Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression

      Abstract

      Background

      Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.

      Objective

      To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults.

      Design

      The cross-sectional study was conducted from February 2017 to May 2017.

      Participants/setting

      A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated.

      Main outcome measures

      Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form).

      Statistical analyses performed

      Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications.

      Results

      Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04).

      Conclusions

      Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Coleman-Jensen A.
        • Rabbitt M.P.
        • Gregory C.A.
        • Singh A.
        Household Food Security in the United States in 2016. Economic Research Report, 237.
        US Department of Agriculture, Economic Research Service, Washington, DC2017
        • Bhattacharya J.
        • Currie J.
        • Haider S.
        Poverty, food insecurity, and nutritional outcomes in children and adults.
        J Health Econ. 2004; 23: 839-862
        • Dixon L.B.
        • Winkleby M.A.
        • Radimer K.L.
        Dietary intakes and serum nutrients differ between adults from food-insufficient and food-sufficient families: Third National Health and Nutrition Examination Survey, 1988–1994.
        J Nutr. 2001; 131: 1232-1246
        • Lee J.S.
        • Frongillo E.A.
        Nutritional and health consequences are associated with food insecurity among U.S. elderly persons.
        J Nutr. 2001; 131: 1503-1509
        • Bernstein M.
        • Munoz N.
        Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness.
        J Acad Nutr Diet. 2012; 112: 1255-1277
        • Slawson D.L.
        • Fitzgerald N.
        • Morgan K.T.
        Position of the Academy of Nutrition and Dietetics: the role of nutrition in health promotion and chronic disease prevention.
        J Acad Nutr Diet. 2013; 113: 972-979
      1. US Department of Agriculture. Economic Research Service. Food security in the U.S. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/. Updated September 6, 2017. Accessed October 10, 2017.

        • Klesges L.M.
        • Pahor M.
        • Shorr R.I.
        • Wan J.Y.
        • Williamson J.D.
        • Guralnik J.M.
        Financial difficulty in acquiring food among elderly disabled women: results from the Women's Health and Aging Study.
        Am J Public Health. 2001; 91: 68-75
        • Goldberg S.L.
        • Mawn B.E.
        Predictors of food insecurity among older adults in the United States.
        Public Health Nurs. 2015; 32: 397-407
        • Brewer D.P.
        • Catlett C.S.
        • Porter K.N.
        • et al.
        Physical limitations contribute to food insecurity and the food insecurity–obesity paradox in older adults at senior centers in Georgia.
        J Nutr Elder. 2010; 29: 150-169
        • Lee J.S.
        • Frongillo Jr., E.A.
        Factors associated with food insecurity among U.S. elderly persons importance of functional impairments.
        J Gerontol B Psychol Sci Soc Sci. 2001; 56: S94-S99
        • Wolfe W.S.
        • Olson C.M.
        • Kendall A.
        • Frongillo E.A.
        Understanding food insecurity in the elderly: a conceptual framework.
        J Nutr Educ. 1996; 28: 92-100
        • Chang Y.
        • Hickman H.
        Food insecurity and perceived diet quality among low-income older Americans with functional limitations.
        J Nutr Educ Behav. 2018; 50: 476-484
        • Sharkey J.R.
        Risk and presence of food insufficiency are associated with low nutrient intakes and multimorbidity among homebound older women who receive home-delivered meals.
        J Nutr. 2003; 133: 3485-3491
        • Leung C.W.
        • Epel E.S.
        • Willett W.C.
        • Rimm E.B.
        • Laraia B.A.
        Household food insecurity is positively associated with depression among low-income Supplemental Nutrition Assistance Program participants and income-eligible nonparticipants.
        J Nutr. 2015; 145: 622-627
        • Kollannoor-Samuel G.
        • Wagner J.
        • Damio G.
        • et al.
        Social support modifies the association between household food insecurity and depression among Latinos with uncontrolled type 2 diabetes.
        J Immigr Minor Health. 2011; 13: 982
        • Laraia B.A.
        • Siega-Riz A.M.
        • Gundersen C.
        • Dole N.
        Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women.
        J Nutr. 2006; 136: 177-182
        • German L.
        • Kahana C.
        • Rosenfeld V.
        • et al.
        Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community-dwelling elderly people.
        J Nutr Health Aging. 2011; 15: 3-8
        • Kim K.
        • Frongillo E.A.
        Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders.
        J Nutr. 2007; 137: 1005-1010
      2. Feeding America and National Foundation to End Senior Hunger (NFESH). The Spotlight on Senior Health: Adverse Health Outcomes of Food Insecure Older Americans. http://www.feedingamerica.org/research/senior-hunger-research/or-spotlight-on-senior-health-executive-summary.pdf. Accessed in August 2017.

        • Cabrera M.A.S.
        • Mesas A.E.
        • Garcia A.R.L.
        • de Andrade S.M.
        Malnutrition and depression among community-dwelling elderly people.
        J Am Med Dir Assoc. 2007; 8: 582-584
        • Smoliner C.
        • Norman K.
        • Wagner K.
        • Hartig W.
        • Lochs H.
        • Pirlich M.
        Malnutrition and depression in the institutionalized elderly.
        Br J Nutr. 2009; 102: 1663-1667
        • Yoshimura K.
        • Yamada M.
        • Kajiwara Y.
        • Nishiguchi S.
        • Aoyama T.
        Relationship between depression and risk of malnutrition among community-dwelling young-old and old-old elderly people.
        Aging Ment Health. 2013; 17: 456-460
        • Jung S.E.
        • Bishop A.J.
        • Kim M.
        • Hermann J.
        • Kim G.
        • Lawrence J.
        Does depressive affect mediates the relationship between self-care capacity and nutritional status among rural older adults? A structural equation modeling approach.
        J Nutr Gerontol Geriatr. 2017; 36: 63-74
        • Johansson Y.
        • Bachrach-Lindström M.
        • Carstensen J.
        • Ek A.C.
        Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study.
        J Clin Nurs. 2009; 18: 1354-1364
        • Konttinen H.
        • Männistö S.
        • Sarlio-Lähteenkorva S.
        • Silventoinen K.
        • Haukkala A.
        Emotional eating, depressive symptoms and self-reported food consumption: a population-based study.
        Appetite. 2010; 54: 473-479
        • Guligowska A.
        • Piglowska M.
        • Fife E.
        • et al.
        Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression.
        Clin Interv Aging. 2016; 11: 1505-1517
        • Locher J.L.
        • Ritchie C.S.
        • Robinson C.O.
        • Roth D.L.
        • West D.S.
        • Burgio K.L.A.
        Multidimensional approach to understanding under-eating in homebound older adults: the importance of social factors.
        Gerontologist. 2008; 48: 223-234
        • Elsner R.J.F.
        Changes in eating behavior during the aging process.
        Eat Behav. 2002; 3: 15-43
        • Li I.C.
        • Kuo H.T.
        • Lin Y.C.
        The mediating effects of depressive symptoms on nutritional status of older adults in long-term care facilities.
        J Nutr Health Aging. 2013; 17: 633-636
        • Webber A.P.
        • Martin J.L.
        • Harker J.O.
        • Josephson K.R.
        • Rubenstein L.Z.
        • Alessi C.A.
        Depression in older patients admitted for post acute nursing home rehabilitation.
        J Am Geriatr Soc. 2005; 53: 1017-1022
        • Holben D.H.
        • Marshall M.B.
        Position of the Academy of Nutrition and Dietetics: food insecurity in the United States.
        J Acad Nutr Diet. 2017; 117: 1991-2002
        • Fillenbaum G.G.
        Multidimensional Functional Assessment of Older Adults: The Duke Older Americans Resources and Service Procedures.
        Lawrence Erlbaum Associates, Inc, Hillsdale, NJ1988
        • Blumberg S.J.
        • Bialostosky K.
        • Hamilton W.L.
        • Briefel R.R.
        The effectiveness of a short form of the household food security scale.
        Am J Public Health. 1999; 89: 1231-1234
        • Furness B.
        • Simon P.
        • Wold C.
        • Asarian-Anderson J.
        Prevalence and predictors of food insecurity among low-income households in Los Angeles County.
        Public Health Nutr. 2004; 7: 791-794
        • Yesavage J.A.
        • Brink T.L.
        • Rose T.L.
        Geriatric depression scale (GDS).
        in: Handbook of Psychiatric Measures. American Psychiatric Association, Washington, DC2000
        • Rubenstein L.Z.
        • Harker J.O.
        • Salva A.
        • Guigoz Y.
        • Vellas B.
        Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).
        J Gerontol A Biol Sci Med Sci. 2001; 56: M366-M372
      3. Muthén L, Muthén B. Mplus Users Guide, 6th ed. Los Angeles, CA: Muthén & Muthén; 2010.

        • Pierce M.B.
        • Sheehan N.W.
        • Ferris A.M.
        Nutrition concerns of low-income elderly women and related social support.
        J Nutr Elder. 2002; 21: 37-53
        • Champagne C.M.
        • Casey P.H.
        • Connell C.L.
        • et al.
        Poverty and food intake in rural America: Diet quality is lower in food insecure adults in the Mississippi Delta.
        J Am Diet Assoc. 2007; 107: 1886-1894
        • Holben D.H.
        • Barnett M.A.
        • Holcomb J.P.
        Food insecurity is associated with health status of older adults participating in the commodity supplemental food program in a rural Appalachian Ohio county.
        J Hunger Environ Nutr. 2007; 1: 89-99
        • Stuff J.E.
        • Casey P.H.
        • Szeto K.L.
        • et al.
        Household food insecurity is associated with adult health status.
        J Nutr. 2004; 134: 2330-2335
        • Polivy J.
        Psychological consequences of food restriction.
        J Am Diet Assoc. 1996; 96: 589-592
        • Wright K.B.
        • King S.
        • Rosenberg J.
        Functions of social support and self-verification in association with loneliness, depression, and stress.
        J Health Commun. 2014; 19: 82-99
      4. National Council on Aging. Healthy Aging Facts. https://www.ncoa.org/resources/fact-sheet-healthy-aging/. Published 2016. Accessed October 2017.

        • Holtfreter K.
        • Reisig M.D.
        • Turanovic J.J.
        Depression and infrequent participation in social activities among older adults: the moderating role of high-quality familial ties.
        Aging Ment Health. 2017; 21: 379-388
        • Ratcliffe C.
        • McKernan S.-M.
        • Zhang S.
        How much does the Supplemental Nutrition Assistance Program reduce food insecurity?.
        Am J Agric Econ. 2011; 93: 1082-1098

      Biography

      S. E. Jung is an assistant professor, Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa.

      Biography

      S. Kim is an assistant professor, Department of Sociology, Texas State University, San Marcos.

      Biography

      A. Bishop is an associate professor, Department of Human Development and Family Sciences, Oklahoma State University, Stillwater.

      Biography

      J. Hermann is a professor, Department of Nutritional Sciences, Oklahoma State University, Stillwater.