Ensuring that vulnerable elderly are well-fed could trim their healthcare costs, especially for emergency-room visits, U.S. researchers say.
Seniors in the Boston area who received meals at home through programs like Meals on Wheels had fewer emergency department visits and fewer hospital admissions than their peers who didn't get the meals, leading to lower medical spending overall, researchers report in Health Affairs.
"We've known for a while that lack of access to nutritious food has important health consequences, but we haven't always had a good sense that our interventions are actually effective," said lead study author Dr. Seth Berkowitz, who was with Massachusetts General Hospital and Harvard Medical School in Boston when the study was conducted.
"It speaks to the potential for these kinds of interventions to really make a difference in people's lives and let us know we should study them more closely," said Berkowitz, now at the School of Medicine of the University of North Carolina at Chapel Hill.
Berkowitz and his colleagues analyzed healthcare claims between 2014 and 2016 from the Commonwealth Care Alliance of Massachusetts, a not-for-profit community-based health plan that manages care for adults who are dually eligible for Medicare and Medicaid.
Medicare is the federal health insurance program for people over age 65 and also covers some younger disabled individuals. Medicaid is a federal-state insurance program for low-income people of any age.
The study team focused on Commonwealth Care Alliance members with at least six months of enrollment in one of two meal delivery programs, and compared them to members who were similar but not participating in a meal program.
Of the meal recipients, 133 got meals that were medically-tailored for certain conditions, such as diabetes or a need for soft foods. Another 624 got untailored meals from the non-profit Meals on Wheels organization. More than 2,300 non-meal-recipients were in the comparison group.
The research team looked at the number and costs of emergency room visits, hospital admissions, use of emergency transportation, inpatient visits, outpatient visits and pharmacy use.
They found that people in the medically-tailored meal program had fewer emergency room visits and inpatient admissions and less emergency transportation use than the comparison group. Those in the nontailored meal program had fewer emergency visits and lower transportation use but about the same rate of inpatient admissions.
People in the medically tailored meal programs had lower medical spending, by about US$570 per month, than the comparison group and those in the nontailored meal program had about US$156 lower medical spending per month.
The average monthly meal-program costs per participant were US$350 for the medically-tailored program and US$146 for the nontailored program.
Subtracting the program costs, that could mean a savings of US$220 for the medically tailored meal program and US$10 for the nontailored food program, the study authors write.
"Addressing issues like food insecurity, though we still need to learn more about the best way to do so, is a promising strategy for improving health," Berkowitz said in an email.
Federal funding supports 35 percent of local food delivery programs. Studies like these could play into conversations about federal funding cuts to programs such as Meals on Wheels, Anthony Campbell of the University of Alabama at Birmingham, who wasn't involved in the research, said in an email. "This study is an excellent example of the type of rigorous research needed."
The budget conversation will also become more prevalent as the U.S. population grows older and requires more support, said Ellen Barnidge of St. Louis University in Missouri, who wasn't involved in the study.
"With the older adult population growing, we need to support programs that keep vulnerable older adults who want to remain in their homes able to do so," she said by email. "It appears from other studies that home-delivered meal programs decrease nursing home admissions, too."
"There's sometimes a stigma attached with accepting these services, and some people don't access services they're eligible for," said Dr. Julie Bynum of the University of Michigan School of Medicine in Ann Arbor, who wasn't involved in the study. "This isn't just about having food on your table but taking care of your overall health and staying out of places like the emergency department," she said in a telephone interview.