1
|
Gyasi RM, Aikins E, Hajek A, Opoku-Ware J, Osei BA, Kwabena-Adade J, Jacob L, Rahmati M, Dakurah G, Peltzer K. Cross-sectional association of food insecurity with loneliness in older adults: The role of sex, age, and psychosomatic factors. J Nutr Health Aging 2024; 28:100328. [PMID: 39096770 DOI: 10.1016/j.jnha.2024.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Food insecurity (FI) is a critical social determinant of poor psychosocial health. While data on the specific roles of sex and age in the FI-loneliness link among older adults are limited, the underlying mechanisms are largely unknown. This study examines the age-sex-specific associations of FI with loneliness among older adults in Ghana and quantifies the extent to which psychosomatic factors mediate the association. METHODS We analyzed cross-sectional data from the Aging, Health, Psychological, and Health-seeking Behavior Study in Ghana. The past 30-day FI was assessed using items on hunger and breakfast skipping frequency due to a lack of resources. We assessed loneliness severity with the University of California, Los Angeles 3-item Loneliness Scale. Multivariable OLS regressions and bootstrapping mediation analysis using the Hayes PROCESS macro plug-in were used to evaluate the associations. RESULTS We included 1,201 individuals aged ≥50 years (mean = 62.9 [SD = 11.9]; women = 63.3%). The prevalence of loneliness was 17.7%. The prevalence of moderate and severe FI was 44.0% and 8.5%, respectively. In the adjusted model, greater FI was significantly associated with loneliness severity (B = .22, SE = .029, p < .001). We found significant interactive effects of FI × age (B = -.17, SE = .023, p < .01) and FI × sex (B = -.28, SE = .036, p < .001) on loneliness. Thus, the FI-loneliness link was respectively more marked among women (B = .25, SE = .035, p < .001) and ≥65 age groups (B = .34, SE = .041, p < .001) than men (B = .16, SE = .051, p < .01) and those aged 50-64 (B = .22; SE = .040, p < .001). Finally, comorbid depression/anxiety (41.07%), hopelessness (48.6%), worthlessness (42.1%), functional limitations (8.2%), and pain severity (6.4%) mediated the FI-loneliness association. CONCLUSIONS Age- and sex-specific associations between FI and loneliness exist among older Ghanaians. Addressing FI in concert with psychosomatic problems in older adults may contribute meaningfully to reducing loneliness in later life.
Collapse
Affiliation(s)
- Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya; National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia.
| | - Emelia Aikins
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Jones Opoku-Ware
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Appiah Osei
- Department of Hospitality and Tourism Studies, School of Business, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joana Kwabena-Adade
- Department of General and Liberal Studies, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain; AP-HP, Université Paris Cité, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 75010 Paris, France; Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), 75010 Paris, France
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - George Dakurah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand; Department of Psychology, University of the Free State, Bloemfontein, South Africa; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
2
|
Amoak D, Braimah JA, Agyemang-Duah W, Sano Y, Antabe R, Dassah E. National health insurance enrolment among elderly ghanaians: the role of food security status. BMC PRIMARY CARE 2024; 25:275. [PMID: 39080513 PMCID: PMC11289956 DOI: 10.1186/s12875-024-02535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/19/2024] [Indexed: 08/02/2024]
Abstract
Older people with food insecurity in Ghana are often exposed to poor health conditions, highlighting the importance of the National health Insurance Scheme (NHIS) enrolment for ensuring they receive necessary medical attention through access to health care services. However, we know very little about the association between food insecurity and National Health Insurance Scheme enrolment among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana (i.e., Upper West, Bono, and Greater Accra regions (n = 1,073)). We find that 77% of older adults reported not being enrolled into the NHIS. Results from logistic regression analysis show that older people who experienced severe household food insecurity were less likely to enroll in the National Health Insurance Scheme than those who did not experience any food insecurity (OR = 0.48 p < 0.001). Based on these findings, we argue that in addition to the traditional socioeconomic factors, addressing severe food insecurity may improve health insurance enrolment among older adults. Additionally, policymakers should also consider older people's socioeconomic circumstances when formulating policies for them to enrol in health insurance.
Collapse
Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, University of Western Ontario, London, ON, Canada
| | - Joseph Asumah Braimah
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | | | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, ON, Canada
| | - Roger Antabe
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| |
Collapse
|
3
|
Osei-Owusu C, Dhillon S, Luginaah I. The impact of food insecurity on mental health among older adults residing in low- and middle-income countries: A systematic review. PLoS One 2024; 19:e0301046. [PMID: 38530847 PMCID: PMC10965102 DOI: 10.1371/journal.pone.0301046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Over the past few years, food insecurity has been increasing globally due to the COVID-19 pandemic, climate change, economic downturns and conflict and a number of other intersecting factors. Older adults residing in low- and middle-income countries are more vulnerable to food insecurity. While the impacts of food insecurity on physical health outcomes have been thoroughly researched, the effect on mental health outcomes remains under-researched, especially among older adults. Hence, this systematic review aims to investigate existing literature to assess how food insecurity impacts the mental health of older persons residing in LMICs. A systematic search of six databases and Google for studies was conducted. The search was limited to studies written in English and published between 2000 to the present. We identified 725 studies, out of which 40 studies were selected for a full-text review and 12 studies were included for a final analysis. The significant finding in all the included studies was that food insecurity is associated with the worsening mental health of older adults. We also found a complex interplay of factors such as gender, age, rural/urban and health conditions associated with the aggravation of several mental health outcomes. The findings of this study illuminate the need for improved food programs to improve food security and, consequently, mental health among older adults.
Collapse
Affiliation(s)
- Cornelius Osei-Owusu
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Satveer Dhillon
- Department of Geography and Environment, Western University, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, Ontario, Canada
| |
Collapse
|
4
|
Flores AC, Sarpong C, Dou N, Na M. Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS). Nutr J 2024; 23:25. [PMID: 38414001 PMCID: PMC10898009 DOI: 10.1186/s12937-024-00918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults. METHODS Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes. RESULTS In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance. CONCLUSIONS Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.
Collapse
Affiliation(s)
- Ashley C Flores
- Department of Nutritional Sciences, 108C Chandlee Laboratory, The Pennsylvania State University, University Park, University Park, PA, 16802, USA
| | - Christopher Sarpong
- Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | - Nan Dou
- Department of Nutritional Sciences, 108C Chandlee Laboratory, The Pennsylvania State University, University Park, University Park, PA, 16802, USA
| | - Muzi Na
- Department of Nutritional Sciences, 108C Chandlee Laboratory, The Pennsylvania State University, University Park, University Park, PA, 16802, USA.
| |
Collapse
|
5
|
Alemany M. The Metabolic Syndrome, a Human Disease. Int J Mol Sci 2024; 25:2251. [PMID: 38396928 PMCID: PMC10888680 DOI: 10.3390/ijms25042251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
This review focuses on the question of metabolic syndrome (MS) being a complex, but essentially monophyletic, galaxy of associated diseases/disorders, or just a syndrome of related but rather independent pathologies. The human nature of MS (its exceptionality in Nature and its close interdependence with human action and evolution) is presented and discussed. The text also describes the close interdependence of its components, with special emphasis on the description of their interrelations (including their syndromic development and recruitment), as well as their consequences upon energy handling and partition. The main theories on MS's origin and development are presented in relation to hepatic steatosis, type 2 diabetes, and obesity, but encompass most of the MS components described so far. The differential effects of sex and its biological consequences are considered under the light of human social needs and evolution, which are also directly related to MS epidemiology, severity, and relations with senescence. The triggering and maintenance factors of MS are discussed, with especial emphasis on inflammation, a complex process affecting different levels of organization and which is a critical element for MS development. Inflammation is also related to the operation of connective tissue (including the adipose organ) and the widely studied and acknowledged influence of diet. The role of diet composition, including the transcendence of the anaplerotic maintenance of the Krebs cycle from dietary amino acid supply (and its timing), is developed in the context of testosterone and β-estradiol control of the insulin-glycaemia hepatic core system of carbohydrate-triacylglycerol energy handling. The high probability of MS acting as a unique complex biological control system (essentially monophyletic) is presented, together with additional perspectives/considerations on the treatment of this 'very' human disease.
Collapse
Affiliation(s)
- Marià Alemany
- Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain
| |
Collapse
|
6
|
Neves Freiria C, Arikawa A, Van Horn LT, Pires Corona L, Wright LY. Food Insecurity Among Older Adults Living in Low- and Middle-Income Countries: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnac161. [PMID: 36306201 DOI: 10.1093/geront/gnac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. RESEARCH DESIGN AND METHODS A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM). RESULTS Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2 years and utilized a quantitative approach (n = 38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. DISCUSSION AND IMPLICATIONS Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.
Collapse
Affiliation(s)
| | - Andrea Arikawa
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | - Leslie T Van Horn
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | | | - Lauri Y Wright
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| |
Collapse
|
7
|
Selvamani Y, Arokiasamy P, Chaudhary M. Association between food insecurity and quality of life among older adults (60+) in six low and middle-income countries. Arch Gerontol Geriatr 2023; 114:105079. [PMID: 37247515 DOI: 10.1016/j.archger.2023.105079] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
Food insecurity is a key social determinant of health and nutrition. However, very few studies have examined the association of food insecurity and quality of life outcomes among older adults in low and middle-income settings. In this study, we examine the association of food insecurity with self-rated poor quality of life, low life satisfaction, and WHO quality of life (WHOQol). Nationally representative data from WHO's Study on global AGEing and adult health (SAGE) consisting of 20,026 older adults were analyzed. The association of food insecurity with self-rated poor quality of life and low life satisfaction was assessed using bivariate and multivariate logistic regression analysis. Multivariate linear regression models examine the association between food insecurity and WHOQol score. Pooled data analysis of six countries showed older adults with severe food insecurity were two times more likely to report poor quality of life (OR = 2.49, CI 2.10, 2.96; p < 0.001) and low life satisfaction (OR = 2.36, CI 1.94, 2.87; p < 0.001), respectively. Similarly, older adults with severe food insecurity had 3.60 (CI-4.25, -2.95; p < 0.001) points lower WHO-QoL score than those who are food secure. These results show that the association of food insecurity is statistically significant with all three outcomes of quality of life in all six countries adjusting for sociodemographic and health measures. Public health and social security interventions are important to prevent food insecurity to promote overall wellbeing of the growing older population in low and middle-income countries.
Collapse
Affiliation(s)
- Y Selvamani
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Chennai, 603203, India.
| | - P Arokiasamy
- Policy Department, SESRI, Qatar University, Qatar
| | - Mamta Chaudhary
- School of Health System Studies, Tata Institute of Social Sciences, Mumbai, 400088, India
| |
Collapse
|
8
|
Roy A. Food insecurity and cognitive function in older adults: findings from the longitudinal aging study in India. BMC Psychiatry 2023; 23:640. [PMID: 37653393 PMCID: PMC10472592 DOI: 10.1186/s12888-023-05118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND As we grow older, food insecurity (FI) may have an impact on our cognitive abilities. The study examines the association of FI with the cognitive function of older adults in India. METHODS We have used the data from the first wave of the Longitudinal Ageing Study of India (LASI), with a sample of 27,032 older adults aged 60 years and older. Bivariate analysis and linear regression models with clusters were applied to show the association. The cognitive performance tests include episodic memory, orientation, arithmetic function, executive function, and object naming. RESULTS The mean cognition was 24.2 (range 0-43), while 36.4%, 2.1%, and 6.4% experienced mild, moderate, and severe FI, respectively. After adjustment for potential confounders, mild (β = -0.18, 95% CI: -0.32, - 0.04) and severe (β = -0.52, 95% CI: -0.82, - 0.22) food insecurity was associated with poor overall cognitive performance. Domain-specific differences in cognition, such as memory, orientation, arithmetic function, executive function, and object naming, were also validated by the level of FI. CONCLUSION The finding suggests that FI is associated with a poor level of cognition among older adults, highlighting the need for increasing the coverage and intervention strategies to address FI in India.
Collapse
Affiliation(s)
- Alok Roy
- Department of Geography, Krishnagar Government College, Krishnanagar, West Bengal, 741101, India.
| |
Collapse
|
9
|
Olawa BD. Satisfaction With Children's Achievements and Health Outcomes in a Sample of Community Older Adults in Nigeria. Innov Aging 2023; 8:igad088. [PMID: 38572400 PMCID: PMC10986747 DOI: 10.1093/geroni/igad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 04/05/2024] Open
Abstract
Background and Objectives In most African societies with little or no social welfare services for older adults, many parents regard their children as personal investments and security for the future. As a result, satisfaction with children's achievements may be necessary for older parents' physical and mental health. This study examined the association between satisfaction with adult children's achievements (SACA) and health outcomes (regarding somatic health, self-rated health, anxiety, and depression) in a sample of Nigerian older adults. Research Design and Methods By using the multistage sampling technique in a cross-sectional survey, 465 older adults (mean age = 74.18 ± 9.42) consisting of 294 women were selected from 14 rural communities in a State in Nigeria. Data were collected using validated instruments and analyzed using multiple linear regression and multigroup analyses in SPSS AMOS. Results High SACA was significantly associated with low somatic health problems, positive self-rated health, and low levels of anxiety and depression, even after controlling for sociodemographic factors, children's support, social engagement, and loneliness. Further analyses indicated that the relationship between SACA and depression was only significant in women and more robust in the widowed. Also, SACA was associated with somatic health among the married but not the widowed. The level of children's support was not a significant moderator. Discussion and Implications Parents can experience positive emotions and, consequently, good health from being satisfied with their children's achievements regardless of perceived children's support. Assessing SACA may aid in better diagnoses and formulation of a more effective clinical intervention to improve the well-being of older adults in developing societies.
Collapse
Affiliation(s)
- Babatola Dominic Olawa
- Institute for Gerontology, University of Vechta, Vechta, Lower Saxony, Germany
- Department of Psychology, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria
| |
Collapse
|
10
|
Braimah JA, Agyemang-Duah W, Amoak D, Sano Y, Antabe R, Dassah E. Healthcare seeking behaviour during illness among older adults in Ghana: does food security status matter? BMC Geriatr 2023; 23:327. [PMID: 37231374 DOI: 10.1186/s12877-023-04023-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ghana's growing older adult population raises critical questions regarding healthcare for these older adults. At the same time, food insecurity is high among older adults in Ghana. This underscores the need to investigate the issues of food security and healthcare seeking behaviour among older adults. However, research on the association between food security status and healthcare seeking behaviour among older adults is scant in the Ghanaian context. In this study, we advance the social gerontology literature by examining the association between food security status and healthcare seeking behaviors among older adults. METHODS Using a multi-stage sampling framework, we collected data from a representative sample of older adults across three regions in Ghana. Data were analyzed using logistic regression technique. We determined the significance of the test at a probability value of 0.05 or less. RESULTS Over two-thirds (69%) of respondents did not seek care during their last illness. Additionally, 36% of respondents were severely food insecure, 21% were moderately food insecure, 7% were mildly food insecure, and 36% were food secure. After controlling for theoretically relevant variables, our multivariable analysis revealed a statistically significant association between food security status and healthcare seeking behaviors with older people who are food secure (OR = 1.80, p < 0.01) and mildly food insecure (OR = 1.89, p < 0.05) being more likely to seek healthcare compared with their counterparts who are food insecure. CONCLUSION Our findings highlight the need for sustainable intervention programs to improve food access and health service use among older adults in Ghana and similar contexts.
Collapse
Affiliation(s)
- Joseph Asumah Braimah
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | | | - Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| |
Collapse
|
11
|
Amoak D, Braimah JA, Agyemang-Duah W, Sano Y, Osei-Kye N, Anfaara FW, Antabe R, Dassah E. Understanding the association between unmet dental care needs and household food security status among older people in Ghana. BMC Oral Health 2023; 23:323. [PMID: 37231472 DOI: 10.1186/s12903-023-03019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
The literature recognizes food insecurity as a barrier to access to health care services. However, we know very little about the association between food insecurity and unmet dental care needs among older people in Ghana. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether older people who experienced household food insecurity differently report unmet dental care needs in comparison to their counterparts without any food insecurity. We find that 40% of older adults reported unmet dental care needs. Results from logistic regression analysis show that older people who experienced severe household food insecurity were more likely to report unmet dental care needs, compared to those who did not experience any type of food insecurity, even after accounting for theoretically relevant variables (OR = 1.94, p < 0.05). Based on these findings, we discuss several implications for policymakers and directions for future research.
Collapse
Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | | | | | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, ON, Canada
| | - Nancy Osei-Kye
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Canada
| | - Florence Wullo Anfaara
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Canada
| | - Roger Antabe
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| |
Collapse
|
12
|
Sifunda S, Mbewu AD, Mabaso M, Manyaapelo T, Sewpaul R, Morgan JW, Harriman NW, Williams DR, Reddy SP. Prevalence and Psychosocial Correlates of Diabetes Mellitus in South Africa: Results from the South African National Health and Nutrition Examination Survey (SANHANES-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105798. [PMID: 37239526 DOI: 10.3390/ijerph20105798] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
In South Africa, there are a limited number of population estimates of the prevalence of diabetes and its association with psychosocial factors. This study investigates the prevalence of diabetes and its psychosocial correlates in both the general South African population and the Black South African subpopulation using data from the SANHANES-1. Diabetes was defined as a hemoglobin A1c (HbA1c) ≥6.5% or currently on diabetes treatment. Multivariate ordinary least squares and logistic regression models were used to determine factors associated with HbA1c and diabetes, respectively. The prevalence of diabetes was significantly higher among participants who identified as Indian, followed by White and Coloured people, and lowest among Black South Africans. General population models indicated that being Indian, older aged, having a family history of diabetes, and being overweight and obese were associated with HbA1c and diabetes, and crowding was inversely associated with HbA1c and diabetes. HbA1c was inversely associated with being White, having higher education, and residing in areas with higher levels of neighborhood crime and alcohol use. Diabetes was positively associated with psychological distress. The study highlights the importance of addressing the risk factors of psychological distress, as well as traditional risk factors and social determinants of diabetes, in the prevention and control of diabetes at individual and population levels.
Collapse
Affiliation(s)
- Sibusiso Sifunda
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria 0001, South Africa
| | - Anthony David Mbewu
- School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Musawenkosi Mabaso
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria 0001, South Africa
| | - Thabang Manyaapelo
- Social Science Core, Africa Health Research Institute, Somkhele 3925, South Africa
| | - Ronel Sewpaul
- Public Health, Societies and Belonging, Human Sciences Research Council, Cape Town 8000, South Africa
| | - Justin Winston Morgan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Nigel Walsh Harriman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA 02138, USA
| | - Sasiragha Priscilla Reddy
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth 6031, South Africa
- The Centre for Critical Research on Race and Identity, University of KwaZulu-Natal, Durban 4041, South Africa
| |
Collapse
|
13
|
Aday RH, Wallace JB, Jones SC, Pogacsnik AR, Leifker KF, Kibe-Pea EW. Understanding the Experiences of Food Insecurity in Older Adult Households. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:239-262. [PMID: 35833580 DOI: 10.1080/01634372.2022.2098443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
Food insecurity is a pressing multidimensional problem that negatively impacts the health and well-being of a significant number of the older population. Finding ways to better address nutritional issues among this vulnerable population is vital to their well-being. Using a mixed-methods approach, we conducted semi-structured phone interviews with a representative sample of 434 low-income older adult households in Tennessee. The aim of this study is to assess the prevalence of food insecurity, examine ongoing barriers, and, using qualitative data, to explore the diverse daily experiences older adults face when confronted with a food insecure lifestyle. Based on the USDA Adult 10-Item Household Screening Module, we found that 30% in our sample were designated as marginally, low or very low food secure. Many of those most vulnerable (older women, widowed or divorced, poor health and below the poverty line) constantly struggled with food insecurity. Being food insecure was attributed to limited financial resources, lack of transportation, health limitations, and a poor psychological state. Utilizing food stretching practicing, governmental agencies offering food supplements, family/friends, religious groups and personal resilience were common coping strategies. Implications and recommendations for service providers are offered.
Collapse
Affiliation(s)
- Ronald H Aday
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - J Brandon Wallace
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Sandra C Jones
- Department of Psychology/Aging Studies, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Amber R Pogacsnik
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Kimberly F Leifker
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Eva W Kibe-Pea
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| |
Collapse
|
14
|
Wiesmann D, Goldsmith R, Shimony T, Nitsan L, Keinan-Boker L, Shohat T. Food Insecurity in Israeli Elderly is Associated with Sociodemographic Characteristics, Disability, and Depression: Policy Implications. Curr Dev Nutr 2023; 7:100006. [PMID: 37180079 PMCID: PMC10111608 DOI: 10.1016/j.cdnut.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/26/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Food insecurity (FI) and poor health can turn into a vicious cycle with detrimental effects, especially in the elderly, however, few studies have examined the relationship between FI and health in this age group. Objectives We investigated associations of FI with physical and mental health and health behaviors among community-dwelling elderly. Methods We used nationally representative, cross-sectional data from the 2014-2015 Israel National Health and Nutrition Survey of the Elderly (Rav Mabat Zahav) on FI, sociodemographic characteristics, noncommunicable diseases (NCDs), disability, self-assessed physical, oral, and mental health for 1006 individuals aged ≥65 y. Results FI affected 12.3% of all households with elderly and was significantly higher among late immigrants and Arabs. Bivariate associations of FI with the number of NCDs, depression, disability in all 6 domains (vision, hearing, mobility, self-care, remembering, communication), poor self-assessed physical and oral health, chewing and swallowing problems, feelings of loneliness, insufficient physical activity, and smoking were significant (P < 0.05). In a multivariable logistic regression controlling for population group, household size, age and sex, FI was significantly associated (P < 0.05) with lack of formal education (OR: 6.26; 95% CI: 1.66, 23.65), being in the lowest (OR: 23.56; 95% CI: 3.71, 149.76) or second-lowest (OR: 16.75; 95% CI: 2.68, 104.52) per capita household income quartile, having one (OR: 2.11; 95% CI: 1.05, 4.23) or several disabilities (OR: 4.04; 95% CI: 1.72, 9.45), and having ever been diagnosed with depression (OR: 3.34; 95% CI: 1.35, 8.28). Conclusions FI is associated with physical and mental health problems, multiple disabilities, and loneliness among Israeli elderly. Providing income support could reduce FI, and subsidized congregate and home-delivered meal services could be expanded to meet the needs of elderly with disabilities and counter social isolation. Because low education, disability, and depression are particularly prevalent among the food insecure and vulnerable groups face language barriers, assistance with applications for these services should be increased.
Collapse
Affiliation(s)
| | - Rebecca Goldsmith
- School of Public Health, The Hebrew University in Jerusalem, Ein Karem, Jerusalem, Israel
| | - Tal Shimony
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Lesley Nitsan
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Tamy Shohat
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Amoak D, Braimah JA, Agyemang-Duah W, Kye NO, Anfaara FW, Sano Y, Antabe R. Understanding the Link between Household Food Insecurity and Self-Rated Oral Health in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010121. [PMID: 36612441 PMCID: PMC9819873 DOI: 10.3390/ijerph20010121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 05/31/2023]
Abstract
There is increasing scholarly attention on the role of food insecurity on the health of older adults in sub-Saharan Africa, including Ghana. Yet, we know very little about the association between food insecurity and self-rated oral health. To address this void in the literature, this study uses a representative survey of adults aged 60 or older from three regions in Ghana to examine whether respondents who experienced household food insecurity rated their oral health as poor compared to their counterparts who did not. We found that 34% of respondents rated their oral health as poor, while 7%, 21%, and 36% experienced mild, moderate, and severe food insecurity, respectively. Moreover, the results from the logistic regression analysis showed that older adults who experienced mild (OR = 1.66, p < 0.05), moderate (OR = 2.06, p < 0.01), and severe (OR = 2.71, p < 0.01) food insecurity were more likely to self-rate their oral health as poor, compared to those who did not experience any type of food insecurity. Based on these findings, we discuss several implications for policymakers and directions for future research.
Collapse
Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, ON N6A 5C2, Canada
| | - Joseph Asumah Braimah
- Department of Health and Society, University of Toronto Scarborough, Scarborough, ON M1C 1A4, Canada
| | | | - Nancy Osei Kye
- Department of Gender, Sexuality, and Women’s Studies, Western University, London, ON N6A 5B8, Canada
| | - Florence Wullo Anfaara
- Department of Gender, Sexuality, and Women’s Studies, Western University, London, ON N6A 5B8, Canada
| | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Scarborough, ON M1C 1A4, Canada
| |
Collapse
|
16
|
Selvamani Y, Arokiasamy P. Association between food insecurity and perceived stress among older adults (50+) in six low- and middle-income countries. Aging Ment Health 2022; 26:2339-2347. [PMID: 34617495 DOI: 10.1080/13607863.2021.1985965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES In this study, we assess the relationship between food insecurity andperceived stress among older adults (50+) in six low- and middle-income countries of China, Ghana, India, Mexico, Russia and, South Africa. METHODS Cross-sectional comparative analysis was conducted using nationally representative data from the WHO's Study on global AGEing and adult health survey. Bivariate and multivariate regression analyses examine if food insecurity was associated with perceived stress. We also examined the mediating role of health conditions on the association between food insecurity and perceived stress. RESULTS Across countries, the mean perceived stress score was higher among the older population with food insecurity. Regression analysis showed significant and positive association between food insecurity and perceived stress. Findings from the pooled data of six countries showed, older adults who experienced severe food insecurity (β = 4.05, p < .001) had higher perceived stress scores. The association was statistically significant in India, Russia, South Africa, and Ghana. CONCLUSION Food insecurity showed significant adverse impact on perceived stress among the older population in low- and middle-income countries. Policy measures to reduce household food insecurity are important for improving both mental and physical health conditions of the growing older population in low- and middle-income countries.
Collapse
Affiliation(s)
- Y Selvamani
- Department of Development Studies, Longitudinal Aging Study in India (LASI), International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
| | - P Arokiasamy
- Department of Development Studies, International Institute for Population Sciences (IIPS), Longitudinal Aging Study in India (LASI), Mumbai, Maharashtra, India
| |
Collapse
|
17
|
Wong LY, Francis SL, Genschel U, Arthur A, Xu F, Weidauer L, Monroe-Lord L, Ventura-Marra M, Sahyoun NR, Kendall C. A cross-sectional assessment of food practices, physical activity levels, and stress levels in middle age and older adults' during the COVID-19 pandemic. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-17. [PMID: 35968050 PMCID: PMC9362154 DOI: 10.1007/s10389-022-01742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022]
Abstract
Aim This cross-sectional study examined how the COVID-19 pandemic impacted the food practices, physical activity (PA) levels, and stress levels of aging adults ages 40 years and older from seven states. It also explored to what extent the COVID-19 outcomes were affected by the social determinants of health (SDH). Subject and methods Respondents (n = 1250) completed an online survey. Descriptive statistics were used to analyze the sociodemographic attributes and COVID-19 responses while the multiple llinear regression (MLR) test evaluated to what extent the SDH variables measured were associated with the reported COVID-19 impacts food practices, PA levels, and stress levels. Results Respondents were mostly White (75.9%), married (58.7%), age 60 years and older (61.8%), with a high school education or higher (97.4%). Most of the respondents (85.8%) live in areas that respondents perceived as supportive of health and well-being opportunities for older adults. Nearly one-half of the respondents reported maintaining their pre-pandemic grocery shopping/food buying frequency (44.7%) and PA levels (48.1%). However, 48.6% reported being "somewhat or very stressed" due to the pandemic. Findings revealed that the COVID-19 impacts on food-buying, PA levels, and stress levels were significantly influenced by age, gender, race, education, location, community, nutritional risk, quality of life, food security, and income (p < 0.05). Conclusion These findings provide valuable information as we continue to confront the impact the COVID-19 pandemic has had on the health and well-being of aging adults. We can use this information to inform future public health programming interventions and opportunities.
Collapse
Affiliation(s)
- Loo Yee Wong
- Department of Food Science and Human Nutrition, Iowa State University, 36 MacKay Hall, 2302 Osborn Drive, Ames, IA 50011-1078 USA
| | - Sarah L. Francis
- Department of Food Science and Human Nutrition, Iowa State University, 36 MacKay Hall, 2302 Osborn Drive, Ames, IA 50011-1078 USA
| | - Ulrike Genschel
- Department of Food Science and Human Nutrition, Iowa State University, 36 MacKay Hall, 2302 Osborn Drive, Ames, IA 50011-1078 USA
| | - Anna Arthur
- University of Kansas Medical Center, Kansas City, KS USA
| | - Furong Xu
- University of Rhode Island, Kingston, RI USA
| | - Lee Weidauer
- South Dakota State University, Brookings, SD USA
| | | | | | | | - Chandler Kendall
- Department of Food Science and Human Nutrition, Iowa State University, 36 MacKay Hall, 2302 Osborn Drive, Ames, IA 50011-1078 USA
| |
Collapse
|
18
|
Harmel B, Höfelmann DA. Mental distress and food insecurity in pregnancy. CIENCIA & SAUDE COLETIVA 2022; 27:2045-2055. [DOI: 10.1590/1413-81232022275.09832021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Abstract Food insecurity is a source of daily stress, especially in women. The aim was to investigate the association between mental distress and food insecurity in pregnant women. Cross-sectional study with pregnant women from the public health service, regardless risk stratification, or gestational trimester in Colombo-PR, Brazil. Poisson regression models were progressively adjusted for exposure variables. Results: Among the participating pregnant women (N=513) the prevalence of mental distress was 50.1%; associated with mild food insecurity (PR 1.34, 95%CI 1.12; 1.61) and moderate/severe food insecurity (PR 1.70, 95%CI 1.33; 2.19). The variable that most changed the association between the outcome and mild food insecurity was income (-4.48%) and, for moderate/severe food insecurity, education (-7.60%). For mild and moderate/severe food insecurity, the greatest reduction occurred with socioeconomic variables 4.5% (PR 1.27, 95%CI 1.05; 1.53) and 8.0% (PR 1.50, 95% CI 1.17; 1.93), respectively. The association between food insecurity and mental distress was consistent, and increased with the degree of food insecurity, with a greater reduction for socioeconomic variables.
Collapse
|
19
|
Frimpong SO, Arthur-Holmes F, Agyemang-Duah W. Financial vulnerability, health outcomes, and well-being of older adults during the COVID-19 pandemic. J Glob Health 2022. [PMCID: PMC9034737 DOI: 10.7189/jogh.12.03021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shadrack Osei Frimpong
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cocoa360, Accra, Ghana
| | - Francis Arthur-Holmes
- Cocoa360, Accra, Ghana
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong
| | | |
Collapse
|
20
|
Gyasi RM, Asamoah E, Gyasi-Boadu N, Zornu O, Asiki G, Phillips DR. Food insecurity and sleep quality among older adults: Findings from a population-based study in Ghana. Maturitas 2022; 157:27-33. [DOI: 10.1016/j.maturitas.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
|
21
|
Awuviry-Newton K, Amoah D, Tavener M, Afram AA, Dintrans PV, Byles J, Kowal P. Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity. J Am Med Dir Assoc 2022; 23:1432.e1-1432.e7. [PMID: 35218730 DOI: 10.1016/j.jamda.2022.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship. DESIGN A cross-sectional study design was employed. SETTING AND PARTICIPANTS A total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in 2015. METHODS Logistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12 months. RESULTS Approximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability. CONCLUSIONS AND IMPLICATIONS Food insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society.
Collapse
Affiliation(s)
| | - Dinah Amoah
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Meredith Tavener
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Center for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Callaghan, Australia
| | - Adjeiwa Akosua Afram
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Pablo Villalobos Dintrans
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santago, Chile; Millennium Institute for Caregiving Research (MICARE), Santiago, Chile
| | - Julie Byles
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Center for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Callaghan, Australia
| | - Paul Kowal
- Center for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Callaghan, Australia
| |
Collapse
|
22
|
Food insecurity and geriatric functional limitations: Observational analysis from the AgeHeaPsyWel–HeaSeeB Survey. Exp Gerontol 2022; 160:111707. [DOI: 10.1016/j.exger.2022.111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
|
23
|
Lee JY, Shen S, Nishita C. Development of Older Adult Food Insecurity Index to Assess Food Insecurity of Older Adults. J Nutr Health Aging 2022; 26:739-746. [PMID: 35842765 DOI: 10.1007/s12603-022-1816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Quantifying the number of older adults that are food insecure in a specific geographic area is critical in developing and scaling public health prevention and response programs at the local level. However, current estimates of older adult food insecurity only consider financial constraints, following the same methodology as the general population, even though the drivers for older adults are different and multidimensional. This study aims to build a general approach to quantify the food-insecurity among older adults at the local level, using publicly available data that can be easily obtained across the country. METHODS 13 risk factors for food insecurity among older adults were identified leveraging existing studies, following the Social Ecological Model (SEM), and the weighted impact of each factor was determined. Publicly available data sources were identified for each factor, ZIP code level data was compared to national averages, and the weighted data for each factor were aggregated to determine the overall food insecurity at the local level. RESULTS Based on the averaged odds ratios across all the studies, of the 13 risk factors, beyond financial constraints, having a disability was the most impactful factor and distance to the nearest grocery store was the least impactful. A ZIP code level model of Honolulu County was developed as an example to demonstrate the approach, showing that food insecurity among older adults in the county was 2.5 times that which was reported from the Current Population Survey (16.5% versus 6.5%). CONCLUSION This evidence-based model considered factors that impact food insecurity among older adults across all the spheres of the SEM. The drivers of food insecurity among older adults are different than the drivers for the general population, resulting in a higher percentage of older adults being food insecure than currently reported.
Collapse
Affiliation(s)
- J Y Lee
- Jenny Jin Young Lee, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, HI, USA,
| | | | | |
Collapse
|
24
|
Kumar S, Bansal A, Shri N, Nath NJ, Dosaya D. Effect of food insecurity on the cognitive problems among elderly in India. BMC Geriatr 2021; 21:725. [PMID: 34922495 PMCID: PMC8684220 DOI: 10.1186/s12877-021-02689-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Food Insecurity (FI) is a crucial social determinant of health, independent of other socioeconomic factors, as inadequate food resources create a threat to physical and mental health especially among older person. The present study explores the associations between FI and cognitive ability among the aged population in India. METHODS To measure the cognitive functioning we have used two proxies, word recall and computational problem. Descriptive analysis and multivariable logistic regression was used to understand the prevalence of word recall and computational problem by food security and some selected sociodemographic parameters. All the results were reported at 95% confidence interval. RESULTS We have used the data from the first wave of longitudinal ageing study of India (LASI), with a sample of 31,464 older persons 60 years and above. The study identified that 17 and 5% of the older population in India experiencing computational and word recall problem, respectively. It was found that respondents from food secure households were 14% less likely to have word recall problems [AOR:0.86, 95% CI:0.31-0.98], and 55% likely to have computational problems [AOR:0.45, 95% CI:0.29-0.70]. We also found poor cognitive functioning among those experiencing disability, severe ADL, and IADL. Further, factors such as age, education, marital status, working status, health related factors were the major contributors to the cognitive functioning in older adults. CONCLUSION This study suggest that food insecurity is associated with a lower level of cognition among the elderly in India, which highlight the need of food policy and interventional strategies to address food insecurity, especially among the individuals belonging to lower wealth quintiles. Furthermore, increasing the coverage of food distribution may also help to decrease the burden of disease for the at most risk population. Also, there is a need for specific programs and policies that improve the availability of nutritious food among elderly.
Collapse
Affiliation(s)
- Shubham Kumar
- International Institute for Population Sciences, Govandi East, Mumbai, 400088 India
| | - Anjali Bansal
- International Institute for Population Sciences, Govandi East, Mumbai, 400088 India
| | - Neha Shri
- International Institute for Population Sciences, Govandi East, Mumbai, 400088 India
| | - Nayan Jyoti Nath
- CHRIST (Deemed-to-be-University), Central Campus, Bengaluru, India
| | - Divya Dosaya
- Birla Institute of Technology and Science, Pilani, India
| |
Collapse
|
25
|
The Mental Health Outcomes of Food Insecurity and Insufficiency in West Africa: A Systematic Narrative Review. Behav Sci (Basel) 2021; 11:bs11110146. [PMID: 34821607 PMCID: PMC8614760 DOI: 10.3390/bs11110146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. (2) Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. (3) Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. (4) Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages.
Collapse
|
26
|
Saha S, Behnke A, Oldewage-Theron W, Mubtasim N, Miller M. Prevalence and Factors Associated with Food Insecurity among Older Adults in Sub-Saharan Africa: A Systematic Review. J Nutr Gerontol Geriatr 2021; 40:171-196. [PMID: 34669566 DOI: 10.1080/21551197.2021.1988027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Food insecurity has been undermining the health and well-being of a growing number of older adults in Sub-Saharan Africa. This review aimed to examine the prevalence of food insecurity and the related contributing factors of food insecurity among older adults in Sub-Saharan Africa. We used PubMed, Scopus, ScienceDirect, and Web of Science Core Collection as our search engines and included 22 articles for data extraction. Prevalence of severe and moderate food insecurity in households with older adults ranged from 6.0 to 87.3% and from 8.3 to 48.5%, respectively. Various socio-economic (e.g., low education level, being widowed, low income, lower wealth position of households, living in a rental house, living in rural areas, lack of social grants or pensions), demographic (e.g., female, Black racial group, larger family size), and health and nutrition status-related (e.g., self-reported poor health status, having a functional and mobility-related disability, psychological disorders) factors influence food insecurity in older adults in Sub-Saharan Africa. The findings of this review can help stakeholders to prioritize the issue of food insecurity, design and implement policies and programs to improve food security among older adults in Sub-Saharan Africa.
Collapse
Affiliation(s)
- Sanjoy Saha
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Andrew Behnke
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, USA
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA.,Office of the Dean, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Noshin Mubtasim
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA
| | | |
Collapse
|
27
|
Gyasi RM, Frimpong S, Amoako GK, Adam AM. Financial inclusion and physical health functioning among aging adults in the sub-Saharan African context: Exploring social networks and gender roles. PLoS One 2021; 16:e0252007. [PMID: 34111127 PMCID: PMC8191946 DOI: 10.1371/journal.pone.0252007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It remains poorly understood how financial inclusion influences physical health functioning in later life in sub-Saharan African context and whether the association differs by gender and social relationships. We aim 1) to examine the associations of financial inclusion with functional impairment during older age in Ghana; and 2) to evaluate whether gender and social networks modify this association. METHODS The cross-sectional analyses are based on a sample (N = 1,201) of study participants aged 50 years and over (M = 66.5 years, SD = 11.9, 63.3% female) deriving from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study. Ordinary least squares (OLS) regression analyses with interactions were performed to estimate the link between financial inclusion and functional health and how the association is modified by gender and older age social networks. RESULTS The mean financial inclusion score was 1.66 (SD = 1.74) in women and 2.33 (SD = 1.82) in men whilst mean activities of daily living (ADL) score was 13.03 (SD = 4.99) and 14.85 (SD = 5.06) in women and men respectively. We found that financial inclusion was associated with decreases in ADL (total sample: β = -.548, p < .001; women: β = -.582, p < .001; men: β = -1.082 p < .001) and instrumental ADL (IADL) (total sample: β = -.359, p = .034; women: β = -.445, p = .026 but not in men). Social networks significantly moderated the association of financial inclusion with ADL such that the financially included who were embedded in a stronger constellation of social networks were 6% less likely to report ADL impairment compared to those with weaker social networks (β = -.062, p = .025). CONCLUSIONS The study provides empirical evidence for a better understanding of the association between financial inclusion and physical health functioning in the context of later life social networks. Interventions for functional health through financial inclusion in sub-Saharan Africa should include improving interpersonal and social networks for older adult and also through gender lenses.
Collapse
Affiliation(s)
- Razak M. Gyasi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Siaw Frimpong
- Department of Finance, School of Business, University of Cape Coast, Cape Coast, Ghana
| | - Gilbert Kwabena Amoako
- Department of Accountancy and Accounting Information Systems, Kumasi Technical University, Kumasi, Ghana
| | - Anokye M. Adam
- Department of Finance, School of Business, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
28
|
Trudell JP, Burnet ML, Ziegler BR, Luginaah I. The impact of food insecurity on mental health in Africa: A systematic review. Soc Sci Med 2021; 278:113953. [PMID: 33971482 DOI: 10.1016/j.socscimed.2021.113953] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.
Collapse
Affiliation(s)
- John Paul Trudell
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Maddison L Burnet
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Bianca R Ziegler
- Department of Geography, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
| | - Isaac Luginaah
- Department of Geography, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| |
Collapse
|
29
|
Lindau ST, Makelarski JA, Boyd K, Doyle KE, Haider S, Kumar S, Lee NK, Pinkerton E, Tobin M, Vu M, Wroblewski KE, Lengyel E. Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women. J Womens Health (Larchmt) 2021; 30:502-513. [PMID: 33818123 DOI: 10.1089/jwh.2020.8879] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.
Collapse
Affiliation(s)
- Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Benedictine University, College of Education and Health Services, Lisle, Illinois, USA
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kate E Doyle
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Shivani Kumar
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Nita Karnik Lee
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA
| | - El Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Marie Tobin
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Milkie Vu
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
30
|
Malek Rivan NF, Yahya HM, Shahar S, Ajit Singh DK, Ibrahim N, Mat Ludin AF, Mohamed Sakian NI, Mahadzir H, Subramaniam P, Kamaruddin MZA. 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 2021; 13:353. [PMID: 33503860 PMCID: PMC7911207 DOI: 10.3390/nu13020353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Nurul Fatin Malek Rivan
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Hanis Mastura Yahya
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Suzana Shahar
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme and Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Norhayati Ibrahim
- Health Psychology Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (N.I.); (P.S.)
| | - Arimi Fitri Mat Ludin
- Biomedical Science Programme and Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Noor Ibrahim Mohamed Sakian
- Occupational Therapy Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Hazlina Mahadzir
- Internal Medicine and Geriatric Department, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Kuala Lumpur 56000, Malaysia;
| | - Ponnusamy Subramaniam
- Health Psychology Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (N.I.); (P.S.)
| | - Mohd Zul Amin Kamaruddin
- Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| |
Collapse
|