Background: Following discharge from the hospital, homebound older adults remain at risk of poor dietary intake and adverse outcomes due to declines in health experienced during hospitalization. However, once home, timely receipt of in-home nutrition services by older adults is challenged by gaps in the continuum of care. Greater insight into the nutrition and wellness service needs of this population is needed to improve service coordination.

Methods: Staff at six home-delivered meal (HDM) programs in six US states enrolled 566 hospital-discharged, homebound older adults into a five-month HDM intervention project. Sociodemographic, nutrition and health risk data were collected at baseline, at 2 months after the initial assessment or at termination of home delivered meal services, and at 5 months after the initial assessment.

Statistical Analyses: Bivariate and multivariate analyses were used to examine relationships between sociodemographic, social, nutritional, and health risk factors, and participant food shopping/meal preparation ability. In addition, associations between these risk factors, adverse changes in living arrangement and short-term HDM program participation were evaluated. An assessment of the food items and cooking appliances available in the home was also performed.

Results: This dissertation suggests that among the hospital-discharged older adults studied: (a) many had a variety of foods available but reported being unable to prepare meals, (b) those who experienced adverse changes in living arrangement over the course of the intervention were more likely to report poor health and nutrition status, functional impairment, and social isolation following hospital discharge, and finally, (c) those who maintained or restored their ability to accomplish food-related instrumental activities of daily living such as shopping and preparing meals were shorter-term users of HDM compared to longer-term users.

Conclusion: Homebound older adults can benefit from timely enrollment to community-based programs nutrition and wellness services like HDM, especially those who are unable to shop and prepare meals. There is also a need at discharge to identify social, functional and nutritional risk factors for adverse outcomes in older adult patients in order to provide appropriate referrals to nutrition and wellness services that can facilitate successful transitions from hospital to home.