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transportation is available and accessible, it is often economically prohibitive for senior citizens on limited incomes. Some projects have solved the problem by a volunteer system. Car pools are formed to transport participants to the project for meals, take them for medical and dental checkups, to barbers and hairdressers, to markets and shops, and on recreational outings.

As a means of minimizing the costs of ancillary services, several projects have developed cadres of indigenous aides who work directly with the participants. Their services may include helping with appointments and transportation, assisting in making applications to health and welfare organizations, and even escorting individuals to relevant agencies. Experience has indicated that the aged people themselves are often most effective in bridging the gap between program participants and representatives of social, health and welfare agencies. Thus the use of such personnel contributes not only to a reduction in program costs but to a better translation of need into remedial action.

5. Evaluation

Only if a program is accompanied by a rigorous evaluation can its full potential be realized in terms of appropriate modification, replication, and implementation on a broad basis. A major task of any demonstration program is that of providing the systematic, objective information on which to base a comprehensive evaluation. Thus, provision was made in the nutrition program for the collection of data regarding the effectiveness of service, its feasibility, and its cost.

Uniform data are being collected from each of the demonstration programs as a means of determining which approaches may be maximally fruitful for the aged. In addition, data being collected in some of the projects deal with the measurement of program impact in terms of such areas as utilization of health services and general morale. Again, data such as these will provide the basis for evaluation of the total program and delineate specific elements of the program which have produced the most favorable results. A copy of a recent report of the ongoing program evaluation is appended to this paper.

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OBSERVATIONS

Reports that have come in from the various programs being conducted across the country contain valuable information on practical problems and solutions, successful approaches, and recommendations for the improvement of the program. These reports have yielded a series of findings which contravert many commonly held misconceptions regarding nutrition programs for the aged.

Fallacy #1

The aged aren't interested in nutrition programs.

The Fact:

Not only are the aged interested, they come to programs
in rain, snow, and summer heat. They wait patiently for
hours to ensure themselves a place at mealtime.

Fallacy #2

As soon as you initiate a program, participants will come.

The Fact:

While a new program may attract many participants, it
will not attract those in direst need the isolated aged
residing in the community. The very nature of social
isolation is such as to preclude participation in such a
program unless concerted case-finding efforts are made.

Fallacy #3

The aged won't or can't learn about nutrition.

The Fact:

The food and nutrition information and education aspects of the
projects are regarded as successful in terms of providing
the aged with a better understanding of nutrition, food prepara-
tion, budgeting and efficient shopping, and providing a better
orientation toward beneficial eating patterns.

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Fallacy #4

Nutrition education programs need deal only with nutrition education, per se.

The Fact:

The more successful nutrition education programs deal with a variety of problems, not only those relating to food, but also to health care, social security benefits, me dicare and medicaide, housing, transportation, etc.

Fallacy #5

Feeding the aged won't make any difference in their lives.

The Fact:

Many of the aged in the programs are receiving adequate food for the first time in many years. But in addition to the nutritional aspects of the program, virtually all program directors report a startling change in the elderly participants. After a time they begin to dress better, develop friendships, become more conscious of health care, and take a livelier interest in social activities.

Fallacy #6

All the aged need is food; this could be provided through various forms of direct income maintenance, not requiring formal meals.

The Fact:

Program staffs have observed that the nutrition problems of the aged stem from multiple causes, and that no single approach could effectively overcome existing obstacles to adequate food and nutrition. Project personnel agree that the provision of some form of income subsidy alone would not be the solution. The problems of nutrition among the aged are closely related to a complex of social, psychological, and physiological factors.

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Fallacy #7

The facilities in which the programs are conducted makes no difference.

The Fact:

Accessibility to the aged population is the most important criterion for the success of any program. The facility should be near the dwellings of the elderly or near convenient transportation. Moreover, projects appear to get underway more easily and quickly when they are located in facilities such as senior centers, where there is an existing program for the aged and patterns of attendance have already been established.

Fallacy #8

Transportation poses no particular problem to the aged.

The Fact:

The lack of adequate transportation facilities poses a tremendous barrier to the aged, not only to participation in nutrition programs but to many other activities that are vita. to their well-being.

Fallacy #9

The aged are too disinterested or too infirm to help in the maintenance of nutrition programs.

The Fact:

Indigenous aides are extremely helpful, both as paid workers and as unpaid volunteers. Many of the aged are quite eager to participate in some meaningful activity. -- an opportunity which has been denied many of them for years. In addition to assisting with the preparation and serving of meals and in counseling members of their peer groups, these aides have often become an important part of the "outreach" program in several projects. Experience suggests that older people who live in the neighborhood, know its inhabitants and are aware of those in need of service, can be particularly effective and persuasive in promoting program enrollment.

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Fallacy #10

The aged just want to be left alone.

The Fact:

The aged generally respond to given social situations in ways that are characteristic of younger people. When rejected by others, they will learn to be alone, albeit unhappily, and will assume the attitudes of the isolated. Brought into a social context and reoriented toward social interaction, they show quick and marked change. Moreover,

this process of resocialization appears crucial to the success of nutrition programs. Again and again program participants have told staff members that when they are alone, without family or friends, there is just no reason to cook. The nutrition programs are specifically directed toward overcoming this lack of motivation.

Fallacy #11

To conduct a nutrition program it is necessary to have extensive kitchen facilities with health department approval.

The Fact:

While there are advantages to on-site preparation of meals, a number of programs rely on the purchase of meals in bulk or in individual packages. It would appear that the cost of commercially prepared meals in some areas is not substantially greater than that of meals prepared on-site, particularly if it obviates the cost of additional staff and extensive building alterations.