Tip Sheets

Reporting on food insecurity and older adults

By Liz Seegert

Food insecurity is a critical public health issue facing millions of older adults in the US. In 2017, there were slightly more than 49 million Americans age 65 and over, and about 8 million of them (16 percent) were considered facing the threat of hunger, according to the National Council for Aging Care. Meals on Wheels America puts that number closer to 10 million older adults. The problem is growing worse as our population ages and socioeconomic disparities increase.

Food insecurity is not just worrying about getting the next meal, however. It is a strong predictor of chronic disease and diabetes, heart disease, stroke and lung disease, say the experts at Meals on Wheels America. Older adults already have higher health care costs and take more medications compared with the rest of the population; these economic realities really squeeze low-income older adults. In addition to worsening physical health problems, poor nutrition can also contribute to mental health problems such as anxiety and depression.

The U.S. Department of Agriculture (USDA) defines food insecurity as a lack of consistent access to enough food for an active, healthy life. While hunger and food insecurity are closely related, they are distinct concepts. Hunger refers to a personal, physical sensation of discomfort; food insecurity refers to a lack of available financial resources for food at the level of the household.

Additional social determinants of health, such as affordable housing, social isolation, education, transportation, neighborhood characteristics and economics may also contribute to food insecurity. Poverty and food insecurity in the United States are closely related, according to Feeding America, a nonprofit network of food banks, food pantries and meal programs. However, not everyone living below the poverty line experiences food insecurity, and people living above the poverty line also may experience this situation.

Food insecurity is divided into low and very low food security. For low food security, a person reports reduced quality, variety or desirability in the diet with little or no reduced food intake. For very low food security, a person reports multiple disrupted eating patterns or reduced food intake. National experts use these definitions in federal and academic surveys and literature. 

The number of food-insecure seniors is projected to increase by 50 percent when the youngest of the baby boomer generation reaches age 60 in 2025.

The top 10 states with seniors facing the threat of hunger are: Arkansas, Mississippi, Louisiana, New York, South Carolina, Texas, District of Columbia, North Carolina, Georgia and Ohio, according to Meals on Wheels.

Health effects of food insecurity

In addition to being a strong predictor of poor health and disease, food-insecure seniors are at increased risk for chronic health conditions, even when controlling for other factors such as income. According to Meals on Wheels:

  • 60 percent are more likely to experience depression

  • 53 percent are more likely to report a heart attack

  • 52 percent are more likely to develop asthma

  • 40 percent are more likely to report an experience of congestive heart failure.

Food insecure older adults eat fewer calories, protein and key vitamins and minerals necessary for good health than do those who are food secure. This can lead to a host of health problems, including low muscle mass, which increases risk of falls and limits mobility; frailty, increased fatigue, impaired cognition and increased hypertension.

Food insecure older adults are 50 percent more likely to have diabetes; three times more likely to suffer from depression; 60 percent more likely to have congestive heart failure or a heart attack; 30 percent more likely to have at least one ADL impairment; and twice as likely to report gum disease and asthma. This Health Affairs analysis found that food insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors 14 years older.

Defeat Malnutrition, a coalition of organizations and stakeholders seeking eradicate this problem in the U.S., says many senior households must make tradeoffs each month between food and paying for utilities, transportation, medical care, or housing. For those households with a family member over age 75, the most common strategy was a tradeoff between medications and food. One of the most vulnerable groups may be minority older adults. Minority groups are more likely to indicate skipping or eating smaller meals due to lack of money, according to the organization.

Help can be uncertain

Neither Medicare nor Medicaid funds meals, food or nutritional supplements for individuals in need. While there are an array of national, state and local programs through different agencies, many lack enough funding to help everyone who needs it. 

Entitlement programs such as SNAP (Supplemental Nutrition Assistance Program) can make a critical difference for older adults who need food. Eligibility is based on several criteria, including income and benefits. The average monthly benefit is $110 for an older adult living alone, and higher for older adults living with others. Yet the rate of participation for eligible older adults is about 42 percent; significantly lower than the 83 percent participation of other eligible populations. There are multiple reasons for this, ranging from participants’ feeling of stigma to frustration with the application process. The Trump administration’s 2019 budget proposed slashing SNAP by $17 billion, according to the Tampa Bay Times.

Other programs are discretionary, and have different eligibility characteristics. Congress funds these programs (usually annually) in varying amounts. The Older Americans Act (OAA) is among the best known, and provides about a third of funding to local Meals on Wheels networks, according to this Washington Post story. As this tip sheet on OAA explains, it was reauthorized in 2016, only through FY 2019.

The Older Americans Act Nutrition Program (OAA NP), administered by state units on aging (SUA) is the largest community-based nutrition services program focused solely on older adults. It is not a stand-alone program but rather, incorporated into comprehensive and coordinated home and community based services. Seniors receive healthy meals five days a week, nutrition education, screening and assessment. Individuals who receive these services are generally older, poorer, and more functionally impaired. They are more likely to be women, minority, live in rural areas or live alone. They also are at higher risk for long-term nursing home placement than the general older population. Advocates say OAA NP funding has not kept pace with inflation nor with the growing number of older adults in need of service. 

The USDA says it distributes food and administrative funds to 47 states, the District of Columbia and two Indian Tribal Organizations. Applicants must be at or below 130 percent of poverty. It has seven programs older adults may qualify for, including Commodity Supplemental Food Program (CSFP), The Emergency Food Assistance Program (TEFAP), Senior Farmers Market Nutrition Program (SFMNP) and Food Distribution Program on Indian Reservations (FDPIR). However, some of these programs are small, with minimal funding and serve limited numbers of older adults. Not all programs are available in every state or community.

Food banks and food pantries may provide groceries only once a month to needy older adults. Often individuals must be mobile enough to stand in line to obtain food. However, some programs have mobile pantries and deliver food to the homebound,

It can be harder for seniors to protect themselves from hunger than it is for the general population. For example, one study found that food-insecure seniors sometimes had enough money to purchase food but did not have the resources to access or prepare food due to lack of transportation, functional limitations or health problems.

The National Resource Center on Nutrition & Aging says it is imperative that health, nutrition and aging service providers along the clinical-to-community care continuum are able to identify food insecurity in older adults and connect them with needed community-based resources.

Story ideas

  • Review federal, state, and local legislation that influences supplemental meal programs.

    • What’s on the chopping block for 2019 and beyond?

    • Are any programs seeing an increase in funding?

    • How will the difference be made up?

  • What are local communities doing to address food insecurity among older residents, e.g., mobile food pantries for seniors who can’t stand in line, home meal delivery for those who don’t qualify for Meals on Wheels, weekend deliveries to supplement existing benefits, etc.

  • Profile a unique program making a difference in seniors’ lives.

  • What are unique challenges to address food insecurity for seniors in rural vs urban areas, and what are some viable solutions?

  • How are other social determinants of health affecting food insecurity in your community? Are there food deserts? Transportation issues? Lack of available, affordable produce in certain neighborhoods?

Resources

Experts

Craig Gundersen, Ph.D.
Professor in Agricultural Strategy
University of Illinois, Urbana
cggunder@illinois.edu

Seth A. Berkowitz, M.D., M.P.H.
Asst. Professor, Department of Medicine
University of North Carolina
and researchers at the UNC Center for Health Equity Research
919-445-6794

Wendy S. Wolfe
Division of Nutritional Sciences,
Cornell University
ww16@cornell.edu

Ellie Hollander
President and CEO
Meals on Wheels America
888-998-6325
Here’s a summary of her keynote at Health Journalism 2017.