Advocating for Policies to Promote Good Nutrition for Equitable Healthy Aging

By 2040, the United States will be home to more than 80.8 million people ages 65 and older. This demographic shift is already underway, with states like Maine, Florida, West Virginia and Vermont having the highest percentages of elders. As we embrace the reality of an aging population, it becomes increasingly urgent to secure the future of healthy aging, and this begins with proper nutrition.

As a professor and the Didactic Program in Dietetics Coordinator at Virginia State University, a Historically Black land grant university and HBCU founded in 1882, I'm deeply committed to advocating for policies that promote good nutrition, especially among minority older adults. Recently, I participated in a webinar with the National Organization of Black Elected Leaders (NOBEL) Women where I addressed the importance of this issue and discussed specific policy actions. NOBEL Women has already passed a Malnutrition Resolution. This post outlines what is needed next.

The Importance of Healthy Aging

The health and well-being of older individuals is crucial for their continued contributions to society. In the United States, this goal is recognized in the Healthy People 2030 national health goals, which include “reducing health problems and improving the quality of life for older adults.” However, issues related to chewing and swallowing difficulties, poor diet and malnutrition often go unnoticed, yet are potent contributors to frailty, functional impairments and a diminished quality of life, especially among the oldest old.

Furthermore, age-related changes in diet and nutrition status can exacerbate chronic diseases to significantly impact quality of life. Most older adults have more than one chronic condition, and older adults of color, including Native American and Black populations, tend to have higher rates of specific nutrition-related chronic diseases such as diabetes and heart disease.

From 2018 to 2022, malnutrition-related deaths have more than doubled in the U.S.

Addressing these nutrition-related challenges is not just about individual health. Limiting chronic diseases and maintaining functionality also have significant impacts on reducing healthcare costs and enhancing overall quality of life. As we continue in the Decade of Healthy Aging, many countries around the world are focusing on healthy aging as a national priority, and the United States should follow suit.

The Alarming Rise in Malnutrition

One of the most concerning trends in recent years is the increase in malnutrition among older adults. In the United States alone, malnutrition-related deaths have more than doubled, from about 9,300 deaths in 2018 to roughly 20,500 in 2022, according to the U.S. Centers for Disease Control and Prevention. Experts suggest that some of this increase may be due to the overall aging of the population.

Additional social determinants of health increase older adults’ risk of malnutrition. Non-Hispanic Black patients are more likely to be at risk for malnutrition and have the highest rate of malnutrition-related hospitalizations and diagnosis of malnutrition among all ethnicities. These disparities among higher-risk groups could be addressed by tailored interventions because with effective screening, assessment, diagnosis, and intervention, malnutrition can be more quickly identified and addressed. There also are specific policy actions that should be implemented, shown below.

Policy Solutions for Promoting Good Nutrition

  1. Increase Dietetics and Nutrition Workforce Diversity: Only 3% of U.S. Registered Dietitian Nutritionists and 7% of dietetic students are Black, yet Blacks make up 13.6% of the U.S. population. We need to ensure that the healthcare workforce of the future reflects the lived experiences and cultures of the populations they serve. Building a more diverse workforce in nutrition and dietetics includes increased and adequate funding for nutrition and dietetics programs, particularly those in historically black colleges and universities (HBCUs), like Virginia State University.

  2. Expand Access to USDA Nutrition Assistance Programs: These programs help provide access to nutritious foods for income-eligible households. About 1 in 5 (19%) African Americans ages 60 and older live below the poverty line, compared with 1 in 10 (10%) of all such older adults, and the Supplemental Nutrition Assistance Program (SNAP) lifts more than 300,000 black older adults out of poverty or deep poverty every year. Yet many barriers prevent even more eligible older adults from enrolling in SNAP. Continuing pandemic-SNAP flexibilities, streamlining SNAP applications, and simplifying the SNAP application process for older adults could all help to expand access.

    The Senior Hunger Prevention Act of 2023 aims to make changes federally that increase minimum benefits, simplify application and certification processes, support outreach enrollment efforts, and expand SNAP food delivery options. States also can make similar changes to streamline state program enrollment and provide education about SNAP benefits and other available programs. Older adults often are not aware of additional USDA programs for which they may be eligible, such as the Senior Farmer's Market Nutrition Program (SFMNP) that provides access to fresh produce, the Child and Adult Care Food Program that offers meals at adult day care centers, and the Commodity Supplemental Food Program (CSFP), which supplements the diets of low-income older adults with USDA foods.
  3. Elevate Other Policy Actions: These include incorporating nutrition education into healthcare professionals’ training, increasing representation of older adults and people of color in nutrition research, expanding Medicare coverage for Medical Nutrition Therapy (MNT), and tailoring the Dietary Guidelines for Americans for older adults. Promoting hospital uptake of the recent CMS Global Malnutrition Composite Score will improve malnutrition care and patient health outcomes in hospitals, as will including malnutrition in State Hospital Quality of Care Regulations. State regulations play a crucial role in shaping the quality of care, including nutrition. Yet only a few states, such as Colorado and Nevada, have mentioned malnutrition in their state hospital regulations, serving as templates for others. Finally, more than half of states are developing a Multisector Plan for Aging to ensure healthy aging throughout the lifespan. Including equity considerations and nutrition would go a long way toward ensuring healthy aging for all.

‘SNAP lifts more than 300,000 black older adults out of poverty or deep poverty every year.’

Our nation faces a pressing need for policies that prioritize the nutrition well-being of minority older adults. The alarming rise in malnutrition rates among these communities underscores the urgency of tailored interventions and equitable access to nutrition programs. By advocating for increased workforce diversity, expanded access to nutrition assistance programs, and other comprehensive policy actions, we can ensure that every older adult, regardless of their race and ethnicity, enjoys a healthy and dignified aging experience. It is our collective responsibility to promote health equity and a brighter future for all as we confront the challenges of an aging population.

Patricia A. Lynch, PhD, RD, LDN, is associate professor and Didactic Program in Dietetics Program coordinator in the Department of Family and Consumer Sciences at the Virginia State University College of Agriculture.

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