Undernutrition Risk in Community-Living Older Adults: Post-COVID-19 Results from the 2023 U.S. National Survey of Older Americans Act Participants

Background: The Older Americans Act (OAA) home-delivered and congregate meal programs and related nutrition services are the largest federal programs in the United States (U.S.) to reduce malnutrition (undernutrition) among community-dwelling older adults. However, the prevalence of undernutrition has received little attention in the OAA programs, while many studies report the prevalence of overweight and obesity. Objective: We documented undernutrition risk prevalence estimates post-COVID-19 in a 2023 nationally representative survey of OAA participants in the U.S. Undernutrition risk prevalence may have been elevated among those surveyed previously in 2022 because data were collected during the COVID-19 pandemic. Methods: Data were obtained from the 2023 National Survey of Older Americans Act Participants (NSOAAP) (n = 4159); a cross-sectional survey of OAA participants randomly selected from a stratified sample of Area Agencies on Aging throughout the U.S. The NSOAAP included measurement of undernutrition risk, the main outcome of interest, using the Malnutrition Screening Tool (MST) that queried self-reports of unintended weight loss and decreased food intake due to poor appetite. MST scores ≥ 2 were defined as indicating undernutrition risk. Data were reported using confidence intervals. Results: In 2023, nearly 1 in 5 NSOAAP respondents were at undernutrition risk; 9.9% (95% CI 7.3–13.0%) of congregate meal participants, 20.8% (95% CI 18.3–23.5%) of home-delivered meal participants, and 21.3% (95% CI 16.7–26.4%) of participants in OAA non-nutrition programs (transportation, case management, or homemaker services). Participants in different OAA program types also differed in many demographic and health-related characteristics. Conclusions: Since undernutrition risk is neither a definitive diagnosis of undernutrition nor its causes, it must be followed up by further nutrition assessment.