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

Abstract 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.