Hunger in America

Irene Berman-Levine, PhD, RD
March 26, 2004

This article is the third of several extracts we are taking from Dr Irene Berman-Levine's book, "Dr Irene's Nutrition Tidbits". You can order the book, which is packed with easily digested research news, tips, menus, and recipes, for US$16 by clicking here . Robert Griffith, Editor.

Hidden hunger in America

Just because we don't see many emaciated children with swollen bellies walking around the streets in the United States, food insecurity and malnutrition are still major problems. For example, estimates indicate that about one in four older Americans are malnourished. Hidden hunger can be:

• the senior who eats only noodles, because within the American healthcare system over 25% of low income people have to choose between buying food and paying for medication.
• the overweight but undernourished woman, whose limited food budget restricts her access to fruits, vegetables, and lean meats.
• the family who faces a choice between buying food or buying heat.
• the exhausted mother trying to breast-feed a child who has no milk because she doesn't have the nutrition, fluids and rest needed to produce milk.
• the child who cannot concentrate in school because he/she does not have access to regular nutritious meals.

I started with this introduction, because I want you to remember that hunger may also be in your own backyard. I live in Harrisburg, Pennsylvania and I'm involved in anti-hunger activities by serving on the board of the Central Pennsylvania Food Bank. The Food Bank is a member of Second Harvest. In America, Second Harvest is the largest domestic hunger-relief organization in the country, with a nation-wide network of nearly 200 food banks (see first link below).

The demand for Food Bank services is a key indicator of the extent of the "hidden" hunger in our communities. In 1999, our food bank distributed over 12.5 million pounds of food to the more than 300 soup kitchens, food pantries and shelters in our 17-county area. The shocking statistics from our hunger study indicate that the Food Bank is providing critical services to extremely vulnerable populations. These populations include seniors, children, the working poor and the poorest of the poor:

• 48% of people served by charitable feeding programs in the United States are children and 12% are 65 years of age and older.
• 46% of the food banks clients are working, but 86% of those households earned $17,500 or less and only (which puts most of them under the poverty line by the United States standards).
• 29% had to choose between paying the rent or mortgage and buying food.
• 60% of households have < $10,000 in annual household income. Among these individuals, 19% do not have a stove!

The problem in the elderly

Older Americans are particularly vulnerable to malnutrition and are the least likely group to participate in government food programs. Nearly 20% of older Americans - one in five - live in poverty or near poverty. Yet federal programs to combat hunger and food insecurity are estimated to reach only a third of needy older Americans. Reasons for low participation include personal pride, confusion over eligibility guidelines, and difficulty in reaching this target population through traditional outreach methods.

One in four elderly patients is malnourished according to a survey of 750 physicians, nurses and administrators of health care institutions. One half of all elderly hospital patients and 40% of nursing home residents are believed to suffer from malnutrition.

It's not just money

Almost 2 million older Americans are faced each year with the impossible choice of buying food or buying needed medicine. But lack of money is only one factor in malnutrition. Many other Americans are not getting proper nutrients because of deficiencies, excesses, or imbalance in food or diet. Social isolation and the psychological impact of loss of spouse and friends, frustrations with aging bodies, and the effects of medications on appetite and taste are just some of the many causes of malnutrition among older Americans.

The first step in combating malnutrition is to identify seniors who are at high risk for poor nutrition. Earlier and better detection of poor nutrition can increase the quality of life of seniors and reduce health care costs.

Detecting poor nutrition in the elderly

A major effort to identify seniors at risk has been implemented by the Nutritional Screening Initiative (NSI - see the second link below). All individuals should be screened for nutritional risk as part of any health assessment. This is very important for seniors because poor nutrition increases the likelihood of illness and can worsen the symptoms of chronic disease. Poor nutrition also increases the chances of the senior cannot maintain an independent living situation.

The NSI has simplified the task of nutritional screening by developing three levels of nutrition screens for older Americans. The first level is a one-page, large print checklist of simple questions that helps identify seniors at risk for poor nutrition. Level One is quick to complete, so it is a useful screen for healthcare providers to include in their health assessments. It can also be self-administered, so senior programs are encouraged to make it available.

The checklist is designed to access basic areas of concern that have the potential to negatively impact nutrition and health. It is sometimes called the DETERMINE checklist because each letter of DETERMINE stands for a nutritional risk factor:

Disease
Eating poorly
Tooth loss/mouth pain
Economic hardship
Reduced social contact
Multiple medicines
Involuntary weight loss/gain
Needs assistance in self-care
Elderly years above age 80

A senior identified at nutritional risk with Level One is ideally referred to a registered dietitian for a more in-depth evaluation and/or the development of a nutritional care plan. The Level Two and Level Three screens are used by health professionals with the facilities for more in-depth interviews.

The bottom line

Time and budget spent on nutrition and healthcare will be returned through cost savings. Nutritional screens and interventions are cost-effective; result in fewer complications; can speed recovery and shorten hospital stays; and reduce hospital expenditure. Studies completed by the American Dietetic Association have demonstrated that for every dollar spent on nutrition screening and intervention, at least $3.25 is saved. So please give your support to the people and organizations trying to battle hunger in America - it's worth it!

Order Dr Irene's book, which is packed with nutritional news, tips, menus, and recipes, for US$16 by clicking here

Dr Irene is also the author of a weekly free newsletter which helps you understand the confusing world of nutrition and motivates you to choose healthy foods. You can sign up for the newsletter by clicking here

Source

• I Berman-Levine PhD, RD. "Welcome to Dr Irene's Nutrition Tidbits" 2002 Nutrition Program Planning Inc., PO Box 60748, Harrisburg, PA 17106-0748, USA

Related Links
Second Harvest
Nutritional Screening Initiative
DETERMINE Online Nutritional Screen
Nutrition in the Elderly