Factors contributing to participation in food assistance programs in the elderly population

Determinants of Nutritional Risk among Community-Dwelling Older Adults with Social Support

BACKGROUND

It is well established that older adults are at risk for malnutrition due to several social and non-social determinants, namely physiological, psychosocial, dietary and environmental determinants. The progression to malnutrition is often insidious and undetected. Thus, nutritional assessment should consider a complex web of factors that can impact nutritional status (NS). The primary objective of this study was to assess the NS of older adults attending senior centres (SCs) and to identify its predictors.

METHODS

This cross-sectional study enrolled a sample of community-dwelling older adults in Lisbon. NS was assessed using Mini Nutritional Assessment (MNA^®). Malnutrition or malnutrition risk (recategorised into a single group) was predicted using binary logistic regression models, considering those participants classified as having a normal NS as the reference group. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures.

RESULTS

A sample of 337 older adults, with an average age of 78.4 years old (range 66-99), mostly women (n = 210; 62.3%), were enrolled. Older adults at risk of malnutrition accounted for 40.7% of the sample. Being older (OR = 1.045, CI 95% [1.003-1.089], p = 0.037), having a worse perception of health status (OR = 3.395, CI 95% [1.182-9.746], p = 0.023), having or having had depression (OR = 5.138, CI 95% [2.869-9.201], p < 0.001), and not having or having had respiratory tract problems (OR = 0.477, CI 95% [0.246-0.925], p = 0.028) were independent predictors of malnutrition or malnutrition risk. An intermediate time of SC attendance was associated with a lower probability of malnutrition or risk (OR = 0.367, CI 95% [0.191-0.705], p = 0.003).

CONCLUSIONS

NS among older adults has a multifactorial aetiology, with a strongly social component and is related to health circumstances. Further research is needed to timely identify and understand nutritional risk among this population.

Effects of Perceived Food Store Environment on Malnutrition and Frailty among the Food-Insecure Elderly in a Metropolitan City

This study aimed to identify food environment factors in the local community that could affect the levels of nutritional status and frailty in 372 older adults (at least 65 years old) experiencing food insecurity and enrolled in the integrated Community Health Promotion Program (CHPP) in two districts of Seoul. The local food environment was assessed using perceived food store accessibility questionnaires. In order to quantify nutrient intake, the 24-h recall method was applied. Malnutrition was measured using the Mini Nutritional Assessment tool, while frailty was assessed using the Frailty Measurement Questionnaire developed for the CHPP. Malnourished or frail elderly adults commonly had a lower intake of cereals and potatoes, meats, and vegetables than those who were not, and their resulting intake levels of energy, protein, iron, and vitamin groups were also significantly lower (all p-values < 0.05). Among the local community food store environment factors, the sufficiency of food stores (odds ratio (OR) = 1.988, 95% confidence interval (CI] = 1.211-3.262), freshness of foods (OR = 1.767, 95% CI = 1.075-2.886), and variety in foods (OR = 1.961, 95% CI = 1.197-3.212) were significant factors affecting the risk of malnutrition. For frailty, the freshness of foods (OR = 1.997, 95% CI = 1.053-3.788), variety in foods (OR = 2.440, 95% CI = 1.277-4.661), and small purchase of foods (OR = 2.645, 95% CI = 1.362-5.139) were significant environmental factors. In conclusion, we found that the perceived food store environment in the local community can influence the occurrence of malnutrition and frailty in vulnerable, urban older adults.

Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse

The purpose of this study is to examine the relationship between food security and cost-related medication underuse among older adults (persons aged 65 years and older) in the United States; and to determine if this relationship differs by sex, chronic disease status, and type of health insurance. Data are from a combined sample of older adults in the 2011 and 2012 National Health Interview Survey (N = 10,401). Both bivariate and multivariate analyses show a dose-response relationship between food insecurity and cost-related medication underuse among the elderly--increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < 0.001). This association is not conditional on sex, chronic disease status, or type of health insurance. However, females and those with a chronic condition are more likely to report cost-related medication underuse than males and those without a chronic condition respectively; and older adults with Medicare and Medicaid or other public insurance are less likely to report cost-related medication underuse than older adults with only Medicare.