Association of post-discharge meal delivery with hospital readmissions among food-insecure older adults.

BACKGROUND: Older adults with food insecurity have higher readmission risk, but evidence on the impact of post-discharge meal delivery remains limited. METHODS: We conducted a retrospective cohort study of adults aged ≥60 discharged home from a single academic health system between September 2022 and April 2024 at risk of food insecurity or malnutrition. Patients were referred to a state-funded Meals on Wheels hospital discharge pilot program providing 2 weeks of home-delivered meals (primary exposure). Outcomes of 14-, 21-, and 30-day unplanned readmissions were assessed using GEE models with a 3-day landmark to exclude early events. Secondary analysis examined categories of time to first meal delivery (≤9 days, 10-14 days, ≥15 days, unknown) compared with no meal delivery. RESULTS: Of 621 unique referrals, 380 referrals (368 patients) met inclusion criteria (mean age 72.4 years, 40.8% male, 62.9% received meals). Meal recipients had lower odds of 14-day (adjusted odds ratio [aOR] 0.31; 95% confidence interval [CI] 0.14-0.69) and 21-day readmission (aOR 0.47; 95% CI 0.23-0.95), with attenuation at 30 days (aOR 0.82; 95% CI 0.44-1.53). Earlier meal delivery (≤9 days) was associated with lower 14-day readmissions (aOR 0.23; 95% CI 0.06-0.81) with attenuation at 21 (aOR 0.37; 95% CI 0.13-1.03) and at 30 days (aOR 0.67; 95% CI 0.29-1.67) compared with No Meals (wide CIs). CONCLUSION: Among food-insecure older adults discharged home, meal receipt, particularly earlier meal delivery, was associated with lower short-term readmissions, with attenuation by 30 days. These findings support the need for prospective evaluation of scalable, low-cost home-delivered meal intervention to reduce readmissions in high-risk, food-insecure adults.