FNOA: Aging Programs (2012)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

 

The focus of this article is to share experiences in designing and implementing ethnic congregate nutrition programs.

Inclusion Criteria:

Articles regarding congregate nutrition programs within Montgomery County, Maryland.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Article search terms and databases not described. 

Design

Narrative review

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Not completed 

Data Collection Summary:

Timing of Measurements

Not applicable

Dependent Variables

Not applicable

Independent Variables

Not applicable

Control Variables

Description of Actual Data Sample:
  • Initial N: Three references included
  • Attrition (final N): Three references
  • Age: Not applicable
  • Ethnicity:
    • Chinese
    • Vietnamese
    • Korean
  • Other relevant demographics:
  • Anthropometrics:
  • Location: Montgomery County, Maryland.

 

Summary of Results:

The Korean Initiative

  • Developed in 1990 by a group of Korean businessman concerned about elderly family members
  • Location is a church and staff by Korean volunteers
  • Culturally tailored nutrition education and physical fitness activities
  • Meal patterns modeled from Senior Units on Aging but tailored for Korean population
  • Menu included minimum use of sodium and encouraged legumes, whole grains, and low fat cooking methods
  • Protein entrees included: Fish, beef, chicken, and occasionally tofu
  • Carbohydrates servings including rice or noodles but often they were in excess of one cup per serving at meal
  • Vegetables included kimchi and dark green vegetables
  • Fresh fruit was always served for dessert
  • Iced tea and milk offered as beverages
  • Senior Nutrition Program trained volunteers on safe handling of food and portion control
  • Older Americans Act funds helped to pay for meals.

 The Vietnamese Meal Pattern

  • In 1991 a Vietnamese organization contacted the Senior Nutrition Program about starting a program similar to the Korean arrangement
  • A Vietnamese restaurant would provide the meals at a reasonable cost
  • Asian meal pattern was used but was different from Korean model: The Vietnamese had fewer items but more varied appearance
  • Entrees included: Beef or chicken stew with vegetables, sandwich
  • Side items included: Noodles, rice, salad
  • Fresh fruit for dessert
  • Beverages: Coffee, no milk.

 Challenges with the Ethnic Congregate Sites (Vietnamese and Korean sites)

  • Senior population had difficulty making reservations, extra food was made to compensate and waste became high
  • Senior Nutrition Program monitored the site but the sites had total autonomy in finding staff, donations, finding food for meals, and ordering and serving meals.  They also arranged for the nutrition education and physical fitness activities with guidance from the Senior Nutrition Program.
  • Senior Nutrition Program had to apply a significant amount of assistance to the Ethnic Congregate sites
  • Difficulty ensuring sites followed safe handling of food guidelines
  • By 1994, sites became so popular that request for proposal with the County's Procurement Office had to be developed to continue providing Older Americans Act nutrition services
  • The request for proposal limited the Senior Nutrition Program on how many meals they could serve so in 1999 they decided to use open solicitation. Four things were now required: contractor must have certified food service manager at every site, outcome measures would now be monitored closely by the county, contractor would keep voluntary donations, and a new form was developed to assess actual meal cost.

Chinese Meals

  • Completed a contract and opened two sites in 2000
  • Menu based on Asian meal pattern
  • Each meal contained three entrees: Beef, pork, chicken, fish or tofu with vegetables
  • Carbohydrates included rice and noodles
  • Vegetables were included in a separate item as well as in the entree
  • Fresh fruit for dessert
  • Iced tea or water for beverage
  • Initially had similar issues of having too much food waste. However, over time more non-Chinese seniors were being served at the sites and had a shortage of food. Meal reservation program was started and this improved the situation.

Growth in Ethnic Meal Volume

  • In 1999, 21,833 meals were served at a cost of $84,538 per site
  • In 2005, 40,575 meals were served at a cost of $170,886 per site
  • Number of sites doubled from six to 12 from 1999 to 2005
  • In 2001, new computer software and documented invoices for number of people served was mandated by the Maryland Senior Units on Aging
  • In 2004, new dietary guidelines were enforced for menu standards but Asian meals did not change as all were doing most of these anyway. However, incorporating more whole grains did prove to be a challenge since most Asian seniors preferred traditional white rice.

Other Findings

  • From 2000 to 2006, the number of ethnic congregate nutrition sites increased from six to 14
  • Growth was due to the creative, flexible ways to open ethnic sites and partly to growth of ethnic communities in the County
  • It is difficult to assess the number of minority seniors but in 2006 they were estimated to be half of all congregate participants (2,376 participants, 4,564 total)
  • Montgomery County has received two awards for developing sites to serve ethnically diverse seniors.
Author Conclusion:

Success in providing Older Americans Act services for elderly ethnic populations requires creativity, flexibility, persistence, knowledge of the culture and empathy. In return, their appreciation is great.

Funding Source:
Other: Funding not disclosed
Reviewer Comments:

Article inclusion/exclusion criteria not well defined, search terms and databases not described. Only three references included.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes