Research

This project determined and compared the dietary and total (food and dietary supplements) mean usual nutrient intake and proportion meeting recommendations, and dietary quality of U.S. older adults (≥60 years) who use food assistance, including the Supplemental Nutrition Assistance Program (SNAP); emergency foods; and community meals or meal delivery; and income-eligible non-participants. Usual nutrient intake among older adults using food assistance and income-eligible non-participants was low with high risk of inadequacy for over 50% of older adults from dietary sources for vitamins D, E, A, C, calcium and magnesium, and total sources for vitamin D, calcium and magnesium. SNAP participants had a higher risk of not meeting the Estimated Average Requirement for vitamin E from diet compared to other non-SNAP program participants (P = 0.001). Dietary quality did not align with the Dietary Guidelines for Americans, with Healthy Eating Index-2015 scores ranging from 56 to 61 out of 100; SNAP-only participants had higher dietary quality compared to multiple program participants (P = 0.02).  Usual nutrient intakes were inadequate and dietary quality was poor among U.S. older adults eligible for food assistance.  Risk for inadequacy was lower after inclusion of dietary supplements.

The potentially complex relationships between senior hunger and the constellation of lifetime social, economic, and health statuses are not well understood, or even described. The primary purpose of this study is to assess patterns and associations among lifetime experiences of social, economic, food, and health hardship for food insecure seniors. A central feature of our work is the incorporation of a life stories approach in addition to longitudinal surveys. From June 2020- February 2021, we collected life history interviews from 107 participants. We conducted bimonthly follow-up interviews starting in August 2020 (continuing until March 2022). Interview guides for life histories and follow-up interviews included open-ended questions and survey style assessments, including the USDA Household Food Security Survey Module, the Survey of Income and Program Participation Adult Well-being Module, the WHO Quality of Life instrument, and the Mental Health Inventory 18. We conducted inductive analysis and content analysis of all qualitative data and estimated descriptive statistics of all quantitative data. Our primary themes for qualitative analysis relate to history of food insecurity, economic insecurity, and household health challenges. Additionally, the following themes emerged from our inductive analysis: violence, sexual and physical; traumatic events; racism, individual and systemic; perceptions of age discrimination; early experiences of sharecropping or leased land; and home gardens. The life course narratives reflect a complex experience of food and other material hardships throughout the lifetime, yet thus far in our analysis, previous experiences of food insecurity, particularly in middle age, have been the most notable predictor variable for senior hunger.

SNAP eligibility and participation rates have been increasing for adults 50 years and older since 2008. At the same time, SNAP participation continues to fall over the life course, with the lowest rates concentrated among individuals 85 years and above. We use longitudinal data from the nationally representative Health and Retirement Survey from 2002 to 2016 to document how SNAP eligibility, participation, and take-up changed over time for older adults. Then, we investigate the role that out-of-pocket medical expenses have played in these changing patterns.  We rely upon the state adoption of the Medicaid Expansion in 2014 as a source of exogenous variation. 

This paper examines the dynamic of food insecurity for older adults over the past two decades and how it relates with different poverty measures, including the official poverty measure, Supplemental Poverty Measure, and Supplemental Poverty Measure enhanced with imputed rent. It further examines how age, birth cohort, and the Great Recession shape the relationship of food insecurity and poverty. The analysis uses data from the 2002 through 2018 Health and Retirement Study and assesses the risk of becoming food insecure as a function of various poverty measures across different age groups and birth cohorts before and following the Great Recession. The results show that compared with the official poverty measure, alternative poverty measures are stronger predictors of the onset of food insecurity. Beyond poverty, many factors, including demographic, economic, and health characteristics, also determine food insecurity. Moreover, there is no clear evidence that the impact of poverty on food insecurity declines at advanced ages or that the impact of the Great Recession on the onset of food insecurity has been smaller among the oldest older adults. Instead, more recent cohorts of older adults exhibit a greater discrepancy between food insecurity and poverty.

Household food insecurity is a concern in the U.S. given the negative effects associated with food insecurity. An interesting finding is that elderly households tend to be more food secure than younger households, even though many are on a fixed income. A relevant question is what might elderly households be doing that is resulting in greater food security? One potential explanation is that in retirement, elderly households can invest in more time-intensive activities that provide greater food security. In this study, we combine time-use diaries with food security surveys to examine whether time spent on food production is associated with lower levels of food insecurity for elderly households. The data show that time spent in meal preparation and eating is increasing with older age cohorts. At the same time, food insecurity is declining steadily with older households. Grocery shopping and non-grocery food shopping do not show any relevant trends. We also compare food insecurity of households that are pre and post retirement eligible to see if food production explains the gap in food insecurity between these household types. We find that time spent on meal preparation and time spent eating explain some of the gap in food insecurity between these households and the results vary by marital status. Finally, we specify a two-stage model to estimate whether time spent on food production causes greater food security. Our specification fails to identify a strong relationship. One potential explanation is that older households in our sample generate bias as we only observe households that still live independently and alone.

We examined the association of Medicare eligibility with food security and food pantry visiting patterns among senior (aged ≥60 years) food pantry clients in Dallas, Texas. We used data from the pantry linked to electronic health records (EHR) from a safety-net healthcare system. Log-binomial regression was employed to calculate prevalence ratios of food insecurity by Medicare eligibility for all clients and separately for clients with various chronic conditions. We examined the impact of Medicare eligibility on food pantry visiting patterns among a non-disabled sample of clients using regression discontinuity. A member of each eligible household can visit once a month. Data from 604 households with 2,636 visits were analyzed for food security assessments. The majority were female (63%), average age was 68.5, many had less than a high school education (39%), and the majority were Black (60%) or Latino/a (29%). Of those with linked EHR data, 75% had at least one chronic condition. Medicare eligibility was associated with improved food security; this association was consistent among clients diagnosed with any chronic condition, but not among clients without any chronic condition. Additionally, we analyzed 119 households with 457 visits for the regression discontinuity analyses and observed that frequency of food pantry visits increased after becoming Medicare eligible. Overall, our findings highlight how Medicare eligibility may improve food security among seniors, potentially attributable to increased food pantry use after aging into Medicare. Future studies should examine underlying pathways of food pantry visiting patterns and their contributions to senior food security.

This project examines reasons why food insecure older adults in the U.S. are under-enrolled in SNAP and why this pattern varies among older adults of different ages. Conventional wisdom suggests several explanations that discourage participation, ranging from older adults’ preferences to program limitations. We examine the topic with two approaches. First, using an administrative dataset from Oregon (n=95,467) including monthly observations over a five-year period, we analyze SNAP spells for near-old (51 years old in 2014) and older people (60+ in 2014). Second, we interview SNAP outreach workers (n=22) to examine program access barriers and lived experiences of food insecurity among older adults in Oregon. We find that while 43% of near-old and older adults (combined) exit SNAP after a short spell (1-12 months), those with long-term continuous SNAP receipt (>55 months) represent the majority (59%) of the near-old and older adult SNAP population at any given time. Moreover, we find higher proportions of long-term SNAP participation among the older cohort (ages 60-64) compared to the younger cohort (ages 51-55). The probability of exiting SNAP is lower among female and Asian older adults, as well as individuals with a previous SNAP spell. The probability of exiting SNAP is higher among near-old and older adults who are Hispanic, have earnings in the previous quarter, and live in households with more than one person. Preliminary interview results (delayed by COVID) describe program outreach deficits, challenges with web-based enrollment and application delays, gaps in services addressing complex needs, and transportation issues.

Using administrative data from Georgia covering January 2018-August 2020, we estimated the effect of services provided through the Older Americans Act (OAA) and the Supplemental Nutrition Assistance Program (SNAP) on food insecurity among older Georgians. Our sample included those who received services prior to and during the COVID-19 pandemic. For the entire sample period (i.e., pre-COVID and during COVID), we found home-delivered meals and other OAA services reduced food insecurity by roughly 3% and 4%, respectively. The effect of SNAP on reducing food insecurity significantly increased from 2.1% (pre-COVID) to 4.7% (during COVID). While we find no effect of congregate meals on food insecurity in the pre-COVID period, the loss of “traditional” congregate meals in a social setting during COVID increased food insecurity by 7%.

Using data from the Panel Study on Income Dynamics (PSID), this small grant conducted three studies designed to increase understanding of food-related hardships among older Americans. Study 1 found that persons who had a work limitation or were food insecure in midlife (ages 40-54) had significantly increased odds (OR: 2.20, p<.05 and OR: 4.23, p<.01, respectively) of living in a food insecure household at age 60 to 69, holding all else constant. Those who worked more during midlife had significantly reduced odds (OR: 0.26, p<.01) of living in a food insecure household in their 60s. Study 2 found that older adults who were currently living in a food secure household had higher odds of healthy aging at age 60 to 69. Having higher midlife income or more time employed in midlife was associated with increased odds of healthy aging, while having a work limitation or a limiting health condition in midlife was associated with lower odds of healthy aging.  Study 3 used an instrumental variable approach to examine the probability of living in a food insecure household among households as their family units receive Social Security at retirement age. Study 3 found limited causal evidence that receipt of Social Security at retirement age is associated with an increased probability of living in a food secure household among the full population. These findings were robust to changes of the dependent variable or the endogenous variable but were sensitive to some of the expansions or contractions of the sample.