9)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants.

*Significantly different from zero at the .10 level, two-tailed test.

**Significantly different from zero at the .05 level, two-tailed test.

***Significantly different from zero at the .01 level, two-tailed test.

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APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.3. Regression-adjusted percentages of individuals who experience 

social isolation, by congregate meal participation status

 Participants Nonparticipants Difference

Outcome Estimate 

Standard 

error Estimate 

Standard 

error Estimate 

Standard 

error

R-UCLA loneliness scorea 

Full sample 4.1 (0.1) 4.1 (0.1) 0.0 (0.1)

Individuals in lower-income 

households

4.4 (0.1) 4.2 (0.1) 0.2 (0.2)

Individuals in higher-income 

households

3.8 (0.1) 4.1 (0.1) -0.3** (0.1)

Individuals who live with other family 

members 

3.8 (0.1) 3.8 (0.1) 0.0 (0.1)

Individuals who live alone 4.3 (0.1) 4.3 (0.1) -0.1 (0.2)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,226 congregate meal participants and 

nonparticipants.

**Significantly different from zero at the .05 level, two-tailed test.

a Revised UCLA loneliness scale ranges from 3 to 9.

R-UCLA = Revised UCLA Loneliness Scale.

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APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.4. Regression-adjusted percentages of individuals who screen 

positively for depression, by congregate meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

PHQ-2 screener (affirm at 

least 2 of 6 questions)

 

Full sample 18.1 (2.1) 24.3 (2.8) -6.2* (3.7)

Individuals in lowerincome households23.6 (3.9) 31.0 (5.0) -7.4 (6.8)

Individuals in higherincome households13.0 (2.9) 16.1 (2.5) -3.1 (3.4)

Individuals who live with 

other family members 

18.4 (3.3) 19.7 (2.9) -1.3 (4.2)

Individuals who live alone 18.4 (2.5) 27.8 (3.7) -9.5* (5.2)

PHQ-2 screener (affirm at 

least 3 of 6 questions)

 

Full sample 6.5 (1.2) 9.3 (1.8) -2.8 (2.4)

Individuals in lowerincome households10.1 (2.4) 15.1 (3.4) -5.0 (4.8)

Individuals in higherincome households3.9 (1.1) 4.6 (1.2) -0.6 (1.7)

Individuals who live with 

other family members 

6.5 (1.8) 6.2 (1.5) 0.3 (2.5)

Individuals who live alone 6.8 (1.7) 12.0 (3.2) -5.2 (4.1)

PHQ-2 screener (affirm at 

least 4 of 6 questions)

 

Full sample 2.3 (0.7) 6.5 (1.7) -4.2** (1.9)

Individuals in lowerincome households4.1 (1.4) 10.6 (2.9) -6.5* (3.6)

Individuals in higherincome households0.9 (0.6) 3.8 (1.0) -2.9** (1.3)

Individuals who live with 

other family members 

3.3 (1.0) 5.4 (1.7) -2.1 (2.2)

Individuals who live alone 2.3 (0.8) 8.5 (2.4) -6.2** (2.6)

PHQ-2 screener 

(raw score)

 

Full sample 0.6 (0.1) 0.8 (0.1) -0.2** (0.1)

Individuals in lowerincome households0.7 (0.1) 1.0 (0.2) -0.3 (0.2)

Individuals in higherincome households0.5 (0.1) 0.6 (0.1) -0.1 (0.1)

Individuals who live with 

other family members 

0.6 (0.1) 0.6 (0.1) -0.1 (0.1)

Individuals who live alone 0.6 (0.1) 0.9 (0.1) -0.3** (0.2)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,226 congregate meal participants home-delivered 

meal participants and nonparticipants.

*Significantly different from zero at the .10 level, two-tailed test.

**Significantly different from zero at the .05 level, two-tailed test.

PHQ-2 = Patient Health Questionnaire 2.

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APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.5. Regression-adjusted percentages of individuals who are satisfied 

with socialization opportunities, by congregate meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

Percentage of individuals 

who are very satisfied with 

socialization opportunities

 

Full sample 67.5 3.3 55.5 2.5 12.0*** 4.3

Individuals in lowerincome households 64.1 4.1 54.5 3.6 9.6 6.1

Individuals in higherincome households 71.2 3.5 56.1 3.6 15.1*** 5.1

Individuals who live alone 75.2 3.2 65.4 2.5 9.8** 4.3

Individuals who live with 

other family members 61.5 4.6 48.4 3.9 13.1** 6.4

Percentage of individuals 

who are satisfied with 

socialization opportunities

 

Full sample 94.0 1.4 85.8 2.1 8.2*** 2.4

Individuals in lowerincome households 92.4 1.9 87.2 2.5 5.2 3.3

Individuals in higherincome households 95.5 1.9 84.0 3.1 11.5*** 3.4

Individuals who live alone 96.7 1.5 90.3 1.6 6.4*** 2.0

Individuals who live with 

other family members 92.1 2.1 82.1 3.4 10.0*** 3.7

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,226 congregate meal participants.

**Significantly different from zero at the .05 level, two-tailed test.

***Significantly different from zero at the .01 level, two-tailed test.

C.9 
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.6. Regression-adjusted percentages of individuals who experience 

social isolation, by home-delivered meal participation status

 Participants Nonparticipants Difference

Outcome Estimate 

Standard 

error Estimate 

Standard 

error Estimate 

Standard 

error

R-UCLA three-item loneliness scorea 

Full sample 4.5 (0.1) 4.3 (0.1) 0.2* (0.1)

Individuals in lower-income 

households

4.5 (0.1) 4.4 (0.1) 0.0 (0.2)

Individuals in higher-income 

households

4.6 (0.1) 4.2 (0.1) 0.4** (0.2)

Individuals who live with other family 

members 

4.3 (0.1) 4.1 (0.1) 0.2 (0.2)

Individuals who live alone 4.7 (0.1) 4.4 (0.1) 0.3 (0.2)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants.

*Significantly different from zero at the .10 level, two-tailed test.

**Significantly different from zero at the .05 level, two-tailed test.

a Revised UCLA loneliness scale ranges from 3 to 9.

R-UCLA = Revised UCLA Loneliness Scale.

C.10
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.7. Regression-adjusted percentages of individuals who screen 

positively for depression, by home-delivered meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

PHQ-2 screener (affirm at 

least 2 of 6 questions)

 

Full sample 18.0 (2.8) 15.1 (1.7) 2.9 (3.7)

Individuals in lowerincome households20.1 (3.1) 14.4 (2.6) 5.7 (4.4)

Individuals in higherincome households17.6 (3.6) 14.7 (2.9) 2.9 (5.0)

Individuals who live with 

other family members 

19.8 (2.9) 16.4 (2.6) 3.4 (4.4)

Individuals who live alone 19.2 (3.8) 12.6 (2.6) 6.6 (5.3)

PHQ-2 screener (affirm at 

least 3 of 6 questions)

 

Full sample 29.2 (2.6) 27.6 (2.9) 1.6 (4.3)

Individuals in lowerincome households29.4 (3.2) 29.1 (4.2) 0.3 (5.7)

Individuals in higherincome households29.4 (3.6) 26.4 (3.5) 3.1 (5.3)

Individuals who live with 

other family members 

30.2 (3.4) 30.0 (3.5) 0.2 (5.3)

Individuals who live alone 28.7 (3.3) 25.3 (4.3) 3.3 (6.2)

PHQ-2 screener (affirm at 

least 4 of 6 questions)

 

Full sample 11.5 (2.1) 11.6 (1.7) -0.1 (2.9)

Individuals in lowerincome households15.4 (2.7) 12.5 (2.7) 3.0 (4.1)

Individuals in higherincome households9.8 (2.2) 9.5 (2.2) 0.3 (3.1)

Individuals who live with 

other family members 

12.1 (2.5) 13.4 (2.5) -1.2 (4.0)

Individuals who live alone 13.0 (3.0) 9.4 (2.3) 3.6 (3.9)

PHQ-2 screener 

(raw score)

 

Full sample 1.1 (0.1) 1.1 (0.1) 0.1 (0.2)

Individuals in lowerincome households1.2 (0.1) 1.2 (0.1) 0.0 (0.2)

Individuals in higherincome households1.1 (0.1) 0.9 (0.1) 0.2 (0.2)

Individuals who live with 

other family members 

1.1 (0.1) 1.1 (0.1) 0.0 (0.2)

Individuals who live alone 1.2 (0.1) 1.0 (0.1) 0.2 (0.2)

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,024 home-delivered meal participants and 

nonparticipants.

There were no statistically significant differences in any outcome measure between participants and 

nonparticipants at the 0.10 level, two-tailed test.

C.11
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.8. Regression-adjusted percentages of individuals who are satisfied 

with socialization opportunities, by home-delivered meal participation status

 Participants Nonparticipants Difference

Outcome Percentage

Standard 

error Percentage

Standard 

error Percentage

Standard 

error

Percentage of individuals 

who are very satisfied with 

socialization opportunities

 

Full sample 44.5 2.4 53.4 2.4 -8.9** 3.6

Individuals in lowerincome households50.3 3.7 52.0 4.0 -1.8 6.4

Individuals in higherincome households39.9 3.4 53.3 3.0 -13.3*** 4.4

Individuals who live alone 46.6 3.8 58.1 3.7 -11.5** 5.8

Individuals who live with 

other family members

42.2 3.4 50.8 3.3 -8.6* 4.6

Percentage of individuals 

who are satisfied with 

socialization opportunities

 

Full sample 82.3 1.6 85.7 2.1 -3.3 2.7

Individuals in lowerincome households83.5 2.0 90.7 2.0 -7.2** 3.1

Individuals in higherincome households80.9 2.9 80.7 3.2 0.2 4.4

Individuals who live alone 80.9 2.8 86.4 2.6 -5.6 4.4

Individuals who live with 

other family members

82.8 2.4 85.7 2.8 -2.9 3.9

Source: AoA NSP outcomes survey, 2015-2016, weighted data.

Note: Estimates are based on an unweighted sample size of 1,029 home-delivered meal participants and 

nonparticipants.

*Significantly different from zero at the .10 level, two-tailed test.

**Significantly different from zero at the .05 level, two-tailed test.

***Significantly different from zero at the .01 level, two-tailed test.

C.12
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.9. Effects of congregate meal program participation on mean Healthy Eating Index-2010 scores, by 

participation status and household income

 Lower income Higher income

HEI-2010 component

Maximum 

score

Participants Nonparticipants Difference Participants Nonparticipants Difference

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Adequacy (higher score indicates higher consumption)

Total fruit 5 4.8 0.20 3.2 0.28 1.6*** 0.35 4.8 0.26 4.0 0.24 0.8** 0.36

Whole fruit 5 5.0 0.00 4.5 0.40 0.5 0.40 5.0 0.00 5.0 0.04 0.0 0.04

Total vegetables 5 4.6 0.24 3.7 0.25 0.9*** 0.34 4.4 0.35 4.1 0.21 0.3 0.41

Greens and beans 5 3.9 0.58 3.2 0.48 0.7 0.75 3.7 0.36 3.7 0.44 0.0 0.57

Whole grains 10 3.7 0.69 3.8 0.40 -0.1 0.80 3.9 0.32 3.7 0.32 0.2 0.45

Dairy 10 6.6 0.80 5.8 0.50 0.8 0.94 7.1 0.43 5.6 0.27 1.5*** 0.51

Total protein foods 5 5.0 0.00 5.0 0.00 0.0 0.00 5.0 0.00 5.0 0.00 0.0 0.00

Seafood and plant 

proteins

5 4.2 0.76 4.1 0.57 0.1 0.95 4.7 0.48 4.7 0.38 0.0 0.61

Fatty acids 10 4.6 0.85 4.4 0.44 0.3 0.96 3.9 0.41 4.2 0.37 -0.3 0.55

Moderation (higher score indicates lower consumption)

Refined grains 10 7.1 0.28 5.3 0.66 1.8** 0.72 8.4 0.31 6.5 0.48 1.9*** 0.57

Sodium 10 1.2 0.62 1.8 0.57 -0.6 0.84 3.3 0.49 2.4 0.47 0.9 0.68

Empty calories 20 13.3 0.97 12.2 0.69 1.1 1.19 12.4 0.34 12.1 0.51 0.3 0.62

Total score 100 64.1 2.74 57.0 2.24 7.1** 3.54 66.7 1.27 61.0 1.57 5.6*** 2.02

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,210 congregate meal participants and nonparticipants.

 ** Difference between participants and nonparticipants is significantly different from zero at the .05 level, two-tailed test.

*** Difference between participants and nonparticipants is significantly different from zero at the .01 level, two-tailed test.

HEI = Healthy Eating Index.

C.13
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.10. Effects of congregate meal program participation on mean Healthy Eating Index-2010 scores, 

by participation status and whether participant lives alone

 Lives alone Lives with others

HEI-2010 component

Maximum 

score

Participants Nonparticipants Difference Participants Nonparticipants Difference

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Adequacy (higher score indicates higher consumption)

Total fruit 5 4.7 0.22 3.7 0.29 1.0*** 0.36 4.9 0.25 3.5 0.27 1.4*** 0.36

Whole fruit 5 5.0 0.01 4.9 0.17 0.1 0.17 5.0 0.00 4.8 0.24 0.2 0.24

Total vegetables 5 4.4 0.35 3.7 0.22 0.6 0.42 4.6 0.30 4.1 0.24 0.5 0.39

Greens and beans 5 3.6 0.36 3.5 0.46 0.1 0.58 4.0 0.55 3.4 0.54 0.6 0.77

Whole grains 10 4.0 0.46 3.8 0.40 0.2 0.61 3.5 0.38 3.7 0.33 -0.2 0.50

Dairy 10 7.2 0.68 6.0 0.37 1.2 0.78 6.5 0.40 5.4 0.32 1.1** 0.52

Total protein foods 5 5.0 0.00 5.0 0.00 0.0 0.00 5.0 0.00 5.0 0.00 0.0 0.00

Seafood and plant 

proteins

5 4.3 0.60 4.1 0.54 0.2 0.81 4.6 0.71 4.8 0.33 -0.1 0.78

Fatty acids 10 4.0 0.70 4.2 0.34 -0.2 0.78 4.6 0.51 4.4 0.41 0.2 0.65

Moderation (higher score indicates lower consumption)

Refined grains 10 7.7 0.30 6.1 0.50 1.6*** 0.59 7.9 0.34 5.8 0.64 2.1*** 0.72

Sodium 10 1.8 0.59 2.6 0.53 -0.8 0.79 3.1 0.70 1.6 0.51 1.5* 0.86

Empty calories 20 12.4 0.71 12.2 0.67 0.1 0.98 13.5 0.51 12.1 0.58 1.4* 0.77

Total score 100 64.0 1.52 59.9 2.18 4.1 2.66 67.3 2.13 58.6 1.51 8.7*** 2.61

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,210 congregate meal participants and nonparticipants.

 * Difference between participants and nonparticipants is significantly different from zero at the .10 level, two-tailed test.

 ** Difference between participants and nonparticipants is significantly different from zero at the .05 level, two-tailed test.

*** Difference between participants and nonparticipants is significantly different from zero at the .01 level, two-tailed test.

HEI = Healthy Eating Index.

C.14
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.11. Effects of home-delivered meal program participation on mean Healthy Eating Index-2010 

scores, by participation status and household income

 Lower income Higher income

HEI-2010 component

Maximum 

score

Participants Nonparticipants Difference Participants Nonparticipants Difference

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Adequacy (higher score indicates higher consumption)

Total fruit 5 4.6 0.33 4.2 0.36 0.4 0.48 4.6 0.36 4.4 0.33 0.2 0.49

Whole fruit 5 5.0 0.04 5.0 0.14 0.0 0.14 5.0 0.03 5.0 0.03 0.0 0.04

Total vegetables 5 4.1 0.30 3.9 0.25 0.2 0.39 4.5 0.25 4.7 0.23 -0.2 0.34

Greens and beans 5 1.9 0.37 3.0 0.53 -1.2* 0.64 3.4 0.52 2.6 0.35 0.8 0.63

Whole grains 10 3.6 0.65 4.2 0.54 -0.6 0.84 3.0 0.30 2.9 0.33 0.2 0.45

Dairy 10 7.6 0.77 5.6 0.41 1.9** 0.87 6.8 0.51 6.0 0.42 0.8 0.66

Total protein foods 5 5.0 0.00 5.0 0.00 0.0 0.00 5.0 0.00 5.0 0.00 0.0 0.00

Seafood and plant 

proteins

5 3.1 0.87 3.9 0.62 -0.8 1.07 4.3 0.63 4.3 0.45 0.0 0.77

Fatty acids 10 3.5 0.45 4.1 0.32 -0.6 0.55 4.4 0.66 4.2 0.37 0.2 0.76

Moderation (higher score indicates lower consumption)

Refined grains 10 7.1 0.48 6.3 0.70 0.8 0.85 7.8 0.49 6.5 0.52 1.3* 0.71

Sodium 10 2.5 0.48 2.2 0.44 0.3 0.65 1.8 0.67 1.5 0.43 0.4 0.80

Empty calories 20 11.4 0.68 11.9 0.60 -0.5 0.90 12.6 0.35 12.0 0.59 0.6 0.69

Total score 100 59.4 2.40 59.4 1.89 0.0 3.06 63.2 1.55 59.1 1.59 4.1* 2.22

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,016 home-delivered meal participants and nonparticipants.

 * Difference between participants and nonparticipants is significantly different from zero at the .10 level, two-tailed test.

 ** Difference between participants and nonparticipants is significantly different from zero at the .05 level, two-tailed test.

HEI = Healthy Eating Index.

C.15
APPENDIX C MATHEMATICA POLICY RESEARCH

Table C.12. Effects of home-delivered meal program participation on mean Healthy Eating Index-2010 

scores, by participation status and whether participant lives alone

 Lives alone Lives with others

HEI-2010 component

Maximum 

score

Participants Nonparticipants Difference Participants Nonparticipants Difference

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Mean 

score

Standard 

error

Adequacy (higher score indicates higher consumption)

Total fruit 5 4.8 0.24 4.2 0.37 0.6 0.44 4.2 0.38 4.3 0.37 -0.1 0.53

Whole fruit 5 5.0 0.01 5.0 0.04 0.0 0.04 4.9 0.22 5.0 0.10 -0.1 0.24

Total vegetables 5 4.2 0.25 4.5 0.30 -0.3 0.39 4.5 0.30 4.2 0.23 0.3 0.37

Greens and beans 5 3.3 0.44 2.8 0.41 0.5 0.60 1.8 0.34 2.8 0.42 -1.1** 0.54

Whole grains 10 3.1 0.35 3.5 0.32 -0.3 0.48 3.6 0.70 3.6 0.50 0.0 0.86

Dairy 10 7.2 0.42 6.4 0.40 0.8 0.58 7.2 0.48 5.2 0.37 2.0*** 0.61

Total protein foods 5 5.0 0.00 5.0 0.00 0.0 0.00 5.0 0.00 5.0 0.00 0.0 0.00

Seafood and plant 

proteins

5 3.3 0.52 4.8 0.37 -1.4** 0.63 4.2 0.85 3.1 0.51 1.0 0.99

Fatty acids 10 3.8 0.40 4.0 0.46 -0.2 0.61 4.1 0.42 4.3 0.38 -0.2 0.57

Moderation (higher score indicates lower consumption)

Refined grains 10 7.1 0.42 6.6 0.51 0.4 0.66 7.9 0.57 6.1 0.61 1.8** 0.83

Sodium 10 2.8 0.61 1.6 0.40 1.2 0.73 1.4 0.54 2.2 0.44 -0.8 0.70

Empty calories 20 11.7 0.63 12.1 0.52 -0.4 0.82 12.5 0.57 11.8 0.62 0.7 0.85

Total score 100 61.2 1.31 60.4 1.71 0.8 2.15 61.2 2.48 57.7 1.50 3.6 2.90

Source: AoA NSP 24-hour dietary recall (Day 1), 2015-2016, weighted data. 

Note: Estimates are based on an unweighted sample size of 1,016 home-delivered meal participants and nonparticipants.

 ** Difference between participants and nonparticipants is significantly different from zero at the .05 level, two-tailed test.

*** Difference between participants and nonparticipants is significantly different from zero at the .01 level, two-tailed test.

HEI = Healthy Eating Index.

C.16
APPENDIX D

USUAL NUTRIENT INTAKE DISTRIBUTIONS FOR NSP NONPARTICIPANTS
This page has been left blank for double-sided copying.
APPENDIX D MATHEMATICA POLICY RESEARCH

TABLES

D.1 Vitamin A (mcg RAE): Usual nutrient intakes of congregate and home-delivered meal 

program nonparticipants ...............................................................................................................D.5

D.2 Vitamin C (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants..............................................................................................................................D.6

D.3 Vitamin D (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants..............................................................................................................................D.7

D.4 Vitamin E (mg AT): Usual nutrient intakes of congregate and home-delivered meal 

program nonparticipants ...............................................................................................................D.8

D.5 Vitamin B6 (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants..............................................................................................................................D.9

D.6 Vitamin B12 (mcg): Usual nutrient intakes of congregate and home-delivered meal 

program nonparticipants .............................................................................................................D.10

D.7 Folate (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.11

D.8 Niacin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.12

D.9 Riboflavin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.13

D.10 Thiamin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.14

D.11 Calcium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.15

D.12 Iron (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.16

D.13 Magnesium (mg): Usual nutrient intakes of congregate and home-delivered meal 

program nonparticipants .............................................................................................................D.17

D.14 Phosphorus (mg): Usual nutrient intakes of congregate and home-delivered meal 

program nonparticipants .............................................................................................................D.18

D.15 Zinc (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.19

D.16 Potassium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.20

D.17 Dietary fiber (g): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.21

D.18 Sodium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants............................................................................................................................D.22

D.19 Protein (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program nonparticipants.....................................................................................D.23

D.3 
APPENDIX D MATHEMATICA POLICY RESEARCH

D.20 Carbohydrate (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program nonparticipants ..........................................................................D.24

D.21 Total fat (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program nonparticipants.....................................................................................D.25

D.22 Linoleic acid (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program nonparticipants ..........................................................................D.26

D.23 Alpha-linolenic acid (as a percentage of calories): Usual nutrient intakes of congregate 

and home-delivered meal program nonparticipants ...................................................................D.27

D.24 Saturated fat (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program nonparticipants ..........................................................................D.28

D.4 
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.1. Vitamin A (mcg RAE): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 600 32.1 151 203 321 513 779 1,113 1,355

Males 220 642 61.1 148 198 317 513 820 1,225 1,569

51–70 years 106 642 73.9 225 272 381 552 799 1,116 1,361

71+ years 114 644 75.1 122 171 285 491 824 1,306 1,695

Females 399 583 36.3 163 217 332 512 754 1,038 1,251

51–70 years 194 642 48.2 218 283 407 585 816 1,080 1,248

71+ years 205 571 41.0 152 203 315 493 740 1,034 1,258

All home-delivered meal 

program nonparticipants

514 633 43.9 176 233 357 551 815 1,139 1,379

Males 175 687 95.8 158 211 329 545 870 1,336 1,713

51–70 years 68 555 69.8 – – – – – – – 

71+ years 107 707 106.5 138 187 306 526 887 1,444 1,885

Females 339 608 47.3 184 238 357 539 780 1,068 1,277

51–70 years 108 418 59.6 56 94 185 337 564 850 1,046

71+ years 231 632 49.6 203 262 382 566 807 1,086 1,293

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

RAE = retinol activity equivalent; SE = standard error.

– The usual intake distribution could not be reliably estimated for this subgroup. 

D.5 
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.2. Vitamin Ca (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 72 3.9 15 22 36 61 95 137 167

Males 220 71 6.8 9 15 30 56 96 145 183

51–70 years 106 80 12.9 6 12 28 60 110 175 223

71+ years 114 68 7.5 13 19 33 56 90 134 165

Females 399 72 4.6 19 26 40 63 94 131 158

51–70 years 194 84 11.3 16 24 41 69 111 164 200

71+ years 205 70 5.0 20 27 41 62 90 122 146

All home-delivered meal 

program nonparticipants

514 76 3.9 12 18 35 62 102 151 187

Males 175 84 9.0 13 21 38 69 113 169 210

51–70 years 68 63 11.6 4 10 25 53 88 134 160

71+ years 107 88 10.1 16 24 42 73 117 171 208

Females 339 72 4.1 11 17 33 59 96 143 177

51–70 years 108 56 12.6 2 4 11 28 65 134 197

71+ years 231 74 4.1 13 20 36 63 99 142 174

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

aThe EAR for vitamin C is 35 mg greater for smokers than nonsmokers. In this analysis, EARs were used for nonsmokers.

D.6 
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.3. Vitamin D (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 3.8 0.19 0.9 1.2 2.0 3.3 5.0 7.1 8.6

Males 220 4.3 0.35 1.0 1.4 2.3 3.7 5.6 7.7 9.4

51–70 years 106 5.0 0.46 1.4 1.9 2.9 4.4 6.4 8.8 10.5

71+ years 114 4.0 0.43 1.0 1.4 2.2 3.5 5.3 7.4 8.9

Females 399 3.7 0.20 0.9 1.2 1.9 3.2 4.8 6.7 8.2

51–70 years 194 3.6 0.20 0.9 1.2 1.9 3.1 4.7 6.7 8.1

71+ years 205 3.5 0.23 0.7 1.0 1.7 3.0 4.7 6.8 8.3

All home-delivered meal 

program nonparticipants

514 3.9 0.20 1.5 1.9 2.6 3.6 4.8 6.2 7.1

Males 175 3.7 0.40 1.2 1.5 2.2 3.3 4.7 6.4 7.7

51–70 years 68 3.7 0.38 1.2 1.6 2.2 3.2 4.6 6.3 7.6

71+ years 107 3.6 0.46 0.6 0.8 1.5 2.7 4.7 7.5 9.6

Females 339 3.9 0.21 1.6 2.0 2.7 3.7 4.8 6.1 7.0

51–70 years 108 2.6 0.42 0.5 0.7 1.2 2.1 3.4 5.1 6.2

71+ years 231 4.1 0.23 1.8 2.2 2.9 3.9 5.0 6.2 7.0

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.7 
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.4. Vitamin E (mg AT): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 5.9 0.28 2.0 2.5 3.6 5.3 7.4 10.0 11.9

Males 220 6.8 0.49 2.7 3.3 4.4 6.1 8.4 11.1 13.2

51–70 years 106 6.5 0.57 2.5 3.0 4.1 5.8 8.1 10.9 12.9

71+ years 114 6.9 0.62 2.9 3.5 4.6 6.2 8.5 11.2 13.3

Females 399 5.5 0.29 1.8 2.3 3.3 4.9 7.0 9.4 11.2

51–70 years 194 6.5 0.78 2.5 3.1 4.3 6.0 8.2 10.7 12.2

71+ years 205 5.3 0.34 1.5 2.0 3.1 4.6 6.8 9.3 11.2

All home-delivered meal 

program nonparticipants

514 5.6 0.25 2.7 3.2 4.1 5.3 6.7 8.3 9.3

Males 175 6.9 0.59 2.8 3.4 4.5 6.2 8.5 11.4 13.6

51–70 years 68 6.2 0.92 2.1 2.6 3.9 5.7 7.8 10.5 12.0

71+ years 107 7.0 0.67 2.9 3.5 4.7 6.4 8.7 11.5 13.5

Females 339 5.1 0.25 3.1 3.5 4.2 5.0 5.9 6.8 7.4

51–70 years 108 4.2 0.38 1.7 2.2 2.9 3.9 5.2 6.4 7.2

71+ years 231 5.2 0.25 3.3 3.7 4.3 5.1 6.0 6.8 7.4

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

AT = alpha-tocopherol; SE = standard error.

D.8 
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.5. Vitamin B6 (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 1.6 0.06 0.7 0.8 1.1 1.5 2.0 2.6 2.9

Males 220 1.9 0.12 0.8 0.9 1.3 1.7 2.3 3.0 3.5

51–70 years 106 2.1 0.20 0.7 0.9 1.3 1.8 2.6 3.6 4.4

71+ years 114 1.8 0.14 0.9 1.0 1.3 1.7 2.2 2.8 3.2

Females 399 1.5 0.07 0.6 0.8 1.0 1.4 1.8 2.3 2.7

51–70 years 194 1.6 0.10 1.2 1.3 1.4 1.6 1.8 2.0 2.1

71+ years 205 1.5 0.09 0.6 0.7 0.9 1.3 1.8 2.4 2.8

All home-delivered meal 

program nonparticipants

514 1.6 0.06 0.7 0.8 1.1 1.5 1.9 2.4 2.8

Males 175 1.9 0.11 0.8 1.0 1.3 1.8 2.3 3.0 3.4

51–70 years 68 2.2 0.41 1.3 1.4 1.7 2.1 2.6 3.2 3.6

71+ years 107 1.8 0.11 0.8 0.9 1.2 1.7 2.3 2.9 3.3

Females 339 1.5 0.06 0.7 0.8 1.1 1.4 1.8 2.2 2.5

51–70 years 108 1.1 0.08 0.4 0.5 0.8 1.0 1.4 1.7 1.9

71+ years 231 1.5 0.06 0.7 0.9 1.1 1.4 1.8 2.2 2.5

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.9 
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.6. Vitamin B12 (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 4.2 0.23 1.2 1.5 2.3 3.6 5.4 7.8 9.4

Males 220 5.7 0.53 1.3 1.8 2.8 4.6 7.3 10.8 13.7

51–70 years 106 6.1 0.82 1.6 2.1 3.1 4.9 7.6 11.4 14.4

71+ years 114 5.6 0.69 1.4 1.8 2.8 4.5 7.1 10.7 13.5

Females 399 3.6 0.19 1.3 1.6 2.3 3.3 4.6 6.1 7.1

51–70 years 194 3.6 0.19 1.3 1.6 2.3 3.3 4.5 6.1 7.1

71+ years 205 3.5 0.21 1.0 1.3 2.0 3.0 4.5 6.3 7.6

All home-delivered meal 

program nonparticipants

514 4.2 0.23 1.7 2.1 2.8 3.9 5.2 6.7 7.8

Males 175 5.1 0.48 1.6 2.0 2.9 4.3 6.4 9.0 11.1

51–70 years 68 5.0 0.47 1.6 2.0 2.9 4.3 6.3 8.8 10.8

71+ years 107 5.0 0.52 1.2 1.6 2.5 4.0 6.3 9.6 11.9

Females 339 3.9 0.25 1.8 2.1 2.7 3.6 4.7 5.9 6.8

51–70 years 108 3.0 0.33 1.4 1.7 2.2 2.8 3.6 4.5 5.0

71+ years 231 4.0 0.28 1.9 2.2 2.8 3.7 4.8 6.1 6.9

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.10
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.7. Folate (mcg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 450 20.1 215 253 326 427 547 680 769

Males 220 521 36.6 197 239 328 460 645 870 1,050

51–70 years 106 501 47.5 179 219 311 447 630 849 1,006

71+ years 114 527 43.8 212 255 339 468 648 878 1,049

Females 399 421 22.6 257 287 341 411 489 568 622

51–70 years 194 446 25.6 267 303 363 437 520 605 655

71+ years 205 415 28.2 286 311 354 408 468 528 567

All home-delivered meal 

program nonparticipants

514 413 15.1 158 195 271 379 517 674 786

Males 175 524 32.7 208 252 339 475 649 864 1,020

51–70 years 68 484 75.5 220 256 332 444 584 772 889

71+ years 107 529 35.1 211 256 349 485 657 864 1,001

Females 339 372 15.8 156 188 256 349 462 587 674

51–70 years 108 298 26.4 96 129 193 278 383 495 565

71+ years 231 383 17.4 172 204 264 353 467 599 697

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.11
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.8. Niacina (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 18 0.6 8 9 13 17 23 28 32

Males 220 21 1.3 10 12 15 20 26 33 38

51–70 years 106 24 1.9 13 15 19 23 29 35 40

71+ years 114 21 1.6 10 11 15 19 25 32 36

Females 399 17 0.6 7 9 12 16 21 26 29

51–70 years 194 18 1.1 9 11 15 18 22 26 28

71+ years 205 17 0.8 7 8 11 16 21 26 29

All home-delivered meal 

program nonparticipants

514 18 0.6 9 11 13 17 21 25 28

Males 175 22 1.1 14 16 18 21 25 29 32

51–70 years 68 27 4.0 13 15 19 25 32 41 46

71+ years 107 21 1.1 15 16 18 21 24 28 30

Females 339 16 0.5 9 10 13 16 19 22 24

51–70 years 108 13 0.8 10 10 12 13 15 16 17

71+ years 231 16 0.6 9 11 13 16 19 23 25

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

aNiacin intakes include preformed niacin only. EARs for niacin are expressed as niacin equivalents, including contributions from tryptophan. Therefore, prevalence 

of adequate niacin intakes may be underestimated. 

D.12
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.9. Riboflavin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 1.8 0.07 0.8 1.0 1.3 1.7 2.2 2.8 3.2

Males 220 2.2 0.13 0.9 1.1 1.5 2.0 2.7 3.5 4.1

51–70 years 106 2.3 0.16 1.0 1.2 1.6 2.1 2.8 3.5 4.1

71+ years 114 2.2 0.16 0.9 1.1 1.4 2.0 2.7 3.5 4.1

Females 399 1.6 0.07 0.8 1.0 1.2 1.6 2.0 2.4 2.7

51–70 years 194 1.8 0.11 0.9 1.1 1.4 1.7 2.1 2.6 2.8

71+ years 205 1.6 0.08 0.8 1.0 1.2 1.5 1.9 2.3 2.6

All home-delivered meal 

program nonparticipants

514 1.8 0.05 0.9 1.0 1.3 1.7 2.1 2.6 2.9

Males 175 2.0 0.11 1.1 1.3 1.5 1.9 2.4 2.9 3.3

51–70 years 68 2.0 0.17 1.4 1.5 1.7 2.0 2.3 2.6 2.8

71+ years 107 2.0 0.12 1.1 1.2 1.5 1.9 2.4 3.0 3.4

Females 339 1.7 0.06 0.8 0.9 1.2 1.6 2.0 2.4 2.7

51–70 years 108 1.4 0.10 0.6 0.8 1.0 1.4 1.8 2.2 2.4

71+ years 231 1.7 0.06 0.9 1.0 1.3 1.6 2.0 2.4 2.7

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.13
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.10. Thiamin (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 1.3 0.04 0.7 0.8 1.0 1.3 1.6 2.0 2.2

Males 220 1.6 0.08 0.7 0.8 1.0 1.4 1.9 2.5 3.0

51–70 years 106 1.8 0.18 0.7 0.8 1.1 1.6 2.2 3.1 3.7

71+ years 114 1.5 0.09 0.7 0.8 1.1 1.4 1.8 2.3 2.7

Females 399 1.2 0.05 0.8 0.9 1.0 1.2 1.4 1.7 1.8

51–70 years 194 1.3 0.07 0.9 1.0 1.1 1.3 1.5 1.6 1.8

71+ years 205 1.2 0.06 0.7 0.8 1.0 1.2 1.5 1.7 1.9

All home-delivered meal 

program nonparticipants

514 1.3 0.04 0.6 0.8 1.0 1.2 1.6 1.9 2.2

Males 175 1.6 0.06 1.0 1.1 1.3 1.6 1.9 2.2 2.4

51–70 years 68 1.7 0.15 0.9 1.0 1.3 1.6 2.1 2.6 2.9

71+ years 107 1.6 0.07 1.1 1.2 1.4 1.6 1.9 2.1 2.3

Females 339 1.2 0.05 0.6 0.7 0.9 1.1 1.4 1.8 2.0

51–70 years 108 1.0 0.06 0.4 0.5 0.7 1.0 1.3 1.6 1.7

71+ years 231 1.2 0.06 0.6 0.7 0.9 1.2 1.5 1.8 2.0

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.14
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.11. Calcium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 719 24.4 314 375 499 674 886 1,126 1,287

Males 220 767 43.8 366 430 558 725 932 1,152 1,311

51–70 years 106 823 62.1 426 490 618 787 989 1,203 1,345

71+ years 114 752 49.9 358 422 539 704 911 1,150 1,314

Females 399 700 27.3 294 357 479 652 867 1,102 1,272

51–70 years 194 775 51.5 368 441 570 741 944 1,162 1,295

71+ years 205 681 31.9 280 340 459 630 847 1,087 1,261

All home-delivered meal 

program nonparticipants

514 714 27.3 296 361 488 666 885 1,131 1,303

Males 175 760 74.6 285 345 469 669 940 1,294 1,563

51–70 years 68 778 70.3 – – – – – – – 

71+ years 107 752 82.0 249 308 437 643 938 1,338 1,629

Females 339 691 26.2 303 365 490 657 852 1,061 1,202

51–70 years 108 621 60.9 224 288 414 580 787 1,011 1,151

71+ years 231 701 27.3 314 380 501 668 862 1,067 1,209

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

– The usual intake distribution could not be reliably estimated for this subgroup. 

D.15
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.12. Iron (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 12.8 0.50 6.3 7.3 9.3 12.1 15.5 19.3 21.8

Males 220 14.1 0.90 6.4 7.5 9.8 13.0 17.2 21.9 25.6

51–70 years 106 14.4 1.28 7.0 8.0 10.2 13.3 17.3 22.0 25.4

71+ years 114 14.1 1.11 6.3 7.4 9.6 12.9 17.2 22.3 26.0

Females 399 12.3 0.54 6.7 7.6 9.4 11.8 14.6 17.5 19.6

51–70 years 194 12.8 0.79 6.9 8.1 10.1 12.5 15.2 17.9 19.5

71+ years 205 12.2 0.67 6.4 7.3 9.0 11.5 14.6 18.0 20.4

All home-delivered meal 

program nonparticipants

514 12.2 0.33 5.5 6.5 8.6 11.5 15.0 19.0 21.8

Males 175 15.0 0.76 6.6 7.9 10.4 14.1 18.5 23.5 27.0

51–70 years 68 16.4 1.98 7.2 8.6 11.4 15.4 20.0 25.8 29.1

71+ years 107 14.8 0.81 6.5 7.8 10.4 13.9 18.3 23.2 26.3

Females 339 11.2 0.38 5.4 6.3 8.2 10.7 13.6 16.8 18.9

51–70 years 108 11.3 0.39 5.4 6.4 8.3 10.7 13.6 16.7 19.1

71+ years 231 11.4 0.43 5.5 6.5 8.3 10.9 13.9 17.1 19.4

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.16
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.13. Magnesium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 232.7 8.36 106.7 126.0 164.8 219.0 284.5 358.4 408.3

Males 220 254.1 12.72 123.8 143.9 184.0 237.9 306.7 382.7 439.3

51–70 years 106 273.6 18.71 137.5 157.4 198.9 256.5 329.2 411.3 468.4

71+ years 114 248.6 14.39 122.7 142.8 179.9 232.4 299.1 377.3 431.8

Females 399 224.1 8.94 100.2 120.1 158.0 210.9 275.3 344.6 394.1

51–70 years 194 254.4 17.22 114.7 140.9 186.2 244.7 312.4 383.0 425.1

71+ years 205 216.6 10.48 99.3 117.2 152.2 201.9 264.8 334.2 384.7

All home-delivered meal 

program nonparticipants

514 224.0 6.69 122.2 139.7 172.3 215.3 265.6 319.6 356.3

Males 175 254.8 14.28 127.1 146.9 184.5 239.4 306.0 384.4 439.3

51–70 years 68 312.3 46.95 122.4 149.1 205.1 287.1 386.6 515.1 591.7

71+ years 107 245.9 14.05 129.2 147.7 183.7 233.1 293.2 362.6 407.3

Females 339 212.1 6.62 123.3 139.1 169.1 206.9 248.9 292.3 320.6

51–70 years 108 189.9 12.23 91.7 110.0 143.3 183.8 230.7 278.6 307.4

71+ years 231 215.2 6.53 128.1 144.4 172.9 210.0 251.1 292.9 321.0

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.17
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.14. Phosphorus (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 1,016 31.4 469 559 736 972 1,244 1,535 1,724

Males 220 1,116 52.7 586 677 850 1,070 1,333 1,606 1,798

51–70 years 106 1,187 68.6 647 734 909 1,139 1,412 1,703 1,897

71+ years 114 1,095 61.4 587 677 837 1,050 1,304 1,582 1,765

Females 399 976 32.3 422 517 693 930 1,207 1,492 1,688

51–70 years 194 1,094 69.6 508 627 825 1,068 1,336 1,603 1,757

71+ years 205 947 39.5 400 489 659 893 1,176 1,473 1,681

All home-delivered meal 

program nonparticipants

514 991 29.4 516 600 754 955 1,187 1,431 1,594

Males 175 1,172 74.1 594 681 848 1,096 1,401 1,769 2,031

51–70 years 68 1,429 151.1 796 896 1,095 1,367 1,679 2,063 2,286

71+ years 107 1,131 72.2 576 660 826 1,060 1,353 1,701 1,931

Females 339 923 26.8 521 597 738 908 1,089 1,269 1,383

51–70 years 108 873 64.8 379 476 648 851 1,078 1,303 1,435

71+ years 231 931 27.9 537 615 748 916 1,094 1,268 1,382

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.18
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.15. Zinc (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 9.2 0.39 3.9 4.7 6.3 8.5 11.3 14.6 16.9

Males 220 10.6 0.70 4.0 5.0 6.9 9.6 13.3 17.4 20.6

51–70 years 106 12.2 1.12 5.3 6.2 8.2 11.0 14.9 19.6 23.0

71+ years 114 10.1 0.80 3.9 4.8 6.6 9.3 12.7 16.6 19.4

Females 399 8.6 0.38 4.1 4.8 6.2 8.1 10.4 13.0 14.9

51–70 years 194 9.5 0.70 6.1 6.8 8.0 9.4 10.9 12.5 13.4

71+ years 205 8.4 0.51 3.7 4.4 5.7 7.7 10.3 13.3 15.6

All home-delivered meal 

program nonparticipants

514 8.9 0.35 3.8 4.5 6.0 8.2 10.9 14.1 16.4

Males 175 11.3 0.63 4.9 5.8 7.6 10.4 13.8 18.0 21.0

51–70 years 68 13.0 1.88 5.8 6.8 8.8 11.9 15.7 20.9 24.0

71+ years 107 11.0 0.58 4.8 5.7 7.5 10.2 13.5 17.5 20.1

Females 339 8.0 0.36 3.7 4.3 5.7 7.5 9.8 12.3 14.1

51–70 years 108 7.7 0.54 4.7 5.3 6.3 7.6 9.0 10.4 11.3

71+ years 231 8.1 0.39 3.7 4.4 5.7 7.5 9.8 12.4 14.3

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.19
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.16. Potassium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 2,110 70.6 954 1,145 1,519 2,018 2,592 3,206 3,603

Males 220 2,354 126.7 1,113 1,320 1,723 2,241 2,866 3,518 3,980

51–70 years 106 2,535 193.1 1,294 1,492 1,893 2,423 3,054 3,724 4,168

71+ years 114 2,303 143.9 1,074 1,286 1,668 2,187 2,810 3,496 3,949

Females 399 2,010 70.7 908 1,102 1,458 1,930 2,470 3,020 3,394

51–70 years 194 2,263 117.1 1,069 1,298 1,689 2,188 2,757 3,344 3,692

71+ years 205 1,947 84.7 877 1,063 1,411 1,869 2,398 2,932 3,294

All home-delivered meal 

program nonparticipants

514 2,156 65.2 1,076 1,265 1,616 2,074 2,600 3,154 3,524

Males 175 2,424 115.7 1,320 1,516 1,868 2,346 2,878 3,454 3,830

51–70 years 68 2,557 254.7 1,496 1,697 2,067 2,521 2,984 3,492 3,760

71+ years 107 2,402 131.3 1,260 1,453 1,820 2,305 2,871 3,496 3,884

Females 339 2,051 66.6 1,015 1,195 1,542 1,986 2,483 2,999 3,336

51–70 years 108 1,700 120.4 700 863 1,178 1,593 2,113 2,684 3,044

71+ years 231 2,098 70.2 1,070 1,261 1,597 2,037 2,525 3,019 3,349

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.20
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.17. Dietary fiber (g): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 13 0.6 5 7 9 13 17 21 25

Males 220 14 0.8 6 7 9 13 17 22 25

51–70 years 106 14 1.2 5 7 9 12 17 23 27

71+ years 114 14 0.9 6 7 10 13 17 22 25

Females 399 13 0.7 5 7 9 13 17 21 24

51–70 years 194 15 1.2 7 8 11 14 18 22 24

71+ years 205 13 0.8 5 6 8 12 16 21 25

All home-delivered meal 

program nonparticipants

514 13 0.5 5 6 9 12 17 21 25

Males 175 15 0.8 6 7 10 14 18 24 27

51–70 years 68 15 2.3 6 7 10 14 19 26 30

71+ years 107 15 0.9 6 7 10 14 18 23 27

Females 339 13 0.6 5 6 8 12 16 20 23

51–70 years 108 11 0.9 3 4 7 10 14 18 20

71+ years 231 13 0.6 5 6 9 12 16 21 24

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.21
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.18. Sodium (mg): Usual nutrient intakes of congregate and home-delivered meal program 

nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 2,747 84.0 1,323 1,554 2,009 2,622 3,337 4,117 4,628

Males 220 3,012 144.3 1,471 1,723 2,216 2,857 3,644 4,478 5,077

51–70 years 106 3,286 187.8 1,844 2,072 2,535 3,148 3,885 4,678 5,212

71+ years 114 2,932 169.3 1,427 1,683 2,146 2,780 3,549 4,407 4,979

Females 399 2,639 87.0 1,274 1,509 1,941 2,524 3,206 3,915 4,408

51–70 years 194 2,928 189.1 1,273 1,587 2,128 2,821 3,616 4,435 4,921

71+ years 205 2,569 99.5 1,276 1,486 1,887 2,437 3,106 3,818 4,323

All home-delivered meal 

program nonparticipants

514 2,696 81.7 1,351 1,576 2,001 2,571 3,246 3,982 4,486

Males 175 3,440 161.4 1,999 2,236 2,672 3,291 4,020 4,860 5,440

51–70 years 68 3,777 477.9 1,927 2,198 2,750 3,540 4,489 5,724 6,470

71+ years 107 3,391 168.8 2,056 2,282 2,711 3,275 3,935 4,671 5,133

Females 339 2,431 84.2 1,317 1,514 1,888 2,364 2,894 3,442 3,800

51–70 years 108 2,313 154.3 1,696 1,823 2,040 2,290 2,566 2,838 2,996

71+ years 231 2,453 96.9 1,306 1,517 1,888 2,379 2,929 3,489 3,868

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.22
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.19. Protein (as a percentage of calories): Usual nutrient intakes of congregate and home-delivered 

meal program nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 16.6 0.26 11.7 12.7 14.4 16.4 18.6 20.8 22.2

Males 220 16.3 0.42 12.6 13.3 14.6 16.1 17.8 19.5 20.6

51–70 years 106 17.4 0.66 11.5 12.5 14.4 16.9 19.9 23.1 25.2

71+ years 114 16.3 0.43 12.6 13.3 14.6 16.2 17.8 19.5 20.6

Females 399 16.7 0.33 11.6 12.6 14.4 16.6 18.9 21.0 22.4

51–70 years 194 17.2 0.47 11.2 12.5 14.7 17.1 19.7 22.1 23.4

71+ years 205 16.6 0.41 11.8 12.7 14.3 16.4 18.6 20.8 22.3

All home-delivered meal 

program nonparticipants

514 16.5 0.33 11.6 12.6 14.2 16.3 18.5 20.8 22.3

Males 175 17.2 0.48 12.3 13.2 14.8 16.9 19.2 21.6 23.2

51–70 years 68 18.8 1.76 13.5 14.5 16.3 18.5 20.9 23.7 25.2

71+ years 107 17.0 0.46 11.7 12.7 14.4 16.6 19.1 21.8 23.4

Females 339 16.2 0.42 11.4 12.4 14.0 16.0 18.2 20.3 21.7

51–70 years 108 16.4 0.75 10.1 11.3 13.5 16.0 19.0 22.0 23.8

71+ years 231 16.2 0.47 11.6 12.5 14.1 16.1 18.1 20.1 21.4

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.23
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.20. Carbohydrate (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 49.0 0.63 36.9 39.5 44.0 49.0 53.9 58.4 61.1

Males 220 46.9 1.13 30.7 34.5 40.8 47.1 53.3 58.7 62.1

51–70 years 106 47.3 1.91 28.9 32.9 39.9 47.5 55.0 61.7 65.6

71+ years 114 46.9 1.18 32.8 36.3 41.5 47.1 52.5 57.3 60.1

Females 399 49.9 0.77 40.0 42.2 45.8 49.9 53.9 57.6 59.9

51–70 years 194 48.7 1.14 39.8 41.8 44.9 48.5 52.3 55.9 57.9

71+ years 205 50.3 0.93 39.1 41.7 45.8 50.4 54.9 58.9 61.3

All home-delivered meal 

program nonparticipants

514 49.4 0.60 37.7 40.2 44.4 49.3 54.2 58.9 61.8

Males 175 46.6 0.95 33.7 36.7 41.3 46.7 51.8 56.6 59.4

51–70 years 68 43.7 2.66 30.8 34.1 39.2 44.3 48.7 52.9 55.0

71+ years 107 47.1 1.06 34.1 37.0 41.7 47.1 52.4 57.5 60.3

Females 339 50.2 0.74 40.0 42.0 45.7 50.0 54.4 58.6 61.2

51–70 years 108 49.2 1.96 37.8 40.0 43.9 48.5 53.8 59.3 62.6

71+ years 231 50.3 0.85 40.2 42.4 45.9 50.2 54.5 58.6 61.1

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.24
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.21. Total fat (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 34.9 0.48 25.8 27.8 31.2 35.0 38.6 42.0 43.9

Males 220 36.1 0.88 25.9 28.1 31.8 35.9 40.2 44.1 46.7

51–70 years 106 36.1 1.72 22.6 25.2 30.1 35.7 41.8 47.5 51.1

71+ years 114 36.1 1.03 28.8 30.4 33.0 36.0 39.1 42.2 44.0

Females 399 34.5 0.55 25.9 27.9 31.1 34.6 37.9 40.9 42.7

51–70 years 194 34.4 0.56 25.9 27.7 31.1 34.5 37.8 40.9 42.6

71+ years 205 34.3 0.70 22.8 25.6 29.9 34.5 39.0 42.9 45.3

All home-delivered meal 

program nonparticipants

514 35.2 0.52 25.4 27.6 31.2 35.2 39.1 42.7 44.9

Males 175 36.7 0.80 27.1 29.2 32.5 36.6 40.6 44.5 46.9

51–70 years 68 36.5 2.10 28.6 30.1 32.8 36.1 39.6 43.5 45.6

71+ years 107 36.8 0.90 26.6 28.9 32.6 36.8 40.9 44.8 47.0

Females 339 34.5 0.62 25.2 27.3 30.8 34.6 38.4 41.8 43.8

51–70 years 108 35.6 1.54 24.4 27.1 31.8 36.0 40.0 43.4 45.2

71+ years 231 34.5 0.69 25.2 27.3 30.7 34.5 38.3 41.6 43.7

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.25
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.22. Linoleic acid (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 6.8 0.13 4.1 4.6 5.5 6.7 7.9 9.1 9.9

Males 220 6.9 0.28 4.1 4.7 5.7 6.8 8.0 9.2 10.0

51–70 years 106 6.3 0.57 2.2 2.8 4.1 5.9 8.1 10.5 12.1

71+ years 114 7.1 0.34 5.3 5.7 6.3 7.0 7.8 8.6 9.0

Females 399 6.8 0.17 4.0 4.6 5.5 6.6 7.9 9.1 9.9

51–70 years 194 7.3 0.44 5.1 5.6 6.3 7.2 8.2 9.1 9.7

71+ years 205 6.6 0.21 3.8 4.3 5.3 6.5 7.8 9.1 9.9

All home-delivered meal 

program nonparticipants

514 6.8 0.22 4.5 4.9 5.7 6.7 7.7 8.7 9.4

Males 175 6.9 0.37 4.0 4.5 5.4 6.6 8.0 9.7 10.8

51–70 years 68 6.8 0.75 4.4 4.8 5.6 6.6 7.8 9.2 10.0

71+ years 107 6.9 0.41 3.9 4.4 5.4 6.6 8.1 9.7 10.7

Females 339 6.7 0.28 4.8 5.2 5.8 6.6 7.5 8.3 8.8

51–70 years 108 6.0 0.47 3.6 4.1 4.9 5.9 7.0 8.1 8.8

71+ years 231 6.8 0.30 5.1 5.4 6.0 6.7 7.5 8.2 8.6

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.26
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.23. Alpha-linolenic acid (as a percentage of calories): Usual nutrient intakes of congregate and 

home-delivered meal program nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 0.7 0.02 0.4 0.4 0.5 0.7 0.9 1.1 1.2

Males 220 0.7 0.04 0.4 0.4 0.5 0.7 0.8 1.0 1.2

51–70 years 106 0.7 0.06 0.3 0.4 0.5 0.6 0.8 1.1 1.2

71+ years 114 0.7 0.05 0.4 0.5 0.6 0.7 0.8 1.0 1.1

Females 399 0.7 0.03 0.4 0.4 0.5 0.7 0.9 1.1 1.2

51–70 years 194 0.8 0.06 0.5 0.5 0.6 0.7 0.9 1.1 1.2

71+ years 205 0.7 0.03 0.3 0.4 0.5 0.7 0.9 1.1 1.3

All home-delivered meal 

program nonparticipants

514 0.7 0.03 0.5 0.5 0.6 0.7 0.8 0.9 1.0

Males 175 0.7 0.03 0.4 0.4 0.5 0.7 0.8 1.1 1.2

51–70 years 68 0.7 0.08 0.4 0.4 0.5 0.6 0.8 1.0 1.1

71+ years 107 0.7 0.04 0.4 0.4 0.5 0.7 0.9 1.1 1.2

Females 339 0.7 0.03 0.5 0.5 0.6 0.7 0.8 0.9 1.0

51–70 years 108 0.6 0.05 0.4 0.4 0.5 0.6 0.6 0.7 0.8

71+ years 231 0.7 0.03 0.5 0.5 0.6 0.7 0.8 0.9 1.0

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error.

D.27
APPENDIX D MATHEMATICA POLICY RESEARCH

Table D.24. Saturated fat (as a percentage of calories): Usual nutrient intakes of congregate and homedelivered meal program nonparticipants 

 Percentiles

 N Mean SE 5th 10th 25th 50th 75th 90th 95th

All congregate meal program 

nonparticipants

619 11.5 0.24 7.8 8.5 9.8 11.4 13.0 14.6 15.6

Males 220 11.8 0.35 7.8 8.6 10.0 11.7 13.5 15.3 16.4

51–70 years 106 12.2 0.57 7.7 8.5 10.0 11.9 14.1 16.3 17.7

71+ years 114 11.8 0.45 8.2 9.0 10.2 11.7 13.2 14.8 15.7

Females 399 11.4 0.28 7.8 8.6 9.8 11.3 12.8 14.2 15.1

51–70 years 194 11.2 0.44 9.3 9.7 10.4 11.2 12.0 12.8 13.2

71+ years 205 11.4 0.35 7.2 8.1 9.5 11.3 13.2 14.9 16.1

All home-delivered meal 

program nonparticipants

514 11.7 0.19 7.5 8.3 9.7 11.5 13.5 15.5 16.9

Males 175 12.3 0.49 7.3 8.2 9.7 11.8 14.2 17.0 19.0

51–70 years 68 12.6 1.31 8.2 8.9 10.4 12.3 14.4 16.9 18.4

71+ years 107 12.2 0.51 7.0 7.9 9.7 11.9 14.4 17.0 18.5

Females 339 11.5 0.24 7.7 8.4 9.7 11.3 13.0 14.8 15.9

51–70 years 108 12.3 0.64 8.0 9.0 10.5 12.2 14.0 15.7 16.7

71+ years 231 11.4 0.29 7.6 8.4 9.6 11.2 13.0 14.7 15.8

Source: AoA NSP 24-hour dietary recall (Day 1 and Day 2), 2015-2016, weighted data.

SE = standard error. 

D.28
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