1150 The American Journal of Clinical Nutrition 26: OCTOBER 1973, pp. 1150-1152. Printed in U.S.A.

Feeding the elderly

Caro E. Luhrs, M .D.
During the past 5 years, increasing public
attention has been drawn to the nutritional
status of the elderly. M any of the 25 million
Americans who are age 65 or over do not eat
well. Poor nutrition in this age group is a
complex phenomenon in which physical,
mental, social, and economic factors may all
play a role.
Some older people do not have sufficient
income to buy all the food they need after the
rent and other expenses have been paid. One
person in five over age 65 lives in poverty.
Some of the elderly are ill and lack the physical
strength to cope with problems of shopping and
fixing meals. Some are just too lonely to really
care much about eating, or they have arthritis
or cataracts which makes the preparation of a
meal difficult. Others fail to eat properly
because they either have no teeth or dentures,
or they have ill-fitting dentures. Because of a
variety of factors, some end up on a tea and
toast dietary routine. Clinical symptoms re-
lated to their poor nutritional status may result.
Our challenge is to develop a variety of ways
to solve the complex nutritional problems of
older people. The Department of Agriculture
has been involved in some new approaches and
some new twists to old approaches. I would like
to share these with you.
To supplement food buying power, the
Department of Agriculture, in cooperation with
state and local governments, administers two
alternative food assistance programs: the Food
Stamp Program and the Direct Food Distribu-
tion Program. One of these two programs is
available in virtually every county and inde-
pendent city in the United States. Of the nearly
15 million people benefitting from these pro-
grams, approximately 2.5 million are age 65 or
older.
Food Stamp Program
The Food Stamp Program was begun in 1964
as a means of supplementing the food purchas-
ing power of low income groups, including the
elderly. It is now the predominant form of food
assistance available in the United States. De-
pending upon their income, participants pay a
certain amount of money for stamps which are
worth more money than what they have paid
for them. Those people with little or no income
get the stamps free. The stamps are used to buy
food at local grocery stores and supermarkets.
A wide variety of foods can be purchased
including those needed for special diets.
For example, an elderly couple pays $0 to
$44, depending on their income, to purchase
$64 worth of stamps. A single person, living
alone, pays $0 to $26 for $36 worth of stamps.
In each case, the stamps are sufficient to
purchase a nutritionally adequate diet.
W hether or not a person is eligible to receive
food stamps depends on his monthly income,
his savings, and other assets. Normally, a person
living alone or in a family is not able to obtain
food stamps if total assets equal or exceed
$1,500. An exception is made for families of at
least two people, when one of the members is
age 60 or over. In that case, the family may
have assets of up to $3,000. A home, life
insurance policies, and personal property do
not count as assets.
Income standards are the same for all ages. A
person living alone can have a yearly income of
$2,100 and still be eligible for food stamps; a
couple may have yearly income of $2,700.
People with incomes above these limits may
also be eligible if they have unusual expenses
such as big medical or hospital bills, or high
rent payments.
New features of the Food Stamp Program
offer particular advantages to the elderly,
especially those with transportation problems.
Although program rules call for a personal
interview as part of the application procedure,
the application form itself can be filled out at
home and mailed to the food stamp office. New
rules allow that someone unable to visit the
office can send an authorized representative or
proxy to the interview. Once a homebound
person is in the Food Stamp Program, he can
have a representative or proxy buy the food

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F EEDI NG THE ELDERLY 1151
stam ps and then spend them f or f ood. In a
Detroit housing project, one v olunteer serv es in
a m ultiple prox y role, buy ing f ood stam ps
and shopping f or sev eral elderly people at one
tim e.
Of f urther help to the hom ebound elderly
person is that in 26 states, f ood stam ps can be
purchased by m ail. T his practice is steadily
grow ing, especially in sm all tow ns and rural
areas.
V olunteer organiz ations that deliv er M eals
on W heels to the hom es of f eeble, sick , or
disabled elderly people m ay now accept f ood
stam ps in pay m ent f or m eals deliv ered. For
m any elderly f olk s w ho liv e alone and hav e
dif f iculty preparing their ow n f ood, the nutri-
tious m eals deliv ered to them daily , M onday
through Friday , are a v eritable godsend. N ot
only does it of ten m ean the dif f erence betw een
tea and toast and a balanced hot m eal but also,
in m any cases, the daily v isit f rom the M eals on
W heels v olunteer is a shut-ins only contact
w ith the outside w orld.
M ore than just a deliv ery serv ice, M eals on
W heels is m ade up of thousands of caring
v olunteers, m any of w hom are as old as the
people they serv e. T ogether the v olunteers
w ork w ith nutrition ex perts in their com -
m unities to plan and prepare special m enus and
to learn how to coax f inick y oldsters into
better eating habits.
T he v olunteers seem to f eel better them selv es
as a result of stay ing activ e by w ork ing in the
program . A s one enthusiastic 68-y ear-old m an
in B altim ore w ho w ork s tw ice a w eek pack ing,
driv ing, and deliv ering put it: I dont f eel any
older than w hen I w as 50.
Direct Food Distribution Program
In areas not serv ed by the Food S tam p
Program , elderly people w ith little incom e can
receiv e f ree f ood donated by the Departm ent of
A griculture and distributed through local
centers. L ocal social serv ice or w elf are agencies
determ ine w hether or not a person is eligible to
receiv e these f ree f oods, based on incom e
standards established by each state and ap-
prov ed by the Departm ent of A griculture. S tate
and local agencies are also responsible f or the
storage and distribution of the f ood.
Donated f oods are the sam e quality as those
purchased in stores. T hey include such staples
as canned m eat, f ruit juices, v egetables, cheese,
peanut butter, and nonf at dry m ilk . T he f oods
hav e been im prov ed in v ariety and am ount and
are now being m ade m ore nutritious through
enrichm ent and f ortif ication. Each person re-
ceiv es enough f ood to supply a nutritionally
adequate diet. In term s of quantity , this m ay
am ount to as m uch as 39 pounds of f ood per
person per m onth. N ew ly designed labels are
brighter w ith larger print and pictures. T his has
been especially helpf ul f or people w ith reading
dif f iculties.
Older people w ith transportation problem s
or phy sical disabilities of ten f ind it dif f icult or
im possible to get to the distribution center or
once hav ing arriv ed, to phy sically carry the
f ood aw ay . L ocal v olunteer and civ ic groups
help ov ercom e these obstacles by deliv ering
f oods to the hom ebound elderly . T he Depart-
m ent of A griculture encourages and supports
this k ind of activ ity through its Driv e to
S erv e program in w hich adult and y outh
v olunteers join f orces to transport donated
f ood to senior citiz ens w ho need the help.
S tarting in Fulton, M issouri 2 y ears ago, Driv e
to S erv e is also operating in B ow ling Green,
K entuck y ; W ilm ington, Delaw are; M cK inney ,
T ex as; A ttleboro, M assachusetts; and S an
B ernardino, Calif ornia, to nam e a f ew areas.
T he United S tates Jay cees recently adopted
Driv e to S erv e as one of their f iv e top
p r i o r i t y n a t i o n a l v olunteer projects in the
h e a l t h a r e a f o r 1 9 7 3 .
Pro viding foods for institutions and
group feeding programs
T he Departm ent of A griculture-donated
f oods are also av ailable through state agencies
to hospitals, nursing hom es, hom es f or the
aged, and other institutional or group f eeding
operations w hich serv e the needy . L atest f igures
show that of 9,000 f ood serv ice outlets
receiv ing donated f oods under the institutional
program , ov er 2,200 of these are prim arily
serv ing people age 65 and ov er. M ost are
residential institutions. A f ew are schools or
other group f eeding centers that prov ide a k ind
of restaurant serv ice f or the elderly . T he
obv ious nutritional benef its of such group-
f eeding situations f or the elderly are enhanced
by the built-in opportunities f or socializ ation
and, in som e cases, f or education and counsel-
ing.

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1152 L UHRS
The Department of Agriculture has recently
issued a helpful how-to-do-it guide for use by
communities that wish to set up group-feeding
or home-delivered meal programs called Nutri-
tion Programs for the Elderly, which is
available for 50 cents from the U. S. Govern-
ment Printing Office.
Project FI ND
Those who have organized food assistance
programs will recognize that locating the many
older Americans who need food help is perhaps
the greatest challenge of all. In August 1972,
President Nixon announced a new program
specifically designed to do just that, to find
elderly persons who are eligible for Federal
assistance but who arent aware that they
qualify and who dont understand how the
food programs work. This program, called
Project FIND, involved the mailing that
month of a food assistance message to all 28
million recipients of Social Security and of
M edicare.
The message described the available food
programs and the rules for making use of them.
A postage-free postcard was included for people
desiring more information or assistance in
applying.
By the end of October, thanks to the efforts
of thousands of volunteers trained by the
American Red Cross who personally responded
to the returned postcard inquiries, some
106,000 older people were added to food
assistance programs.
Summary
I have described some currently operating
food assistance programs for the elderly. Pre-
dominant among these is the Food Stamp
Program.
W hat about the future? There is a growing
conviction in this country that perhaps the best
way to help people in need is to provide them
with money rather than with a vast array of
bureaucratic services. W ith money, one has the
freedom to set ones own priorities. W ith food
stamps, one is committed to buying food.
Un d e r t h e r e c e n t l y p a s s e d S o c i a l S e c u r i t y
Amendments of 1972, the Food Stamp Pro-
gram for the elderly will be cashed out as of
January 1, 1974, and a new, nationally uniform
system of cash benefits will be established for
the needy aged. W ith more money, less
bureaucracy, and the right to set priorities, it is
hoped that older people will be brought back
closer to the mainstream of American life.
As President Nixon reflected upon signing
these amendments into law:
Churchhill was a great leader at 81. Holmes
was a great jurist at 91 - Clara Barton led the
Red Cross at 83, and Connie M ack led the
Athletics at 88. M ichelangelo was painting at
89; Toscanini was conducting at 87 -. - I
believe that millions of older Americans can
make great contributions to our Nations
progress if only they have the chance. This
really is the point of our Government programs
and policies-to help older Americans play a
full, continuing role in the great adventures of
America. E l

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