A never-ending cycle: Malnutrition, food insecurity and mental-health risk
A lack of social wellness and poor mental health put people at risk for malnutrition and food insecurity, while malnutrition and food insecurity increase the chance of poor mental health, particularly among older adults. As social and emotional wellness are key components of the International Council on Active Aging’s (ICAA) Dimensions of Wellness, ICAA recognizes that community support and access to mental health services are crucial to break the cycle of poor nutrition / poor mental health and help older adults live long and active lives.
Mental illness impacts quality of life
One in four older adults lives with mental illness and/or substance use disorder (SUD). Depression is the most common condition, and anxiety and sleep disturbances are reported often. Almost half of older adults have reported that COVID-19-related worry and stress have had a negative impact on their mental health, and older people have been disproportionately affected by loneliness, social isolation and grief during the pandemic.
Mental illness increases the likelihood of poor health outcomes and mortality for common conditions such as heart disease, cancer, hip fractures and diabetes. Serious mental illness reduces life expectancy by 11 to 30 years, largely due to increased comorbid conditions such as heart disease and diabetes. Medicare spending for beneficiaries with mental illness and/or SUD is two to three times higher than spending for other Medicare beneficiaries. Yet only 4% to 28% of older adults with mental health and/or SUD receive appropriate treatment, and Black and Latino older adults have less access to affordable, culturally competent mental health services than do their White peers.
Low nutrient intake can be a risk factor in some mental health issues, and B vitamins, Vitamin D, protein and minerals such as calcium and potassium can affect depression and other mood disorders. In addition, medications, alcohol and other substances can affect both mental health and nutrition issues.
Food insecurity increases mental health risks
Food insecurity occurs when people do not consistently have access to enough nutritious food to allow an active, healthy life. Food insecurity can occur when people are worried about running out of food (low food security) or when they do not have access to high-quality or a good variety of foods. People with very low food security may show multiple signs of disrupted eating and/or reduced intake due to not having enough to eat.
Many older adults are on fixed incomes and/or have high medical expenses, and poverty, poor health and food insecurity are all influenced by systems of oppression, with stronger feedback loops among marginalized communities. For example, Black and Latino older adults experience food insecurity at more than double the rate of White older adults.
Food insecurity is also associated with fair or poor self-rated health, mental distress, and cognitive decline. When people are experiencing food insecurity, they may choose coping strategies that can compromise their health, such as skipping preventive or needed medical care, underusing or not taking needed medications, forgoing foods needed for special medical diets or making trade-offs between food and other basic necessities.
Addressing mental health and malnutrition through community-based services
Many evidence-based programs have been developed to address mental health in the community setting (see more resources here) and to support caregivers. Community-based services can partner with local mental health providers for referrals and collaboration, train staff to implement mental health and substance use screenings and address challenges—such as housing, access to food and economic security—that may contribute to mental health issues. Addressing such issues may require blending funding from sources such as the Older Americans Act Title III-D, health system/plan funding, Substance Abuse and Mental Health Services Administration(SAMHSA) block grants, philanthropy and ACL discretionary/Prevention and Public Health Fund.
Screenings are simple and effective tools to identify those at risk for malnutrition, and it is easy to include food insecurity and malnutrition screeners, such as the two-question Hunger Vital Sign and two-question Malnutrition Screening Tool in routine care appointments and health screenings. SAMHSA has designed a toolkit to help organizations that provide services to older adults understand and educate their clients about the issues of malnutrition.
Key federal nutrition programs like Supplemental Nutrition Assistance Program (SNAP) are shown to reduce food insecurity and malnutrition. Nutrition services programs related to the Older Americans Act (OAA), such as Meals on Wheels and congregate meals, can provide both food and socialization and help screen for nutrition risk for people 60 years and older. These programs can be found using the Eldercare Locator Tool or Meals on Wheels America “Find Meals” tool. Defeat Malnutrition Today’s National Blueprint provides professional materials and a consumer resource hub with educational tools.
Over the last year, the Biden administration has made mental health a priority, addressing health inequities of Medicare coverage and expanding access to care through Telehealth. As we emerge from the COVID-19 pandemic and launch more community-based programs, we can expand mental health support to the most vulnerable. By addressing both nutrition and mental health needs of older adults, we can help break the cycle and promote active aging.
Meredith Ponder Whitmire, JD, Policy Director of Defeat Malnutrition Today and National Association of Nutrition and Aging Services Programs
Allison Lacko, PhD, Senior Nutrition Research and Policy Analyst of Food Research and Action Center
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.