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Food Insecurity Prevalent in Urban Older Adults

Key findings

  • In this cross-sectional study, the U.S. Adult Food Security Survey Module was administered to 475 adults, age 60 or older, who attended an urban primary care practice and had at least two concurrent chronic conditions
  • Food insecurity was identified in 8% of participants, sometimes despite enrollment in the Supplemental Nutrition Assistance Program and access to community food resources
  • The strongest risk factors for food insecurity were being young, being African American and having a mental health diagnosis

Efforts are emerging to embed screening for health-related social problems into primary care. One of those problems—food insecurity—is known to negatively impact the health outcomes of patients with multiple chronic conditions.

Christine S. Ritchie, MD, MSPH, director of research in the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital, Jane Jih, MD, PhD, at the University of California, San Francisco, and colleagues recently conducted one of the first studies of food insecurity in older primary care patients with multiple chronic conditions. According to their report in the Journal of General Internal Medicine, the strongest risk factors for food insecurity were being younger, African American and having a mental health diagnosis.

Study Methods

Using an electronic health record system, the researchers selected 475 adults, age 60 or older, who attended an urban primary care practice and had at least two concurrent chronic conditions. Between March and December 2016, they administered the 10-item U.S. Adult Food Security Survey Module by telephone.

Prevalence of Food Insecurity

Food insecurity, defined as at least three affirmative responses to the survey, was identified in 39 participants (8%). Of those, 13% reported being enrolled in the federal Supplemental Nutrition Assistance Program, and 69% reported using at least one community food resource.

Compared with food-secure participants, food-insecure participants:

  • Had a higher burden of chronic disease (21% vs. 46%, had at least five chronic conditions)
  • Were more likely to have alcohol or drug abuse, psychoses and/or depression documented in their records (26% vs. 67%)
  • Were more likely to report polypharmacy (12 vs. 17 total medications)
  • Had more primary care visits in the past year (3.5 vs. 5.3 visits)

Independent Risk Factors

On multivariate analysis, the factors most strongly associated with food insecurity were:

  • Being African American — increased the risk nearly six-fold compared with being white (OR, 5.8; 95% CI, 2.2–15.6)
  • Having at least one of the above-mentioned mental health diagnoses — increased the risk four-fold compared with having no such diagnosis (OR, 4.1; 95% CI, 1.9–9.0)
  • Older age — lowered the risk by 8% (OR, 0.92; 95% CI, 0.87–0.98). The median age of food-insecure participants was 68 vs. 73 for food-secure participants

Implications for Screening

Electronic health record systems may allow a population-health approach to identifying patients who are experiencing food insecurity. Among older adults with multiple chronic conditions, focusing screening on patients who have a mental health diagnosis may be an efficient way to identify those who may benefit from a referral to food resources.

6x
greater risk of food insecurity in older adults with multiple chronic conditions who were African American

4x
greater risk of food insecurity in older adults with multiple chronic conditions who had one or more mental health diagnoses

Learn more about Geriatric Medicine at Mass General

Refer a patient to the Division of Palliative Care & Geriatric Medicine

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