Are we Leaving our Seniors Food Insecure and Deserted?

Food insecurity and under-nutrition have negative consequences for our underserved senior populations. Haskell and DeAngelo look at the issue and explain how bills like the Healthy Food Access for All Americans bill are essential.

Image of senior citizen's hands using knife and fork to cut into a plate of cooked vegetables.

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While the memes of yesterday of our aging population eating cat food have all but vanished, imagine Grandma, Mimi, Nana, Grandpa, or Papa forced to live on boxed macaroni and cheese and hot dogs.  Unfortunately, for many seniors access to a variety of affordable, nutritious food can be a matter of life and death which should be addressed by federally aided access and outreach. 

Communities that lack affordable and nutritious food are commonly known as ‘food deserts.’ According to the U.S. Department of Agriculture, an urban ‘food desert’ is an area where people live more than 1 mile from a supermarket, and a rural ‘food desert’ an area where people ten miles away or more. But the distance to supermarket is only the first mile of the problem, the type of food available at the destination is also at issue. As such, most nutritionists and community leaders have expanded the definition of ‘food desert’ to be ‘any place where fresh food is sparsely available’; fresh food in this case being synonymous with low sugar, mildly processed carbohydrates, and fresh fruits and vegetables.

Food insecurity, on the other hand, is defined as the ‘disruption of food intake or eating patterns because of lack of money and other resources.’ In other words, a lack of sufficient, healthy, nutritious food.  The United States Department of Agriculture (USDA) divides food insecurity into two categories:

Low food security: Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.

Very low food security: Reports of multiple indications of disrupted eating patterns and reduced food intake.

Food insecurity affects millions of aging adults in the U.S. Statistics show that more than 2.9 million food-insecure households included an adult age 65 or older. Among those individuals aged 65+ and who live alone, more than 1.3 million (or 8.9 percent) were food insecure and 512,000 (or 3.4 percent) struggled with very low food security.

“Research shows that certain groups of older adults are at greater risk for food insecurity than others. Food-insecurity rates tend to be higher among older adults who are low income, less educated, Black, Hispanic, separated or divorced, never married, renters, residing in the South (e.g., Louisiana, Mississippi, North Carolina, Texas, Alabama), unemployed, living alone, living with a disability, living with grandchildren, or “younger” older adults (i.e., those 50 to 59 years of age).” (Food Research Action Center).

 

For these individuals, food insecurity may be either long term or short term (especially during the time of our pandemic) and may be influenced by multiple factors including income, transportation availability (during the pandemic public transportation is challenging), un-employment or under employment, poverty, inadequate housing, social isolation, physical challenges, and existing chronic disease.

Chronic disease in seniors is a very strong predictor of food insecurity. “Low-income older adults with functional limitations have 69 percent higher odds of food insecurity and 65 percent higher odds of poor dietary quality, based on national survey data. According to one study, older adults with two to four chronic conditions and five or more chronic conditions are 2.12 and 3.64 times as likely to be food insecure, respectively, than older adults with no or one chronic condition.

In addition, older adults engaging in cost-related medication nonadherence (i.e., taking less medication than prescribed due to cost) are 1.9 times more likely to be food insecure than those not reporting such practices.” (Jih, J. et al., 2018) But because nutrition and health are inextricably linked, the question for Grandma and Grandpa becomes can they eat a nutritious chicken or an egg.

Research has shown that food insecure seniors consume much lower quantities of key essential nutrients. “In one study, food insecure seniors had consumptive levels of iron (13.3%), calcium (9.7%), and protein (9.2%) that were lower than food secure seniors. In addition, food insecure seniors were health deficient as compared to food secure seniors. Food insecure seniors were more likely to have diabetes (74%), depression (262%), congestive heart failure (71%), and asthma (78%) (Senior Food Insecurity Studies). Ultimately, the lack of a variety, healthy, nutritious food in sufficient quantities can cause and exacerbate health issues for seniors and may contribute to life or death.

So, what has been done to help rectify this issue?

Strategies to improve food security and nutrition/health are currently in place, including the Supplemental Nutrition Assistance Program (SNAP), Home-Delivered Nutrition Program, Congregate Nutrition Program, Commodity Supplemental Food Program, Senior Farmers’ Market Nutrition Program, and Child and Adult Care Food Program. But, while these outstanding programs have well-documented benefits for older food insecure adults, many do not necessarily participate in them.

SNAP is administered by USDA and is an effective anti-poverty initiative. It acts in a “first responder” capacity against food insecurity and under-nutrition. Over 36 million people participate in SNAP monthly. However, only an estimated 48 percent of eligible seniors participate in SNAP; compared to 86 percent of eligible non-senior adults. Lack of participation is linked directly to psycho-social issues: chronic disease, family issues, transportation, personal mobility, cultural stigma, technology misunderstandings, and barriers in SNAP knowledge (e.g., who qualifies, how the program works, and what are the actual benefits).  Luckily, the Snap Online Purchasing pilot, which was expanded due to Covid-19, will allow some of our technologically literate seniors better access to the program although challenges persist in finding grocery stores that will deliver with limited stock during Covid-19 as well as additional burdens of delivery fees for those in poverty.

The Commodity Supplemental Food Program (CSFP), Congregate Nutrition Program and Home-Delivered Nutrition Program and the Emergency Food, are programs designed for low-income adults 60 years or older which allows individuals, in states that participate, a monthly food box, or meals with canned fruits and vegetables, cheese, shelf stable milk, cereal, potato, beans, peanut butter and grains. These healthy meals and nutritional services are provided and are targeted to adults who are 60 and older and are in the greatest socio-economic need. Additionally related nutrition services and counseling are provided to those who have mobility issues. Still many seniors remain unserved either due to personal choice or lack of ability.

In February 2021, in the House of Representatives, a new bill was introduced the “Healthy Food Access for All Americans” (HFAAA) which is designed to offer grants and tax credits for businesses in food deserts and food insecurity areas (for locations here). These businesses must be certified as “Special Access Food Providers” by both the US Treasury and the USDA. If signed into law, it would allow a one-time 10 or 15% tax credit for new construction or renovation for approved supermarkets, and permanent food banks depending on conditions.  In addition, it would allow qualitied 503(c)1 food banks, farmer’s markets, and mobile markets a 10% grant for services for the year. The bill currently is in several committees. The adage of “a chicken on every plate” popular in our aging populations’ childhood may again become a reality.

Ultimately, food insecurity and under-nutrition have negative consequences for our underserved senior populations. In addition, food insecurity is costly for society. Federal nutrition programs have been an exceptional support mechanism if seniors choose to utilize them. It is essential that we increase access for seniors to these programs as well as access to the stores, food banks, and farmer’s markets that offer a supply of nutritious food.  Bills like the Healthy Food Access for All Americans bill are essential to supporting and expanding these outcomes.

Disclaimer.

 

References

Jung, N.M., et. al. (2016) Gender differences in the prevalence of household food insecurity: a systematic review and meta-analysis. PHN Volume 20 - Issue 5: 10 November 2016, pp. 902-91. https://www.cambridge.org/core/journals/public-health-nutrition/article/gender-differences-in-the-prevalence-of-household-food-insecurity-a-systematic-review-and-metaanalysis/B3B0DE2E04C0413E48267E63B400EC36

Zarei, M, et al. (2021) Food Insecurity and Dietary Intake Among Elderly Population: A Systematic Review. Int J Prev Med. 2021 Jan 19;12:8. doi: 10.4103/ijpvm.IJPVM_61_19. eCollection 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106269/

da Silva Miguel, E et al. (2020) Association between food insecurity and cardiometabolic risk in adults and the elderly: A systematic review. J Glob Health. 2020 Dec;10(2):020402.doi: 10.7189/jogh.10.020402. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568919/

Myers, CA (2021) Food Insecurity and Psychological Distress: A Review of the Recent Literature. Curr Nutr Rep. 2020 Jun; 9(2): 107–118. doi: 10.1007/s13668-020-00309-1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282962/pdf/nihms-1581512.pdf

Patterson, JG, et al. (2020) Disparities in food insecurity at the intersection of race and sexual orientation: A population-based study of adult women in the United States SM Popul Health. 2020 Dec; 12: 100655. Published online 2020 Aug 22. doi: 10.1016/j.ssmph.2020.100655 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442904/pdf/main.pdf

Coleman-Jensen, A., Rabbitt, M. P., Gregory, C. A., & Singh, A. (2019). Household food security in the United States in 2018. Economic Research Report, 270. Washington, DC: U.S. Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/webdocs/publications/94849/err-270.pdf?v=3669.5

Jackson, J. A., Branscum, A., Tang, A., & Smit, E. (2019). Food insecurity and physical functioning limitations among older U.S. adults. Prev Med Rep. 2019 Feb 18; 14:100829. doi: 10.1016/j.pmedr.2019.100829. eCollection 2019 Jun https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430734/

Gundersen, C., & Ziliak, J. (2017). The Health Consequences of Senior Hunger in the United States: Evidence from the 1999–2014 NHANES. Prepared for Feeding America and the National Foundation to End Senior Hunger. Available at: https://www.feedingamerica.org/sites/default/files/research/senior-hunger-research/senior-health-consequences-2014.pdf

Berkowitz SA, Basu S, Gundersen C, Seligman HK. State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity. Prev Chronic Dis 2019;16:180549. DOI: http://dx.doi.org/10.5888/pcd16.180549external icon https://www.cdc.gov/pcd/issues/2019/18_0549.htm#1

Ziliak, J. P., & Gundersen, C. (2019). The State of Senior Hunger in America 2017: An Annual Report. Prepared for Feeding America. Available at: https:// www.feedingamerica.org/research/senior-hunger-research/senior

Mabli, J., Ghsoh, A., Schmitz, B., Shenk, M., Panzarella, E., Carlson, B., & Flick, M. (2018). Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Health Care Utilization. Report submitted by Mathematica Policy Research to the U.S. Department of Health and Human Services, Administration for Community Living, Center for Policy and Evaluation. https://acl.gov/sites/default/files/programs/2018-10/NSPevaluation_healthcareutilization.pdf

AARP Foundation and the Food Research & Action Center. (2015). Combating Food Insecurity: Tools for Helping Older Adults Access SNAP. Available at: https://cupdf.com/document/combating-food-insecurity-tools-for-helping-older-adults-access-snap-aarp.html

Vigil, A. (2019). Trends in Supplemental Nutrition Assistance Program Participation Rates: Fiscal Year 2010 to Fiscal Year 2017. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support. https://www.fns.usda.gov/snap/trends-participation-rates-fy-2010#:~:text=Key%20findings%20include%3A,rate%20has%20been%20fairly%20stable.

Jih, J., Stijacic-Cenzer, I., Seligman, H. K., Boscardin, W. J., Nguyen, T. T., & Ritchie, C. S. (2018). Chronic disease burden predicts food insecurity among older adults. Public Health Nutrition, 21(9), 1737–1742. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204426/

Helping Older Adults Struggling Against Hunger Access Food in the Age of COVID-19 https://frac.org/wp-content/uploads/FRAC-Brief-Helping-Older-Adults-Struggling-Against-Hunger-Access-Food-in-the-Age-of-COVID-19.pdf

FRAC Older Adult (age 60+) Nutrition Programs Referral Chart During COVID-19

https://frac.org/wp-content/uploads/Older-Adult-Nutrition-Programs-During-COVID-19-Referral-Chart.pdf

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