forward during these later years. I have known many instances and that is the reason for my statement.

Mr. Chairman, one question.

Perhaps, Miss Krettek, you are not qualified in this area. Do you have information which would lead you to state to the committee that often persons who become older have, rather than a failing of eyesight, a strengthening of eyesight after they have passed a certain plateau in their lives? We do have a considerable reservoir of people who, very possibly, read more than younger folks. Is this true?

Miss KRETTEK. Yes; I think there is a very definite basis for that assumption and, also, I think a great deal of it depends on the fact that older people have more time available, and will read if books are made available to them.

I think there is a great need to get books to older people. In some instances, libraries enlist the support of volunteer groups, such as service leagues, the Junior League, various organizations of this kind, to help take books to elderly people who are not able to get to the library themselves, to also take them to homes and various institutions, and if materials are available then I think the people read a great deal. They might also like to have books read to them if they get to the place where they cannot read themselves.

Senator RANDOLPH. Mr. Chairman, I know it will be your purpose and the desire of the staff to give more emphasis to this matter of reading that we might think at the very outset of such a hearing of that type. I am very glad that you have found it important to have this type of testimony presented.

Senator MCNAMARA. Thank you, Senator.

Thank you again. We appreciate your testimony very much.
Miss KRETTEK. Thank you.

Senator MCNAMARA. From the American Dietetic Association, Mrs. Nelda Ross Larsson.

STATEMENT OF MRS. NELDA ROSS LARSSON, THE AMERICAN DIETETIC ASSOCIATION

Mrs. LARSSON. I do not have a prepared statement. I would like just to make a few detailed points.

Senator MCNAMARA. You go right ahead in your own manner. Mrs. LARSSON. The American Dietetic Association is an educational and scientific organization. It has about 14,000 members professionally qualified dietitians and nutritionists. About 47 percent are dietitians in hospitals; 4 percent are nutritionists in public or private agencies; and others may be college teachers of nutrition, dietetics, and institution administration or may be engaged in nutrition research. Members may be employed in commercial food service, with commercial food companies in college food service, and in school-lunch programs. Thus many of our members have opportunities to contribute to the solving of problems of the aged both on their jobs and as members of a community program.

We also have a scientific journal which is published monthly by which we disseminate information to our 52 State and territorial

organizations and 135 local organizations as well as to many subscribers in the United States and abroad.

As to some of the specific problems of the aged: The aged, living alone, do not perhaps make up such a large number, but many of them may not be properly nourished. They are disinterested. They are uninformed both as to food selection and as to food purchasing. They may lack proper facilities for cooking and storage.

An incident was told of one old gentleman who had to go down. two flights of stairs to a community kitchen and by the time he had his meal prepared he was too tired to eat.

They may lack the proper physical energy for shopping and preparing food.

Some suggestions which have been made include the delivery of one prepared meal a day. That has been done in several communties.

The facilities of some nursing homes are open to nonresidents one meal a day. Some golden age clubs have provided a meal a day.

There has been a question asked as to whether school-lunch facilities might be used for the feeding once a day for this group. This would be a community situation which would have to be investigated.

In some communities, a shopping service has been provided for some of the older people who are able to prepare food, but who do not have the courage to go to the supermarket any more.

The institutions of the aged, whether they are homes, nursing homes or institutions for the aged, the licensing regulations are rather vague as to what the nutritional requirements and food service should be. We feel that those should certainly be made more definite. The licensing agency should provide assistance to the administrator of nursing homes, through consultations, through workshops, through educational materials and programs.

Professionally qualified dietitians and nutritionists are scarce, so we do not have a problem of locating the older dietitian in a position. The services of a qualified dietitian consultant might be available to an organization of nursing homes. In some communities a dietitian has been employed on one of her 2 days off a week to work for a home. In other instances a certain number of homes have shared the services of a dietitian.

The Public Health Service is sending a dietitian to another State to work with the licensing agency on an educational program.

The American Dietetic Association has published a simple booklet which has been sent to you on "Eating Is Fun for Older People, Too." It can be of value to the nursing homes. We sold something like 11,000 copies. We have initiated projects dealing with nursing homes. Original research on aging has been published in the association journal as well as articles dealing with community programs.

The August 1959 issue, for example, has an article by Marjorie Hesseltine, chief nutritionist of the Children's Bureau on dietitians and nutritionists in community health programs. A good deal of our work is done as volunteers in community councils; in teaching groups about nutrition; in teaching groups about how to buy more economically, and how to cook with limited facilities. We have counseled the individual senior citizens in homes and institutions about the importance of the nutritional diet. We have given some consultation service in institutions for the aged and have given workshops and classes for cooks and other employees in improvement of service.

We have also taught some individuals on therapeutic diets, as requested by the physician.

In considering what needs to be done, the licensing regulations should include more definite nutrition requirements and food service standards. The licensing agency would then follow and interpret these regulations.

The State health agencies should be encouraged to step up participation in work with the aged.

In some instances it might be well to increase professional staff. There are only nine States who have a nutritionist now who works full time with the aged or chronically ill. A further study of nutritional requirements of the aged should be encouraged and referred to the proper laboratories and organization.

At the present time, we know that the older person requires fewer calories but for all other food nutrients were are accepting the standards for other adults. Research probably should be done in this area.

A simple uniform accounting system with the accompanying forms for nursing homes might give a basis for comparison of home to home. This would assist in part as a basis for rate structure in a given community. The menu should be available for review to compare with purchase of food.

A simple kit could be developed by our association with the nursing homes, which would give nutritional standards and foods needed to attain them. A simple menu system, simple purchasing information, accounting procedures, sources of standardized recipes, and instructions for the routine diets which may be served in most nursing homes. Homemakers and retired professional workers could be offered refresher courses to prepare them to participate more effectively in communities on programs, or committees, and as consultants in nutrition and food service. This is something which probably could be a State or Federal supported program.

In some industrial organizations where they have had preretirement lectures, nutrition lectures have been given and were well received.

This point was not in our statement which was submitted to you, but it should be emphasized, that nutrition is for everyone, not only for the aged. We would like to see a program in which we would publicize good nutrition for everyone, whether it is the aged person living alone, or in an institution, or in the family which included the aged person. There are many programs which give misinformation or which perpetuate food fads. It would seem that radio or television could be encouraged to carry programs giving correct nutrition information in a stimulating and authoritative manner on a continuing basis.

Recently, the Department of Agriculture revised "Food Guide for Older Folks." I do not know just how much publicity it has received but this guide is one reference which should be publicized.

I thank you very much, Senator McNamara, for the privilege of making the statement.

Senator MCNAMARA. Thank you. Your information and suggestions and recommendations are surely very pertinent and the subcommittee will give them consideration.

Thank you for your contribution.

Mrs. LARSSON. Thank you.

(The statement referred to above follows:)

STATEMENT FROM THE AMERICAN DIETETIC ASSOCIATION, CHICAGO, ILL.

The American Dietetic Association is an educational, scientific organization of about 14,000 professionally qualified dietitians and nutritionists. Approximately 47 percent of the members are engaged in hospital dietetics and 4 percent are nutritionists. Thus 51 percent of the membership have potential to give service to the aged. Members of the national organization are also members of the 52 affiliated State dietetic associations. There are about 135 local dietetic associations.

(a) A summary description of your interest and work in the field of aging The members of the association are interested in maintaining and improving the nutrition of the aged and aging. The services rendered to this segment of the population are concerned with nutrition and related areas.

Members as individuals and as members take part in planned association activities participating in giving service to the aged in the following ways: (1) Counseling and teaching individual senior citizens, in their homes and in institutions, the importance and need of eating good food. Interpreting therapeutic diets as prescribed by the physician.

(2) Teaching groups of the aged about nutrition. Senior citizen centers, community centers, golden age groups and special meetings afford these opportunities.

(3) Evaluating the nutritional adequacy of food served in homes for the aged. This was a national project of the association in 1949. A followup of this study was conducted and published in 1957 in the Journal of the American Dietetic Association.

(4) Giving assistance to the personnel in homes for the aged and nursing homes. Consultation service has been given to these institutions. Administrators and cooks have been instructed in ways to improve food service.

(5) Developing and publishing a booklet entitled "Eating Is Fun-For Older People, Too" was done as a national project. The booklet has assisted the homes for the aged and the nursing homes materially because of the basic and elementary principles it contained concerning food service. Eleven thousand copies have been sold. Publishing and distributing a leaflet entitled "Forget Birthdays." Approximately 95,000 copies have been distributed.

(6) Participating in home care and rehabilitation programs and assisting in the development of programs similar to "meals on wheels."

(7) Publishing in the Journal of the American Dietetic Association much of the original research that has been done in the area of nutrition of the aged. (b) Some analytical evaluation of your activities with an indication of additional responsibilities you might logically undertake

In the participation of the activities listed above, we have established the need for nutrition services in the medical care programs as well as the community programs for the aged.

Further services could be rendered by employment of part-time or shared dietitians by institutions providing care to the aged in a given community.

Further development of ways and means to feed the aged who are unable to do so themselves because of physical restrictions or financial limitations is needed. Programs such as Meals on Wheels have great potentialities. It has been suggested that group feeding similar to the school-lunch program could be considered. It seems highly probable that the present school-lunch facilities could be used as a basis for this service.

Further committee and project work could be undertaken to determine food habits of the aged and this information used as a basis for community action. A survey of activities by members would assist in an evaluation of kinds of assistance now being given and would point the way to other areas in which dietitians and nutritionists could work.

The association could more pointedly indicate the responsibility each member has to contribute to community programs for the aged. Perhaps more emphasis could be given to the nutrition of the aged in programs at local and State association levels.

(c) The specific problems of aging as you see them out of your own organizational experience

(1) Less interest in food is shown by persons living alone.

(2) Many aged individuals live alone in one room with limited facilities for cooking.

(3) Many aged individuals cannot or do not know how to get the best return for their food dollar. Additional problem is that of shopping.

(4) Lack of understanding and interpretation of therapeutic diets prescribed by physicians.

(5) Institutions for the aged frequently do not feed their patients and residents food that will meet the recommended nutrition standards of the Food and Nurition Board of the National Research Council.

(6) Institutions frequently serve the evening meal so early that patients and residents are often hungry before the next meal.

(7) Institutions are restricted in their purchase of food because of limited funds.

(8) Nutrition is not always included in programs for the aging inasmuch as this area is not represented on the planning program.

(d) The relative responsibilities of voluntary groups, local committees, the States and Federal Government in meeting these specific problems as you have outlined them

In almost every community where voluntary groups are found there will be professionally qualified dietitians and nutritionists who will be helpful in planning programs for the aged. Their particular contribution and participation will be in nutrition education programs for the older population such as talks, demonstrations, and counseling of diet upon referral by physicians. Nursing homes and homes for the aged would be encouraged to improve nutrition and food service if the State licensing agency would incorporate improved standards in this area in licensing legislation and if they would enforce and interpret these standards in granting licensing.

Nursing home associations could be encouraged to employ a nutritionist or dietitian who would give counseling and consultation service to the homes belonging to the association.

The tate and Federal Governments by supporting and participating in giving refresher programs to homemakers and retired professionally qualified dietitians thus better preparing them to participate more effectively in their own communities, as part time, shared and consultants in nutrition and food service to the aged in his home or institution.

It would seem reasonable for the State and Federal Governments to stimulate activity to extend or increase the consultation service to groups providing nutrition service to the aged.

The nutrition services in State health agencies should be encouraged to develop and to step up their participation in working with the aged.

Senator MCNAMARA. Now from the Friendly Seniors and Unitarian Church, Mrs. Helen Duey Hoffman.

Mrs. Hoffman, since it is rather late and we have gone well past the time when we should adjourn, I am going to ask you this question: Would you like to proceed briefly or would you rather come back at another time when we can give you more time?

STATEMENT OF MRS. HELEN DUEY HOFFMAN, THE FRIENDLY SENIORS OF ALL SOULS CHURCH (UNITARIAN)

Mrs. HOFFMAN. I have already made a statement which is here on the table.

Senator MCNAMARA. You have a prepared statement. We will make your statement part of the record.

(The statement referred to follows:)