Topic: Homelessness and

Malnutrition

Presented by:Natalie Bailey, Francesca de Oliveira, and

Rita Torres-Annan

NURS 310- Scholarly Inquiry in Nursing3/21/14

Introduction

Malnutrition significantly contributes to morbidity and mortality in the U.S. homeless living in shelters and in low income households.

A difficult population to access There is not much research on this topic

Synopsis of TopicPrevious studies indicate:• Homeless and low income adults are a marginalized,

neglected segment of the population • Known to experience poorer physical health than the general

population• Malnutrition in this population contributes to increased

morbidity and mortality rates• Many barriers in this population to access and obtain

nutritional food such as:– Geographical limitation– Cost of food– Lack of nutritional education • Available resources providing suboptimal nutritional

meals.

Geographical Limitations

• Many do not own a car and rely on alternative transportation for shopping such as:• Walking• Bike Riding• Paying for other source of transportation

• Limits the amount of groceries they can carry home“ Despite fast food being viewed as unhealthy and linked

with obesity, participants still purchased it because it was close to their homes and therefore convenient”

(Haynes-Maslow, Parson, Wheeler, Leone, 2011)

Cost of Food• Food insecure populations consume diets of

inexpensive, low-nutrient dense foods, high in fat and added sugars and low in vegetables and fruit, resulting in overweight and obesity.

• Buying fruits and vegetables are done on sale because they are expensive.• Priority is on meat products.

Lack of Nutritional Education• Perceived health status– perception of weight (self/others)• Societal ‘norms’• Cultural differences

• Perceived food nutrition levels– Quality/Caloric content

• Awareness of nutritional needs• Awareness of resources available

Available Resources Providing Sub-Optimal Nutrition

• According to Tsai & Rosenheck, 2013, a nationally representative survey of 1704 homeless adults and 400 soup kitchens and shelter providers in 20 cities found that 63% of homeless adults reported obtaining meals from soup kitchens and 51% from shelters in a one week period.

• On average soup kitchens provide excessive amounts of calories, more than twice as sodium as desirable, and high amounts of saturated fat, potentially contributing to overweight/obesity and other chronic non-communicable diseases.

• Services providing resources limited by funding.• Soup kitchens reliance on food donations often limit availability of

healthful alternatives.

Nursing Significance • There is an importance of providing education

regarding nutritional needs to:– The homeless and low income population– Those who service them– General population

• Serving low-nutrient dense food to homeless people is of concern due to its role in chronic diseases and the coexisting conditions commonly found in the homeless.

EBP Change Proposal

• Step 1:– Gather population and establish needs

• Step 2:– Provide information regarding studies

• Step 3:– Evaluate knowledge, and resources available

• Step 4:– Implement bridging knowledge and deficit to potentially

reduce hospitalization in vulnerable population.

ReferencesBaggett, T. P., O'connell, J. J., Singer, D. E. and Rigotti, N. A. 2010. The unmet health care needs of homeless adults: a national study. American Journal

of Public Health, 100 (7), pp. 1326--1333.

Baggett, T., Singer, D., Rao, S., O'Connell, J., Bharel, M., & Rigotti, N. (2011). Food insufficiency and health services utilization in a national sample of

homeless adults. Journal of General Internal Medicine, 26(6), 627-634.

Dammann, K. W., Smith, C. and Richards, R. 2011. Low-income minority and homeless mothers’ perceptions of their 9--13 year-old children’s weight

status, diet, and health. Maternal and child health journal, 15 (1), pp. 106--114.

Eckstein, K. C., Mikhail, L. M., Ariza, A. J., Thomson, J. S., Millard, S. C., & Binns, H. J. (2006). Parents’ perceptions of their child’s weight and health.

Pediatrics, 117(3), 681–690.

Haynes-Maslow, L., Parsons, S. E., Wheeler, S. B., & Leone, L. A. (2013). A Qualitative Study of Perceived Barriers to Fruit and Vegetable Consumption

Among Low-Income Populations, North Carolina, 2011. Preventing Chronic Disease: Public Health Research, Practice, and Policy,10(120206).

Retrieved December 3, 2013, from http://dx.doi.org/10.5888/pcd10.120206

Tsai, J., & Rosenheck, R. (2013). Obesity among chronically homeless adults: Is it a problem?. Public Health Reports, 128(1), 29-36.

Wiig, K., & Smith, C. (2009). The Art Of Grocery Shopping On A Food Stamp Budget: Factors Influencing The Food Choices Of Low-income Women As

They Try To Make Ends Meet. Public Health Nutrition, 12(10), 1726.

Sisson LG, Lown DA. (2011). Do soup kitchen meals contribute to suboptimal nutrient intake and obesity in the homeless population? Journal of

Hunger & Environmental Nutrition, 6(1), 312–23.