The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Older

Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults' health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities.

Food Insecurity in Older Adults in Canada and the United States: A Concept Analysis

A concept analysis using the method of Walker and Avant was undertaken to clarify the concept of food insecurity in older adults in Canada and the United States. A literature review was undertaken to conduct a concept analysis of food insecurity in older people. Food insecurity is associated with multiple negative health outcomes and may be experienced differently by older adults as compared to younger adults. It is therefore important to understand the concept of food insecurity as is relates to older adults. Four defining attributes of food insecurity in older adults in Canada and the United States were identified: (i) inability to acquire or prepare enough food, (ii) compromising on food quality or preference, (iii) uncertainty or anxiety around the ability to acquire or prepare food, and (iv) socially unacceptable or non-normative practices. These attributes may allow for improved policies and programs aimed at addressing food insecurity in older adults by better meeting the needs of older individuals. Additional research into food insecurity as experienced by Canadian and American older adults could help to further clarify the concept.

Determinants of food insecurity among elderly people: findings from the Canadian Community Health Survey

Food insecurity among elderly people is a major public health concern due to its association with several health conditions. Despite growing research and implementation of diverse income-based policy measures, food insecurity among elderly people remains a major policy issue in Canada. Additional research could inform food policy beyond strategies that target improving the financial resources of elderly people. Drawing data from the Canadian Community Health Survey (N = 24,930), we explored the correlates of food insecurity among older adults using negative log-log logistic regression techniques. Our findings show that certain categories of elderly people are more prone to food insecurity. These segments include seniors who are visible minorities (OR = 1.29, p < 0.01), live alone (OR = 1.13, p < 0.05), have a very weak sense of community belonging (OR = 1.40, p < 0.001), in poor physical health (OR = 1.20, p < 0.01), and those in lower age and income categories. These findings corroborate previous studies that demonstrate that food insecurity among elderly people is a complex phenomenon influenced by diverse socio-economic factors. In Canada, food security policies targeted at elderly people have largely prioritised poverty alleviation through income support programmes. While these programmes can improve the purchasing power of elderly people, they may not be sufficient in ensuring food security. There is a need to embrace and further investigate an integrated approach that pays attention to other contextual socio-economic dynamics.

Food Insecurity and Aging: A Scoping Study of the Literature

Literature on food insecurity (FI) and aging is limited and scattered across disciplines, the reasons for which include the nascence of the study of "hunger" more generally, and relatively lower rates of FI among older people. This scoping review synthesized and characterized the current research to prompt a more critical examination of food insecurity and aging. Data extraction included reviewing and characterizing the empirical, methodological and conceptual contributions of each study, accessed from selected health sciences and social sciences databases. Thirty-eight studies were included from 2,041 titles. Different methods and operationalizations of FI and age were found to be used across studies. Thematic analysis revealed, with few exceptions, consistent tendencies towards the biomedicalization of the FI issue alongside aging. These findings reinforce the value of population-level monitoring of FI and uptake of standard measures. Moving forward, the issue of FI and aging is an opportune topic for critical social analysis.

Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression

BACKGROUND

Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.

OBJECTIVE

To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults.

DESIGN

The cross-sectional study was conducted from February 2017 to May 2017.

PARTICIPANTS/SETTING

A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated.

MAIN OUTCOME MEASURES

Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form).

STATISTICAL ANALYSES PERFORMED

Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications.

RESULTS

Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04).

CONCLUSIONS

Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.

Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana

BACKGROUND

OBJECTIVES

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana.

DESIGN

A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper.

SETTING

All participants were in the New Orleans metro area and were surveyed in 2011.

PARTICIPANTS

Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older.

MEASUREMENTS

Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping.

RESULTS

Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men.

CONCLUSIONS

FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.

‘It is nice to see someone coming in’: Exploring the Social Objectives of Meals-on-Wheels

Malgré le fait que La Popote roulante a des aspects nutritionnels et sociales, il y a un manque de recherche sur les objectifs sociaux de ce service. Cette étude a pour but de développer une compréhension des objectifs sociaux du programme et d’explorer l’étendue à laquelle ils sont remplis par La Popote roulante en Irlande. Un examen de la littérature a suggéré que potentiellement le service peut répondre à trois objectifs sociaux : (a) offrant des repas aux destinataires avec contact social, (b) aidant à revigorer un intérêt dans les repas en les faisant plus réguliers et (c) aidant à développer l’acceptation du service. Des entrevues ont été menées avec 66 destinataires de repas à explorer ces thèmes et les augmenter si nécessaire. Les résultats de l’étude montrent que les destinataires des repas dérivent du service un contact social limité; que les heures des repas bien reglées n’étaient pas important pour la plupart des destinataires; et même que beaucoup étaient peu disposés à accepter le service.

The relationship between income and food insecurity among Oregon residents: does social support matter?

Objective

Millions of US households experienced food insecurity in 2005. Research indicates that low wages and little social support contribute to food insecurity. The present study aimed to examine whether social support moderates the relationship between income and food insecurity.

Design

Using a mail survey, we collected data on social support sources (social network, intimate partner and community) and social support functions from a social network (instrumental, informational and emotional). We used hierarchical logistic regression to examine the potential moderation of various measures of social support on the relationship between income and food insecurity, adjusting for potential confounding variables.

Setting

Oregon, USA.

Subjects

A stratified random sample of Oregonians aged 18–64 years (n 343).

Results

We found no evidence of an association between social support and food insecurity, nor any evidence that social support acts as a moderator between income and food insecurity, regardless of the measure of social support used.

Conclusions

Although previous research suggested that social support could offset the negative impact of low income on food security, our study did not find support for such an effect.

Participation in health-promoting behaviour: influences on community-dwelling older Chinese people

AIM

This paper reports a study to determine the factors affecting community-dwelling older Chinese people's health-promoting behaviour in the domains of physical activity, healthy dietary practices and stress management, and to identify any barriers to these behaviours.

BACKGROUND

Previous studies have identified factors affecting different types of health-promoting behaviours, including perceived self-efficacy, perceived benefits and five individual characteristics (age, sex, marital status, education and perceived health) of older non-Chinese people. However, few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people's health-promoting behaviour.

METHOD

Individual face-to-face interviews were completed in 2002-2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 (years mean 76). Participants had no apparent communication and cognition impairments. A structured interview schedule was used to collect the data.

RESULTS

Multiple regression analysis showed that perceived self-efficacy, perceived benefits and sex together explained 38.4% of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong. Fatigue during and after physical activity, enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour.

CONCLUSION

When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers, community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour. Future studies should include more critical factors based on theories, empirical evidence and knowledge of culture with samples that are random and from more diverse community settings.

Tailoring Nutrition Education Intervention Programs to Meet Needs and Interests of Older Adults

Methods for determining appropriate content of older adult nutrition education intervention programs and strategies for effectively delivering nutrition messages to older learners are presented. Educators can determine the nutrition education needs and interests of their older learners by using results of food intake surveys and assessment screening tools, written surveys, interviews and group discussions. Findings of recent reports using these methods are summarized. Additionally, published experiences with and suggestions for tailoring education intervention programs for older adult audiences, including those of particular racial/ethnic groups, are reviewed. The need for research in this area is presented. This article is one of a series of literature reviews of topics related to nutrition education for older adults.