Problem: A large percentage of vulnerable older adult (OA) Chicago residents experience risk factors for food insecurity (FI)1. A Chicago community hospital’s program refers OAs who screen positive for FI for assistance in accessing nutritional resources. However, it is unclear how well the program addresses OA’s FI.

Purpose: To evaluate the Chicago community hospital’s FI screening and referral program for OAs. The evaluation plan was based on the Center for Disease Control and Prevention’s framework for program evaluation and the Donabedian framework.

Methods: Retrospective chart reviews were conducted on patients (>60 years old) who evisited the emergency department (ED), were admitted through the ED, or were admitted directly to the post-surgical unit after scheduled surgeries. Semi-structured interviews were conducted with OAs (n=5) to assess correct identification of food insecure OAs and to investigate patient barriers/facilitators in discussing FI with social workers (SWs) and clinical dietitians (CDs). Proportions were tallied and themes identified.

Results: Nearly 80% of the OAs admitted through the ED and 10% of scheduled admissions to the post-surgical unit were screened. Only 4% of OAs visiting the ED were screened, with all screening positive for FI. About 35% of the referrals submitted by SWs from 2019 to May 2021 were for patients who visited the ED. Among patients admitted, CDs documented patients’ FI status more often than SWs. There were discrepancies between SW and CDs’ screenings and between the project evaluator’s screenings and patients’ documented FI status. Patients reported the limited time in discussing FI with SWs/CDs and the challenges in accessing nutritious foods after discharge as barriers.

Recommendations: The hospital should establish a program to systematically screen OAs visiting the ED or admitted directly to the post-surgical unit. CDs and SWs should be trained to screen for FI using an evidence-based screening tool and utilize a common template incorporating FI status. A list of resources should continue to be provided at discharge for food insecure OAs. Findings underscore the importance of establishing systematic evidence-based screening programs to accurately identify and refer food insecure OAs.

References
1) Chicago Department of Public Health. (2019). Healthy Chicago databook: Older adult health. https://www.chicago.gov/content/dam/city/depts/cdph/statistics_and_reports/CCHE-001_OlderAdults_Databook_r5a.pdf

Meera Mohan DNP, AGPCNP-BC

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