There was a significant reduction in self-reported feelings of loneliness among homebound seniors who had home-delivered meals, compared with those who did not.
Image credit: Michael Cohea/Brown University
The pressure to cut costs brings with it the possibility of overlooking the less tangible benefits when seeking alternative models in the provision of a public service.
Nutrition service providers are no exception, and the new study - conducted as a randomized, controlled trial - shows that home-delivered meals do more than nourish physical well-being; they also have a positive emotional effect in the lives of older people who are stuck at home.
It appears that the regular knock on the door, with the opportunity to exchange some friendly words with the person delivering the meal, goes a long way to reducing feelings of loneliness in older people in need.
Lead author Kali Thomas, assistant professor (research) of health services, policy and practice at Brown University School of Public Health in Providence, RI, says:
"This continues to build the body of evidence that home-delivered meals provide more than nutrition and food security."
Prof. Thomas, a former volunteer for Meals on Wheels, believes the study is one of only a few that has rigorously examined the long-presumed psychological benefits of home-delivered meal service. It is certainly the first randomized, controlled trial to measure the effect on loneliness, she notes.
Many participants socially isolated
The trial participants were 626 older adults from eight American cities who were on waiting lists to receive Meals on Wheels. They were randomly assigned to three groups.
In one group, the participants received a daily fresh meal, in another they received a weekly delivery of frozen meals, and in the third group they remained on the waiting list - this was the control group.
The trial ran for 15 weeks. All participants were interviewed at the start and end of the period.
The interviews assessed participants' feelings of loneliness using two measures. One measure was a standard scale comprising three questions. This yielded a score from 0-9, with higher scores indicating greater loneliness.
The second measure was the single question: "Do services received from the home-delivered meals program help you feel less lonely?"
The team found no significant differences in either of the loneliness measures across the three groups at the start of the trial. On the loneliness scale, each group averaged between 3-4.
But from other data that the researchers collected, it was clear that many of the participants were socially isolated.
For example, more than half lived alone, 14% had nobody to contact for help, and only 25% took part in group activities. Also, as many as 20% had contact with friends and family no more often than once or twice a month.
When they analyzed the before and after results, the researchers found that both measures showed a statistically significant reduction in self-reported feelings of loneliness among those who had home-delivered meals, compared with those who did not.
The statistical significance was unaffected by adjustments to take into account factors that might have an influence, such as income, age, education, race, living alone, contact with friends and family and participating in group activity.
The average loneliness score for the participants who did not receive home-delivered meals (the controls) after 15 weeks was 4.17. For the other two groups - daily and weekly meal delivery - it was 3.44.
Daily delivery appeared to have stronger effect than weekly
The single-question measure highlighted a difference in the two home delivery groups.
The group that received daily meals were three times more likely to say the home-delivery meal service helped them feel less lonely than the group that only received their meals weekly.
Prof. Thomas hopes the findings will help policymakers in their evaluation and structuring of public and private programs that serve the elderly in their homes, and concludes:
"In a time when resources are being further constrained and demand is increasing, it is important that we have evidence that guides decision-making in terms of what services to provide and how best to provide them."
Prof. Thomas says many studies have shown that loneliness among older people is linked to a greater risk for medical problems, emergency department visits and nursing home placement.
Further to this, Medical News Today recently learned of a study that found loneliness can lead to illness by triggering cell changes. Research involving the University of Chicago and published in the Proceedings of the National Academy of Sciences shows how loneliness leads to fight-or-flight stress signaling, which can ultimately affect the production of white blood cells.