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Wang X, Qi J, Zhang K, Xie H, Wu X. The joy of eating: how eating experiences enhance the well-being of older adults. Front Public Health 2024; 12:1438964. [PMID: 39314795 PMCID: PMC11417023 DOI: 10.3389/fpubh.2024.1438964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction The active aging strategy has as its policy implications the health, security, and participation of older people. The joy of eating is the main goal of establishing community-based service facilities for older people, as well as a source of health and well-being and a sense of meaning in the lives of older people. Methods Based on the theory of human-environment relations and cognitive-emotional personality systems (CAPS), the study constructed a structural equation model of the eating experience, nostalgia, place attachment, and the well-being of the older adults in the community canteens as an interactive situation, and explored the relationship between the eating experience and the well-being of older people in the community canteens through the partial least squares structural equation modeling (PLS-SEM). Results The results of the study show that the older adults' eating experience has a significant positive effect on their well-being, and "eating" can make older adults feel happy. Older adults' eating experience has a significant effect on nostalgia, place attachment, and well-being, but nostalgia does not have a significant effect on older adults' well-being, and place attachment in the community canteens can enhance older adults' well-being. Meanwhile, the study further confirmed that place attachment plays a mediating role in the effect of eating experience on older adults' well-being. Discussion The findings of the study promote the development of the fields of healthy eating, quality of life assessment, and dietary memory management for older people to a certain extent and provide an important reference for promoting the balanced layout and effective spatial design of community service facilities for older people.
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Affiliation(s)
- Xinmin Wang
- Colleges of Resource and Environmental Engineering, Tianshui Normal University, Tianshui, China
| | - Jianwu Qi
- Department of Tourist Management, South China University of Technology, Guangzhou, China
| | - Kai Zhang
- Colleges of Architecture, Xi’an University of Architecture and Technology, Xi’an, China
| | - Huiji Xie
- Department of Tourist Management, South China University of Technology, Guangzhou, China
| | - Xingnan Wu
- Department of Tourist Management, South China University of Technology, Guangzhou, China
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Leng S, Jin Y, Vitiello MV, Zhang Y, Ren R, Lu L, Shi J, Tang X. Association of food insecurity with successful aging among older Indians: study based on LASI. Eur J Nutr 2024; 63:859-868. [PMID: 38200307 DOI: 10.1007/s00394-023-03322-6] [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: 10/08/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Whether food insecurity (FI), a social determinant of health, is linked with successful aging (SA) in the older generation remains uncertain. This study explored the association of FI with SA among older Indians. METHODS Data were collected from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-2018). Older adults (≥ 60 years) who completed both the FI and the SA surveys were selected. FI was indicated by the lack of access to enough food in the past year. SA was determined by five components: (1) low probability of diseases; (2) low probability of disability; (3) high cognitive functionality; (4) low probability of depression; and (5) active social engagement. The association of FI and SA was assessed using multivariable logistic regression adjusted for potential covariates. Subgroup analyses were performed to evaluate interactions with age, sex, alcohol use, smoking, and place of residence. RESULTS 27,579 participants met the eligibility criteria. Overall prevalence was 7.13% for FI and 19.41% for SA. Following full adjustment, FI was inversely associated with SA (OR 0.56; 95% CI 0.49-0.65) and with each of SA's five components. No significant interactions of FI and SA were observed in subgroup analyses stratified by age, sex, alcohol use, smoking, or place of residence. CONCLUSIONS FI was inversely associated with SA among older Indians. These findings need to be validated by future studies which should also explore potential underlying mechanisms, and whether interventions decreasing FI might increase SA.
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Affiliation(s)
- Siqi Leng
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Yuming Jin
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Ye Zhang
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Rong Ren
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China
| | - Lin Lu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Jie Shi
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Urology, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China.
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Vaudin A, Dean W, Sahyoun N. Quality of Life and the Role of Food and Eating as Described by Community-Dwelling Older Adults. J Nutr Gerontol Geriatr 2024; 43:14-35. [PMID: 37880995 DOI: 10.1080/21551197.2023.2269118] [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: 10/27/2023]
Abstract
While food and eating are important determinants of health, there is limited information on how they affect quality of life (QOL). This study aimed to understand (1) the factors that impact QOL, (2) the effect of food and eating on QOL, from the perspective of community-dwelling older adults. Twenty-five older adults completed semi-structured interviews. The constant comparative method was used to assign codes to participant's responses and organize them into categories, which were used to form a conceptual framework. Five main themes emerged showing factors affecting QOL: health and vitality; independence; mental and emotional well-being; socialization and support; and activities. Four themes were identified demonstrating how food and eating affect QOL: food access and choice; food preparation; health and vitality; and food enjoyment. Relationships between themes suggest food and eating have a broad effect on factors impacting QOL. To develop and tailor community interventions to improve older adults' QOL, measurement tools should include these effects.
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Affiliation(s)
- Anna Vaudin
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, USA
| | - Wesley Dean
- Department of Food and Resource Economics, University of Copenhagen, Frederiksberg C, Denmark
| | - Nadine Sahyoun
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, USA
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Fong JH. Risk Factors for Food Insecurity among Older Adults in India: Study Based on LASI, 2017-2018. Nutrients 2023; 15:3794. [PMID: 37686826 PMCID: PMC10490409 DOI: 10.3390/nu15173794] [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: 08/03/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Food security is linked to the nutritional status and well-being of older adults. India is a rapidly aging nation that ranks highly on the 2022 Global Hunger Index. This paper examines the prevalence and risk factors of food insecurity in India's older population. METHODS We used data from the 2017-2018 Longitudinal Aging Study in India. The sample size was 31,532 adults aged 60 years and above. Food insecurity was measured using a four-item version of the Food Insecurity Experience scale. Multivariable logistic regressions using individual-level weights were implemented to assess the risk factors of food insecurity. RESULTS The prevalence of food insecurity was 10.5% in the weighted sample. Sociodemographic factors were important in explaining food insecurity. Older adults who were male, younger, lowly educated, socially disadvantaged, in rural areas, and outside the Northern region were most vulnerable to food insecurity, controlling for various confounders. Additionally, low economic status, no occupational pension, currently working, social isolation, physical impairment, functional disabilities, poor self-rated health, and arthritis were associated with an increased risk of food insecurity. CONCLUSIONS More active food assistance programs catering to older adults and a better provision of economic and social security are warranted to establish a food-secure environment for rapidly aging India.
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Affiliation(s)
- Joelle H Fong
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259771, Singapore
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Vaudin A, Dean W, Chen J, Sahyoun NR. Service Awareness Among Older Adults Experiencing Barriers to Food and Eating. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:564-574. [PMID: 37389500 DOI: 10.1016/j.jneb.2023.04.005] [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: 08/04/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To explore (1) the services older adults use to address the barriers to food access they face and (2) how they found out about these services. DESIGN Semistructured, basic descriptive qualitative in-person interviews. SETTING Senior center and participants' homes. PARTICIPANTS A convenience sample of 24 older adults recruited from suburban and urban settings. Primarily Black females, living alone, and able to leave home without help. PHENOMENON OF INTEREST Financial and nonfinancial barriers to food access, awareness of services available. ANALYSIS Codes were assigned to portions of the text in which participants described how they learned about a service. These codes were categorized into one of the 3 larger themes that emerged: (1) intentionally sought by the participant, (2) intentional outreach by the service, and (3) encounters in daily life and environment. RESULTS Most connections to services were made through encounters in participants' daily life and environment; for example, word of mouth from family, friends or neighbors; connection through other services; referral from health care professionals; and seeing the service in their neighborhood. CONCLUSIONS AND IMPLICATIONS Robust social networks, medical screening, and referral may promote awareness of food assistance services. Future research and outreach should target those who are most isolated.
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Affiliation(s)
- Anna Vaudin
- Department of Nutrition and Food Science, University of Maryland College Park, College Park, MD
| | - Wesley Dean
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland College Park, College Park, MD
| | - Nadine R Sahyoun
- Department of Nutrition and Food Science, University of Maryland College Park, College Park, MD.
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Carlson SM, Giovanni ME, Neyman Morris M. The Relationship of Food Insecurity to Nutritional Risk in Independent Living Older Adults. J Nutr Gerontol Geriatr 2023:1-19. [PMID: 37211756 DOI: 10.1080/21551197.2023.2202157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Understanding the factors that augment optimal health during aging is critical as the US older adult population is increasing. Most research about food insecurity, nutritional risk, and perceived health among older adults are in urban areas or congregate living facilities. Thus, the purpose of this project was to study the relationships among these factors, plus activities of daily living, in community-dwelling older adults in a medium-sized city. Using a qualitative-quantitative study design, a cross-sectional survey was completed by 167 low-income senior apartment residents. Food insecurity in this group was higher than the national and state rate, yet nutrition assistance programs were underutilized and participants under 75 years were more food insecure than their older counterparts. Food insecure residents were at greater nutritional risk, had poorer self-reported health status, were more likely to be depressed, and had a less independent function, including limitations on the ability to shop for and prepare food. The study area is desirable to retirees due to lower cost of living; however, access to services, such as grocery stores, public transportation, and health care providers is limited. This research indicates the need for increased outreach, nutrition assistance, and support services to ensure healthy aging in these regions.
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Affiliation(s)
- S M Carlson
- Montefiore Health System, Bronx, New York, USA
| | - M E Giovanni
- Department of Nutrition and Food Science, California State University, Chico, California, USA
| | - M Neyman Morris
- Department of Nutrition and Food Science, California State University, Chico, California, USA
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Selvamani Y, Elgar F. Food insecurity and its association with health and well-being in middle-aged and older adults in India. J Epidemiol Community Health 2023; 77:252-257. [PMID: 36754599 DOI: 10.1136/jech-2022-219721] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
AIM Food insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India. METHODS Cross-sectional nationally representative data were collected in wave 1 (2017-2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass. RESULTS Food insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8). CONCLUSIONS Food insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.
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Affiliation(s)
- Y Selvamani
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Frank Elgar
- Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
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Muhammad T, Saravanakumar P, Sharma A, Srivastava S, Irshad CV. Association of food insecurity with physical frailty among older adults: study based on LASI, 2017-18. Arch Gerontol Geriatr 2022; 103:104762. [PMID: 35841798 DOI: 10.1016/j.archger.2022.104762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Food security can be directly linked to nutritional status and either directly or indirectly, it has an impact on health status and well-being of the population. Physical frailty is one of the most important phenotypes used to understand the vulnerable nature of older adults. This paper examined the association between food security and physical frailty in older adults. METHODS We used data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1. The sample size was 31,464 older adults aged 60 years and above. Physical frailty was assessed using the modified version of frailty phenotype proposed by Fried and colleagues. Multivariable logistic regression was used to establish the association between food insecurity with physical frailty. RESULTS A proportion of 30.65% of older adults were frail in this study. Older adults with food insecurity had higher prevalence of exhaustion (12.1% vs 6.5%), unintentional weight loss (65.5% vs 5.1%), and weak grip strength (8.6% vs 7.9%) in comparison to their food secure counterparts. After adjusting for a large number of confounders, older adults who reported food insecurity had significantly higher odds of being frail [AOR: 2.68; CI: 2.26-3.19] in comparison to older adults with no food insecurity. CONCLUSION The study showed that food insecurity is associated with physical frailty among older adults in India. It is suggested that food security programs in the country may be considered as an effective strategy to prevent physical frailty among older adults.
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Affiliation(s)
- T Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - Priya Saravanakumar
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Building 10, Level 7, 235 Jones St, Ultimo, Sydney, NSW 2007, Australia
| | - Abhishek Sharma
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra 400088, India
| | - C V Irshad
- Department of Humanities and Social Sciences, Indian Institute of Technology, Madras, 600036 India.
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Chakraborty R, Kundu J, Jana A. Factors Associated with Food Insecurity among Older Adults in India: Impacts of Functional Impairments and Chronic Diseases. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-022-09510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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T M, Sulaiman KM, Drishti D, Srivastava S. Food insecurity and associated depression among older adults in India: evidence from a population-based study. BMJ Open 2022; 12:e052718. [PMID: 35440447 PMCID: PMC9020306 DOI: 10.1136/bmjopen-2021-052718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 03/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The present study aimed to examine the associations of several indicators of food insecurity with depression among older adults in India. DESIGN A cross-sectional study was conducted using country-representative survey data. SETTING AND PARTICIPANTS The present study uses data of the Longitudinal Aging Study in India conducted during 2017-2018. The effective sample size for the present study was 31 464 older adults aged 60 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome variable was major depression among older adults. Descriptive statistics along with bivariate analysis was presented. Additionally, binary logistic regression analysis was used to establish the association between the depression and food security factors along with other covariates. RESULTS The overall prevalence of major depression was 8.4% among older adults in India. A proportion of 6.3% of the older adults reduced the size of meals, 40% reported that they did not eat enough food of their choice, 5.6% mentioned that they were hungry but did not eat, 4.2% reported that they did not eat for a whole day and 5.6% think that they have lost weight due to lack of enough food in the household. Older adults who reported to have reduced the size of meals due to lack of enough food (adjusted OR (AOR): 1.76, CI 1.44 to 2.15) were hungry but did not eat (AOR: 1.35, CI 1.06 to 1.72) did not eat food for a whole day (AOR: 1.33; CI 1.03 to 1.71), lost weight due to lack of food (AOR: 1.57; CI 1.30 to1.89) had higher odds of being depressed in reference to their respective counterparts. CONCLUSION The findings suggest that self-reported food insecurity indicators were strongly associated with major depression among older Indian adults. The national food security programmes should be enhanced as an effort to improve mental health status and quality of life among older population.
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Affiliation(s)
- Muhammad T
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - K M Sulaiman
- Department of Migration & Urban Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Drishti Drishti
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
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Srivastava S, Muhammad T. Rural-urban differences in food insecurity and associated cognitive impairment among older adults: findings from a nationally representative survey. BMC Geriatr 2022; 22:287. [PMID: 35387591 PMCID: PMC8985064 DOI: 10.1186/s12877-022-02984-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/25/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Due to rapid urbanization, Covid-19 pandemic and increasing food prices, a higher rate of food insecurity has been observed in recent years in India. Thus, we aim to study the prevalence of food insecurity among older Indian adults and the association of food insecurity as a modifiable risk factor with late-life cognitive impairment. METHOD Data for this study were obtained from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the study was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming) adapted from the cognitive module of the US Health and Retirement Study (HRS). Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariable logistic regression analysis was used to fulfil the objectives of the study. RESULTS It was found that 7.7% of older adults in rural areas reduced their size of meals due to unavailability (urban, 3.2%), 41.2% of them did not eat enough food of their choice (urban, 38.3%), 6.9% were hungry but did not eat food (urban, 2.6%), 5.0% did not eat for whole day (urban, 2.2%), and 6.9% lost weight due to lack of food in their household (urban, 2.9%). It was found that older adults who did not have enough food of their choice had significantly higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment in reference to their counterparts. Similarly, the older adults who were hungry but did not eat were 30% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from cognitive impairment in reference to their counterparts. Interaction model revealed that older adults who had food insecurity in rural areas had higher odds of cognitive impairment than older adults who had food insecurity in urban areas. CONCLUSION The findings of the study highlight that the food security status in older adults may bring about greater challenges due to their limited economic resources. Interventions focusing on food security may have unintended positive impacts on late-life mental wellbeing as the older age is associated with higher cognitive deficits.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
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Sakr-Ashour FA, Wambogo E, Song HJ, Sahyoun NR. Home-delivered meal programme participants may be at greater risk of malnutrition without the meal programme. Public Health Nutr 2021; 25:1-8. [PMID: 34620256 PMCID: PMC9991720 DOI: 10.1017/s1368980021004274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES (1) To examine total quality of foods consumed on the day a home-delivered meal (HDM) of the Older Americans Act Nutrition Program (OAANSP) was served, and when a HDM was not served; and (2) to estimate proportion of HDM participants and non-participants meeting the daily average recommendations for guidance-based foods and nutrients. DESIGN Cross-sectional study. SETTING Data were obtained from the national 2015-2017 Outcomes Evaluation Study of HDM participants in the USA. PARTICIPANTS Adults aged 67 years and older (n 1227), 620 HDM recipients and 607 matching non-participants examined in three groups: (1) meal recipients who received a HDM on the day of the 24-h dietary recall; (2) no-meal recipients who did not receive a HDM on the day of the recall and (3) matching HDM non-participants. RESULTS Healthy Eating Index (HEI)-2010 scores of HDM participants were significantly lower on the day the meal was not received compared with when a meal was received (52·5 v. 63·4, P < 0·0001). There was no significant difference in the total HEI-2010 scores of HDM meal recipients and HDM non-participants. Despite the meal, less than 20 % of HDM participants and non-participants met the 2010-Diet Guidelines for Americans recommended average daily intake for fruit, vegetables, dairy, protein foods and solid fats. CONCLUSION HDM participants' diet quality is poorer when they do not receive a meal putting them at increased risk of malnutrition. Expanding the OAANSP to offer meals on weekends and/or to include more than one meal/d is recommended to improve the diet of this vulnerable population.
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Affiliation(s)
- Fayrouz A Sakr-Ashour
- University of Maryland, Department of Nutrition and Food Science, 0102 Skinner Building, College Park, MD20742, USA
| | - Edwina Wambogo
- University of Maryland, Department of Nutrition and Food Science, 0102 Skinner Building, College Park, MD20742, USA
| | - Hee-Jung Song
- University of Maryland, Department of Nutrition and Food Science, 0102 Skinner Building, College Park, MD20742, USA
| | - Nadine R Sahyoun
- University of Maryland, Department of Nutrition and Food Science, 0102 Skinner Building, College Park, MD20742, USA
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Diallo AF, Falls K, Hicks K, McQueen Gibson E, Obaid R, Slattum P, Zanjani F, Price E, Parsons P. The Healthy Meal Program: A food insecurity screening and referral program for urban dwelling older adults. Public Health Nurs 2020; 37:671-676. [DOI: 10.1111/phn.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ana F. Diallo
- Virginia Commonwealth University School of Nursing Richmond VA USA
- Virginia Commonwealth University Institute of Inclusion, Inquiry & Innovation Richmond VA USA
| | - Katherine Falls
- Virginia Commonwealth University School of Nursing Richmond VA USA
| | | | | | - Rawan Obaid
- School of Nursing George Washington University Washington DC USA
| | - Patricia Slattum
- School of Pharmacy Virginia Commonwealth University Richmond VA USA
| | - Faika Zanjani
- Virginia Commonwealth University Institute of Inclusion, Inquiry & Innovation Richmond VA USA
- Department of Gerontology College of Health Professions Virginia Commonwealth University Richmond VA USA
| | - Elvin Price
- Virginia Commonwealth University Institute of Inclusion, Inquiry & Innovation Richmond VA USA
- School of Pharmacy Virginia Commonwealth University Richmond VA USA
| | - Pamela Parsons
- Virginia Commonwealth University School of Nursing Richmond VA USA
- Virginia Commonwealth University Institute of Inclusion, Inquiry & Innovation Richmond VA USA
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Developing the Expanded Food Security Screener and Pilot Testing It for Prioritization of Applicants to the Home-Delivered Meal Program. TOP CLIN NUTR 2020. [DOI: 10.1097/tin.0000000000000199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
South Africa represents one of the most rapidly aging countries in sub-Saharan Africa with a rising burden of age-related psychological morbidities. Despite having one of the highest human development scores in the region, the country faces serious poverty and food insecurity related challenges. Previous studies have shown a positive association between food insecurity and poor mental health among the adult population, however there is no systematic evidence on this association among the elderly population in an African setting. In the present study, we aimed to address this research gap by analyzing cross-sectional data (n = 931) on the over-50 population (>50 years) from the SAGE (Study on global AGEing and adult health) Well-Being of Older People Study (WOPS) of the World Health Organization, conducted between 2010 and 2013. The outcome variable was perceived depression and the explanatory variables included several sociodemographic factors including self-reported food insecurity. The independent associations between the outcome and explanatory variables were measured using multivariable regression analysis. Results showed that close to a quarter of the population (22.6%, 95% CI = 21.4, 24.7) reported having depression in the last 12 months, with the percentage being markedly higher among women (71.4%). In the multivariable regression analysis, self-reported food insecurity was found to be the strongest predictor of depression among both sexes. For instance, severe food insecurity increased the odds of depression by 4.805 [3.325, 7.911] times among men and by 4.115 [2.030, 8.341] times among women. Based on the present findings, it is suggested that national food security programs focus on promoting food security among the elderly population in an effort to improve their mental health status. Nonetheless, the data were cross-sectional and the associations can’t imply causality.
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Gaitán-Rossi P, García-Appendini IC, Félix-Beltrán L, Vilar-Compte M. Food Insecurity Among Older Adults: A Multilevel Analysis of State-Level Interventions. J Appl Gerontol 2019; 40:170-178. [PMID: 31838938 DOI: 10.1177/0733464819894233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To analyze whether state-level social programs for older adults (OAs) in Mexico are associated with a reduction: (a) in the prevalence of severe food insecurity (SFI) and (b) in the magnitude of the effect of municipal marginalization on SFI. Method: Cross-sectional study based on urban OAs (65-100 years) from the 2010 census. Three-level logistic multilevel regression models were estimated to explain SFI. Results: Controlling for individual and municipal characteristics, states with social programs for OAs are generally associated with lower SFI prevalences (odds ratio [OR] = 0.68 [0.48, 0.95]) and mitigate the effect of marginalization on SFI when compared with states with no programs. Compared with in-kind food programs and voucher-based programs, monetary transfers are associated with a significant reduction in SFI prevalence (OR = 0.68 [0.46, 0.99]). Conclusion: States with programs for OAs, mainly monetary transfers, are associated with lower SFI prevalences.
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Tong M, Tieu L, Lee CT, Ponath C, Guzman D, Kushel M. Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study. J Public Health (Oxf) 2019; 41:240-249. [PMID: 29617886 PMCID: PMC6636692 DOI: 10.1093/pubmed/fdy063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. METHODS We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security. RESULTS The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22-0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69-5.38), oral pain (AOR = 2.15, 1.24-3.74) and cognitive impairment (AOR = 2.21, 1.12-4.35) were associated with increased odds of very low food security. CONCLUSIONS Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.
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Affiliation(s)
- M Tong
- School of Public Health, University of California, Berkeley, USA
| | - L Tieu
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - C T Lee
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
| | - C Ponath
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - D Guzman
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - M Kushel
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
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Brooks JM, Petersen CL, Titus AJ, Umucu E, Chiu C, Bartels SJ, Batsis JA. Varying Levels of Food Insecurity Associated with Clinically Relevant Depressive Symptoms in U.S. Adults Aged 60 Years and Over: Results from the 2005-2014 National Health and Nutrition Survey. J Nutr Gerontol Geriatr 2019; 38:218-230. [PMID: 31074705 DOI: 10.1080/21551197.2019.1611520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Food insecurity refers to restricted or uncertain access to and ineffective utilization of nutritious and safe foods. Although food insecurity is linked to poorer physical health consequences among older adults, national estimates are not well known on food insecurity and depression. Using the 2005-2014 National Health and Nutrition Examination Survey, this study examines the associations between varying food insecurity levels and clinically relevant depressive symptoms (defined by PHQ-9 ≥ 10) among adults ≥60 years old (n = 7969). Rates of clinically relevant depressive symptoms in marginal, low, and very low food security were 12.3, 16.3, and 25.2%, respectively. Marginal, low, and very low food security were significantly associated with clinically relevant depressive symptoms: odds ratio (OR) = 1.12 (95% confidence intervals [CI] 1.07-1.18), OR = 1.07 (95% CI 1.03-1.12), and OR = 1.24 (95% CI 1.16-1.32), respectively. Given the intersection of food insecurity and depression, geriatric health professionals should work to improve health and nutrition programs for older adults at risk for or experiencing both public health concerns.
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Affiliation(s)
- Jessica M Brooks
- a Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College , Lebanon , NH , USA.,b Department of Rehabilitation and Health Services, University of North Texas , Denton , TX , USA
| | - Curtis L Petersen
- c The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College , Lebanon , NH , USA.,d Department of Epidemiology, Geisel School of Medicine at Dartmouth College , Lebanon , NH , USA
| | - Alexander J Titus
- d Department of Epidemiology, Geisel School of Medicine at Dartmouth College , Lebanon , NH , USA.,e Program in Quantitative Biomedical Sciences, Dartmouth College , Lebanon , NH , USA
| | - Emre Umucu
- f Department of Rehabilitation Sciences, University of Texas at El Paso , El Paso , TX , USA
| | - Chungyi Chiu
- g Department of Kinesiology and Community Health, The University of Illinois at Urbana-Champaign , Champaign , IL , USA
| | - Stephen J Bartels
- a Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College , Lebanon , NH , USA.,c The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College , Lebanon , NH , USA
| | - John A Batsis
- c The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College , Lebanon , NH , USA.,h Department of Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,i Centers for Health and Aging , Lebanon , NH , USA
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Burris M, Kihlstrom L, Arce KS, Prendergast K, Dobbins J, McGrath E, Renda A, Shannon E, Cordier T, Song Y, Himmelgreen D. Food Insecurity, Loneliness, and Social Support among Older Adults. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2019.1595253] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mecca Burris
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
| | - Laura Kihlstrom
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
| | | | | | | | | | | | | | | | | | - David Himmelgreen
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
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Abstract
AbstractObjectiveTo discern the impact of food donations provided by a food pantry and soup kitchen on food security.DesignIn this cross-sectional study, participants completed a demographic questionnaire, core food security module, FFQ and list of food donations. The FFQ was utilized to assess diet quality as estimated via the 2010 Healthy Eating Index.SettingClients were selected randomly from a food pantry and soup kitchen in Central Texas, USA.ParticipantsA total of 222 adults.ResultsApproximately 73 % of participants lacked food security. Compared with the food secure, the food insecure consisted of 61 % men, 42 % Caucasians, 56 % single and 67 % homeless. Also, of the food insecure, 60 % were soup kitchen clients and 64 % had an annual income <$US 1000 (P<0·01). The probability of food insecurity was reduced by ≥1·17-fold when the total dietary intake included the food donations, as these were rich in fruits, total vegetables and grains, dairy and protein foods (P<0·05).ConclusionsFood insecurity was quite prevalent in this sample of individuals who visited food pantries and soup kitchens. The addition of food donations improved the quality of the participants’ total diet and had a positive influence on food security. Thus, community organizations should financially support these food assistance agencies and strive to offer a variety of healthy and tasty foods in adequate quantities to provide optimum diet quality.
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21
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Kihlström L, Burris M, Dobbins J, McGrath E, Renda A, Cordier T, Song Y, Prendergast K, Serrano Arce K, Shannon E, Himmelgreen D. Food Insecurity and Health-Related Quality of Life: A Cross-Sectional Analysis of Older Adults in Florida, U.S. Ecol Food Nutr 2018; 58:45-65. [PMID: 30582362 DOI: 10.1080/03670244.2018.1559160] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Individuals 65 years or older will comprise an estimated 20.0% of the U.S. population by 2030. This study investigated the association between food insecurity and health-related quality of life (HRQoL) among an older adult population (n = 234). HRQoL was measured using Healthy Days, a validated survey tool developed by the Centers of Disease Control and Prevention. Food-insecure individuals were more likely to report ≥14 physically unhealthy days (OR = 1.49, 95% CI 0.47-4.78) and ≥14 days with activity limitations (OR = 4.07, 95% CI 0.68-24.1). Although nonsignificant, the findings highlight food insecurity as a potentially important social determinant of health throughout the life course, including at an older age.
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Affiliation(s)
- L Kihlström
- a Department of Anthropology , University of South Florida , Tampa , FL , USA.,b Department of Family and Community Health , University of South Florida , Tampa , FL , USA
| | - M Burris
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - J Dobbins
- c Humana, Inc ., Louisville , KY , USA
| | - E McGrath
- c Humana, Inc ., Louisville , KY , USA
| | - A Renda
- c Humana, Inc ., Louisville , KY , USA
| | - T Cordier
- c Humana, Inc ., Louisville , KY , USA
| | - Y Song
- c Humana, Inc ., Louisville , KY , USA
| | | | - K Serrano Arce
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - E Shannon
- e Feeding Tampa Bay , Tampa , FL , USA
| | - D Himmelgreen
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
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Fernandes SG, Rodrigues AM, Nunes C, Santos O, Gregório MJ, de Sousa RD, Dias S, Canhão H. Food Insecurity in Older Adults: Results From the Epidemiology of Chronic Diseases Cohort Study 3. Front Med (Lausanne) 2018; 5:203. [PMID: 30050904 PMCID: PMC6052142 DOI: 10.3389/fmed.2018.00203] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: The public health problem of food insecurity also affects the elderly population. This study aimed to estimate the prevalence of household food insecurity and its associations with chronic disease and health-related quality of life characteristics in individuals ≥65 years of age living in the community in Portugal. Methods: The data were collected from the Epidemiology of Chronic Diseases Cohort Study 3 (EpiDoC3)-Promoting Food Security Study (2015-2016), which was the third evaluation wave of the EpiDoC and represented the Portuguese adult population. Food insecurity was assessed using a psychometric scale adapted from the Brazilian Food Insecurity Scale. The data on sociodemographic variables, chronic disease, and management of chronic disease were self-reported. Health-related quality of life were assessed using the European Quality of Life Survey (version validated for the Portuguese population). Logistic regression models were used to determine crude and adjusted odds ratios (for age group, gender, region, and education). The dependent variable was the perceived level of food security. Results: Among older adults, 23% were living in a food-insecure household. The odds of living in a food-insecure household were higher for individuals in the 70-74 years age group (odds ratio (OR) = 1.405, 95% confidence interval (CI) 1.392-1.417), females (OR = 1.545, 95% CI 1.534-1.556), those with less education (OR = 3.355, 95% CI 3.306-3.404), low income (OR = 4,150, 95% CI 4.091-4.210), and those reporting it was very difficult to live with the current income (OR = 16.665, 95% CI 16.482-16.851). The odds of having a chronic disease were also greater among individuals living in food-insecure households: diabetes mellitus (OR = 1.832, 95% CI 1.818-1.846), pulmonary diseases (OR = 1.628, 95% CI 1.606-1.651), cardiac disease (OR = 1.329, 95% CI 1.319-1.340), obesity (OR = 1.493, 95% CI 1.477-1.508), those who reduced their frequency of medical visits (OR = 4.381, 95% CI 4.334-4.428), and who stopped taking medication due to economic difficulties (OR = 5.477, 95% CI 5.422-5.532). Older adults in food-insecure households had lower health-related quality of life (OR = 0.212, 95% CI 0.210-0.214). Conclusions: Our findings indicated that food insecurity was significantly associated with economic factors, higher values for prevalence of chronic diseases, poor management of chronic diseases, and decreased health-related quality of life in older adults living in the community.
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Affiliation(s)
- Simone G. Fernandes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana M. Rodrigues
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Osvaldo Santos
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Maria J. Gregório
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rute Dinis de Sousa
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sara Dias
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Helena Canhão
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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23
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Vilar-Compte M, Gaitán-Rossi P, Pérez-Escamilla R. Food insecurity measurement among older adults: Implications for policy and food security governance. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2017. [DOI: 10.1016/j.gfs.2017.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Adams GB, Lee JS, Bhargava V, Super DA. Offsetting the Effects of Medical Expenses on Older Adults' Household Food Budgets: An Analysis of the Standard Medical Expense Deduction. THE GERONTOLOGIST 2017; 57:359-366. [PMID: 27927729 DOI: 10.1093/geront/gnw126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/09/2016] [Indexed: 11/12/2022] Open
Abstract
The Supplemental Nutrition Assistance Program (SNAP) provides critical nutrition assistance to over 40 million Americans each month. Low-income older adults (60 and older) and disabled participants experience additional budgetary constraints because of high out-of-pocket medical expenses. In recent years, some states have adopted a "Standard Medical Expense Deduction" (SMED) for senior and disabled beneficiaries, making it easier to report medical expenses in the SNAP application process. We conduct a descriptive national analysis that shows increases in benefit levels and reporting of medical expenses for states that have implemented SMED. We then present descriptive findings from Medicare claims data among a sample of low-income older adults in need of food assistance in Georgia. Average medical expenses among this sample approach $200 per month, whereas those for persons diagnosed with multiple chronic conditions exceed $300 per month. Policy implications of this analysis include the need for more states to consider adoption of SMED or alternative estimating approaches, leading to increases in benefit levels for the neediest beneficiaries and decreases in administrative burden among state agencies. We present two possible policy approaches states might take to receive approval for these changes from U.S. Department of Agriculture.
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Affiliation(s)
| | | | - Vibha Bhargava
- Department of Financial Planning, Housing, and Consumer Economics, University of Georgia, Athens
| | - David A Super
- Georgetown Law, Georgetown University Law Center, Washington, District of Columbia
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Cheng Y, Rosenberg M, Yu J, Zhang H. Food security for community-living elderly people in Beijing, China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:747-757. [PMID: 26094641 DOI: 10.1111/hsc.12255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
Food security has been identified as an important issue for elderly people's quality of life and ageing in place. A food security index composed of three indicators (food intake, food quality and food affordability) was developed to measure the food security status of community-living elderly people. Food security was then examined among community-living elderly in the central urban districts of Beijing, China. Data were collected by a questionnaire survey in the summer of 2013 and the response rate was 78.5%. Descriptive statistics and binary logistic regression were applied to analyse food security and the associations between food security and demographic and socioeconomic factors. The results showed that 54.2% of the surveyed elderly experienced food security. Participants with better education (OR = 1.68) and better health (OR = 1.47) were more likely to experience food security. The young-old were less likely to experience food security than the older old (OR = 0.94). Elderly people who lived with their children were less likely to experience food security than those who lived alone (OR = 0.43). The results of impact factors on food security highlight both similarities with studies from more developed countries and the unique challenges faced in a rapidly changing China with its unique social, cultural and political systems. The food security index we developed in this study is a simple and effective measure of food security status, which can be used in surveys for evaluating the food security status of elderly people in the future.
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Affiliation(s)
- Yang Cheng
- School of Geography, Beijing Normal University, Beijing, China.
| | - Mark Rosenberg
- Department of Geography, Queen's University, Kingston, Ontario, Canada
| | - Jie Yu
- Department of Geography, Queen's University, Kingston, Ontario, Canada
| | - Hua Zhang
- School of Geography, Beijing Normal University, Beijing, China
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Bhargava V, Lee JS. Food Insecurity and Health Care Utilization Among Older Adults. J Appl Gerontol 2016; 36:1415-1432. [PMID: 26912734 DOI: 10.1177/0733464815625835] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the relationship between food insecurity and health care utilization (physician, inpatient, emergency room, and home health visits) among older adults. Survey data collected from Georgia Advanced Performance Outcomes Measures Project 6 linked to the Centers for Medicare and Medicaid Services (GA Advanced POMP6-CMS) data 2008 ( N = 957) were analyzed. Nearly one half of the sample (48.3%) was food insecure. Food insecure individuals were significantly less likely than food secure individuals to have any physician (69.7% vs. 80.2%) and home health visits (24.9% vs. 32.3%) during 2008. However, there were no significant differences in levels of health care utilization by food secure and food insecure older adults. Food secure and food insecure older adults utilized comparable levels of health care services. Public assistance programs such as Medicare and meal services targeted toward older adults may enable economically constrained, food insecure older adults to access needed health care services.
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Myles T, Porter Starr KN, Johnson KB, Sun Lee J, Fischer JG, Ann Johnson M. Food Insecurity and Eating Behavior Relationships Among Congregate Meal Participants in Georgia. J Nutr Gerontol Geriatr 2016; 35:32-42. [PMID: 26885944 PMCID: PMC4883100 DOI: 10.1080/21551197.2015.1125324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study explored relationships of food insecurity with cognitive restraint, uncontrolled eating, and emotional eating behaviors among congregate meal participants in northeast Georgia [n = 118 years, age 60 years and older, mean (SD) age = 75 ( 8 ) years, 75% female, 43% Black, 53% obese (Body Mass Index ≥ 30)]. Food insecurity was assessed with a 6-item questionnaire. Scores ranged from 0 to 6 and were defined as high or marginal food security, FS, 0-1 (70%); low food security, LFS, 2-4 (20%); very low food security, VLFS, 5-6 (10%); and low and very low food security, LVLFS, 2-6 (30%). Eating behavior was assessed with an 18-item Three-Factor Eating Questionnaire R-18. In bivariate analyses food insecurity was consistently associated with cognitive restraint scores above the median split and to a lesser extent with uncontrolled eating scores (p ≤ 0.05). No association was found between emotional eating and food insecurity. In multivariate linear and logistic regression analyses, food insecurity was consistently associated with cognitive restraint (p ≤ 0.05) even when controlled for potential confounders (demographics, Body Mass Index, and chronic diseases). Food insecurity was also associated with uncontrolled eating (p ≤ 0.05), but the relationship was attenuated when controlled for potential confounding variables. Although cognitive restraint is defined as the conscious restriction of food intake to control body weight or promote weight loss, these findings suggest there may be other dimensions of cognitive restraint to consider in nutritional assessment and interventions among food-insecure older adults.
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Affiliation(s)
- TaMara Myles
- a Department of Foods and Nutrition, University of Georgia , Athens , Georgia , USA
| | - Kathryn N Porter Starr
- b Department of Geriatrics, Duke University Medical Center , Durham , North Carolina , USA
| | - Kristen B Johnson
- a Department of Foods and Nutrition, University of Georgia , Athens , Georgia , USA
| | - Jung Sun Lee
- a Department of Foods and Nutrition, University of Georgia , Athens , Georgia , USA
| | - Joan G Fischer
- a Department of Foods and Nutrition, University of Georgia , Athens , Georgia , USA
| | - Mary Ann Johnson
- c Institute of Gerontology and Department of Foods and Nutrition , University of Georgia , Athens , Georgia , USA
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Sattler ELP, Lee JS, Bhargava V. Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes. J Nutr Gerontol Geriatr 2015; 33:401-17. [PMID: 25424513 DOI: 10.1080/21551197.2014.959680] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Little is known about diabetes management among low-income older Americans. This study used statewide self-administered survey and Medicare claims data to examine the relationships of food insecurity and medication (re)fill adherence in a sample of Medicare Part D beneficiaries with type 2 diabetes in need of food assistance in Georgia in 2008 (n = 243, mean age 74.2 ± 7.8 years, 27.2% African American, 77.4% female). (Re)fill adherence to oral hypoglycemics was measured as Proportion of Days Covered. Food insecurity was assessed using a six-item validated standard measure. About 54% of the sample were food insecure. About 28% of the diabetic sample did not (re)fill any diabetes medication and over 80% had at least one diabetes complication. Food insecure participants showed comparable (re)fill adherence to food secure participants. However, 57% of food insecure participants were nonadherent to oral hypoglycemics. Underlying basic needs must be addressed to improve diabetes management in this population.
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30
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Lee JS. Food insecurity and healthcare costs: research strategies using local, state, and national data sources for older adults. Adv Nutr 2013; 4:42-50. [PMID: 23319122 PMCID: PMC3648738 DOI: 10.3945/an.112.003194] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food insecurity in older adults is a clinically relevant problem with important implications for healthcare costs; however, few studies have examined the relationship between food insecurity and the healthcare cost burden in older adults. It may be due in part to lack of appropriate data and methods to examine these issues in the existing datasets. It is critical to identify and obtain the data necessary for estimating healthcare costs associated with food insecurity and to explore specific mechanisms by which food insecurity is related to adverse health outcomes and associated healthcare costs. This paper discusses how to best utilize and link available, nationally representative datasets and develop infrastructure and procedures to establish state and local datasets. As an example, an innovative approach tested in Georgia to establish a state-level dataset in a sample of low-income, older adults in need of food assistance is discussed. In this approach, data from the state aging services client database and the Centers for Medicare and Medicaid Services data were linked. Such efforts are essential to estimate the healthcare cost burden of food-insecure older adults who have a particularly higher burden of chronic diseases and direct future research, program, and policy decisions to improve the food and healthcare security of low-income, older adults.
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Affiliation(s)
- Jung Sun Lee
- Department of Foods and Nutrition, University of Georgia, Athens, USA.
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31
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Abstract
It is estimated that by 2050 there will be 2 billion people aged 60 years and older in the world. The evidence base for the health benefits of good nutrition and physical activity, as well as weight loss among overweight and obese adults, is growing and a number of policies and guidelines are available to guide health professionals in serving older people at various stages of the lifecycle. There are many potential influences on dietary habits including individual factors, families and friends, community characteristics, the food and supplement industry, and public policy. This review focuses on the evidence base for factors influencing diet in older adults, food insecurity, Na, vitamin D, vitamin B12, protein, obesity and the benefits of energy restriction in overweight and obese older adults. Research is needed to continue to increase the evidence base for appropriate ways to improve diet and health in older people. Also, much of the available information is from the US, so there is a need to conduct research in other areas of the world.
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32
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Bhargava V, Lee JS, Jain R, Johnson MA, Brown A. Food insecurity is negatively associated with home health and out-of-pocket expenditures in older adults. J Nutr 2012; 142:1888-95. [PMID: 22933748 DOI: 10.3945/jn.112.163220] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food insecurity is a persistent, growing, and clinically relevant problem in older adults; however, its effect on healthcare expenditures is not known. This study examined the relationship of food insecurity with Medicare and out-of-pocket expenditures in older Georgians enrolled in Medicare and meal services using 2 complementary datasets: Georgia Advanced Performance Outcomes Measures Project 6 (GA Advanced POMP6) and Medicare claims data in 2008 (n = 903, mean age 76.9 ± 7.8 y, 31.0% male, 64.2% white). Due to the mixed distribution of healthcare expenditure data (e.g., high nonusers, right-skewed distribution for users), 2-part models were used. Approximately one-half of the sample was food insecure (50.4%) and was more likely to report poorer health status and to have chronic diseases than food-insecure individuals. Food-insecure older adults were less likely to have any Medicare expenditure than food-secure older adults. Among those who had positive Medicare expenditure, however, food-insecure and food-secure individuals had similar Medicare expenditures. Food-insecure and food-secure older individuals were equally likely to incur out-of-pocket expenditure. However, among those who had positive out-of-pocket expenditure, food-insecure older individuals had lower out-of-pocket expenditures than their counterparts. Adjusted mean Medicare and out-of-pocket expenditures of food-insecure individuals were $1875 and $310 less than food-secure individuals in 2008, respectively. These findings based on the innovative methodological approaches and datasets suggest complex relationships between food insecurity and healthcare expenditures in older adults, reflecting unique healthcare access and usage patterns.
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Affiliation(s)
- Vibha Bhargava
- Housing and Consumer Economics, University of Georgia, Athens, GA, USA
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