Improving the Safety and Nutritional Adequacy of the Home Food Supply of Elderly Recipients of Home Delivered Meals

NON-TECHNICAL SUMMARY: The Rutgers Food Policy Institute will partner with the Meals on Wheels Association of America (MOWAA) and selected Meals on Wheels (MOW) agencies in five states to conduct an in-depth study of homebound, elderly individuals who receive home-delivered meals (HMD). The majority of the data will be collected during regularly scheduled re-evaluation interviews conducted in the clients' homes every six months. Rutgers researchers will train MOW employees in a research protocol that will involve measuring all of the food in clients' homes using a UPC handheld scanner, similar to technology used in supermarkets. The data will be analyzed in a way that will identify what nutritional needs would not be met if home delivery of meals were to be unexpectedly interrupted. In addition to analyzing the food, the employee will administer a survey to the client, which will ask about demographics, food procurement and food safety behaviors. Finally, the employee will conduct a brief food safety inspection of the clients' kitchens. In addition, the proposed research will involve two interventions designed to improve the safety of the food consumed by this vulnerable group. MOW agency employees will test a labeling system, in which the food delivered to the clients will be date labeled to alert the clients when the food is no longer safe for consumption. A second intervention will involve the MOW employee testing and adjusting the temperature of the clients' home refrigerators. The proposed research will strengthen the nation's food defense system by identifying and addressing the critical nutrition needs of this vulnerable population, particularly during times of emergency. The research has the potential to improve the safety of the food consumed by this population, through food safety audits of their homes and the testing of two interventions designed to decrease the likelihood that they would contract foodborne illness. Dissemination of the resulting research findings and recommendations will be accomplished through a partnership with the Extension Disaster Education Network (EDEN) and MOWAA, both of whom have national constituencies poised to act on the recommendations.

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APPROACH: The staff of five MOW agencies will collect data from 200 clients each, yielding a total sample of 1,000 participants. With the informed consent of the clients, MOW staff will conduct the research activities in the clients' homes during re-evaluations that are conducted every six months. MOW agency staff will inventory the food in the clients' homes, conduct a food safety audit and administer a survey during this meeting. Two additional interventions (using labels and refrigerator temperature adjustments) will also be tested. The in-home inventory of the food supply will be conducted by trained MOW staff members using handheld barcode scanners connected to laptop computers. Almost all the foods in the household will be inventoried (with exceptions such as except alcoholic beverages, commercially prepared baby food, and pet foods). As each food is scanned, a MOW staff member will use the software to record any visible product dating information. Products that exceed the storage times recommended by the Food Safety and Inspection Service (2007) will be set aside so that they can be discussed with and discarded by the client. Containers that show possible "botulism" warnings including bulging or badly dented cans will be discarded by the MOW staff member after explaining the danger of such items to the client. The MOW staff member will use a food safety audit checklist based on the instruments developed for studies of food safety in home kitchens. Interviewers will be trained to collect demographic, food procurement, and health-related questions using a face-to-face 30-minute interview protocol. We will test if putting a label with an easily visible "eat by" date on the delivered meals will encourage recipients to discard food that may pose food safety dangers. Two weeks prior to re-evaluation interview, the agency will put non-obtrusive labels on the food containers. On the interview day, the employee will record the number of MOW meals in the client's refrigerator and their dates. The employee will explain the new easy to read "eat by" labeling system. Clients will be encouraged to discard food that is past the safe date for consumption. The employee will leave behind a large print flyer explaining the new system. Two weeks post-interview, the volunteer delivering meals will record the number of previously delivered meals in the refrigerator, and the dates on those meals, to test the efficacy of the intervention. The MOW staff will measure the temperature of client's refrigerator using a hand-held infrared thermometer. If the refrigerator temperature is not within the recommended temperature the study employee will adjust the temperature dial accordingly. The temperature of the refrigerator will be recorded for a second time on the same day that the labeled meals stored in the refrigerator are checked. If the temperature of the refrigerator is still not in the recommended range, the study employee will adjust it a second time in an attempt to get it into range; however, subsequent temperature measurements will not be recorded for the purpose of the study.