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A time to recognize the impact of malnutrition and food insecurity on aging well

Malnutrition Awareness WeekTM, taking place September 19–23, 2022, is a prime opportunity to raise awareness about the more than 34.8 million people living in US households that struggle to put food on the table. Not everyone who is food insecure is malnourished, and not everyone who is malnourished has a hard time getting enough food to eat. But food insecurity and malnutrition do go hand in hand, and these related conditions impact tens of millions of people.

Up to 50 percent of older adults are malnourished or at risk of malnutrition, and millions of older adults experience food insecurity. Those numbers demonstrate how important it can be for healthcare providers to educate their older clients about malnutrition and food insecurity and to connect them to nutrition programs such as the US Department of Agriculture Supplemental Nutrition Assistance Program (SNAP, often identified as food stamps).

As used in this blog post, the term food insecurity means a household-level economic and social condition of limited or uncertain access to adequate food. And malnutrition is considered a state of deficit, excess or imbalance in protein, energy or other nutrients that adversely impacts an individual’s own body form, function and clinical outcomes.

The food insecurity rate of 7.1 percent among households with adults 65 and older is—perhaps surprisingly—lower than the national average of 10.2 percent. This lower rate is due in large part because Social Security and Medicare have reduced poverty rates among older adults. Additionally, after they turn 60, adults are often eligible for programs like home-delivered meals or congregate meals. They can also benefit from SNAP policies that streamline access and allow older applicants to claim additional deductions such as medical and uncapped excess housing costs. A considerable body of evidence shows the critical role SNAP plays in improving the food security and physical and mental health of older adults. Unfortunately, too few older adults are enrolled in these programs. In 2018, only 48 percent of eligible older adults participated in SNAP.

Figure 1 shows risk factors for food insecurity for older adults. (From the Food Research & Action Center)

 

Even though older adults have lower overall rates of food insecurity, certain groups still struggle to access enough food. This is largely driven by poverty and factors like household composition, as shown in Figure 1. Older adults in multigenerational households may struggle because parents, grandparents and other caregivers often sacrifice their own food and nutrition needs so the children can eat. Fueled by underlying structural discrimination and other inequities, food insecurity rates are disproportionately higher for older adults in Black, Latinx and other households of color compared to older adults in white households.

Food insecurity fuels some of our nation’s most chronic, serious and costly health conditions. As shown in Figure 2, adults experiencing food insecurity face many health challenges that can be exacerbated by coping strategies such as forgoing medical care and medication to pay for food. Among adults, food insecurity and associated health-compromising coping strategies can hinder healthy aging. Such strategies can result in poor glycemic control or end-stage renal disease and increase physician encounters, office and emergency room visits and hospitalizations.
 

Physical and mental health consequences associated with food insecurity among older adults

Diabetes

Functional limitations

Obesity

Fair or poor self-rated health

Hypertension

Cognitive decline, mental distress

Heart disease

Osteoporosis

Peripheral arterial disease

Gum disease

Malnutrition

Asthma

Figure 2 details conditions related to food insecurity in older adults. (From reports by the National Foundation to End Senior Hunger and AARP)

Food insecurity and malnutrition are interconnected conditions, with food insecure older adults having lower nutrient intakes. Food insecurity and malnutrition are also related to health equity as poor diet and lack of access to healthy foods can contribute to health disparities.

Malnutrition can have deleterious effects on older adult health, especially when other conditions are present. Unfortunately, malnutrition is not frequently identified or treated, although it is preventable. Healthcare professionals and others caring for at-risk older adults need tools and information to identify those in need and help them take advantage of resources so they can access nutritious food. With effective tools, food insecurity and malnutrition can be better identified and addressed, leading to improved health outcomes.

In recognition of Malnutrition Awareness Week, get involved by learning more about food insecurity and its connections to malnutrition. Here are some great resources to get you started.

  • Take a free, one-hour, online course, Screen & Intervene: Addressing Food Insecurity Among Older Adults. The Food Research & Action Center, in collaboration with AARP Foundation, designed this course to help frontline health workers and others identify and address food insecurity and connect older adults to nutrition resources like SNAP. Participants are eligible to receive one Continuing Medical Education (CME) credit.
  • Participate in an improvement activity. The Centers for Medicare & Medicaid Services included a food insecurity and nutrition-risk improvement activity for office-based physicians and clinicians who participate in the Merit-Based Incentive Payment System starting in 2022. Integrating quality nutrition care into this framework can help to better address chronic diseases and support active aging. For more information, visit the Malnutrition Quality Improvement Initiative.

Alexandra Ashbrook, JD, LLM, is director of Root Causes and Specific Populations at Food Research & Action Center.

Laura Borth, MS, RD, is a policy associate at Defeat Malnutrition Today.

Note: This information is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from research. The view expressed here are not necessarily those of the ICAA, we encourage you to make your own health and business decisions based upon your research and in partnership with a qualified professional.

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