• Dr. Jenneffer Pulapaka

THE COMPLICATIONS OF ELDER FOOD INSECURITY


“I believe every patient needs a physician who will be an advocate to help them regain their health.'' - Dr. Jenneffer Pulapaka, DPM, ACFAS, CWSP, DABMSP, FACCWS

How does food insecurity impact our elderly population? From 2001 to 2015, the number of older adults who were food insecure more than doubled to 5.4 million individuals in the United States. Food insecurity was reported to affect all aspects of their life and health, along with increasing stress and reducing coping abilities. There is "increasing evidence demonstrating that food insecurity is an important risk factor for poor health has made it virtually incontrovertible that dietary quality, not just calories, is an essential component of supporting food security". Furthermore, food insecurity is associated with an increased risk for numerous chronic conditions, including depression, insomnia, substance abuse, diabetes mellitus type 2, obesity, hypertension, coronary heart disease, congestive heart failure, dyslipidemia, and chronic kidney disease.

How is this different from adults or children?

Elderly patients with multiple chronic conditions/diseases were significantly more likely to report food insecurity. For many of the food insecure elderly, there is a "stigma effect arising from welfare use" that may lead to reduced self-esteem and result in depressive moods, which exacerbates chronic diseases. "To make matters worse, food insecurity is associated with increased cost-related medication non-adherence. Because if you don't have money for food, one probably doesn't have money for medications. Hence, contributing to an increased burden on our healthcare system, as noted in the 2017 Rand Report.

Sadly, numerous research papers report that adults with depression have higher rates or levels of multiple chronic disease risk factors, including cardiovascular disease, dyslipidemia, hypertension, insomnia, substance abuse, diabetes, obesity, metabolic syndrome, physical inactivity, and systemic inflammation.

Elderly SNAP participants with very low food security have even higher odds of depression and correlated with negative self-attitudes. But, there is now research that is beginning to delve into whether reforms to the food assistance program aimed at reducing stigma can help alleviate emotional distress and increase the quality of food among the elderly welfare recipients.

With that noted, SNAP does not cause these problems, like obesity; rather, it is likely that more obese populations are enrolled in SNAP. Adults can use SNAP to one's advantage because the 2019 study reported that very low food security and physical health outcomes were negatively significant before SNAP enrollment. But, decreased after SNAP participation, indicating that SNAP may have prevented poor physical health resulting from very low food security. So, on the positive side, SNAP is associated with a reduction in health care costs; "low-income adults who participate in SNAP incur an average of $1,400 per year less in health care expenditures compared with matched nonparticipants " and "perceived farmers' market access related to lower incidence of overweight/obesity in SNAP".

Elder food insecurity is a complicated and dynamic construct involving chronic medical conditions, mental fitness, and the overall lifestyle of our communities. The takeaway is that there are ways to improve the health and wellness of our society regardless of income; through healthful foods, social support, quality sleep, physical fitness, positive emotions, and cessation of substance abuse. So, how will you uplift your community in 2020?

Dr. Jenneffer Pulapaka

Podiatric Surgeon & Wound Care Physician

DeLand Foot and Leg Center

Sources:

Aligning Programs and Policies to Support Food Security and Public Health Goals in the United States. Seligman HK, Berkowitz SA.

Annu Rev Public Health. 2019 Apr 1;40:319-337. doi: 10.1146/annurev-publhealth-040218-044132. Epub 2018 Nov 16.

PubMed [citation]

PMID: 30444684

PMCID: PMC6784838

Food stamps, food insecurity, and health outcomes among elderly Americans.

Pak TY, Kim G.

Prev Med. 2020 Jan;130:105871. doi: 10.1016/j.ypmed.2019.105871. Epub 2019 Oct 31.

PMID:31678175

Predictors of Diet-Related Health Outcomes in Food-Secure and Food-Insecure Communities.

Kaiser ML, Dionne J, Carr JK.

Soc Work Public Health. 2019;34(3):214-229. doi: 10.1080/19371918.2019.1575313. Epub 2019 Feb 15.

PubMed [citation]

PMID:30767652

Ziliak JP, Gundersen C. The State of Senior Hunger in America 2015: An Annual Report - Supplement 2017.

Rand Report 2017: https://www.rand.org/topics/health-health-care-and-aging.html

Atypical depressive symptoms and obesity in a national sample of older adults with major depressive disorder. Chou KL, Yu KM Depress Anxiety. 2013 Jun; 30(6):574-9.