What Drove Program Participants to Initially Attend Congregate Meals? Socialization, Health, and Other Reasons

Abstract

The Congregate Nutrition Services support efforts to keep older Americans independent and engaged in their communities. We examined participants’ self-reported reasons for initially attending the congregate meals program and whether reasons differed by participant characteristics. Descriptive statistics and tests of differences were used to compare participants (n = 1,072). Individuals attended congregate meals for several reasons, with the top two being socialization (36.3%) and age- or health-related reasons (18.7%). Those attending for socialization were less likely to be lower income, have food insecurity, or live with 3+ ADL limitations while participants who first attended due to age or health-related reasons were more likely to be low income, food insecure, and from historically marginalized populations. Health and social service professionals and community organizations could expand data collection on older adults in their communities and partner with congregate meal providers to encourage participation for individuals with unmet nutritional, health, and socialization needs.

Keywords:

• Aging-in-community
• aging in place
• Community engagement
• congregate nutrition
• nutrition services program
• older adults
• Older Americans Act
• socialization

Introduction

The majority of older adults prefer to remain in their homes as they age, allowing them to retain their independence and social ties to the community.^1,2 However, for some older adults, additional help is needed to maintain their physical, mental, and emotional health and well-being as they navigate through life-changing events, such as limitations in mobility and the loss of family and friends. Maintaining independence and connection with others through Area Agencies on Aging (AAAs) and local service providers is the goal of the Older Americans Act (OAA), and more specifically the OAA Nutrition Program.¹ This study examines the importance of community-based congregate meal programs offered via the OAA Nutrition Program and how initial participation at congregate meal sites varies among older adults.

The OAA Nutrition Program is a federally authorized, national program which targets adults aged 60 and older (referred to as older adults) who have the greatest social and economic need. The purpose of the program is to reduce hunger, food insecurity, and malnutrition; enhance socialization; and promote health and well-being.³ Numerous professional consensus papers, research studies, and program evaluations have demonstrated the successful impact of the OAA nutrition program in these areas, reinforcing the importance of meeting the nutritional, overall health, and socialization needs of the older adult population to address wider societal physical and mental health goals.^4–7 One important component of the OAA Nutrition Program is Congregate Nutrition Services, which provide meals in congregate settings such as senior centers, faith-based organizations, senior housing facilities, and other community locations.⁸

Demographic, health, and socioeconomic differences among congregate meal participants and the general population of individuals aged 60 and older suggest that some subgroups are more likely than others to participate in congregate nutrition programs. For example, older adults who attend congregate meals are often in poor health, have one or more chronic conditions, and take three or more prescription medications.^9–11 Older adults are also more likely to attend congregate meals when they have physical needs, mobility limitations, or difficulty with activities of daily living.^12,13 One study found that 41 percent of congregate meal participants report six or more chronic conditions.¹⁴ In addition, 51 percent of congregate meal participants live alone, compared to 25 percent nationally, and 57 percent are age 75 or older, compared to 7 percent nationally.^15–17 Conversely, older adults who are members of historically marginalized racial and ethnic groups appear less likely to attend congregate meal programs (35% compared to 40% of adults 60 and older nationally), although participation also could vary by region.^16–18

Congregate meal programs support the health of older adults by reducing the incidence of food insecurity, hunger, and malnutrition; increasing socialization opportunities; and improving overall quality of life.^10,19–22 Once participants begin to attend congregate meals, the majority stay for at least a 12-month period.⁹ Compared to nonparticipants, congregate meal participants, particularly those who are low-income, are more likely to remain living in their homes and are less likely to be admitted to a nursing facility.⁶ Furthermore, congregate meal participants who live alone are less likely than nonparticipants to have a hospital admission or emergency department visit that led to a hospital admission.⁶ Older adults attending congregate meals benefit from the healthy foods, classes, and resources available at the meals site;¹⁶ yet congregate meal site attendance has been on the decline. For several years, attendance at congregate meal sites steadily dropped until it stabilized between 2014 and 2019 at 1.5 million persons.^23,24

Despite benefits of program attendance, to our knowledge, existing studies have not used national congregate meal program data to explore why program participants first came to the program and what led them to seek services. Existing literature on the topic of congregate meal participation has focused on who attends the program, why the program was selected over other food security programs, and the length of, motivations for, or barriers to participation.^25,26 These studies are often based on data collected from specific states or sites (e.g., the state of Ohio or senior centers) or through interviews or focus groups. In some studies, information was collected about motivations for future program attendance from a sample of individuals who do not attend or qualify for the congregate meal program.^25,26 This study addresses a gap in the literature by using national data collected among active congregate meal attendees to explore reasons participants initially sought the service and compares characteristics of those reporting different reasons for initially attending to provide additional insight into these groups. Findings can inform methods to support more older adults to utilize congregate meal programs and other services that enhance their independence and provide opportunities for engagement in their communities.

Materials and method

Data source

This study was a cross-sectional analysis of data from the Administration on Aging’s publicly available 2019 National Survey of Older Americans Act Participants (NSOAAP). The NSOAAP is funded by Title III of the OAA, and the survey was conducted by the Administration for Community Living (ACL), U.S. Department of Health and Human Services. The NSOAAP uses a two-stage sample design that selects approximately 350 AAAs out of 622 AAAs throughout the country to participate. Following AAA selection, ACL conducted telephone surveys with a random sample of their clients who were age 60 and older and used one of six services funded by the OAA (i.e., home-delivered meals, congregate meals, assisted transportation, case management, homemaker, and caregiver support). The resultant data from the ACL studies are publicly available via ACL’s AGID database.²

For this study, the authors accessed the NSOAAP data files that included older adults who reported they attended a congregate meal site at least twice in the past year (n = 1,072). More details about the NSOAAP sample selection, survey design, and specific interview questions are available on ACL’s website.³ The survey collected information on congregate meal attendees’ demographic information (e.g., race, age, sex) and information to learn more about the attendees and the quality and effectiveness of the congregate meal program. The data included survey weights to obtain better estimates for the total population that attends AAA congregate meal sites.

Study variables

Our study focused on the responses to the following NSOAAP survey question: We are interested in why you initially sought services from [Name of Agency]. What was going on in your life that led you to seek services? The closed-ended response options for this question included: Illness; Illness of a person close to you; Death of a spouse; Problems with mobility; Could no longer take care of myself; Could no longer take care of my home; as well as one open-ended option: other (specify). If the participant selected the “other (specify)” option, they had the opportunity to give an open-ended response. For this study, two independent coders reviewed and categorized all of these open-ended responses to create themes for analysis, combining responses with the existing closed-ended survey answer choices as appropriate. We categorized responses into six categories to identify the main reasons congregate meal participants started attending the program.

To understand variation in responses to the above-described question about what triggered congregate meal participation, we explored a variety of personal characteristic variables from the NSOAAP files. We included responses to specific questions about participant characteristics, socioeconomic status, and health. For individual participant characteristics, we included the NSOAAP variables for age, categorized as younger-, middle-, older middle- and oldest older adults as follows: 60–64, 65–74, 75–84, and 85 or older; sex; marital status; and education. In the survey, marital status had six response options, which we classified into three groups for the purposes of our analysis: married/living with a partner, widowed, and divorced/separated/never married. For education, we grouped participants into two categories: less than a high school degree and a high school degree or higher.

For socioeconomic status, we included variables that could help us understand OAA target populations, which are at-risk populations defined as older adults with the “greatest economic need” and “greatest social need.”⁸ These include older adults who identify as members of historically marginalized racial or ethnic groups, older adults in rural communities, older adults with limited English proficiency, older adults at risk for institutional care, and low-income older adults. The NSOAAP survey presents income level as a binomial variable, with respondents indicating an annual income level above or below $20,000. Accordingly, for this study individuals with an annual income of less than $20,000 per year are described as low-income. Other key variables included individuals who were experiencing food insecurity (binominal: ever cut or skip meals because there is not enough money for food/has not cut or skip meals), were living alone, or were participating in Supplemental Nutrition Assistance Program (SNAP) or receiving Medicaid benefits.

To explore participant health, we examined activities of daily living (ADL) limitations and health conditions. Participants were asked if they had difficulty with each of the following six ADLs: bed/chair transfer, bathing, dressing, walking, eating (feeding self), and toileting. We categorized the number of ADL limitations into three groups: no ADL limitations, difficulty with one or two activities, or difficulty with three or more activities. For health conditions, participants were asked whether they had any of 15 total health conditions (e.g., diabetes, cancer, dementia) and for this analysis, we created a categorical variable with four groups: none or one condition, two or three conditions, four or five conditions, and six or more conditions. We also included a self-rated health variable that was based on the NSOAAP question “In general, how is your health?” and collapsed responses from five categories into a binomial variable: fair/poor health or good/very good/excellent health.

Finally, we explored a few other characteristics that could affect participation in congregate meal program participation, including veteran status and loneliness. We used the UCLA loneliness scale (which was included in the survey) to determine if the participant was feeling lonely.²⁷

Statistical analysis

We examined whether there were distinct differences in the reasons OAA participants reported for first attending congregate meal programs. We conducted a descriptive analysis of the demographic, socioeconomic, and health characteristics and statistically compared the characteristics of two groups based on their initial reason for attendance using weighted t-tests and chi-squared tests (i.e., those first attending for one reason, such as socialization, and all those first attending for other reasons). We used sample survey weights that were intended to obtain better estimates for the total population that attends AAA congregate meal sites. We conducted our analyses using STATA version 17.0.

Results

Sample description

Weighted sample characteristics are presented in Table 1. Most congregate meal participants were aged 65 to 84 (73.2%), and almost 20 percent were over 85 years of age. Most study participants were white (77.2%), about 12 percent were Black or African American, and 8 percent also identified as Hispanic or Latino. Two-thirds of participants were female (66.6%). Most participants reported having a high school degree or higher education (86.9%). About 43 percent reported living alone, and slightly more than half of participants (57%) were not married or partnered.

Table 1. Characteristics of the 2019 National Survey of Older Americans Act Participants (NSOAAP) congregate meal program respondents.

Variables (%)	Total (n = 1,072)
Age
60–64 Years	7.5
65–74 Years	35.4
75–84 Years	37.8
85+ Years	19.3
Race
White only	77.2
Black/African American only	12.3
Other	10.5
Hispanic ethnicity	7.6
Female	66.6
Living alone	43.0
Marital status
Married/partnered	43.0
Widowed	34.2
Divorced, separated, or never married	22.7
Income less than $20,000	39.3
High school degree or higher	87.0
Urban	20.8
Rural	38.3
Food insecurity	10.8
SNAP	12.5
Medicaid	19.9
Self-reported fair/poor health	27.4
Activities of Daily Living (ADLs) limitations
No ADLs	62.4
1 or 2 ADLs	30.7
3+ ADLs	7.0
Total health conditions
None or 1 condition	6.5
2 or 3 Conditions	18.2
4 or 5 Conditions	31.9
6 Or more conditions	43.5
Lonely	19.1
Veteran	17.4

Note: All individual variables without subordinate categories in the table (e.g., Hispanic ethnicity, female, living along) are binomial variables with only the reference category shown.

Next, we examined socioeconomic characteristics. Approximately 39 percent of participants reported having an annual income below $20,000. Some congregate meal participants reported being food insecure (10.8%), having Medicaid coverage (19.9%), or participating in SNAP (12.5%). In terms of geographical distribution, 21 percent of participants lived in urban areas and 38 percent lived in rural areas.

The data indicated that overall health and functional status varied across participants. More than half of participants reported not having any ADL limitations (62.4%), while about 38 percent reported having at least one ADL limitation. Approximately 75 percent of participants indicated having four or more total health conditions, and 25 percent reported having none to three total health conditions. About 27 percent of participants self-reported that they were in fair or poor health. Additionally, 17.4 percent were veterans, and 19.1 percent indicated that they were lonely.

Reasons for attending

After coding the open-ended NSOAAP responses to the survey question, We are interested in why you initially sought services from [Name of Agency]. What was going on in your life that led you to seek services?, we identified six response categories. The reasons for attending the congregate meals program and the number of participants that gave each reason are presented in Figure 1. The top reason participants attended a congregate meal site for the first time was socialization. Over a third of participants (36.3%) gave this as their reason for initially attending the program. Examples of the open-ended responses related to socialization include the following:

Figure 1. Percent distribution of the reasons congregate meal participants reported they initially attended the program (N = 1,072).

• “After my husband passed away, I needed to be around others.”

• “Sometimes you don’t get to see anybody, [here at the meal site] you get to socialize with people.”

• “[I] wanted to be a part of the community and see friends.”

Another frequently mentioned reason for initially attending a congregate meal site included needing assistance because of an age- or health-related reason (18.7%). This response primarily revolved around participants indicating that getting food or preparing meals was difficult because of their age or health, or that age- or health-related needs were the main influencers in their decision to attend a congregate meal site. A few examples of the open-ended responses that were coded to age- or health-related needs follow:

• “[I’m] 80 years old and need a little help.”

• “[I’m] getting older, losing eyesight and balance.”

• “[I] could not stand enough to cook.”

The few other reason categories each account for under 15 percent of congregate meal participants: accompanying others or being referred (12.3%); becoming old enough to attend the program/the program being convenient to attend (8.3%, e.g., turned 60 years old, attends the meal site for other programs); a nonfinancial food reason (4.9%, e.g., enjoyed the food, meals were nutritious), and needing assistance for financial reasons (4.1%). Finally, 11 percent refused to answer the question, did not know, had no reason, or provided an open-ended response that was distinctly different from the other above-described categories.

We performed additional analyses examining statistical differences in reasons for attending the congregate meal program by race/ethnicity and food insecurity. Differences by racial and ethnic group (Table 2) indicate that white congregate meal participants (42%) were more likely than other groups to report that they initially attended the program for socialization. Older participants who identify as members of historically marginalized racial and ethnic groups were more likely to attend for an age- or health-related reason, with more than 28 percent of Black/African American participants, 33.8 percent of other or multiracial respondents, and over 46 percent of Hispanic older adults reporting this reason. Congregate meal participants with diverse racial and ethnic identities were less likely than white participants (11.9%) to report attending because they accompanied others or were referred, or because they now qualified/felt attendance was convenient (9.7%). There were no statistically significant differences between attending for a nonfinancial food reason or attending for a financial reason by race and ethnicity.

Table 2. Bivariate analysis of reasons for initially attending congregate meal programs, by race and Hispanic ethnicity (weighted).

	Race and Hispanic Ethnicity
Reasons (% within race/ethnicity)	White	Black or African American	Other or mixed race	Hispanic ethnicity	χ^2	p-Value
Socialization	42.0	29.4	28.0	21.3	2.76	0.045*
Age or health related reason	12.9	28.7	33.8	46.1	9.51	0.000***
Accompanied other or referred	11.9	7.4	4.1	6.0	2.77	0.041*
Qualified or convenient	9.7	5.1	2.6	1.3	4.31	0.012*
Nonfinancial food reason	3.9	3.6	7.9	0.0	1.30	0.274
Financial related reason	3.5	7.8	0.1	3.5	1.59	0.203

Notes: Applying NSOAAP dataset weights, n = 1,495,042. Reasons do not total 100.0 percent because no reason/other reason is not included in the table.

^* p<.05; ***p<.001.

Table 3 presents differences in the reasons given by self-reported food insecurity (i.e., reporting that they have ever cut or skipped meals because there was not enough money for food). Congregate meal participants experiencing food insecurity were more likely than food-secure participants to report they initially attended the program for an age- or health-related reason (35.5%). They were less likely to report they attended the program for socialization (22.5%) compared to those not experiencing food insecurity. There were no statistically significant differences between attending by accompanying others or being referred or attending for a nonfinancial food reason by self-reported food insecurity.

Table 3. Bivariate analysis of reasons for initially attending congregate meal programs, by food insecurity (weighted).

	Experiencing food insecurity
Reasons (% within food insecurity)	Yes	No	χ^2	p-Value
Socialization	22.5	40.2	9.24	0.002**
Age or health related reason	35.5	16.9	10.98	0.001***
Accompanied other or referred	7.1	10.6	1.20	0.274
Qualified or convenient	1.5	8.7	7.32	0.007**
Nonfinancial food reason	5.4	3.8	0.54	0.461
Financial related reason	8.9	3.1	6.27	0.012*

Notes: Applying NSOAAP dataset weights, n = 1,506,795. Reasons do not total 100.0 percent because no reason/other reason is not included in the table.

* p<.05; **p<.01; ***p<.001.

Characteristic differences of those attending for socialization

Table 4 presents the weighted results for statistical differences on several demographics, socioeconomic, and health characteristics among the congregate meal participants who gave socialization as their reason for first attending, compared to those who first attended for another reason. We found a relationship approaching significance between first attending for socialization and participant age groups. Specifically, results showed a greater percentage (44.6%) of participants 75–84 years old initially attended for socialization reasons compared to the other age groups (ages 60–64 (5.5%), ages 65–74 (30.7%), and age 85+ (19.1%)). A greater percentage (83.8%) of white non-Hispanic participants also first attended congregate meals for socialization reasons compared to Black/African American non-Hispanic participants (9.3%) and other race groups (6.9%).

Table 4. Distribution of the characteristics of congregate meal participants who attended for socialization reasons compared to all other reasons reported (weighted).

Variables (%)	Reported socialization	Reported another reason	p-Value
Age			0.058
60–64 Years	5.5	8.6
65–74 Years	30.7	38.3
75–84 Years	44.6	33.6
85+ Years	19.1	19.4
Race
White only	83.8	73.2	0.029*
Black/African American only	9.3	14.2
Other	6.9	12.7
Hispanic ethnicity	4.3	9.5	0.064
Female	68.5	65.5	0.499
Living alone	45.6	41.3	0.339
Marital status
Married/partnered	41.4	41.3	0.147
Widowed	39.9	30.7
Divorced, separated, or never married	18.7	25.2
Income less than $20,000	30.5	44.4	0.003**
High school degree or higher	91.3	84.4	0.009**
Urban	13.6	25.2	0.001**
Rural	41.1	36.6	0.320
Food insecurity	6.4	13.6	0.002**
SNAP	5.3	16.9	0.000***
Medicaid	11.0	25.4	0.000***
Self-reported fair/poor health	24.1	29.4	0.207
Activities of daily living (ADLs) limitations
No ADLs	63.7	61.6	0.008**
1 or 2 ADLs	33.3	29.0
3+ ADLs	3.0	9.4
Total health conditions
None or 1 condition	5.0	7.4	0.486
2 or 3 Conditions	17.3	18.7
4 or 5 Conditions	30.8	32.6
6 or More conditions	46.9	41.3
Lonely	19.5	18.8	0.869
Veteran	17.3	17.4	0.974

Notes: Applying NSOAAP dataset weights to the population of older adults who attend congregate meals for socialization n = 576,943; another reason n = 937,048. Any percentages that do not total 100.0 percent are due to missing data.

* p<.05; **p<.01; ***p<.001.

Participants who have a high school education or greater were more likely (91.3%) to initially attend congregate meal sites more for socialization, compared to other reasons. However, a smaller percentage of participants with income less than $20,000 (30.5%), who live in urban areas (13.6%), were classified as food insecure (6.4%), were receiving Medicaid (11.0%), or participating in SNAP (5.3%) were found to attend congregate meals statistically less for socialization compared to those initially attending for other reasons. In terms of health characteristics, participants who initially attended for socialization were more likely to have two or fewer ADLs (97%) compared to those attending for other reasons. Lastly, there were no statistically significant relationships found with nonwhite Hispanic participants, sex, living alone, loneliness, veteran status, self-reported health and total number of health conditions, and initially attending congregate meals for social reasons.

Characteristic differences of those attending for an age or health reason

Table 5 presents the weighted characteristics of the congregate meal participants who stated that they first attended the program for an age- or health-related reason compared to those who attended for other reasons. Many of the relationships contrast the participant characteristics that were statistically significant for those who attended for social reasons. For example, participants who initially attended for age- or health-related reasons were more likely to identify as Black/African American (20.0%), Hispanic (18.3%), or have another racial or ethnic identity other than white (20.8%), compared to other reasons. A greater percentage of congregate meal participants with income less than $20,000 (58.5%), living an urban setting (32.7%), reporting food insecurity (20.4%), on Medicaid benefits (35.9%), or participating in SNAP (19.8%) initially attended for age- or health-related reasons compared to other reasons. Unmarried (32.6%) and widowed (42.2%) participants are also more likely to have initially attended congregate meals for age- or health-related reasons compared to all other reasons.

Table 5. Distribution of the characteristics of congregate meal participants who attended for age or health related reasons compared to all other reasons reported (weighted).

Variables (%)	Reported age or health reason	Reported another reason	p-Value
Age
60–64 Years	6.2	7.8	0.730
60–74 Years	34.8	35.6
75–84 Years	36.0	38.2
85+ Years	23.0	18.5
Race
White only	59.2	81.2	0.000***
Black/African American only	20.0	10.6
Other	20.8	8.2
Hispanic ethnicity	18.3	5.0	0.018*
Female	73.4	65.1	0.11
Living alone	49.3	41.5	0.179
Marital status
Married/partnered	25.2	47.0	0.000***
Widowed	42.2	32.5
Divorced, separated, or never married	32.6	20.5
Income less than $20,000	58.5	34.8	0.000***
High school degree or higher	73.9	90.0	0.002**
Urban	32.7	18.1	0.013*
Rural	26.5	41.0	0.002**
Food insecurity	20.4	8.6	0.011*
SNAP	19.8	10.8	0.040*
Medicaid	35.9	16.1	0.001***
Self-reported fair/poor health	42.8	23.7	0.001***
Activities of daily living (ADLs) limitations
No ADLs	45.6	66.3	0.000***
1 or 2 ADLs	35.8	29.5
3+ ADLs	18.6	4.3
Total health conditions
None or 1 condition	4.6	6.9	0.183
2 or 3 Conditions	10.8	19.9
4 or 5 Conditions	32.9	31.7
6 or More conditions	51.7	41.5
Lonely	22.5	18.3	0.398
Veteran	11.4	18.8	0.027*

Notes: Applying NSOAAP dataset weights to the population of older adults who attend congregate meals for age/health reason n = 285,341; another reason n = 1,228,650. Any percentages that do not total 100.0 percent are due to missing data.

* p<.05; **p<.01; ***p<.001.

The health variables indicate that a greater proportion (18.6%) of participants who had three or more ADLs attended congregate meals for an age- or health-related reason when compared to other reasons. Participants who self-reported fair or poor health were also more likely (42.8%) to have attended for an age- or health-related reason compared to other reasons. Age, sex, loneliness, and total number of health conditions were found to have no statistically significant relationship with attending for an age- or health-related reason.⁴

Discussion

Our study used national data to explore the self-reported reasons congregate meal participants first attended the program. Although there are complex issues affecting older adults’ lives, acting and interacting simultaneously to influence their participation in congregate meal programs, ACL’s NSOAAP survey question asks participants to think back to the reason they initially sought services. This question provides insights into the reason(s) they believe led them to ultimately attend their first congregate meal.

Attending for socialization

There were several primary reasons that older adults seek and attend their local congregate meals programs, with the main reason being for socialization opportunities. Over one-third of older adults who were active in the program in the past year said they started coming to meet people, to socialize with peers and friends, or to cultivate a deeper connection to others in the community. The analysis of differences among these participants and those who reported other reasons indicated that individuals going for social opportunities were more often white, widowed, aged 75 to 84, and have at least a high school education. Furthermore, they were less likely to be lower income, live in cities, have food insecurity, or live with three or more ADL limitations.

The congregate meals program is a social service that is effectively reaching a wide variety of older Americans and providing a gateway or access point into other home- and community-based services as they age.¹⁶ Participants benefit from the healthy meals, activities, and resources available at the congregate meals site, and they have opportunities to build connections within their community and local aging service providers. Congregate meal sites provide opportunities for communities and local organizations to be proactive and preventive in supporting older adults aging in place in their neighborhoods.^28–30 Congregate meal participants are less likely to screen as having depression and more likely to have a greater satisfaction with their socialization opportunities.³¹ With the ongoing national effort to keep older people living in their homes for as long as they desire, services like congregate meals promote engagement and maintain mental health, well-being, and quality of life.

Very few federal interventions and programs were designed to increase or enhance participants’ socialization opportunities, even though a mounting body of research points to the negative impact of social isolation and loneliness on individual and community health and well-being.^32–35 The Congregate Nutrition Services is one such program, and studies suggest that program participation supports older adults’ quality of life, increases their socialization opportunities, and results in more positive socialization outcomes.^10,21 Although one study suggests that there is no relationship between feeling lonely and participating in congregate meal programs,¹⁰ loneliness and social isolation are two distinct constructs where social isolation is related to a person’s lack of social contacts and participation.³⁶ This study, which looked at differences within congregate meal program participants, rather than among participants and nonparticipants, found that increasing their social opportunities was a major reason older adults sought out their local congregate meals program, and this was not tied to feelings of loneliness. Congregate meals can play a vital role in supporting older adults throughout the country who want to continue to live independently in their communities and find ways to engage socially.

Attending for an age or health reason

Another predominant reason for initially attending congregate meals was assistance for an age- or health-related reason, which typically translated to a stated inability to cook or prepare meals on their own. Unlike the congregate meal attendees who seek socialization opportunities, those who reported attendance because of their age or health were more often members of historically marginalized racial or ethnic groups, unmarried, have less than a high school education, and live in urban areas. This group of participants was also more likely to be lower income, have poorer health, use government assistance programs, and experience food insecurity. Although they likely benefit from the congregate meal program in several areas of their life, the primary reason they started attending was for an affordable meal they did not need to prepare themselves.

Although several articles have examined the characteristics of congregate meal participants and found that many experience various physical limitations and health issues,^9–14 we believe this is the first study to explicitly identify age or health challenges as a primary driver for first attending a congregate meal program among a subset of older adults. Our results add to existing work⁴ which found that congregate meal sites were important for social support and encouraging access to affordable healthy foods.

This under-resourced population attending for age- and health-related reasons can be greatly assisted by attending congregate meal sites. Similar to this study, prior research has found that prevalence of food insecurity among older adults has been linked to diverse racial and ethnic identities, lower income older adults, those who are younger (ages 60–69), and although not examined in this study, those who rent their residences.³⁷ Other research demonstrates food insecurity’s myriad negative health consequences including higher mortality rates, increased healthcare expenditures, and decreased quality of life.³⁸ The congregate meal program addresses food and nutrition security, while also connecting participants to the wider network of coordinated home- and community-based programming, thereby combating older adults’ need for other supports, including healthcare services.^22,39–42

Encouraged by others to attend

About 12 percent of participants indicated that they first attended congregate meals because they accompanied others or were referred, demonstrating a relational interaction leading to attendance. Accompanying others or being referred was statistically more common among older adults who identified as having Hispanic ethnicity and those ages 65–74 (results not shown). These results suggest that social services, community-based organizations, such as faith-based organizations, and healthcare professionals may play a key role in raising awareness and encouraging attendance of the congregate meal program among older clients.

Policy and practice implications

The findings from this research effort underscore the continued importance of congregate meal sites to support older adults’ nutrition and socialization needs, while also serving as access points for obtaining other needed services in their communities. The intent of the OAA Nutrition Services to address nutrition, socialization, and health and well-being was exceedingly prescient and remains as valid and impactful today as when it was conceived 50 years ago (with slight modifications during reauthorizations).

Because the congregate meals program attracts a variety of older adults with differing needs who come to the program for diverse reasons, additional policy recommendations could encourage congregate meal sites to gather descriptive data about their participants, including their reasons for attending, and perhaps with the coordinated assistance of academic or other evaluative expertise, to enhance the understanding of how best to meet older adults’ needs and plan services accordingly. In particular, this study identified differences in reasons for attending congregate meal sites by race, ethnicity, age, sex, and a variety of social factors. Understanding the self-described concerns of the older adult population may help congregate meal sites to structure their meal, other nutrition services (e.g., nutrition education, nutrition counseling), programming, and referral networks to best meet the needs of diverse older adults, addressing person-centered unmet needs.

Concerning practice implications, our study findings suggest that learning about older adults’ motivations for seeking services can help professionals better link these individuals to available local programming. Health care and social services staff are trusted professionals who often interact with people 60 years and older, and whose organizations are invested in improving the physical and mental health of this population. Interactions with older adults (e.g., in a medical setting or benefits eligibility assessment), provide insight into unmet needs, allowing for personalized referral opportunities to a congregate meal location that is proximal and accessible. Providers can make referrals online through the ACL ElderCare Locator (eldercare.acl.gov, 1-800-677-1116) or through a growing number of automated referral systems (e.g., electronic medical record, Health Information Exchanges). Increasing provider referrals may expand congregate meal participation and better support the health and independent living of older adults nationwide.

Similarly, many government offices and community-based organizations also have direct contact with older adults who have unmet nutrition, social, and health needs. Government offices (e.g., departments of motor vehicles, housing authorities, post offices, libraries) can improve existing practices by posting congregate meals flyers, providing informative videos, or offering congregate meals news via “hold” messages on their phone lines. These communications can be created in partnership with the organizations hosting the local, regional, or statewide congregate meal programs, highlighting the availability of socialization, access to services, and healthy meals. Other community organizations (e.g., food banks, homeless shelters, faith-based groups) are also in a unique position to refer older adults to congregate nutrition programs by identifying those with unmet needs for nutrition, socialization, and other community-based assistance.

Study limitations

This study was based on one year of NSOAAP data, which is a cross-sectional and self-reported survey that only includes older adults receiving services from OAA-funded service providers. Additionally, the NSOAAP question asking why participants initially sought services is asked of all OAA program participants surveyed, and our results indicate that the closed-ended responses available did not align well with the reasons congregate meal participants cited for attending. Most congregate meal participants (76%) answered “Other,” and open-ended responses can pose challenges because they can be vague, unrelated, or misunderstood. The open-ended structure also allows an infinite number of possible answers, which while providing more detail and rich responses, may be harder to combine and analyze. Finally, this study included only those individuals who received services, who were motivated to attend largely for social issues and health-related factors. Therefore, there is likely a population of older adults who would benefit from program attendance but who are not yet accessing or aware of the services; these older adults may have different drivers for participation.

Future research

We believe this study was the first to explore why congregate meal participants initially attended the program and whether there were differences among those who attended for one reason or another. As such, the study is largely exploratory in nature. Further study is needed to dig deeper into these drivers, particularly among those attending because they needed assistance, to expand upon their reasons for attendance, their experience going for the first time, and their perspectives on how to get others in need to start attending, as well as effective referral approaches. More research about specific subpopulations of older adults also would help to address any potential disparities in existing service access or service needs by personal characteristics.

Given that this study suggests that many participants of the congregate meals program are older adults who have fewer unmet health and assistance needs, there is also a need to study older adults who are not attending congregate meal programs, their potential need for these services, and their reasons for not having participated previously. Additionally, there is a need to understand any relationships between congregate meal program participation and other types of home- and community-based service use as people age. The congregate meals program may provide an early access point into the available services and aging network as program participants age.

Conclusion

Older Americans Act Nutrition Services attract participants with a wide variety of characteristics and unmet needs. Connecting with others (i.e., socialization) and access to needed nutritional services that arise from age- or health-related needs are key avenues for attracting new participants. The unique eligibility framework—the sole program requirement is that individuals must be at least 60 years old, with no income eligibility—enables this program to have the potential for considerable public health impact to improve the physical and mental health of a growing community-based older population. Health and social service providers, and a wide variety of community-based organizations and government entities, are in a position to partner with congregate meal sites to encourage attendance. Highlighting the socialization and nutritional assistance that congregate meal programs can provide may help to encourage more older adults to attend their first congregate meals program.

Take away points

• We believe this is the first study to examine the reasons congregate meal participants initially sought services using national data from active participants.

• We believe this study is the first to explicitly show that:

  • The predominate reason older adults are attending congregate meal programs is for socialization opportunities.

  • Reasons for participation in congregate meal programs varies demographic, socioeconomic and health characteristics.

  • Distinct subpopulations of congregate meal attendees exist, some who are less vulnerable and going for social engagement and some who are more vulnerable and attend due to a need.

• Though these data are prior to the 2020 COVID Public Health Emergency (data is from 2019), we discuss the findings within the context of nationwide site closures and modified reopening. We recommend congregate meal sites consider the various needs of subgroups of older adults in their community to ensure all can benefit from the program even with new site modifications (e.g., grab-and-go meals).

Acknowledgment

The opinions and views expressed in this manuscript are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor, the Administration of Community Living, or any other funding organization.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The Administration on Aging’s National Survey of Older Americans Act Participants (NSOAAP) questionnaires, data, and documentation are publicly available at https://agid.acl.gov/.

Additional information

Funding

This work was supported by the Administration for Community Living under contract number [HHSP233201500039I/75P00120F37027].

Notes

1 OAA Nutrition Programs are overseen by the Administration for Community Living (ACL). More information about these programs can be found via the ACL website: https://acl.gov/programs/health-wellness/nutrition-services

2 https://agid.acl.gov/DataFiles/Documents/NPS/2019SurveyDocumentation.pdf

3 Ibid.

4 Although logistic regression using these variables raises multicollinearity concerns, we ran two models to assess the characteristics that influence attending a congregate meal for socialization or age- or health-related reasons. The same characteristics that were statistically significant in the bivariate analyses were also statistically significant in the logistic regressions.