Home-delivered meals for persons with dementia: Which model delays nursing home placement?

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PROJECT SUMMARY Older adults with a diagnosis of Alzheimer’s disease and/or a related dementias (ADRD) are at increased risk of food insecurity. There is a strong, documented link between food insecurity and health. However, less is known about how home-delivered meals, designed to reduce food insecurity, enable older adults with ADRD to remain in their homes (vs moving to a nursing home). While meals have traditionally been provided daily to clients’ homes by a volunteer or paid driver who visits with the client and reports any concerns about the client to the meal provider, less frequent deliveries of frozen meals have emerged in recent years as a lower-cost alternative. In this model, participants are provided two weeks’ worth of meals in one bulk delivery via postal courier. Our R61 is a pilot pragmatic randomized controlled trial that compares the outcomes between these two common approaches for delivering meals to food insecure persons with ADRD. In order to generate preliminary evidence of efficacy to justify scaling up this pilot study to a Phase III trial, this administrative supplement seeks to expand the sample size from a feasibility study of 10 individuals at two Meals on Wheels programs to a pilot of 235 participants at three programs. In addition, we propose to incorporate two additional data sources to analyze from our prior work that, when combined, will give us the power needed to determine preliminary efficacy of the interventions. The research conducted during the R61 will not only test and validate procedures to recruit individuals with ADRD on Meals on Wheels waiting lists and evaluate their outcomes, but will also be the first to prospectively evaluate the time to nursing home placement among older adults with ADRD who receive the two predominant meal delivery options. The knowledge generated from this research will set the stage for a larger, Phase III trial that will evaluate the effectiveness of receiving daily home- delivered meals and accompanying wellness check and socialization versus frozen, mailed meals on the time to nursing home placement (primary outcome) as well as days in community and hospital transfers (secondary outcomes) among 2000+ food insecure older adults with ADRD; and 2) characterize differences in the context, processes, and mechanisms contributing to the outcomes observed between the two modes of meal delivery among older adults with ADRD. Ultimately, the knowledge generated from this line of research will help healthcare entities, senior nutrition programs, persons with ADRD, and their families choose between the meal delivery model that best meets the nutrition-related needs of persons with ADRD and prevents nursing home placement.