According to the United States Department of Agriculture (2018), “food insecurity is a complex, multidimensional phenomenon which varies through a continuum of successive stages as the condition becomes more severe”. Food insecurity does not simply equate to an individual being hungry and the physical discomfort and nutritional loss associated with decreased food intake. It also manifests itself in psychological ways because people who are food insecure have to constantly worry about how they will obtain food (Martin et al., 2012). The use of assessment ools can help identify an individual’s extent of food insecurity. As occupational therapy practitioners recognize the potential for food insecurities within the older adult population in the community, it is well within their current domain to evaluate the impact of food insecurity.
Occupational therapy practitioners providing services to community-dwelling older adults are in an optimal position to incorporate basic food screenings and assessments into their practice to identify individuals at risk of food insecurity and challenges through food-related activities (Pooler et al., 2018). When occupational therapists understand the complexity of food insecurity, they can address its many dimensions in a client-centered context. Older adults may encounter numerous natural and built barriers, including home accessibility, inclement weather, and neighborhood accessibility, which all affect their ability to leave home.
The prevalence of food insecurity among older adults is a growing public health and occupational justice issue. Inadequate nutrition exacerbates and contributes to chronic illness. With increased awareness of older adults’ risks for food insecurity, OTs possess the tools and skills to mitigate the risks and ensure participation in essential occupations.
A universal screening tool to identify food insecurity is the Hunger Vital Sign™. It is a validated and quick two-question screening tool to identify the risk of food insecurity. Households are considered at risk if they answer that either or both of the following two statements is “often true” or ”sometimes true” (compared with “never true”):
- “Within the past 12 months, we worried whether our food would run out before we got money to buy more.”
- “Within the past 12 months, the food we bought just didn’t last, and we didn’t have money to get more.”
The client-centered Occupational Performance Measure of Food Activities (OPMF) is a 15-item scale that helps OTs obtain information regarding perceived satisfaction, performance level, and satisfaction related to shopping, cooking, eating, dining out, and healthy eating.
The U.S. Household Food Security Survey Module (HSFFM): Six Item Short Form is valuable for identifying the four levels of food insecurity. The HSFFM is within the scope of occupational therapy practice in identifying food insecurity (Pooler et al., 2018).
The Making Meals Performance Measure (MMPM) captures an individual’s ability to create meals with a limited number of food items within a specified period of time. Data points include: number of meals created, number of food items used, number of food units used, and percentage of overall food units used. A complexity score is also calculated.
The COPM is a client-centered, interview-based assessment that identifies and prioritizes areas of decreased functional performance in daily activities. The occupational therapy practitioner can guide the conversation to also include food-related occupations in order to establish areas of importance with older clients who may be at risk of food insecurity and potential malnutrition.
Criticism surrounding federal programs that simply provide food has prompted a shift toward developing and implementing nutrition education programs that can be used in conjunction with food provision, to combat food insecurity (Dollahite et al., 2014). This shift acknowledges that those who lack the funds for food may also lack the knowledge and skills, which if learned, could help decrease food insecurity. Current assessments that are used to report the efficacy of these emerging programs focus largely on knowledge acquisition and are self-report measures. As the recognition for new approaches to addressing food insecurity grows, occupational therapists have an opportunity to demonstrate how strategic engagement in everyday activities can empower people in poverty to maximize their skills in food resource management and attain food security (Schmelzer & Leto, 2018).
Programming for those living in poverty and struggling with food insecurity aligns with occupational therapy’s role in addressing population health needs. While OT’s role in developing programming for this population is well-founded, the use of valid and reliable assessments, which capture skill-based change, is also needed to demonstrate the distinct value of the profession.
