DISCUSSION
The primary purpose of this investigation was to describe the home food
environment of hospital-discharged older adults. Our findings show that
the majority of participants had a variety of foods available in their home
following at least three days of hospitalization and the majority had
functional kitchen appliances. However, of importance is that more than a
third of participants reported being unable to both shop and prepare meals.
Our analysis focused on these two nutrition-related activities because of their
importance to nutritional intake and functional ability in communitydwelling
older adults (33). Thus, our findings suggest that having access to
nutritious foods in the home does not necessarily imply that individuals will
be able to utilize this food in meal preparation. The inability to shop or prepare
meals with foods available in the home could place older adults at
nutrition risk, which raises awareness to the need for formal and informal
support (34, 35). Merely providing groceries will not be sufficient for a large
segment of the older adult population returning home from the hospital.
Participants who were unable to shop or prepare meals were also more
likely to report having depressive symptoms and difficulty eating. Depression
in older adults is of great concern given its relationship to declines in physical
and cognitive status, nutrition risk, social interaction, quality of life, and health
resource utilization (36–39). Individuals experiencing depression may be less
motivated to strive toward wellness through compliance with the medical care
regimen prescribed at discharge (37) and may be less inclined to consume sufficient
calories to meet energy and nutrient needs (9). Also, while most participants
had a variety of food available in the home, difficulties reported with
eating could further limit dietary intake. Thus, specific questions that elicit
information on nutrition-related physical functioning during discharge planning
may be useful in identifying older adults who would benefit from timely
enrollment in home- and community-based services to address their nutrition
and health needs. Formal services for nutrition support such as the HDM program
may be difficult to secure immediately following hospitalization due to
the popularity of the program and resulting waiting lists (16). On average, CC
participants were at high risk of social isolation; therefore participation in an
HDM program soon after hospital discharge may also be important to overcome
limited social support for some older adults.
Low educational attainment and cognitive impairment were more frequently
reported among those unable to both shop and prepare meals. Studies
have shown that declines in cognitive status are common (up to 50%)
among hospitalized older adult patients for a myriad of medical and environmental
reasons (38, 39). Since both shopping and preparing meals are cognitively
tasking activities (40), cognition must be evaluated at the hospital level
in relationship to these activities