Measuring Food Insecurity in Older Adults Using Both Physical and Economic Food Access, NHANES 2013-2018

Authors: VAUDIN, ANNA - University Of Maryland; Moshfegh, Alanna; SAHYOUN, NADINE - University Of Maryland

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/4/2022
Publication Date: 3/14/2022
Citation: Vaudin, A.M., Moshfegh, A.J., Sahyoun, N.R. 2022. Measuring Food Insecurity in Older Adults Using Both Physical and Economic Food Access, NHANES 2013-2018. Journal of Nutrition. 152(8):1953-1962. https://doi.org/10.1093/jn/nxac058.
DOI: https://doi.org/10.1093/jn/nxac058

Interpretive Summary: Economic food insecurity has been shown to be a good indicator of vulnerability in the general population. However, in older adults, food insecurity may also be due to factors other than economic, such as physical inability to shop or cook. To determine the proportion of older adults in the United States who have difficulties with physical and/or economic access to food and to assess the relationship of physical and economic food insecurity with diet quality and with mental health of older adults, data from respondents age 60 and older in three cycles of the National Health and Nutrition Examination Survey (2013-14, 2015-16, 2017-18) were analyzed. Results showed that older adults who were physically and/or economically food insecure had significantly lower diet quality and had higher depression score than those who were food secure (p<0.01). However, those who were both physically and economically food insecure had the lowest diet quality and were the most depressed, regardless of covariates, and were the group with the most chronic conditions and the highest proportion of women, those living alone, and those in poverty (p<0.001). Older aduts who face both economic and physical barriers to food access are the most vulnerable with regards to socioeconomic characteristics, diet quality, and mental and physical health. Adding ability to shop and cook to food insecurity measurement tools can help identify those most at risk and provide appropriate supports.

Technical Abstract: Economic food insecurity has been shown to be a good indicator of vulnerability in the general population. However, in older adults, food insecurity may also be due to factors other than economic, such as physical inability to shop or cook. The objectives of this research are to determine the: 1) proportion of older adults in the United States who have difficulties with physical and/or economic access to food; 2) differences in characteristics, diet quality, and mental and physical health by economic and/or physical access to food; and 3) relationship of physical and economic food insecurity with diet quality and with mental health. Data from adults age 60 and older in three cycles of the National Health and Nutrition Examination Survey (2013-14, 2015-16, 2017-18) were used. Groups were created based on economic food security (measured using the USDA Household Food Security Survey Module) and physical food security (measured using questions evaluating ability to shop and cook). Depression, Healthy Eating Index score (HEI), and socioeconomic characteristics were compared by food security group. Rao-Scott Chi-squares were used to test for significant differences between categorical variables and t-tests for continuous variables, by food insecurity status. Associations between food security status, HEI, and depression score were examined using linear regression analysis. Those who were physically and/or economically food insecure had significantly lower diet quality and had higher depression score than those who were food secure (p<0.01). However, those who were both physically and economically food insecure had the lowest diet quality and were the most depressed, regardless of covariates, and were the group with the most chronic conditions and the highest proportion of women, those living alone, and those in poverty (p<0.001). Those who face both economic and physical barriers to food access are the most vulnerable with regards to socioeconomic characteristics, diet quality, and mental and physical health. Adding ability to shop and cook to food insecurity measurement tools can help identify those most at risk and provide appropriate supports.