Nutrition Needs Survey

Almost one in every 12 seniors above 60 is considered food insecure. Nutrition plays a major role in the quality of life for an aging adult, including physical, mental and social health. The Jayhawk Area Agency on Aging is conducting this survey in our three county planning and service area (Jefferson, Douglas, and Shawnee) to determine prevalence of food insecurity for seniors and assist with development of programs and services related to the nutrition needs of individuals age 60 and older. Your responses are confidential and only group data will be reported.

Question Title

* 1. Please respond yes or no

	Yes	No
Do you eat less than 2 meals daily?	Do you eat less than 2 meals daily? Yes	Do you eat less than 2 meals daily? No
Do you eat less than 2 servings of fruits and vegetables daily?	Do you eat less than 2 servings of fruits and vegetables daily? Yes	Do you eat less than 2 servings of fruits and vegetables daily? No
Do you eat less than 2 servings of dairy products (milk, cheese, yogurt, etc.) daily?	Do you eat less than 2 servings of dairy products (milk, cheese, yogurt, etc.) daily? Yes	Do you eat less than 2 servings of dairy products (milk, cheese, yogurt, etc.) daily? No
Do you usually drink less than 6 glasses of water, milk, or juice daily?	Do you usually drink less than 6 glasses of water, milk, or juice daily? Yes	Do you usually drink less than 6 glasses of water, milk, or juice daily? No
Do you drink 3 or more alcoholic beverages daily?	Do you drink 3 or more alcoholic beverages daily? Yes	Do you drink 3 or more alcoholic beverages daily? No
Do you take 3 or more different prescriptions and/or over-the-counter drugs daily?	Do you take 3 or more different prescriptions and/or over-the-counter drugs daily? Yes	Do you take 3 or more different prescriptions and/or over-the-counter drugs daily? No
Do you have problems with dentures, teeth, or mouth, which make it hard to eat?	Do you have problems with dentures, teeth, or mouth, which make it hard to eat? Yes	Do you have problems with dentures, teeth, or mouth, which make it hard to eat? No
Have you made changes in the kind and/or amount of food you eat because of an illness and/or condition?	Have you made changes in the kind and/or amount of food you eat because of an illness and/or condition? Yes	Have you made changes in the kind and/or amount of food you eat because of an illness and/or condition? No
Are you physically not always able to grocery shop, cook, and/or feed yourself?	Are you physically not always able to grocery shop, cook, and/or feed yourself? Yes	Are you physically not always able to grocery shop, cook, and/or feed yourself? No
Do you eat alone most of the time?	Do you eat alone most of the time? Yes	Do you eat alone most of the time? No
Do you usually not have enough money to buy the food you need?	Do you usually not have enough money to buy the food you need? Yes	Do you usually not have enough money to buy the food you need? No
Have you unintentionally gained or lost more than 10 pounds in the last 6 months?	Have you unintentionally gained or lost more than 10 pounds in the last 6 months? Yes	Have you unintentionally gained or lost more than 10 pounds in the last 6 months? No
Do you consider yourself home-bound? Meaning it is a taxing effort to leave your home.	Do you consider yourself home-bound? Meaning it is a taxing effort to leave your home. Yes	Do you consider yourself home-bound? Meaning it is a taxing effort to leave your home. No
Do you live alone?	Do you live alone? Yes	Do you live alone? No

Question Title

* 2. Is cost an issue in choosing overall food options?

Yes

Question Title

* 3. In the last 12 months have you ever cut the size of your meals or skipped meals due to not having enough money for food?

Yes