Live Long and Prosper: Optimal Nutrition for Today s Aging Realities

Transcription

1 NUTRI-BITES Webinar Series Live Long and Prosper: Optimal Nutrition for Today s Aging Realities September 12, 2012 Presenter: Nancy Wellman, PhD, RD Adjunct Professor, Tufts University Friedman School of Nutrition Science & Policy Moderator: James M. Rippe, MD Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Academy of Nutrition and Dietetics Commission on Dietetic Registration and American Culinary Federation

2 Webinar logistics } Continuing Education Credit certificates will be ed as a PDF within 14 days. } A recording of today s webinar and slides will be available to download as a PDF within 2 days at: } A summary PowerPoint of this presentation will be available to download within 2 days at ww.conagrafoodsscienceinstitute.com } The presenters will answer questions at the end of this webinar. Please submit questions by using the Chat dialogue box on your computer screen.

3 ConAgra Foods Science Institute } With a mission of: Promoting dietary and related choices affecting wellness by linking evidence-based understanding with practice

4 Today s Faculty } Nancy Wellman, PhD, RD, FADA Adjunct Professor, Tufts University Friedman School of Nutrition Science & Policy } Moderator: James M. Rippe, MD Leading cardiologist, Founder and Director, Rippe Lifestyle Institute

5 Learning Objectives } Review the beneficial effects of nutrition in health promotion, risk reduction and disease management of older Americans } Outline federal and community food and nutrition programs available for older adults } Describe access issues and opportunities to promote healthful aging and optimal nutrition status } Identify strategies food and nutrition professionals can apply to integrate food and nutrition programs and services into home and community settings } Help older adults meet their nutrition needs following hospital discharge by adding nutrition into discharge planning and transition care

6 Live Long & Prosper: Optimal Nutrition for Today's Aging Realities Nancy S Wellman, PhD, RD Adjunct Professor, Tufts University Friedman School of Nutrition Science & Policy September 2012

7 AGEISM: Personal Impact Positive self-perceptions of aging increase life span by ~7.5 years Negative self-perceptions of aging decrease life expectancy Greater impact on survival than gender, SES, loneliness, functional health R X : De-legitimize ageism in society Levy et al. J Pers Soc Psy 2002;2:

8 AGEIST Language Because the term elderly connotes a stereotype, avoid using it as a noun. Use the elderly only when referring to the entire population, but older person(s), aging population, persons 65 years and older is/are preferred. Am Medical Assoc Manual of Style: 10 th ed, 09, p 416. Pub Manual of Am Psych Assoc: 6 th ed, 09, Chap 3. Senior considered passé, especially by today s 78 M Boomers. Elder: Native American term of respect

9 ACCENTUATE the POSITIVE! Successful Aging Active Aging Productive Aging Healthy Aging The Changing Face of Aging Functionality Functional Fitness Physical Fitness Fitness Physical Activity Age-friendly Environments HEALTH PROMOTION DISEASE PREVENTION Forget the word EXERCISE

10 DON T Say: You re not getting older, you re getting better! DO Say: You re getting older & better!

11 Demographics of Aging: Dramatic Changes People age 65 + in the US 2010: 40 million = 13% = 1:8 2030: 72 million = 20% = 1:5 doubled compared to Yr 2000 Relatively few (1.3 M, ~3%) of 65+ in nursing homes Percentages increase dramatically w/ age: 1.1%, yr; 3.5%, yr; 13.2%, s & 1980s: >21%, 85+ Older Americans 2012 Key Indicators of Well Being,

12 2011 MetLife Market Survey: Annual Rates Nursing Homes (n=2,003) Assisted Living Communities (1,492) Home Care (1,644) Adult Day Services (1,341) Semi- Private Private Home Health Aide Homemaker $78,110 $87,235 $41,724 $21,840 $19,760 $18,200 NH residents: Median resident age: 66% women 82.7 yr

13 Health Status: Older Americans Older Americans enjoy longer lives & better physical function than did previous generations For some, rising obesity & an increased burden in housing costs may compromise these gains. Obesity--major cause of preventable disease & premature death 2010: 38% of those 65+ (vs. 22%, 1994) 2010: 44% of those 65-74; 29%, 75+. High housing cost burden: 40% of those 65+ Spending >30% of income on housing Older Americans 2012 Key Indicators of Well Being,

14 Life Expectancy: Older Americans Have increased at both ages 65 & 85 At 65: can expect to live 19.2 more yr At 85: 7 yr for women; 5.9 yr for men Varies by race; difference decreases with age At birth: 4.3 yr higher White vs. Black At age 65: 1.3 yr higher White vs. Black At age 85: Black 6.8 vs. White 6.6 yr Lower than many industrialized nations: eg, Japan: women 65 live 3.7 yr longer than US women; men, 1.3 yr Older Americans 2012 Key Indicators of Well Being,

15 INDICATOR 20 Functional Limitations

16 INDICATOR 25 Obesity

17 INDICATOR 16 Chronic Health Conditions

18 Nutrition Prevention Spectrum in Aging Nutrition Definition Goals Activities Primary Prevention Secondary Prevention Tertiary Prevention Health Promotion Risk Reduction Treatment / Therapy Prevent disease & Lessen health risks by Treat or remediate disability by reducing screening & early those with diagnosed or eliminating treatment before health conditions potential risk factors observable symptoms Enhance/maintain wellness through behavioral or environmental changes Generalized education or facilitation of healthful diets Maintain/improve nutritional status &/or avoid illness among those susceptible due to genetics, lifestyle, age, etc Anticipatory screening, detection, early intervention Prevent/delay disease progression, disability, pain, premature death Individualized nutrition T X for acute conditions & chronic diseases

19 INDICATOR 23 Diet Quality

20 Inter-related Factors Affecting the Nutritional Well-Being of Older Adults Family Money Medical Problems Exercise & Recreation Crime/ Abuse Friends Diet Modifications Neighborhood Transportation Nutritional Well-Being Shopping Skills Medications Mental Disorders, Dementia Dental Chewing/ Swallowing Skills Cooking Skills Religion Housing Fig 2 Physiological Changes

21 Impacts of Food & Nutrition on Health AGE-RELATED CONDITIONS / DISEASES Hearing Loss; Macular Degeneration; Destructive Joint Disease: knees and hips; Loss of Muscle Mass: Sarcopenia; Cognition / Mental Health POOR DIETS CHRONIC DISEASES Heart Disease; Hypertension; Diabetes; Osteoporosis; Some Cancers: colon and breast; Arthritis; COPD; Renal Disease ACUTE CONDITIONS Dehydration; Pressure Ulcers; Infections; Pneumonia; Influenza; Fractures; Tooth Abscesses; Gum Disease Without Adequate Healthy, Safe Food & Nutrition Services: Deafness; Blindness; Reduced Smell &Taste; Chewing & Swallowing Problems; Joint Destruction--Costly Replacements; Confusion, Forgetfulness, Memory Loss; Uncontrolled High Blood Pressure--Heart Attack, Stroke; Uncontrolled Diabetes--Amputations, Blindness, Nerve Disorders, Dialysis; Osteoporosis-- Weakened Bones, Decreased Mobility and Falls; Decreased Immune Response--Flu, Colds, Upper Respiratory Infections, HIV/AIDS; Decreased Organ Function & Organ Failure; Wasting-- Dwindles or Failure to Thrive ; Involuntary Weight Loss: fl Body Mass Index, fl Muscle Mass; Excessive Weight Gain--Obesity; fl Serum Albumin--Protein Malnutrition; Pressure Ulcers Slower Recovery Longer Hospital Stays Hospital Re-Admission Premature NH Admission Increased Morbidity & Mortality Poor Appetite Depression Anxiety Sleep Disturbance Reduced Quality of Life Lessened Independence Increased Healthcare Costs Low Stamina

22 IMPACT OF MALNUTRITION ON FUNCTIONALITY Underweight MALNUTRITION Limits Muscle Strength Reduces Stamina Prevents Physical Activity Obesity Decreases ability to: Perform ADLs & IADLs: Eat, Walk, Grocery Shop, Prepare Meals Grip Items & Lift Heavy Objects Increases Dependency Increases Need for Caregiver Assistance Increases Risk for Falls & Fractures *Threatens Independence *Reduces Quality of Life * Increases Healthcare Costs 23

23 Federally Funded Community Food & Nutrition Programs USDA SNAP (Food Stamps) SNAP-Education Commodity Supplemental Food Program The Emergency Food Assistance Program TEFAP Senior Farmers Market Nutrition Program Child & Adult Care Food Program US DHHS Older Americans Act Nutrition Program ( meals-on-wheels ) including Nutrition Services Incentive Program (NSIP) Eldercare Locator: Connecting you to Community Services NET/Public/Index.aspx Medicare & Medicaid

24 Supplemental Food Assistance Program: SNAP America s National Nutrition Safety Net alleviates hunger & improves nutrition by increasing food purchasing power of low-income households, enabling them to obtain a more nutritious diet by preparing food at home. Households receive monthly benefit allotments as electronic debit cards (also known as EBT, or electronic benefit transfer) Operated by state & local welfare offices; Federal Gov t oversees States operations Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program

25 SNAP Profile 2012 Serves 1:7 Americans; 46 M people/month $134/person in 21 M households Monthly gross income <130% Federal poverty guidelines ($2,422, family of 4; FY 2012) Monthly net income <100% poverty guidelines; assets <$2,000. Households with age 60+ & disabled members: exempt from gross income limit; assets <$3,250. Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program

26 SNAP & Those Age 60+ Lowest participation rate: 8% 73% of whom live alone 34% of eligible receive benefits Stay in the program longer 4% deducted allowable medical expenses ~16% of all households include 60+ member; ~20%, disabled member Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program

27 SNAP & Those Age 60+ Major non-participation reason: perceived LOW BENEFITS OAA Nutrition Program (group & home delivered meals) appear to substitute for SNAP benefits rather than complement them. SNAP-Ed: Putting Healthy Food Within Reach $375M; all states Guidance at Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program

28 COMMODITY SUPPLEMENTAL FOOD PROGRAM Supplement diets & improve health of low-income pregnant & breastfeeding women other new mothers <1 yr postpartum Infants & children up to age 6 those age 60+ Low income = <130% poverty for OA; <185% others 1 OA = $14,521/yr; 1 W/I/C = $20, States & 2 tribal organizations $176M FY

29 COMMODITY SUPPLEMENTAL FOOD PROGRAM Monthly average: >518,000 people (FY 2010) > 497,000 people 65+ = 96% > 21,000 women, infants, children Commodities in food packages Infant formula & cereal, nonfat dry & ultra hi temp fluid milk, juice, farina, oats, ready-to-eat cereal, rice, pasta, peanut butter, dry beans, canned meat/poultry/fish, canned fruits, vegetables Quantities often impractical for 1-2 person households

30 THE EMERGENCY FOOD ASSISTANCE PROGRAM: TEFAP Low-income, homeless, needy & older persons; states set criteria ~4M households annually $260 M for food + surplus commodities Commodity foods to local agencies via states Food banks, soup kitchens, pantries, OAA Nutr Prog ~80 products: canned fruit, veggies, juice, dried egg mix, meat/poultry/fish, dried beans, pasta, milk, rice/grits/cereal, soup

31 SENIOR FARMERS MARKET NUTRITION PROGRAM 60+, Low income (<185% poverty) $21 M, FY 12; 43 states & 8 tribal organizations 863,100 people received coupons, FY ,070 farmers at 4,600 farmers markets, 3,450 roadside stands, 14 community supported agriculture programs Benefits: $20-50(max)/yr; $2-4/mo average Fresh fruits, vegetables, herbs, honey Programs provide nutrition education: variable

32 CHILD & ADULT CARE FOOD PROGRAM: CACFP Low income children; functionally impaired adults & 60+ Daily, 3.2 M children & 112,000 adults in nonresidential day centers; also resident children in emergency shelters & youths in eligible afterschool care programs 1-2 nutritious meals & 1-2 snacks daily (3 total) Provides cash &/or commodity foods; reimbursement tiers as in free/reduced/full school meals Federal regulations recently updated; State administered; limited data available on OA Plans to provide more training/technical assistance

33 Older Americans Act (OAA) Persons age 60+ (Native Americans, 50+) NO income requirements -- Forbids Means-Testing Means-testing: determination of eligibility for services based on a specific level of income PURPOSE: Reduce hunger & food insecurity Promote socialization Promote health & well-being; delay adverse health conditions thru access to nutrition & other disease prevention & health promotion services Helps maintain independence; aging in place

34 Older Americans Act AGING NETWORK 56 State Units on Aging: SUAs 629 Area Agencies on Aging: AAAs local service providers 256 Tribes & Native Hawaiian Organizations Infrastructure Gap: Nutrition Expertise RD Staff: 2 nat l, 1 regional, ~50% in SUAs Eldercare Locator: Connecting you to Community Services

35 Older Americans Act NUTRITION PROGRAM Congregate Nutrition Services (IIIC-1) 5 (or more) days a week Congregate setting, including adult day centers Nutrition screening, assessment, education & counseling to older adults, including caregivers Home-Delivered Nutrition Services - Homebound (IIIC-2) 60+ homebound, spouses, disabled in same household Hot, cold, frozen, dried, canned or supplemental meals Nutrition screening, assessment, education & counseling to older adults, including caregivers

36 Older Americans Act NUTRITION PROGRAM NUTRITION SERVICES M Home-Delivered Meals = 60% 868,100 older individuals ~168 meals/yr 96.4 M Congregate Meals = 40% 1.7 M in a variety of community settings ~56 meals/yr Serves <5% of older Americans an average ~3 meals/wk

37 Profile of Participants Poorer, older, sicker, frailer, more likely to live alone, be members of minority groups, live in rural areas. 70% HD, 55% C: age % HD, 39% C: live alone 39% HD, 26% C: in poverty BMIs; 2/3s more likely to be abnormal Homebound more likely underweight Those able to leave the home more likely overweight or obese. Reaches the most vulnerable -- those most in need of services to remain independent & at home

38 Profile of Participants ~60% say: 1 program meal = >50% daily food intake ~50% at high nutritional risk ~84% need assistance with >1 IADLs (shopping, housework, mobility) Homebound especially frail 1:3 qualify as NH appropriate needing assistance w/ 3 ADLS (bathing, dressing, eating, toileting) 92% say meals allow them to remain at home ~1:3 Congregate & >1:3 HD in POVERTY; YET only 8% C & 19% HD in SNAP

39 OA NUTRITION PROGRAM & WIC Comparison Older Americans Act Nutrition Program Serves <5% of Older Adults $ 125 M 1975 $ 816 M fold increase WIC: Special Supplemental Nutrition Program for Women, Infants & Children Serves ~53% of all infants born in the US $ 20.6 M 1974 $ 7.1 B fold increase

40 Barriers to Program Participation Non-participation in federal community programs Lack of awareness of community programs Reluctance to accept food assistance; stigma of public assistance, esp. SNAP Inadequate funding of service programs Lack of transportation Same reasons: 1971 White House Conference on Aging Nutrition Background Paper Eldercare Locator: Connecting you to Community Services

41 Parallel Systems Influence Service Provision to Older Adults Older Americans Act Service System Home & Community Based Service System Public Health System Health Care System Food Assistance Programs Funded by USDA Private Pay Systems Private Industry State Units on Aging, Area Agencies on Aging, Local Nutrition Service Providers Part of a comprehensive & coordinated home & community based service system Medicaid Waiver Programs, Managed Care Organizations State/county funded systems & services State/county/city health departments Chronic disease self management programs, BRFSS Food safety & sanitation Direct Health Care system, physicians, hospitals, nursing homes, rehabilitation centers Transition care, Medical Nutrition Therapy SNAP, SNAP-ED, TEFAP, CSFP, CACFP, SFMNP Food stamps, food banks/pantries, soup kitchens, community gardens Fee for Service based on fair market value Insurance companies, managed care companies Private case management Restaurants, carryout, fast food, healthy fast food Frozen /other packaged meals, grocery stores, home delivery by post

42 Functionality Care Transitions Health Food insecure older adults have impairment/health issues as if they are 14 yrs older than their actual age Rate of readmission: Well-nourished: 11% Malnourished: 25% Majority of patients in health care facilities are at-risk of or are already malnourished Administration for Community Living ::: Administration on Aging

43 "For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives." USDHHS Secretary Kathleen Sebelius, 4/2012 US Administration for Community Living (ACL) includes the Administration on Aging 27 M Americans will need long-term services & supports (LTSS) by 2050

44 Care Transition Themes: Their Relation to the Older Americans Act Interdisciplinary Teams & Service Coordination Coordination of services (medical/ human services) Workforce development & training Planning Partnerships Coordination of benefits Enhanced Follow-Up Case Management/ Care Coordination In-home services Home-delivered meals Transportation Monitoring/assistive devices Medication management Disease prevention & health promotion Patient/Client Activation Assessments Self-directed care/coaching Health/nutrition education Insurance counseling Family caregiver support, counseling, training

45 A Multi-System Problem: Example Never the Twain Shall Meet: Dual Systems Exacerbate Malnutrition in Older Adults Recently Discharged from Hospitals Locher & Wellman. J Nutr Geron Geriatr 2011;30:124 2 parallel but non-intersecting systems providing services to frail older adults; Coordination is sorely needed! Affordable Health Care Act places an undeniably robust emphasis on community care given its mandate to cut costs.

46 Disconnect between Hospital & Home Hospital-based Health Care System Hospital Discharge Planners: community nutrition services not readily available RDs: not involved in discharge planning; low awareness of community nutrition programs Community-based Social Service System Social Service Providers: low awareness of nutrition s importance to health, independence, recovery, re-admissions, LOS, aging in place RDs: too few within the Aging Network Referrals to community nutrition programs, esp. OAA NUTRITION PROGRAM, in TRANSITION CARE is essential for at-risk older adults.

47 Care Transition: Problems Ahead Starting next month, Medicare will prod hospitals to improve practices. Hospitals with high readmissions for 3 conditions (heart attack, pneumonia, heart failure) will be paid less than hospitals with fewer preventable readmissions. *Transition from one care source to another: moment with high risk for communications failures, procedural errors & unimplemented plans. *People with chronic conditions, organ system failure & frailty: at highest risk because their care is more complicated & they are less resilient when failures occur. *Strong evidence: possible to significantly reduce hospital readmissions caused by flawed transitions. *A Morgan, 8/24/12; Administration for Community Living

48 Home & Community Based Services & Hospital Readmissions Evaluation of the home food environment of hospitaldischarged older adults: 1:3 unable to both shop & prepare meals. Anyanqu, Sharkey, Jackson. Home food environment of older adults transitioning from hospital to home. J Nutr Gerontology Geriatrics 2011;30:105. Lower risk of hospital admissions with greater volume of attendant care, homemaking services & home-delivered meals. Xu et al. Volume of home- and community-based Medicaid waiver services and risk of hospital admissions. J Am Geriatric Soc 2010;58(1):109. Those post-discharge with unmet needs for ADL: particularly vulnerable to readmission. Hospital readmission among older adults who return home with unmet need for ADL disability. Depalma, Xu et al. Gerontologist Aug 2. [Epub ahead of print]

49 Safe Effective Transition Care Requirements* Patient & caregiver involvement Person-centered care plans shared across care settings Standardized & accurate communication & information exchange between transferring & receiving providers Medication reconciliation & safe medication practices Sending provider maintains responsibility for the patient s care until the receiving clinician/location confirms the transfer & assumes responsibility. *A Morgan, 8/24/12; US Administration for Community Living

50 Nutrition isn t considered important for healthier aging be it food security, food safety, public health, health care, hospital discharge planning, transition care, LTSS/LTC, Medicare, Medicaid, NH, ALFs, Board & Care homes. Lip service only re importance of nutrition for healthier aging Non-scientists & social service persons don t think the evidence is there &/or find the science too complicated. OR Food/nutrition is too simple attitudinal challenge for many, including MDs & PhDs. Health care & social science is embracing physical activity better & faster.

51 Affordable Care Act: State Led Academy of Nutrition & Dietetics Step-by-Step Guide to include nutrition services by building connections with state officials & being involved in state demonstration projects what are you & your state doing? Policy Initiatives & Advocacy Committees/Task Forces: State Regulatory Specialists, State Policy Reps, Public Policy Coordinators, Reimbursement Reps Medicare & Medicaid now emphasize prevention Incentivizing hospitals to make appropriate referrals by linking reimbursement to preventable adverse events following discharge, eg, re-admissions, etc. what are you & your hospital doing?

52 What is/are Long Term Services & Supports: LTSS & LTC? Services & supports needed when one s ability to care for self is fl by chronic illness, disability or frailty. Usually provided by: Family & friends at home: Caregivers Home & community based services: Home health care, personal care, adult day services, OAA service providers Institutions (NH) or residential care facilities

53 Home & Community Nutrition Issues Examine disconnects: social service, health care, public health, food safety & food security systems given major shift to Home/Community Based Services & Transition Care. Examine inclusion/non-inclusion of food & nutrition services in most home & community programs. Probe low nutrition capacity (staff, infrastructure, etc) & lack of uniformity in OAA Nutrition Program. Give greater attention to older persons (in more discrete categories) in all program evaluations.

54 Home & Community Nutrition Issues Document food & nutrition intervention outcomes in home/community services; define research terms (evidence based, weight of evidence, etc) Examine workforce s understanding of how adequate food & nutrition affect ability to remain healthier & independent at home with a good Quality of Life. Raise general awareness of healthier aging via nutrition, food security, prevention, independence, QoL, functionality & disease management to promote self-help & improve consumer directed choices.

55 Roles for Dietitians Participate in Service provision in HCBC & transition care Documenting cost effectiveness & efficiency Providing technical assistance & training Developing & implementing evidence based nutrition education Educate Physicians, Discharge Planners, Case Managers, RNs, Administrators, Social Workers Older Adults & Caregivers Advocate for Inclusion of food & nutrition services in transition care & HCBS Establishment of screening & referral systems in HCBS Adequate & sustained funding for meals & nutrition services Comprehensive & coordinated community based nutrition services in transition care Comprehensive nutrition services in Medicare & Medicaid via the Affordable Care Act Position: Food & Nutrition Programs for Community Residing Older Adults

56 Opportunities/Challenges for Home & Community Based Services State programs vary: Get involved! Service system, structure Parallel system collaborations Funding Resources Capacity Expertise Food & nutrition services are limited: Get involved! May not be perceived as essential Dietitians may not be valued

57 Affordable Care Act / Health Care Reform Rules & Programs Step-by-Step Guide for Success Resources Sample Affiliate (State Dietetic Association) Plan of Action Make a difference for RDs in your state! Make a difference for public health in your state!

58 Opportunity Today RDs have a unique opportunity to make a difference in the lives of the growing number of older adults & the quality of programs & systems being developed for transition care & in the Affordable Care Act.

59 POSITION PAPERS Food & Nutrition for Older Adults: Promoting Health & Wellness. J Acad Nutr Diet 2012;112: Food & Nutrition Programs for Community-Residing Older Adults. J Am Diet Assoc 2010;110:46. Individualized Nutrition Approaches for Older Adults in Health Care Communities. J Am Diet Assoc 2010;110:

60 Online Resources AGING STATISTICS Profile of Older Americans annual ex.aspx Older Americans 2012 Key Indicators of Well Being efault.aspx Aging Integrated Database (AGID) Program Results & Evaluation ex.aspx

61 Online Resources Nutrition Services (OAA Title IIIC) TC/Nutrition_Services/index.aspx#funding Home & Community Based Long Term Care TC/index.aspx Aging & Disability Resource Centers Centers for Medicare & Medicaid:

62 Affordable Care Act Resources AoA s Health Reform website eform.aspx USDHHS health care reform website Affordable Care Act text & related information /home/le gislativedata.php?n=bss;c=111

63 Care Transitions Resources Partnership for Patients ml Community-based Care Transitions Program mid=cms AoA s Aging & Disability Resource Centers & care transitions Care Transitions Quality Improvement Organization Support Ctr Innovative Communities Report: Long-Term Quality Alliance content/themes/ltqamain/custom/images//innovative- Communities-Report-Final pdf

64 Questions?

65 Nutri-Bites Summary Live Long and Prosper: Optimal Nutrition for Today s Aging Realities This webinar covered: The beneficial effects of nutrition in health promotion, risk reduction and disease management of older Americans Federal and community food and nutrition programs available for older adults Access issues and opportunities to promote healthful aging and optimal nutrition status Strategies food and nutrition professionals can apply to integrate food and nutrition programs and services into home and community settings Approaches to help older adults meet their nutrition needs following hospital discharge

66 Nutri-Bites Webinar details } For CPE information: astachnik@rippelifestyle.com } Continuing Education Credit certificates will be ed as a PDF within 14 days. } Today s webinar will be available to download as a PDF within 2 days at: } A slide summary PowerPoint of this presentation will be available to download within 2 days at:

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