Food Insecurity

To understand the concept of seniors being hungry, it is critical to understand what it means to be “food insecure.” Food insecurity exists when there is “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways” (Facts Behind Senior Hunger, n.d.). Essentially, an individual is not receiving and/or does not have access to the necessary foods and nutrients to help sustain their life. The concept of being “hungry” is a state of mind, meaning there is a physical aspect to the lack of food. Attending to an area where people are hungry and basically starving is a much more immediate and severe problem to solve. Being food insecure, on the other hand, helps include people who may have enough food and don’t technically live consistently in hunger. Still, the food they are eating—usually in large amounts—isn’t up to nutritional and dietary standards.

The older adult population is growing, and the number of people aged 65 and older is expected to rapidly increase in the coming years. As the population ages, society will be challenged with meeting the needs of this demographic and assisting them in maintaining their health, wellness, and quality of life. Remaining actively engaged as one age can promote healthy aging and a better quality of life for older adults (Richardson et al., 2014). Research supports that physical, cognitive, and mental health issues all can have a negative impact on food security and food-related activities. Nearly one in every six seniors in America faces the threat of hunger and not being properly nourished (The Facts Behind Senior Hunger, 2022). This applies to those who aren’t sure where their next meal is coming from and those who don’t have access to the healthiest possible food options. The issue is severe enough that the American Association of Retired Persons (AARP) reports that seniors face a healthcare bill of more than $130 billion every year due to medical issues stemming from senior hunger (The Facts Behind Senior Hunger, 2022). In 2017, there are just more than 49 million Americans aged 65 and over, and about 8 million of them can be considered facing the threat of hunger (Cup, 2018). Not only is senior hunger a current issue, but the threat of it also persisting as a problem into the future is high because of the high rate of seniors expected to exist.

Poor health is both a risk factor for food insecurity among older adults and a consequence of food insecurity for this population. Older adults who are food insecure often experience negative mental and physical health conditions and outcomes, such as diabetes, fair or poor health status, depression, lower cognitive function, limitations in activities of daily living, hypertension, congestive heart failure, peripheral arterial disease, history of a heart attack, osteoporosis, gum disease, and asthma (Hartline-Grafton, 2019). The association between poor health and food insecurity is particularly strong for diet-related conditions: food-insecure older adults (compared to food-secure older adults) are 19 percent more likely to have high blood pressure, 57 percent more likely to have congestive heart failure, 65 percent more likely to be diabetic, and 66 percent more likely to have experienced a heart attack (Gundersen & Ziliak, 2017). In addition, food insecurity significantly increases the risk of falls, which are the leading cause of fatal and nonfatal injuries for older adults (Bergen et al., 2016).

According to one study, food-insecure Medicare Advantage members had a 1.69 times greater likelihood of experiencing a fall in the past year, compared to their food-secure peers. Because of limited financial resources, adults — including older adults — who are food insecure also may use coping strategies to stretch budgets that are harmful to health. Examples of these coping strategies include engaging in cost-related medication underuse or nonadherence (e.g., skipping doses, taking less medicine, delaying to fill a prescription, not taking certain medications with food); postponing or forgoing preventive or needed medical care; purchasing a low-cost diet that relies on energy-dense, but nutrient-poor, foods; watering down food or drinks; forgoing the foods needed for special medical diets (e.g., diabetic diets); and making trade-offs between food and other basic necessities (e.g., housing, utilities, and transportation) (Afulani et al., 2015; DelVecchio et al., 2015; Mayer et al., 2016; Seligman et al., 2012).

Food insecurity, along with the health-compromising coping strategies associated with food insecurity, can exacerbate existing disease processes — including older adults — with diabetes, end-stage renal disease for people with chronic kidney disease, and low CD4 counts (a measure of immune system health) and poor antiretroviral therapy adherence among people living with HIV (Aibibula et al., 2016; Young et al., 2013). Not surprisingly, food insecurity is a strong predictor of greater healthcare utilization and increased healthcare costs across the lifespan. In 2014, the direct and indirect health-related costs of hunger and food insecurity in the U.S. were estimated to be a staggering $160 billion (Cook & Poblacion, 2016). Among older adults, those who are food insecure have more frequent hospitalizations and visits to physician offices and emergency rooms than their food-secure counterparts. And in terms of healthcare costs, one study found that “on average, food insecurity added about 11 percent to the healthcare costs of older adults with and without a specific chronic condition” (Garcia et al., 2018). Community-dwelling older adults are at distinct risk for food insecurity as opposed to those who reside in residential or assisted living facilities. As one example of the vulnerable, community-dwelling older adult population, home-delivered meal recipients are a group at high risk for experiencing food insecurity and have historically presented with multiple health conditions and health service needs. Results from the 2016 National Survey of Older Americans Act (OAA) indicated that home-delivered meal recipients not only had difficulty participating in food-related activities but also had substantial self-care, home management, and mobility impairments as well. The prevalence of functional impairments and food-related activity difficulties among the home-delivered meal population is one example of why the food-insecure older adult population requires urgent attention from occupational therapy practitioners who provide services in community-based settings.