Understanding the Experience of Food Insecurity by Elders Suggests Ways to Improve Its Measurement

Abstract

A full conceptualization of the elderly food insecurity experience has been lacking, leading to limitations in the definition and measurement of food insecurity in elders. Based on the qualitative analysis of two in-depth interviews 6 mo apart with each of 53 low income urban elders, using principles of grounded theory, the experience of elderly food insecurity was shown to have four components: quantitative, qualitative, psychological and social. The inability to obtain the right foods for health is a new element specific to elders. Common to each of these components were dimensions of severity, time and compromised food choice. Although money is a major cause of food insecurity, elders sometimes have enough money for food but are not able to access food because of transportation or functional limitations, or are not able to use food (i.e., not able to prepare or eat available food) because of functional impairments and health problems. These findings suggest that augmentation of the U.S. Household Food Security Survey Module (FSSM), a national measure of food insecurity based on research in younger persons, may result in more accurate assessments for elders. We developed 14 new items for possible augmentation and administered them by telephone to these same elders along with the FSSM. Elders were independently classified according to food insecurity status based on their experience from the in-depth interviews, and these definitive criteria were used to evaluate the new and existing items. The results suggest that "couldn't afford right foods for health" and two policy-relevant immediate causes, "couldn't get the food I needed" and possibly "unable to prepare," should be added, although further testing is needed.

Using Initiative to Achieve Autonomy: A Model for Advanced Practice in Medical Nutrition Therapy

“…This suggests a trend toward using qualitative methods when quantitative methods cannot be used (31). In dietetics and nutrition, grounded theory has been used to describe interactions and roles in dietetics and as a basis for better understanding of food insecurity and menu development (32)(33)(34).…”

Linking Neighborhood Characteristics to Food Insecurity in Older Adults: The Role of Perceived Safety, Social Cohesion, and Walkability

“…1,13 Such outcomes are significantly more prevalent among older adults with lower incomes. 13 Moreover, food insecurity among older adults is associated with poor self-reported health, 1 increased functional impairment, 14,15 and lower quality of life. 16 While studies have documented that both individual or household-level factors are associated with food insecurity among both the elderly and non-elderly, [17][18][19] research on contextual, neighborhood-level contributors to nutritional insecurity is limited to a single investigation of the effect of neighborhood-level social factors.…”

Associations between residential food environment and dietary patterns in urban-dwelling older adults: results from the VoisiNuAge study

“…Similarly, a poor food environment (i.e. a pressor) may be associated with food insecurity, especially among seniors with few transportation options (5)(6)(7) . Qualitative (6,12) and marketing science studies (13,14) show that a diversified food shopping environment, adequate store size, proximity to supermarkets and other food stores, and convenient means of transportation can support healthful dietary self-management.…”