Introduction
dementia
An overwhelming majority (81%) of the 5.3 million older adults with dementia live in the community, and an estimated 25% to 30% live alone.Home-delivered meals, by organizations such as Meals on Wheels (MOW), promote food security, socialization, and independence among older adults who are homebound. Partially funded by Title III of the Older Americans Act, about 5000 programs served more than 880 000 older adults in 2019, over half of whom lived alone, were older than 75 years, and indicated that the meals provided more than half of their total food for the day.Historically, home-delivered meals have been provided to clients in their homes 5 to 7 days each week (referred to as daily-delivered meals). Meals typically come ready to eat and are delivered by a volunteer or paid driver who may informally socialize with the client and report any concerns about their well-being to the meal program staff. In recent years, the model of mailing 1 to 2 weeks’ worth of frozen meals (referred to as drop-shipped meals) has emerged as a lower-cost alternative. While both models provide the same nutritional benefit, older adults receiving drop-shipped frozen meals do not experience the socialization, assistance, and identification of service needs, which are believed to drive many of the positive outcomes associated with receiving home-delivered meals. In addition, frozen meals require reheating; therefore, older adults receiving frozen meals may not have the convenience of ready-to-eat meals. The additional benefits afforded by the daily-delivered model are likely to be especially important for older adults who are homebound with dementia—a population who experiences social isolation,Therefore, the primary objective of this pilot, pragmatic randomized clinical trial was to assess the association between daily-delivered vs drop-shipped frozen meals and nursing home admission among homebound adults with dementia and to test the feasibility of tracking enrollment, examining baseline characteristics, monitoring participants’ intervention fidelity, measuring the proportion of participants linked with Centers for Medicare & Medicaid Services (CMS) data, and analyzing the primary study outcome.