The association of the Korean Healthy Eating Index with chronic conditions in middle-aged single-person households

BACKGROUND/OBJECTIVES

This study investigated the association between dietary quality based on the Korean Healthy Eating Index (KHEI), and the prevalence of chronic conditions among middle-aged individuals (40-60 ys of age) living alone.

MATERIALS/METHODS

The participants were selected (1,517 men and 2,596 women) from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018 and classified into single-person households (SPH) and multi-person households (MPH). Nutrient intake, KHEI, and the prevalence of chronic conditions were compared according to household size. The odds ratios (ORs) of chronic conditions were analyzed according to the tertile levels of KHEI by gender within each household size category.

RESULTS

Men in SPH had a significantly lower total KHEI score (P < 0.0001) and a lower prevalence of obesity (OR, 0.576) than those in MPH. For men, the adjusted ORs for obesity, hypertension, and hypertriglyceridemia in the first tertile (T1) of KHEI scores within SPH compared with the third tertile (T3) were 4.625, 3.790, and 4.333, respectively. Moreover, the adjusted OR for hypertriglyceridemia in the T1 group compared to the T3 group within the MPH was 1.556. For women, the adjusted ORs for obesity and hypertriglyceridemia in T1 compared to T3 within the SPH were 3.223 and 7.134, respectively, and 1.573 and 1.373 for obesity and hypertension, respectively, within MPH.

CONCLUSIONS

A healthy eating index was associated with a reduced risk of chronic conditions in middle-aged adults. Greater adherence to a healthy eating index could lower the risk of chronic conditions in middle-aged adults living alone.

Older Adults and the Food Security Infrastructure

This project explores the correlates of state variation in food security using data from the 2008 to 2018 Current Population Survey's Food Security Supplements. The focus is on the relationship between state-level availability and accessibility of congregate and home-delivered meal programs, the Supplemental Nutrition Assistance Program (SNAP), the Senior Farmer's Market Nutrition Program (SFMNP) and the Commodity Supplemental Food Program (CSFP) on food security among lower-income households headed by older adults (ages 60 and up). Results show evidence that a senior-specific state level food security infrastructure plays a role in the food security status of households headed by older adults.

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.

Navigating Infodemics, Unlocking Social Capital and Maintaining Food Security during the COVID-19 First Wave in the UK: Older Adults' Experiences

In March 2020, a national UK lockdown was implemented in response to rapidly rising COVID-19 infections. Those experiencing the most severe public health restrictions were ‘shielding’ groups as well as those over 70 years of age. Older age adults, many of whom were active, independent, and socially connected were immediately instructed to stay at home, to limit all external social contact and consider contingency for maintaining personal food security and social contact. The purpose of this qualitative study was to explore the experiences of older adults during the first UK lockdown (March–June 2020), specifically how our sample reacted to public health messaging, staying food secure and drawing on available social capital within their community. Semi-structured telephone interviews were conducted with eight participants. In addition, twenty-five participants completed a qualitative ‘open-ended’ survey. The data was collated and analysed, adopting a Thematic Analysis informed approach. Three themes were identified: (1) Too Much Information, (2) The Importance of Neighbours and Connections and (3) Not Wishing to be a Burden. These findings offer a rich insight into how early lockdown measures, never witnessed since World War 2, exposed existing pre-pandemic inequalities and concerns relating to loneliness, isolation and wellbeing. The findings are of relevance to researchers, older adult advocate groups and policy makers to inform post COVID-recovery within communities to ensure healthy ageing.

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.

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review

Participation in home-delivered meals programs may contribute to the health and independence of older adults living in the community, especially those who are food insecure or those who are making transitions from acute, subacute, and chronic care settings to the home. The purpose of this study was to conduct a comprehensive and systematic review of all studies related to home-delivered meals in order to shed light on the state of the science. A complete review of articles appearing in PubMed using the keyword "Meal" was conducted; and titles, abstracts, and full-texts were screened for relevance. Included in this review are 80 articles. Most studies are descriptive and do not report on outcomes. Frequently reported outcomes included nutritional status based on self-reported dietary intake. Additionally, most studies included in this review are cross-sectional, have a small sample size, and/or are limited to a particular setting or participant population. More rigorous research is needed to (1) gain insight into why so few eligible older adults access home-delivered meals programs, (2) support expansion of home-delivered meals to all eligible older adults, (3) better identify what home-delivered meals models alone and in combination with other services works best and for whom, and (4) better target home-delivered meals programs where and when resources are scarce.

Predictors of Food Insecurity among Older Adults in the United States

OBJECTIVE

Food insecurity among U.S. households is a national concern. Since 2010, the U.S. Healthy People goal has been to reduce food insecurity to 6%. Despite this goal, 14.5% of households remained food insecure in 2013 (U.S. Department of Agriculture). The purpose of this study was to examine the antecedents of food insecurity among older adults through the lens of the social ecological model.

DESIGN AND SAMPLE

This retrospective cross-sectional study utilized secondary data from the National Health and Nutrition Examination Survey (NHANES) from the years 2007 and 2008 from a sample that included 2,045 adults 60 years of age and older.

MEASURES

Variables related to the constructs of the social ecological model were examined using descriptive, chi-square, and logistic regression analyses.

RESULTS

Analyses of the model indicated that the severity of depression, reports of financial support, and having ever received household food stamp benefits had statistically significant main effects on food insecurity among older adults.

CONCLUSIONS

The study findings have implications for nursing practice, education, and research and could facilitate the development of screening methods, interventions, and policy evaluation that focus on food insecurity at multiple spheres of influence among the targeted population.

Indicators of material hardship and depressive symptoms among homebound older adults living in North Carolina

This study used the concept of material hardship to understand how unmet needs related to food, housing, and health influence depressive symptoms among homebound older adults (N = 345) in North Carolina. Using data from the Nutrition and Function Study, 37% reported high levels of depressive symptoms and 17.4% indicated not receiving needed health care. Approximately 10% of respondents were food insecure; 30.7% were at risk for food insecurity; and 39.7% reported having to choose between either food and medication or food and paying bills. Adjusted logistic regression model revealed that food insecurity status (OR = 4.9) and age 60-74 y (OR = 2.4) were significantly associated with a greater number of depressive symptoms. Other indicators of material hardship, such as having a major financial difficulty, unmet health need, and inadequate housing, were not significant. By far, food insecurity was the most salient influence on depressive symptoms. These findings have important implications for service providers, researchers, and policymakers.

Food security of older adults requesting Older Americans Act Nutrition Program in Georgia can be validly measured using a short form of the U.S. Household Food Security Survey Module

Food security is a newly recommended outcome measure for the Older Americans Act Nutrition Program (OAANP); however, it is unknown how best to evaluate the need for this program and assess its impact on a large scale. Therefore, we measured food security in all new OAANP participants and waitlisted applicants in Georgia between July and early November, 2008 (n = 4731) with the self-administered mail survey method used in the ongoing Georgia Performance Outcomes Measures project. We used a modified 6-item U.S. Household Food Security Survey Module (HFSSM) with a 30-d reference period and 2 reminder postcards. Approximately 33% of those identified completed the survey (n = 1594, mean age 74.6 ± 9.5 y, 68.6% female, 30.6% black). Most of the respondents (91%) completed all 6 food security questions, whereas 26 did not respond to any question. Infit and outfit statistics for each of the 6 questions were within an acceptable range. Psychometric properties observed in our food security data were generally similar to those in the nationally representative survey conducted by the Census Bureau and suggest that our food security statistics may be meaningfully compared with national food security statistics published by the USDA. Our findings suggest that food security can be reasonably measured by a short form of HFSSM in older adults requesting OAANP. Such methodology also can be used to estimate the extent of food insecurity and help guide program and policy decisions to meet the nutrition assistance needs of vulnerable older adults.

Food insecurity, food and nutrition programs, and aging: experiences from Georgia

Food insecurity and hunger are real and growing problems in the United States. Among older adults, the prevalence of food insecurity is at a 14-year high and occurred in more than 8% of households with older adults in 2008 according to USDA. However, the rate is at least 10% higher when less severe degrees of food insecurity are considered. Emerging research suggests that several segments of the older adult population are particularly vulnerable to food insecurity, including those receiving or requesting congregate meals, home-delivered meals, and other community-based services. Thus, national and state estimates of food insecurity may obscure problems in specific subgroups of older adults. Older adults are at high risk of chronic health problems that can be exacerbated by food insecurity, poor nutritional status, and low physical activity. To help improve targeting of food and nutrition programs to those most in need because of food insecurity and/or nutrition-related chronic health problems, the purposes of this review are (1) to define the prevalence and consequences of food insecurity; (2) to discuss the outcomes of some food, nutrition, disease prevention, and health promotion programs targeted to older adults in Georgia, the state with the 3rd highest prevalence of food insecurity; and (3) to make recommendations for research, service, and advocacy related to monitoring and alleviating food insecurity and related health problems in older adults.

Physical limitations contribute to food insecurity and the food insecurity-obesity paradox in older adults at senior centers in Georgia

The purpose of this study was to explore the relationship of obesity and physical limitations with food insecurity among Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 621, median age = 76 years, 83% female, 36% Black, and 64% White, convenience sample). Food insecurity was assessed using the modified 6-item US Household Food Security Survey Module; obesity was defined as Body Mass Index (BMI) or waist circumference (WC) class I or II obesity; and physical limitations (arthritis, joint pain, poor physical function, weight-related disability) were based on the Disablement Process. A series of multivariate logistic regression models found weight-related disability and obesity (WC class II) may be potential risk factors for food insecurity. Thus, obesity and weight-related disability may be risk factors to consider when assessing the risk of food insecurity and the need for food assistance in this vulnerable subgroup of older adults.

Unmet Needs for the Older Americans Act Nutrition Program

This study documents the size of unmet needs for Older Americans Act Nutrition Program (OAANP) and characteristics of program participants and waitlisted people based on the data from the Georgia client database systems. About 60% of those who requested the OAANP service between July and early November, 2008 ( n = 4,952) were on waitlists. Waitlisted people, especially those on the Home-Delivered Meals (HDM) waitlist, were more likely to report poorer sociodemographic characteristics, poorer self-reported health status, food insecurity, and nutritional risk. Requesting HDM was the foremost significant factor associated with unmet needs. Other race/not disclosing race information and living alone also increased the odds of being on the waitlists. There is a critical unmet need for the OAANP in Georgia, especially among those targeted by the Older Americans Act and requesting HDM. Federal and state policy makers, administrators, and program providers should better understand and meet the need of nutritionally vulnerable older Georgians.

Area agencies on aging: a community resource for patients and families

This article presents an overview of the Older Americans Act (OAA) so that home health clinicians may become more knowledgeable about this healthcare legislation. The OAA was passed in 1965 and has evolved significantly over time. The purpose of the OAA is to help older adults maintain their highest level of functional activity to remain in their homes as long as possible. Embedded within the OAA are key programs and services for older adults called Area Agencies on Aging (AAAs). It is vital that home health clinicians understand how the AAAs can help their patients and families. This article educates clinicians about the available services that AAAs have to offer.