Cognitive Impairment and Supplemental Nutrition Assistance Program Take-Up Among the Eligible Older Americans

Abstract

Objectives Participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible adults 60 and older is much lower than among the younger population, and rates continue to decline throughout the life course while at the same time the risk of cognitive impairment increases. Due to the high administrative burden associated with SNAP eligibility processes, cognitive impairment may be associated with low uptake of SNAP among the low-income older adult population, particularly among more socially disadvantaged groups (females, Blacks, and those living alone). We provide new evidence that changes in cognitive functioning are associated with reductions in the probability of SNAP take-up among eligible older adults. Methods Using panel data from the Health and Retirement Study, we estimate linear probability fixed-effects models to assess the effect of cognitive decline on the likelihood of SNAP participation among eligible adults aged 60 and above, controlling for observed characteristics that change over time as well as individual, time, and state fixed effects. Results Reduced levels of cognitive functioning that rise to the classification of dementia were strongly associated with reductions in the probability of SNAP take-up among eligible older adults. Results were particularly salient for females and those living alone. Discussion One barrier to SNAP take-up among older adults may be cognitive impairment with the size of effect differing by gender and living arrangement. Policymakers may want to consider initiatives to increase SNAP participation among older adults, including a focus on further simplification of eligibility and recertification processes that reduce administrative burden.

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

“…Our study examined food insecurity as the exposure, which builds on findings by Lu and colleagues given that SNAP participation among eligible older adults is underused compared with other segments of the population (48% compared with 86% overall in 2018). 36,62…”

“…Recent findings by Lu and colleagues examined SNAP participation among SNAP-eligible adults—a group that is vulnerable to food insecurity—and found faster memory function decline among those experiencing food insecurity or not participating in SNAP compared with their counterparts. Our study examined food insecurity as the exposure, which builds on findings by Lu and colleagues given that SNAP participation among eligible older adults is underused compared with other segments of the population (48% compared with 86% overall in 2018) …”

“…We also created missing indicators (1 = data missing, 0 = otherwise) for mother’s educational level and father’s educational level as missing parental education data may indicate that the respondent did not reside with their parents during childhood, which is a marker of social capital . To minimize the possibility that those with lower cognition are less likely to apply for SNAP benefits, we additionally controlled for preexposure cognition, ie, dementia risk and memory score in 2012 …”

“…34,35 To minimize the possibility that those with lower cognition are less likely to apply for SNAP benefits, we additionally controlled for preexposure cognition, ie, dementia risk and memory score in 2012. 36…”

“…A previous study using HRS data found that among SNAP-eligible adults, participants with reduced levels of cognitive function were less likely to participate in SNAP. 36 However, in an advance over earlier work, we adjusted for preexposure cognition, minimizing this potential bias. Second, residual confounding remains a possibility in our study.…”