摘要：Objectives. We assessed outcomes of an integrated nutrition and exercise program designed for Older Americans Act Nutrition Program participants as part of the Administration on Aging’s You Can! campaign. Methods. A 10-site intervention study was conducted. Preintervention and postintervention assessments focused on nutrition and physical activity stages of change, self-reported health status, dietary intakes, physical activity, and program satisfaction. Results. Of 999 enrollees, the 620 who completed the program were aged 74.6 years on average; 82% were women, and 41% were members of racial/ethnic minority groups. Factors associated with program completion were site, health conditions, and nutrition risk. Seventy-three percent and 75% of participants, respectively, made a significant advance of 1 or more nutrition and physical activity stages of change; 24% reported improved health status. Daily intake of fruit increased 1 or more servings among 31% of participants; vegetables, 37%; and fiber, 33%. Daily steps increased 35%; blocks walked, 45%; and stairs climbed, 24%. Program satisfaction was 99%. Conclusions. This easy-to-implement program improves diets and activity levels. Local providers should offer more such programs with the goal of enabling older Americans to take simple steps toward successful aging. The Older Americans Act (OAA) Nutrition Program is the largest federally funded nutrition assistance program aimed toward adults 60 years and older. 1 , 2 Established in 1972, it is administered by the US Administration on Aging. Frequently called “meals on wheels” (this misnomer refers only to home-delivered meals), the program’s purpose was never limited to providing meals. Among its stated purposes—still applicable 35 years later—were promoting health, decreasing malnutrition, preventing physical and mental deterioration, and reducing social isolation. Today, the program annually provides about 250 million nutritious meals, other nutrition services, and socialization opportunities to 3 million adults older than 60 years. States and local communities successfully leverage OAA funds to build coordinated service systems at a rate of about $2 for every federal dollar. The OAA Nutrition Program is available to all individuals 60 years or older regardless of income. However, it is targeted to those in greatest social or economic need, particularly to low-income members of minority groups and individuals residing in rural areas. The Nutrition Program is a primary source of support for many older people ineligible for services provided by means-tested programs with income criteria, such as food stamps. Indeed, the program is the chief service system of any type for older individuals slightly above the poverty level. Of the participants, 80% to 90% have incomes below the poverty level to 125% of the poverty level, 76% are older than 75 years, and 60% live alone. 3 Participants’ voluntary contributions cover about 20% of the cost of a meal, and a single meal eaten at a community site is often their primary source of food for the entire day (for 60% of participants, this meal provides half or more of the total day’s food). Nutrition Screening Initiative Checklist scores, which indicate level of nutrition risk, are high for 43% of participants and moderate for 48%. 3 Nutrition risk is based on factors or characteristics associated with an increased likelihood of poor nutritional status, commonly called malnutrition. These factors include the presence of various acute or chronic diseases and conditions, insufficient or inappropriate food intake, poverty, dependency on others or disability, and long-term or multiple medication use. In addition to typically offering 5 midday meals per week at community sites and in homes, the program provides nutrition services that include screening, education, and counseling. It also provides linkages to other supportive in-home and community-based services such as homemaker–home health aide services, transportation, and even home repair and home modification programs. Each day, the 4000 local agencies serve as few as 20 clients to several thousand clients. Most agencies have modest budgets and depend on volunteer staff to a great degree. The Eat Better & Move More (EBMM) program 4 was developed specifically for local OAA Nutrition Program sites and the Administration on Aging’s national You Can! campaign. 5 The latter, part of the Steps to a HealthierUS initiative, 6 encourages all Americans, including older adults, to live longer, healthier lives by being physically active, eating nutritious diets, obtaining preventive screenings, and making healthful choices such as not smoking. Because nutrition and physical activity are cornerstones of successful aging, 7 EBMM incorporates both of these elements. The program, which is simple, ready to use, and designed to fit modest local agency resources, fits the interests and needs of community-dwelling older adults who want to maintain their quality of life and independence. We sought to document EBMM’s effectiveness in a variety of community sites nationwide that serve diverse older populations, including members of racial/ethnic minority groups.
