POSITION PAPER* SOCIALIZATION THROUGH NUTRITION PROGRAMS FOR THE ELDERLY** * Paper prepared at the request of Commissioner John B. Martin, for the task force of nutritionists, aging specialists, and food industrialists meeting on August 8, 1970, Washington, D.C. ** Prepared by Douglas Holmes, Ph.D., Director, Center for Community Research, 33 West 60th Street, New York, New York 10023 POSITION PAPER: SOCIALIZATION THROUGH NUTRITION PROGRAMS FOR THE ELDERLY Rather than attempting to provide any detailed overview of current knowledge regarding the relationship between socialization and participation in the nutrition programs, I will attempt here to outline broadly several topical areas which then might serve as a basis for discussion. In truth there exists little, if any, material of an unequivocal nature which defines this relationship; in the past, research and program experience with the aged has raised more questions than have been answered. Adhering to the general suggested format for these papers, this discussion will be divided into four parts: (1) a statement of the problem, (2) an overview of what has been done to date regarding the problem, (3) a discussion of what actions now are planned, and (4) suggestions for additional needed action. (1) Statement of the problem: Perhaps the best way in which to discuss the nature of the problem is to discuss those reasons why we are, or should be, interested in socialization. Several "reasons" become apparent, as Many, if not most of us working with the aged feel that isolation is "bad" and social interaction "good". We regard the aged as extensions of ourselves, and thus as individuals for whom participation in social/interpersonal activities is a requisite for selffulfillment. Thus, we feel that wherever possible in work with the aged, a necessary component of such work should be addressed to facilitating and promoting social interaction among this group. -2. More pragmatically, there is fragmentary evidence which suggests that participation in social/recreational activities reduces the need for hospital admissions, medical care, and general senile deterioration. In addition, there are many studies which demonstrate a significant relationship between morale and social engagement. In retrospect, it would seem that such relationships have been shown to exist for all age groups, even among primates who seek out others of their species with whom to interact. Unfortunately, such evidence as exists for a positive relationship between social participation and general well-being among the aged is of a correlational nature, i.e., while morale may be associated with social interaction, it has not been shown conclusively that social action causes high morale-the relationship might be just the opposite. Indeed, one group of investigators have postulated a "disengagement hypothesis", according to which aged people seek to disengage from social/interpersonal activities as they grow older. In reviewing this position, it would seem that while this may be true of some aged, there are others who are effectively forced from the domain of interpersonal relationships, who are insulated and isolated from society against their will. It would seem that a given aged person's wish for social activities, and the benefits he or she may derive from social participation, relate directly to that individual's past history. If the individual has been a "loner" for 70 years, it is doubtful whether he can be turned into a "social butterfly"; it is just as unlikely that, if such a transformation were to occur, positive changes in other spheres of life would occur. (2) Socialization as a necessary antecedent to adequate nutrition: Initially, we must note that for most mealtime is a social event. 68-179 O 71 14 -3. In some cultures particularly, much of family activity centers about the preparation and ingestion of food. Jews and Italians, for example, often place what others may regard as an inordinate emphasis upon food. It might be helpful to distinguish between hunger and appetite. Hunger reflects a basic need of the organism, which all but the profoundly ill will seek to satisfy. Appetite, on the other hand, has social connotations, in that the desire for a specific food borne of its historical significance for the individual, rather than as a means to appease a perceived physiological need. Thus, the hungry aged individual may satisfy his hunger by eating foods which are not necessarily the most beneficial, e.g., the "tea and toast" syndrome reported by many working with the aged. In developing appropriate nutrition patterns among the aged, we perhaps should address ourselves more to appetite than to hunger, and by thus doing focus more on relating the ingestion of food to the individual's past social history. In other words, we should again focus upon making mealtime a social activity, in which the foods selected will constitute a diverse reflection of the diverse stimuli provided by the social context. There is some research which has shown that the greater the degree of participation in social activities, the better the nutritional intake. Again, this evidence tends to be correlational, rather than causal. Recognizing that hunger, at least, is a function of metabolic rates, and that the rate of metabolism is increased through physical activity, it would seem that social/interpersonal activities, particularly those which are accompanied by some form of physical activity, would increase metabolism, and thus increase hunger in the appropriate context, appetite would be increased, as well. -4. Some investigators believe that a relationship exists between companionship and the digestive process per se. A case has been cited, for example, of an aged woman whose metabolism was such that despite good nutritional intake, she was in severe negative nitrogen balance. After a family member had come to live with her, however, her metabolic processes changed so that the same meals provided the proper nitrogen balance. While this case can only be regarded as suggestive, it does seem that there may be a profound relationship between social interaction and physiological processes. Finally, group meals programs, and even home-delivered meals programs, involve a certain amount of social interaction. At least one of the projects supported by the Administration on Aging reported that until the formerly isolated aged had re-developed interpersonal skills, mealtime was a virtual chaos, in which a number simply were not fed. Thus it would seem that facilitative social interaction is a prerequisite to the maintenance of the nutrition programs per se. (3) Social activities as a necessary concomitant of nutrition programs: Certainly a function of any nutrition program should be to teach and motivate participants to seek better nutrition, with or without continued participation in a specific program. Learning theory, research in learning, and program experience with all age groups, including the aged, supports strongly the view that the best reinforcer of learning, i.e., the best "teaching device" is the participation with and reinforcement by peers. As noted above, appropriate social interaction is necessary for the maintenance of meals program, In addition, if the potential of such a program is to be realized in terms of providing nutrition education to participants, per se. |