Although the COVID-19 pandemic has worsened many health-related problems for older adults, food insecurity is one that has gotten relatively little attention.
“The pandemic has exacerbated existing trends in food insecurity,” Cindy Leung, ScD, MPH, assistant professor of public health nutrition at the Harvard T.H. Chan School of Public Health, in Boston, said in an email. “People who were already experiencing food insecurity found themselves at more severe levels, and other people were experiencing food insecurity for the first time. Older adults were no exception, on top of a higher risk of COVID-related disease burden and hospitalizations.”
Scope of the Problem
Food insecurity — generally defined as a lack of access to a sufficient amount of nutritious foods — was an issue in the U.S. even before the pandemic started. Leung and her then-colleagues at the University of Michigan in Ann Arbor, conducted a survey of about 2,000 older adults in 2020, which found that 14% of those ages 50-80 had experienced food insecurity in 2019. This appeared to be linked with worse physical and mental health, the researchers reported. “Nearly half of adults age 50-80 who were food insecure rated their physical health as fair or poor (45%), compared to 14% of those who were food secure,” while “almost a quarter of those who were food insecure reported fair or poor mental health (24%) compared to 5% of those who were food secure.”
The researchers also found that approximately 54% of food-insecure respondents had multiple (two or more) chronic conditions, compared to 41% of food-secure individuals (P<0.001). Food-insecure individuals were more likely than food-secure individuals to report having asthma; chronic bronchitis or chronic obstructive pulmonary disease; chronic pain; diabetes; kidney disease; or a sleep disorder than food-secure respondents (P<0.001 for all). There were no significant differences in cancer, heart disease, high blood pressure, high cholesterol, or non-alcoholic fatty liver disease by food security status, however, they noted.
“Food insecurity is actually a really big problem among older adults,” Nicole Heckman, vice president of benefits access at the AARP Foundation, said in a phone interview at which a press person was present. “Nearly 9.5 million adults ages 50 and older are food insecure.”
Heckman gave several reasons for the problem. “One is obviously a lack of income,” she said. “Those that are at or below the poverty line struggle to afford the food they need, especially when we think about the inflation and just the crazy food prices and how much they have gone up over the last 2 years.”
In addition, “there are places that are food deserts or food swamps, where people do not have easy access to culturally appropriate, healthful food,” said Heckman. “These are the communities where the nearest stores might be corner stores that have a very limited selection of food.” Finally, she added, “when we’re talking about older adults and people living with a disability, there may be access issues with getting to the store because of a disability or limited movement.”
Lack of Awareness of SNAP Eligibility
The federal government addressed the general issue of food insecurity during the pandemic in part by expanding access to food programs like the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, as well as expanding the dollar value of available benefits. However, Heckman said, “many older adults aren’t actually aware of the programs and benefits to help them put food on their table. Research from AARP and Mathematica shows that there are over 3 million older adults that missed out on more than $200 a month in SNAP benefits” during the pandemic.
Why did they miss out? “Sometimes people aren’t aware that they’re eligible — maybe earlier in their life, they were not eligible, but something has happened; they’ve had a change of circumstances, a life event or death of a partner as an example, where now they’re eligible, but they weren’t before and they don’t know,” Heckman said. Stigma and misinformation are also issues. “A common misperception amongst older adults is that you need to have children in the home or that if they participate, families with children will not be able to participate. And that’s simply not true. The program grows to the size that is needed in communities and states across the U.S.”
Heckman praised the administration for bringing food insecurity into the spotlight during its White House Conference on Hunger, Health, and Nutrition last September. In conjunction with the conference, the White House announced that as part of more than $8 billion pledged in public- and private-sector contributions, “at least $2.5 billion will be invested in start-up companies that are pioneering solutions to hunger and food insecurity.”
What Clinicians Can Do
Food insecurity among older adults was also the subject of a December hearing held by the Senate Special Committee on Aging. “Congress must continue to support programs like the Older Americans Act Nutrition Program, SNAP, the Senior Farmers Market Nutrition Program, and Senior Food Boxes,” committee chairman Sen. Robert Casey (D-Pa.) said in a press release. “And we must continue work to reduce barriers to access. No senior should have to choose between putting food on the table or taking a needed medication.” Casey has introduced two bills related to the issue: the Senior Nutrition Task Force Act — cosponsored by Sen. Tim Scott (R-S.C.), the committee’s ranking member — would establish an interagency task force to develop ways to combat the problem; and the Tools for Ensuring Access to Meals Act would provide funding to act on the task force’s recommendations.
How can clinicians find out if a patient is food insecure? “We have a wonderful tool, the two-item Hunger Vital Sign, to help clinicians screen for food insecurity,” said Leung. “This tool has been widely adopted in many healthcare systems as part of growing recognition of the importance of food insecurity and other social determinants on health outcomes. I would advise to screen for food insecurity and to identify strategies that the clinic can provide to assist patients with food insecurity,” such as giving out a list of community food pantries and congregate meal sites or partnering with a local food bank to provide SNAP application assistance.
For those who want to learn more, the AARP Foundation and the Food Research & Action Center have developed a free “Screen and Intervene” 1-credit continuing medical education course that providers can take to learn about how to screen for food insecurity in their patients, Heckman said.