How clinicians can identify, address food insecurity in older patients
Almost 8% of all U.S. households had at least one adult aged 65 years and older experience food insecurity in 2017, a number almost certain to increase as more Americans grow older, according to researchers.
Multiple studies indicate food insecurity is a critical social determinants of health, the circumstances in which people live and work and how they influence a person’s well-being. In 2017, then-Surgeon General Vivek H. Murthy, MD, MBA, wrote it was “underrecognized,” calling it “a top public health priority for the nation.”
“We must leverage multisectoral approaches across government, nonprofit, health care, and research to study and scale effective strategies,” Murthy wrote.
Last year, ACP released a position paper and AAFP launched The EveryONE Project to provide ways clinicians can address the social determinants of health into their practices. The AAFP’s initiative was spurred by a survey among its members that showed 64% were not properly staffed to address the risk factors for social determinants of health with patients and 56% felt unable to provide solutions to patients.
Jennifer A. Pooler, MPP, of the advanced analytics practice area at IMPAQ International in Columbia, Maryland, and colleagues acknowledged the difficulties in identifying food insecurity.
“Recognizing food insecurity can be especially challenging given the frequent co-occurrence of food insecurity and obesity in the United States because dietary intake in food-insecure households frequently shifts away from healthier, more expensive foods and toward cheaper foods that are typically more obesogenic,” they recently wrote in the Journal of the American Geriatrics Society.
Pooler and colleagues wrote that poor health, out-of-pocket health expenses, functional impairment and lack of reliable transportation are all potential risk factors of food insecurity. They cautioned that such status may be sporadic, not always visible, and more frequent among Medicaid recipients, dual Medicare-Medicaid enrollees and patients with multiple comorbidities.
Pooler and colleagues identified tools that clinicians can use to combat food insecurity:
- Online courses from www.seniorhealthandhunger.org;
- CDC’s food insecurity algorithm at www.nopren.org/working_groups/hunger-safety-net/clinical-linkages;
- Food Resource & Action Center’s resource library at http://www.frac.org/research/resource-library/combating-food-insecurity-tools-helpingolder-adults-access-snap-2; and
- Resource guide and toolkit from www.impaqint.com/OASDOH.
The consequences of food insecurity go beyond hunger, Pooler and colleagues wrote.
“Food-insecure older adults are more likely to be in fair or poor health, with frequently associated comorbidities including diabetes, depression, hypertension, heart disease, and gingivitis. Food-insecure older adults are also more likely to have limitations in activities of daily living,” they wrote, adding that those who are food insecure, with the help of their clinician, can change their status.
“There is good evidence ... that programs supporting food security can improve health outcomes and the likelihood of aging in place among older adults, suggesting that clinical interventions are warranted.” – by Janel Miller
AAFP.org https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/sdoh-survey-results.pdf. Accessed Jan. 15, 2019.
Chung EK, et al. Curr Prob Pediatr Adolesc Health Care. 2016;doi:10.1016/j.cppeds.2016.02.004.
Murthy VH. Public Health Rep. 2016;doi:10.1177/0033354916664154.
Pooler JA, et al. J Am Geriatr Soc.2018;doi:10.1111/jgs.15736.
Singh GK, et al. Int J MCH AIDS. 2017;doi:10.21106/ijma.236
Disclosures : Murthy was surgeon general at the time of his remarks. Pooler and colleagues report no relevant financial disclosures.