Older People in Emergencies; Addressing Food Insecurity, Health Status and Quality of Life: Evaluating the “365+ Days of Care” Program

Abstract

During emergencies, older adults stand among the most vulnerable, facing long-lasting food insecurity and overall health issues. The “365+ Days of Care” food aid program addressed food insecurity and poor quality of life among vulnerable older adults following a devastating wildfire in Greece. Our aim was to evaluate the program’s efficiency, using a process evaluation framework and a partial cost–utility analysis. In total, n = 133 wildfire-hit residents (≥65 years) received daily tailored, pre-cooked meals and/or weekly food packages. The study outcomes were assessed from baseline to 12 months later. Focus groups and interviews (n = 30), researcher observations, and questionnaires were used to assess the beneficiaries’ perception of the initiative. Within the 12-month follow-up period, food insecurity and malnutrition risk decreased, whereas Mediterranean diet adherence; quality of life; and physical, social, and mental health were improved (p < 0.05). A one-point increase in food insecurity was positively associated with improved quality of life, general health, limitation in activities, body pain, vitality, and pain/discomfort (p’s < 0.05), and it was marginally associated with mobility, anxiety/depression, and self-evaluated health status (p’s < 0.1). Quantitative and qualitative data characterized it as successful, acceptable, beneficial, and of high quality. The partial cost–utility ratio was one QALY gained per EUR 22.608. The utilization of well-designed food aid programs during emergencies can alleviate food insecurity and improve quality of life in older adults.

Food Insecurity in Greece and across the Globe: A Narrative Literature Review

“…Public health policies, such as intensifying humanitarian aid, including food aid programs [56,89] and setting up food banks, are definitely important relief measures to a number of people experiencing food insecurity [90,91]. However, in the best-case scenario, these measures may improve people's food insecurity status only on a temporary basis; thus, they do not challenge the underlying causes and mechanisms of food insecurity.…”

“…Moreover, food access for low-income persons is affected by: (a) food price increases and volatility as a downstream effect of climate variability induced food loss at the production/distribution stage, as well as through (b) climate extreme induced diminished employment opportunities in the food (or other) sector, collectively resulting in income loss and inability to reach household food demands [55]. Furthermore, extreme climate events and subsequent environmental degradation reduce developing countries' and lowincome communities' resilience and adaptive capacity, increasing their vulnerability to food insecurity, malnutrition and food crises [1,56].…”

Relationship Between Food Insecurity for Variable Reasons, Physical Activity and Selected Health Situations Among Older Adults in Poland: A Cross-Sectional Study

“…Therefore, in order to develop conceptual models related to the health of the elderly, it is necessary to seek interdependencies and links between health and all of its determinants, especially because public health initiatives to improve the health of the population to date have been related to the prevention or treatment of chronic diseases without considering food security measures [47]. In planning such health-related conceptual models, one should not forget about food security, as it is known to be related to physical activity levels [18,46], nutritional status, the presence of malnutrition [26, 34 55] and chronic non-communicable (metabolic) diseases [19,22,34]. The relationship of food security to diseases leading to a loss of mobility and to self-assessed health remains debatable [18].…”

“…In planning such health-related conceptual models, one should not forget about food security, as it is known to be related to physical activity levels [18,46], nutritional status, the presence of malnutrition [26, 34 55] and chronic non-communicable (metabolic) diseases [19,22,34]. The relationship of food security to diseases leading to a loss of mobility and to self-assessed health remains debatable [18].…”

“…Although the relationships among food security, physical activity levels [18,46] and factors related to the health of the elderly [18,19,22,26,34,42,55] are known, there is a lack of research assessing the relationship between the causes for food insecurity and factors related to physical activity and health. To fill the gap in scientific research into the causes for food insecurity among the elderly and their relationship to physical activity and the incidence of metabolic diseases and those leading to a loss of mobility, it was hypothesized that reasons for food insecurity, such as long distances from home to food procurement sites and impaired food procurement associated with a loss of mobility, are more related to low physical activity, the incidence of metabolic diseases and diseases leading to a loss of mobility than reasons related to a lack of financial resources or a lack of social support.…”