Evaluating the relationship between urban environment and food security in Georgia's older population

Food Insecurity and Aging: A Scoping Study of the Literature

“…In documenting all of the theoretical references, applications of theory, and novel conceptual models and frameworks, we found that much of the theorization in this collection of studies to be oriented towards explaining how older people uniquely experience food insecurity and are uniquely vulnerable to food insecurity. For example, many theoretical applications delved (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003;Wolfe et al, 1998;Wolfe et al, 1996) and lack of social support (Radermacher et al, 2010a) -In addition to economic constraints, older people face greater variety of physiologic and social barriers to healthful diet (requiring therapeutic diet), physical disability and dependence on others for food assistance, social isolation and functional impairments, transportation problems (Guthrie and Lin, 2002) -Older people at risk of poor nutrition through food insecurity (inadequate financial resources, functional impairments, social isolation, oral problems, dietary modifications, regular use of medications) (Sharkey, 2004) -Frequent co-existence of functional impairments (that impact ability to acquire, prepare, eat food), social isolation, adverse effects of multiple medications, depression, limited access to resources, challenges in local food environment (Green-LaPierre, 2012) -More factors related to nutritional and health status for older people, including aging process, health, psychological, social, economic factors (Johnson et al, 2011) Aging Process -Increasing cognitive and physical limitations (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003) -Vulnerability through aging process (changing circumstances, chronic disease and physical disabilities that impact ability to access, prepare, and consume food) (Russell et al, 2014;Radermacher et al, 2010a) -Age aggregates negative effects of poor health on elderly (Nord, 2003) -Social capitalincreasing reliance on others alongside aging (Green-LaPierre et al, 2012) -Changes with agingphysical (disabilities), psychological (depression, cognition), social changes (widowhood, poverty, relocation) that impede ability to obtain and prepare optimal meals (Pierce et al, 2002) Physical, Cognitive, Physiological Differences -Prevalence of food insecurity among older people may be lower (compared to younger populations), but health consequences may be more serious (Afulani et al, 2015, Bhargava et al, 2012) -Reduced mobility or function in isolated elderly or ill persons (Wolfe et al, 2003) -Dietary vulnerability, malnutrition among older people…”

“…Behavioural and Physiological Responses to Adversity -Cumulative effects of persistent or intermittent food insecurity or limited food access on energy stores and nutritional risk status (Brewer et al, 2010, Johnson et al, 2011 Cumulative Disadvantage -Unmet needs, accumulated disadvantage can contribute to health status in later life (Alley et al, 2009) Resilience, Coping Skills, Resourcefulness, Past Experiences, Generational Lens -Elderly may have different perceptions, attitudes, experiences than younger people (Guthrie and Lin, 2002; Sun Lee & Frongillo, 2011) -"Generational lens"pride, self-sufficiency, "you cannot always get what you want attitude" colours the nature of food insecurity for older people (Green-LaPierre et al, 2012) -Resourcefulness developed from past experiences, developed unique strategies to cope with hunger (Green-LaPierre et al, 2012) -Older people may be more resilient to food insecurity (Johnson et al, 2011) Food Insecurity and Aging La Revue canadienne du vieillissement 39 (4) (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003, Chung et al, 2011, Woltil, 2012) -Differential availability of food programs, transportation, grocery stores in different communities (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003, Chung et al, 2011, Woltil, 2012) -Amplification of immediate environmental factors on older people to result in greater food hardshipdue to fixed incomes alongside higher food prices and travel costs + strong neighbourhood attachments, limitations in driving/walking/public transit infrastructure make access outside neighbourhood difficult) (Fitzpatrick et al, 2015) -Local social supports for older people may be dwindlingvolunteer sector shrinking and younger people outmigrating for employment [Sharkey & Schoenberg, 2005] -Without public transit, older people are reliant on volunteer drivers, private transport services, or reliant on family and friends (Green-LaPierre et al, 2012) Healthy Survivor Effect -Older people who have managed to remain living to advanced old age in the community are more likely to have more family, neighbor, voluntary, or other sources of care and assistance to buffer against food insecurity (Quine & Morrell, 2005) Living Arrangement…”

“…Living Alone, Homeboundedness -Vulnerability derived from living alone, unable to leave dwelling to shop, unable to prepare food without assistance (Quine & Morrell, 2005) -Homeboundedness and food insufficiency (Sharkey & Schoenberg, 2005) -Older people living at home and living alone vulnerable to food insecurity (from decreased fertility rates, relational ambivalence, decreasing capacity of younger generations to care (Radermacher et al, 2010a) Social-Relational Social Support -Disconnectedness from intergenerational family networks and informal networks for logistics of food (providing transportation, buying food supplies, cooking)friends and family cannot always help as planned (Frongillo et al, 2003, Green-LaPierre et al, 2012, Radermacher et al, 2010b) -Social support can act as a buffering effect on food insecurity among older people (as a management strategy, help-seeking behaviour) (Frongillo et al, 2003) Social Isolation -Social isolation in older people contributes to food insecurity, and is augmented by broader factors of poverty, gender, race (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003, Chung et al, 2011, Woltil, 2012) -Older people vulnerable to being alonesocial dimension of food (social aspect of eating, difficulty in food preparation for one person, depression-induced appetite loss) (Temple, 2006) Subgroup Disadvantage…”

“…Subgroups of Older People at Risk for Poor Nutrition and Health Status (economic, social exclusion, disparities in health care access) -Women, racial or ethnic minorities, economically disadvantaged, homebound (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003, Sun Lee & Frongillo, 2011 -Female, African American, living in a central city, living in southern USA, oldest old, eating alone, disability, along with income may account for differences in FI between lower and higher income groups (Guthrie & Lin, 2002) -Disparities in health care access, underutilization of medical care services across subgroups of older people, could potentially lead to differential effects on nutritional status, overall well-being, successful aging (Bhargava et al, 2012) Gender Economic Disadvantage (paid work, savings, assets, pensions, poverty risk) -Women as economically vulnerable subgroup of older people due to discontinuation of work and/or lack of savings or pensions (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003) -Limited monetary resources available to older women (Quine & Morrell, 2005) -Senior women disproportionately affected by poverty (Green-LaPierre et al, 2012) -Socio-biology could explain how sex could modify association between food insecurity and obesity (Ahn et al, 2014) Continued Barriers to Accessing Services and Supports -Differential access to necessary material resources may be one way disadvantaged groups experience poorer health outcomes (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003) -Older subgroup (ethnic minorities) experience high nutritional risk and many barriers to accessing services and supports (Radermacher et al, 2010a) Economic Disadvantage -Minority older people vulnerable (limited life course opportunity, cumulative disadvantages, current NH environments) (Woltil, 2012) -Relationships between race/ethnicity, socio-economic status, health and cultural aspects of dietary intake important to food insecurity among older people in minority groups (Klesges et al, 2001) Income Fixed, Inadequate Income -Older people vulnerable due to finances (fixed income, medical costs, unexpected expenses) (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003, Johnson et al, 2011 -Inadequate finances and infirmity lead to inability to access food (Quine & Morrell, 2005) -All elderly at risk for poor nutrition, limited resources can further increase risk…”

“…Behavioural Cost-Related Trade-offs -Food compromises (due to health-related food requirements, physical functioning, unexpected health care costs) (Keller et al, 2006;Shannon et al, 2015;Frongillo et al, 2003) -Choosing inexpensive unhealthy foods (Alley et al, 2009;Sharkey & Schenberg 2005;Ahn et al, 2014) Stress Eating -Stress and depression may lead food-insecure older people to cope with stress by eating excessively (Ahn et al, 2014) Shifting Sands of Social Class -Social class may help to explain patterns of food consumption but may be less relevant to older people (Deeming, 2011) addressingthe issue, and the futility in approaching the issue with a single intervention lever. Another major assumption was with respect to the "aging process", whereby aging was framed as progression entailing inevitable (and often insinuated universal) general decline, disability, and disease.…”