Older Adults Living With Food Insecurity: The Impact on Psychological Health

Abstract Food insecurity (FI) refers to inadequate access to nutritious foods, either in terms of quality or quantity. In older adults, FI is associated with functional impairment, isolation, financial vulnerability, lower quality of life, and poorer health (e.g., diabetes, cardiovascular disease; Fernandes, et al). The effects of FI on psychological health broadly, however, have not been well-documented among older adults. This study sought to examine the impact of FI severity on psychological health indices among older adults. Older adult clients of local food pantries completed self-report measures of FI severity, worry, internalized weight stigma, trauma history, and eating disorder (ED) symptoms/behaviors. Participants (N=124, aged 66+) included: 68.5% women, 67.7% Hispanic, 75.8% □high school education, 51.0% household income < $10,000/year. Controlling for gender in all analyses, results indicated that FI severity predicted increased worry (p < .001, 21.9% variance), greater internalized weight stigma (p = .04, 3.9% variance), and a trend for increased risk for lifetime traumatic event exposure (OR = 1.4, 95% CI [.98, 2.01]). Regarding ED symptoms, male gender (OR = 6.60, 95% CI [1.96, 22.23] and higher FI severity predicted risk for self-induced vomiting in the past month (OR = 2.5, 95% CI [1.15, 5.36], risk for laxative/diuretic use for weight control (OR = 2.16, 95% CI [1.03, 4.52], and greater dietary restraint (p < .001, 16.1% variance). Male gender was associated with higher risk for binge eating in the past month (OR = 3.19, 95% CI [1.10, 9.24], while FI severity was not. Implications will be discussed.

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Predictors of Food Insecurity Before and During COVID-19 Among Middle-Aged and Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.3420 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 956-956

Author(s):

Emily Nicklett ◽

Jianjia Cheng

Keyword(s):

Older Adults ◽

Food Security ◽

Food Insecurity ◽

Repeated Measures ◽

Community Dwelling ◽

Future Research ◽

Median Income ◽

Middle Aged ◽

Increased Risk ◽

The Impact

Abstract The indirect impact of COVID-19 on food security of middle aged and older adults is not well understood. This study examines changes in risk factors for food security from 2018-2020 in a population-based sample. Using data from the Health and Retirement Study (2018 and 2020 waves), we utilized generalized estimating equations (GEE) with repeated measures to examine factors associated with food insecurity among US adults aged 50 and older (n=3170) before COVID-19 and since COVID-19. The prevalence of food insecurity doubled from 2018 (4.83%) to 2020 (9.54%). In multivariate analyses, the population-averaged odds of experiencing food insecurity was 81% higher in 2020 compared to 2018. Other factors significantly associated with higher odds of food insecurity included being female (OR: 1.29), Black (OR: 1.46), lowest quintile for wealth (OR: 1.82), not working due to a disability (OR: 3.29), renting (OR: 2.04), greater IADL limitations (OR: 1.32), and greater number of chronic illness comorbidities (OR: 1.14). Factors significantly associated with lower odds of food insecurity included older age (65-74: OR: 0.73; 75+: OR: 0.56) and being above the median income level (OR: 0.47). Partnership status, education level, and ADL limitations were not significantly associated with the population-averaged odds of experiencing food insecurity. This study identified factors related to food insecurity among a community-dwelling sample of middle aged and older adults in the U.S. Future research should examine the impact of policies and intervention strategies to address the disproportionate impact of COVID-19 on populations at increased risk of experiencing food insecurity.

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The Impact of Poor Nutrient Intakes and Food Insecurity on the Psychological Distress among Community-Dwelling Middle-Aged and Older Adults during the COVID-19 Pandemic

Nutrients ◽

10.3390/nu13020353 ◽

2021 ◽

Vol 13 (2) ◽

pp. 353

Author(s):

Nurul Fatin Malek Rivan ◽

Hanis Mastura Yahya ◽

Suzana Shahar ◽

Devinder Kaur Ajit Singh ◽

Norhayati Ibrahim ◽

...

Keyword(s):

Older Adults ◽

Psychological Distress ◽

Food Insecurity ◽

Psychological Health ◽

General Health Questionnaire ◽

Peninsular Malaysia ◽

Community Dwelling ◽

Middle Aged ◽

Telephone Interviews ◽

The Impact

This study aimed to investigate the impact of food insecurity and poor nutrient intake on the psychological health of middle-aged and older adults during the COVID-19 pandemic. A sub-sample of 535 individuals aged 52 years and above, from the earlier cohort and interventional studies (n = 4) from four selected states in Peninsular Malaysia, were recruited during the COVID-19 outbreak (April to June 2020). Telephone interviews were conducted by trained interviewers with a health sciences background to obtain participants’ information on health status, physical activity, food security, and psychological health (General Health Questionnaire-12; normal and psychological distress). Univariate analyses were performed for each variable, followed by a logistic regression analysis using SPSS Statistics version 25.0. Results revealed food insecurity (OR = 17.06, 95% CI: 8.24–35.32, p < 0.001), low protein (OR = 0.981, 95% CI: 0.965–0.998, p < 0.05), and fiber intakes (OR = 0.822, 95% CI: 0.695–0.972, p < 0.05) were found to be significant factors associated with the psychological distress group after adjusting for confounding factors. The findings suggested that food insecurity and insufficiencies of protein and fiber intakes heightened the psychological distress during the COVID-19 pandemic. Optimal nutrition is vital to ensure the physical and psychological health of the older population, specifically during the current pandemic.

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THE IMPACT OF FOOD INSECURITY ON THE HEALTH AND WELL-BEING OF OLDER ADULTS: THE GROUPS MOST AT RISK

Innovation in Aging ◽

10.1093/geroni/igz038.2705 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S738-S738

Author(s):

Lauren E Popham ◽

Erin McGovern

Keyword(s):

Older Adults ◽

Food Insecurity ◽

Prescription Drugs ◽

Low Income ◽

Well Being ◽

National Council ◽

Assistance Program ◽

Increased Risk ◽

Nutrition Assistance ◽

The Impact

Abstract Older adults who experience food insecurity (4.6 million) often have worse health outcomes. Food insecure older adults consume less nutrients, which puts them at greater risk of developing chronic diseases. They are at increased risk of falls due the impact of poor nutrition on muscle mass, bone density, and balance. Low-income older adults are often forced to choose between buying groceries and paying other bills. The Supplemental Nutrition Assistance Program (SNAP) plays an important role in reducing food insecurity. SNAP enables older adults to buy the nutritious food they need, while freeing up resources to pay for everyday things to meet their health needs such as prescription drugs. Research shows that medication adherence increases when low-income older adults enroll in SNAP. Despite the beneficial impact of enrolling in SNAP, it’s estimated that 55% of eligible adults age 60 and older are not participating in this critical program. To understand which older adults are missing out on SNAP, the National Council on Aging engaged researchers at Leading Age LTSS Center at UMass Boston to analyze data from the 2014 Health and Retirement Study. The results show that some of the most vulnerable older adult populations are less likely to participate in SNAP even though they are eligible (i.e., Hispanic, age 75 and older, those who are not utilizing healthcare, etc.). The findings suggest that more targeted outreach to these groups is needed to ensure that the most vulnerable populations of older adults access this critical benefit.

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Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

BMC Psychiatry ◽

10.1186/s12888-021-03257-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

T. Muhammad ◽

Shobhit Srivastava ◽

T. V. Sekher

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Psychological Health ◽

Daily Living ◽

Basic Needs ◽

Well Being ◽

Asset Ownership ◽

Increased Risk

Abstract Background Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. Methods Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. Results About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21–1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72–0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. Conclusion The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

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Food Insecurity in the United States: Identification, Treatment, and Implications

Innovation in Aging ◽

10.1093/geroni/igaa057.2791 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 772-773

Author(s):

Rose Ann DiMaria-Ghalili ◽

Connie Bales ◽

Julie Locher

Keyword(s):

United States ◽

Older Adults ◽

At Risk ◽

Food Insecurity ◽

Well Being ◽

The United States ◽

Health Clinic ◽

High Risk Population ◽

Geriatric Syndrome ◽

The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

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The Science of Ageism: Two Steps Forward, One Step Back

Innovation in Aging ◽

10.1093/geroni/igaa057.2222 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 646-646

Author(s):

Jerin Lee ◽

Natalie Shook

Keyword(s):

Psychological Health ◽

Well Being ◽

Census Bureau ◽

Complex Nature ◽

The Past ◽

Growing Pains ◽

Research Findings ◽

One Step ◽

Prejudicial Attitudes ◽

The Impact

Abstract The past two decades have been marked by a rapidly aging population in the U.S. (U.S. Census Bureau, 2018), making prejudicial attitudes toward older adults (i.e., ageism) and the impact of such attitudes more relevant. As such, ageism researchers have worked tirelessly to not only understand this normalized and insidious form of bias, but also develop efforts to combat it. This symposium will feature four ageism researchers who will showcase both the growing pains and novel contributions of ageism research, ranging from the impact of ageism on psychological health to ageism interventions to issues related to the measurement of ageism. Specifically, Dr. Ayalon will present findings regarding difficulties with the assessment of exposure to ageism and the consequences of ageism for psychological well-being. Dr. Horhota will share research demonstrating challenges associated with confronting ageism. Dr. Levy will present a model showcasing factors associated with the reduction of ageism. Ms. Lee will discuss research findings examining the construct validity of several ageism measures. These talks highlight theoretical and real-world implications associated with the complex nature of ageism, providing important directions for enriching ageism research going forward.

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What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol

BMJ Open ◽

10.1136/bmjopen-2021-049974 ◽

2021 ◽

Vol 11 (6) ◽

pp. e049974

Author(s):

Luciana Pereira Rodrigues ◽

Andréa Toledo de Oliveira Rezende ◽

Letícia de Almeida Nogueira e Moura ◽

Bruno Pereira Nunes ◽

Matias Noll ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Study Protocol ◽

Average Length ◽

Length Of Hospital Stay ◽

Case Control Studies ◽

Cross Sectional ◽

Increased Risk ◽

Review Study ◽

The Impact

IntroductionThe development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission.Methods and analysisA systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case–control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems.Ethics and disseminationEthical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete.PROSPERO registration numberCRD42021229328.

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Food Insecurity and Dietary Quality in Older Adults: Do Nutrition Assistance Programs Play a Protective Role?

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_007 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1379-1379

Author(s):

Nicholas Bishop ◽

Sarah Ullevig ◽

Krystle Zuniga ◽

Kaipeng Wang

Keyword(s):

Older Adults ◽

Food Insecurity ◽

Healthy Eating Index ◽

Dietary Quality ◽

Linear Modeling ◽

Assistance Programs ◽

Supplemental Food ◽

Nutrition Assistance ◽

Nutrition Assistance Programs ◽

The Impact

Abstract Objectives The emergence of food insecurity as a primary nutrition-related health issue among older adults suggests a need to examine how nutritional assistance programs are related to food insecurity and dietary quality in aging populations. This project examines food insecurity and dietary quality in US adults age 65 and older and the impact of nutrition assistance programs. Methods The sample was drawn from the 2012 Health and Retirement Study and 2013 Health Care and Nutrition Study and included 3779 respondents representing a population of 37,217,566 adults aged 65 and older. Food insecurity was a binary measure based on the USDA six-item US Adult Food Security Survey Module. Two forms of nutritional assistance included receipt of supplemental food from sources such as food banks and Meals-on-Wheels (1 = yes, 0 = no) and reported receipt of SNAP benefits (1 = yes, 0 = no). Dietary quality was measured using the Alternative Healthy Eating Index-2010 based on a food frequency questionnaire. General linear modeling adjusting for covariates and complex sampling design was used to test if nutritional assistance moderated the association between food insecurity and AHEI-2010. Results Around 10% of the sample was food insecure, 14% reported receipt of supplemental food, and 6.4% were SNAP benefit recipients. In covariate-adjusted models, food insecurity and receipt of SNAP benefits were not associated with AHEI-2010, but receipt of supplemental food was (b = −1.39, SE = 0.67, P = 0.038). Receipt of supplemental food moderated the association between AHEI-2010 and food insecurity (P = 0.001). Simple effect estimates suggested that among those not receiving supplemental food, the food insecure had lower AHEI-2010 scores than the food secure (b = −2.15, SE = 0.88, P = 0.014). Among those receiving supplemental food, the food insecure had greater AHEI-2010 scores than the food secure (b = 2.62, SE = 1.25, P = 0.035) and similar AHEI-2010 scores as the food secure not receiving supplemental food. Conclusions Preliminary analysis suggests that receipt of supplemental food appears to be associated with better dietary quality among food-insecure older adults and confirms the importance of food assistance programs in combating the negative effect of food insecurity on dietary quality. Funding Sources This work is supported by the Texas State University Research Enhancement Program.

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Dual Effects of Hearing Loss and Dementia on Functional Limitations in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.690 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 214-214

Author(s):

Michael McKee ◽

Yunshu Zhou ◽

Joshua Ehrlich ◽

Elham Mahmoudi ◽

Jennifer Deal ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Self Care ◽

Household Activity ◽

Cross Sectional ◽

Age Related ◽

Increased Risk ◽

Lower Mobility ◽

Independent Effects ◽

The Impact

Abstract Age-related hearing loss (HL) is both common and associated with elevated risk for cognitive decline and poorer health. To care for an aging population, it is critical to understand the effect of coexisting HL and dementia on functional activities. The effect of co-existing dementia and self-reported HL on daily functioning were assessed. A cross-sectional analysis was performed using nationally-representative data from the 2015 National Health and Aging Trends Study consisting of U.S. adults 65+. The sample included 1,829 adults with HL (22.8%) and 5,338 adults without HL. Multivariable Poisson regression was used to model the independent effects and interaction of self-reported HL and dementia status on three validated functional activity scales (self-care, mobility, and household). All analyses adjusted for sociodemographic and medical factors. HL participants were more likely to be white, older, male, less educated (p <0.01). 8.4% had possible dementia and 6.5% had probable dementia. Respondents with HL or possible or probable dementia had significantly lower mobility, self-care, and household activity scores (p<.001 for all comparisons) compared to their peers. A small yet significant interaction was present in all models, suggesting that HL respondents with co-occurring dementia had lower mobility, self-care, and household activity scores than predicted by the independent effects of dementia and self-reported HL (p<.001 for all comparisons). Older adults with co-occurring dementia and HL are at increased risk for poor functioning and should be screened by healthcare providers. Future work should consider the impact of intervention in this vulnerable/at-risk population.

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Assessing Barriers to Medication Adherence in Pediatric and Adolescent and Young Adult (AYA) Patients on Anticoagulation

Blood ◽

10.1182/blood-2020-139660 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 9-10

Author(s):

Kevin E Todd ◽

Meghan E Mcgrady ◽

Anne Blackmore ◽

Carrie Hennessey ◽

Lori Luchtman-Jones

Keyword(s):

Young Adults ◽

Linear Regression ◽

Medication Administration ◽

Self Report ◽

Adolescent And Young Adult ◽

The Past ◽

Children And Young Adults ◽

The Impact ◽

The Relationship ◽

Lower Adherence

Background: Medication nonadherence rates as high as 50-75% have been widely reported in children and adolescents with chronic medical conditions. Anticoagulation nonadherence is associated with increased morbidity and mortality from hemorrhagic and thrombotic complications, reported mostly in older adult populations. As direct oral anticoagulant use increases, it is critical that pediatric clinicians understand the prevalence, adverse sequelae, and predictors of nonadherence for various anticoagulants prescribed for children and young adults to facilitate self-management in this population. To begin to address these critical knowledge gaps, this study explored the frequency of reported barriers to anticoagulation adherence and the relationship between reported barriers and adherence among a cohort of children and young adults who were prescribed anticoagulants through a pediatric thrombosis clinic. Methods: Data for this abstract were collected as part of a quality improvement (QI) initiative in the pediatric thrombosis clinic from May 2019 to November 2019. This QI initiative included the administration of a self-report measure which asked families to rate the presence/absence of 19 barriers to adherence and respond to two items assessing adherence ("How many anticoagulation doses did you/your child miss in the past 7 days?"; "Did you/your child miss any anticoagulation doses in the past month?"). Patients aged > 10 years (yr.) and/or their caregivers (for patients 0-17 yr.) visiting the clinic for anticoagulation follow-up completed the measure. With IRB approval, results from 161 anonymous measures from 130 families (n = 37 caregivers; n = 62 patients; n = 31 patient/caregiver dyads) were analyzed. Descriptive statistics were used to summarize the most frequent barriers, rates of adherence, and concordance of barriers within patient/caregiver dyads. Linear regression was used to explore relationships between barriers and adherence after controlling for medication administration type (injections versus oral). To ensure only one measure per family was included in this analysis, the regression was run on the subset of measures completed by caregivers of children < 18 yr. and patients ≥ 18 yr. (n = 105 [37 caregivers + 62 patients + 31 caregivers from patient/caregivers dyad = 130 families; 130 - 25 families with missing adherence data = 105 families]). Results: Of 161 reporters, 120 reported at least 1 barrier. The most common barriers were medication side effects (n = 44), alterations in lifestyle secondary to medication (n = 44) and forgetting to take the medications (n = 37). The distributions of barriers by reporter and medication type are illustrated in Figure 1. Of 31 dyads, 26 reported 1 or more barriers. Only 6 caregiver/child dyads reported the same set of barriers. The remaining 77% (n = 20) of caregivers endorsed different barriers than their children. On average, patients and caregivers reported 1.85 barriers (SD = 1.95, range 0 - 10) and that they/their child took 96% of prescribed doses (SD= 9%, range = 71 - 100%). The linear regression was significant (F(2, 102) = 4.19, p = 0.02, R2 = 0.08). After controlling for medication type (p = 0.06), a greater number of barriers was significantly associated with lower adherence (t = -2.63, p = 0.01). Every one unit increase in total barriers (1 additional barrier reported) was associated with a decrease of .26% in adherence. Discussion: Although self-reported adherence was high, 75% of patients and caregivers reported 1 or more barriers to adherence. A greater number of barriers is associated with lower adherence, regardless of medication route, suggesting that addressing reported barriers might improve adherence. The spectrum of reported barriers was diverse, differing even within patient and caregiver dyads. Therefore, it is important to evaluate both patients and caregivers to fully assess the burden of barriers. Future studies are needed to evaluate the impact of addressing barriers and the relationship between anticoagulation adherence, barriers, and health outcomes. Figure 1 Disclosures Luchtman-Jones: Corgenix: Other: Provided discounted kits for study; Accriva Diagnostics: Other: Provided kits for study.

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