Food security in older adults: community service provider perceptions of their roles

Understanding the Experiences of Food Insecurity in Older Adult Households

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.

Meals on Wheels: Promoting Food and Nutrition Security among Older Persons in Cape Town, South Africa

Food insecurity (FI) prevails in Sub-Saharan Africa. Yet, in South Africa, although many people, including the elderly, are vulnerable to FI, little is known about the experiences of older persons (OPs) with FI and the interventions thereof. In South Africa, Meals on Wheels Community Service (MOWCS) provides readymade home meal deliveries for OPs through 209 branches across the country. Therefore, this study investigated MOWCS' role in the promotion of food security among the OPs at the Brooklyn branch, Cape Town. The study was grounded within the food security framework and focused on the availability, accessibility, utilization, and stability of food at Brooklyn MOWCS. Using qualitative research methods, 10 semi-structured interviews and one focus group discussion (N = 5) were conducted with Brooklyn MOWCS beneficiaries, in addition to three key personnel interviews conducted with staff. Data were analysed using Open Code 4.03. The findings showed Brooklyn MOWCS as a stable source of affordable and nutritious meals to OPs. The portion size satisfied hunger; occasionally, one portion sufficed for two meals. Respondents admitted the meal ingredients represented various food groups and rated them as "healthy". However, some financial challenges hindered the extension of MOWCS services to the wider community. For instance, they only had three paid employees and were overcrowded within church premises. Findings also showed race and gender disparity among respondents; 90% were White and 10% were of Mixed Ancestry, with no Black or Asian OPs represented, and only 10% were male. These outcomes are typical of the current ethnic profile of the overall Brooklyn MOWCS beneficiaries in SA. This calls, therefore, for such interventions to be extended to all South African demographic groups as an initiative to alleviate food and nutrition insecurity among all OPs.

Long-term support referrals to enhance food security and well-being in older adults: Texas physicians and nurses on what works

Aim

Senior participation in the congregate meal programs (CMPs) has alarmingly declined over the past decade in Texas as elsewhere in the nation. The purpose of this survey study was to identify the possible reasons for this decline from the viewpoint of the Texas physicians and nurses who are key in coordinating care and ensuring food security for the vulnerable older Texans by referring them to community-based long-term support services (LTSS).

Subject and methods

The methodology adopted was an online panel survey of physicians and nurses from rural and urban Texas counties. Structured multiple-choice and open-ended questions primarily focused on provider referral processes, reasons for connecting older clients to CMPs, perceptions about various aspects of these programs, possible reasons for the decline in participation, suggestions to make the programs an integral part of the community-based LTSS referral system, and how to address the COVID-19 pandemic constraints on the programs.

Results

As a majority of the healthcare providers surveyed were unaware of the CMPs in their communities, the study spotlighted an urgent need for a better-coordinated referral process centered on strategic marketing and awareness-building about the CMPs, including an extensive healthcare provider education component as well as an overall improvement in meal quality and variety.

Conclusion

The study highlights a need for additional research so decision-makers better understand how to best disseminate information to healthcare providers to improve the referral mechanisms, increase the referrals, and enhance the overall CMP program quality to benefit the vulnerable food-insecure 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.

Using citizen science to empower older adults to improve a food security initiative in Australia

Food security is an increasing problem for older adults who are living longer and having to stretch their resources further. Initiatives such as subsidized community market days are increasingly important in bolstering food security amongst these groups but there have been few attempts to understand these initiatives from the perspective of community members. This exploratory study examined the utility of a novel citizen science approach to engage older adults in evaluating and improving a local food security initiative. Using the Our Voice methodology, citizen scientists recorded their perceptions of their local Market Day via photographs and audio narratives. Thirteen citizen scientists captured 127 photographs and 125 commentaries. Citizen scientists participated in workshops to discuss, code and synthesize their data, and used their findings to advocate for change. A number of improvements to the Market Day were made by key stakeholders on the basis of citizen scientist recommendations, including improving the processes for sourcing and storing food and changing the layout to improve access. This study demonstrates that citizen science is a useful and feasible approach to engaging community members in capturing data and advocating for change to ensure that local initiatives meet the needs of communities.

Food Security Status among U.S. Older Adults: Functional Limitations Matter

This study aimed to assess the relationship between food security and health outcomes among older adults (age 65+) in the U.S. We used a pooled sample (2011-2015, N = 37,292) from the National Health Interview Survey (NHIS) and ordered logit models to assess characteristics associated with food security including health conditions (diabetes and hypertension) and functional activity limitations. We estimated that 1.3 million individuals aged 65+ in the U.S. had low/very low food security. Having at least one functional limitation (OR = 1.717, 95% CI = 1.436, 2.054) was significantly associated with low/very low food security. Having fair or poor health status (OR = 3.315, 95% CI = 2.938, 3.739) was also a significant factor for food security among older adults, while having health insurance coverage (OR = 0.467, 95% CI = 0.341, 0.64) was negatively associated with food insecurity. Demographics and socioeconomic characteristics were significantly related to food insecurity among seniors. Seniors with functional limitations and poor health status are at risk for food insecurity. Interventions at the clinical site of care may be useful in addressing food security issues for older adults.

Is food insecurity a problem among the elderly in Sharpeville, South Africa?

The objective of this study was to determine the prevalence of food and nutrition insecurity and assess the socio-demographic factors associated with food and nutrition insecurity among 146 free-living elderly persons attending a care centre in Sharpeville, South Africa. Measurement instruments included socio-demographic-, 24-hour-recall and dietary diversity questionnaires and the validated household food insecurity access scale/score (HFIAS). Data were analysed with IBM SPSS Software, version 25.0. The prevalence of food insecurity from HFIAS was 60% (n = 87), with a variety of balanced responses being employed. Significant relationships were observed between HFIAS and age (r = 0.301; p = 0.000) and with household income (r = −0.258; p = 0.007). An association was observed between HFIAS and marital status (p = 0.005). Regression analysis showed that age and being single were predictors of food and nutrition insecurity. This study indicated a problem of household food insecurity with poor dietary intakes among these elderly people, mostly due to poverty and being single. More research on associations between food security and socio-economic variables is needed to plan and implement appropriate strategies to address food and nutrition insecurity in South Africa.

Using the Social Ecological Model to Identify Drivers of Nutrition Risk in Adult Day Settings Serving East Asian Older Adults

Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population. [Research in Gerontological Nursing, 13(3), 146-157.].

Disability and food access and insecurity: A scoping review of the literature

A scoping review was conducted, using a social ecological model approach, of 106 articles examining the effect of disability on food access and (in)security. Results of the review show a consistently increased risk of food insecurity among people with disabilities with a higher risk for mental health disabilities, and among disabled younger adults. Mediators of this relationship were underexplored. Disability was mainly conceptualized as a problematic category preventing food access while ignoring disabling social and environmental barriers. A social model of disability can inform future research by acknowledging the role of socio-environmental influences on the production and experience(s) of disability.

Mental Illness, Not Obesity Status, is Associated with Food Insecurity Among the Elderly in the Health and Retirement Study

OBJECTIVES

Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

METHODS

We conducted a cross-sectional study of 2868 participants' aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

RESULTS

Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

DISCUSSION

Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.

Qualitative Research in the CJA/RCV: An 18-Year Analysis (1995-2012)

Some researchers have suggested that qualitative research is increasing in the gerontology field, but little systematic analysis has tested this assertion. Using the Canadian Journal on Aging/La Revue canadienne du vieillissement as a case study, we analysed articles reporting on original research from 1995 to 2012. One in four articles were qualitative, and results in three-year intervals show a clear increase in qualitative research findings during this 18-year time frame: (a) 1995-1997: 10 per cent; (b) 1998-2000: 19 per cent; (c) 2001-2003: 25 per cent; (d) 2004-2006: 25 per cent; (e) 2007-2009: 29 per cent; and (f) 2010-2012: 43 per cent. In all time intervals (with the exception of 2004-2006), French language articles were more likely to use a qualitative research design compared to English language articles. Topics, methodologies, and data collection strategies are also discussed.

The Good Food Box Pilot Project as a Contribution to Addressing Food Accessibility in the Elderly

The Good Food Box (GFB) is a program that offers fresh produce to community members. The implementation of a GFB pilot project targeting the elderly in Côte Saint-Luc (CSL) is described. Feasibility is evaluated in terms of partnerships necessary to realize the project and suitability of the GFB among seniors. Outcomes, lessons learned, and future directions are also discussed. GFBs were delivered biweekly for 10 weeks to 14 participants over the age of 65 years. Baseline and final surveys were administered to assess user satisfaction and effects of the project. Overall, participants were satisfied, finding the location convenient and the produce to be of excellent quality. Respondents also indicated an increased quantity of fresh fruits and vegetables in their home and an enhanced connection with the community. Many participants commented on excessive quantity and difficulty preparing certain products, demonstrating that the GFB may not be practical for all seniors. Smaller quantities and volunteer assistance could improve the program. Following the successful pilot project, the GFB was expanded to all members of the CSL community. Using the GFB as a major source of fresh produce will positively impact the health and quality of life for those who reside within the community.

Food security: who is being excluded? A case of older people with dementia in long-term care homes

OBJECTIVES

PURPOSE

To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature.

METHOD

Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included.

RESULTS

Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents' satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents' food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents' food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents' food security.

CONCLUSIONS

The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs.