Nutrition: Home-delivered and Congregate Meal Services for Older Adults

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends home-delivered and congregate meal services for older adults living independently (i.e., not residents of senior living or retirement community centers). Systematic review evidence shows reductions in malnutrition.

The full CPSTF Finding and Rationale Statement and supporting documents for Nutrition: Home-delivered and Congregate Meal Services for Older Adults are available in The Community Guide Collection on CDC Stacks.

Intervention

Meal services provide nutritious meals to adults 60 years and older who are living independently (i.e., not residents of senior living centers). Interventions prioritize those with greater social and economic needs and are delivered as one of the following:

  • Home-delivered meal services, or
  • Congregate meal services provided in group settings, such as senior centers, that give older adults an opportunity to socialize.

Meals typically follow nutritional guidelines, are usually provided five days per week, and may follow cultural- or health-related needs, such as diabetic requirements.

About The Systematic Review

This CPSTF finding is based on evidence from a systematic review published in 2020 (Walton et al., 20 studies, search period database inception January 2019) combined with more recent evidence (8 studies, search period January 2019 to May 2021).

Study Characteristics

  • Studies were conducted in the United States (11 studies), Australia (2 studies), Canada (2 studies), the United Kingdom (2 studies), Finland (1 study), the Netherlands (1 study), and South Korea (1 study).
  • Studies were conducted in urban and rural populations (5 studies), urban populations (4 studies, and rural populations (1 study).
  • All eleven studies conducted in the United States reported racial and ethnic distributions. Studies included participants who self-identified as White (median 63.4%; 13 studies), Black or African American (median 30.9%; 10 studies), Hispanic or Latino (median 16.1%; 6 studies), Asian (median: 1.7%; 2 studies), American Indian or Alaska Native (0.7%; 3 studies), or other race/ethnicity (median 11.1%; 2 studies). None of the studies included participants who self-identified as Native Hawaiian or other Pacific Islander.
  • Eleven studies reported on socioeconomic status and living situation (either alone or with family members).
    • The median proportion of participants with low levels of socioeconomic status was 68.0%.
    • The median proportion of participants living alone was 56.2%.

Summary of Results

The systematic review included 20 studies (24 study arms). Studies assessed home-delivered meal services (19 study arms), congregate meal services (4 study arms), or either (1 study arm).

Home-delivered Meal Services

Dietary Behaviors

  • Percent meeting Recommended Daily Allowances (RDA) for energy increased by 7.1 percentage points (6 studies)
  • Percent meeting Recommended Daily Allowances (RDA) for protein increased by 5.9 percentage points (6 studies)

Food and Nutrition Security

  • Percent malnourished decreased by 15.5 percentage points (9 studies, 10 study arms)

Congregate Meal Services

Food and Nutrition Security

  • Percent malnourished decreased by 9.0 percentage points (2 studies, 3 arms)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the systematic review, the CPSTF finding should be applicable to older adults living independently in urban or rural settings in the United States, independent of socioeconomic status.

Evidence Gaps

  • How does intervention effectiveness vary by the following:
    • Race or ethnicity?
    • Extent of participants’ support systems (e.g., friend networks, children)?
    • Participants’ literacy level, education, and English proficiency?
    • Access to food (proximity to grocery stores)?
    • Frequency of meals provided?
  • What is the impact on dietary intake of including nutrition education?
  • Are participants more likely to be referred to other community-based supports and programs than older adults who are not receiving meal services?
  • Does participation affect activities of daily living, instrumental activities of daily living, or medication adherence?
  • Do interventions demonstrate improvements for aging in place? Long term studies would be beneficial.

Implementation Considerations and Resources

CPSTF does not endorse any specific meal service intervention.

  • Programs are encouraged to follow nutrition standards such as the Dietary Guidelines for Americans (U.S. Department of Health and Human Services and U.S. Department of Agriculture 2020), even when not required, to ensure continued health benefits for participants.
  • Programs may incorporate nutrition education about healthy food and beverage choices based on participants’ current weight and activity level.
  • It is important to develop policies on food safety and sanitation to minimize risk for foodborne illnesses. This may also include food safety education for those involved in food preparation and delivery.

Home-delivered meal services

  • When considering the frequency of meal delivery, programs may want to balance interest in addressing participants’ loneliness and exposure to communicable diseases.
  • Programs may consider serving meals that allow for delayed consumption, for example ready-to heat or frozen meals rather than hot meals.
  • Programs may consider incorporating food safety education and packaging that supports proper storage of leftovers.

Congregate meal services

  • Programs may consider balancing socialization and providing meals with protecting older adults against communicable diseases.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.