Original Article

OPEN: Developing and Piloting a Tool to Identify Food Insecurity in Older Adults

Authors: Alexandra King, MD, Regina Roofeh, MPH, Christian Nouryan, MA, Meng Zhang, PhD, Maria Torroella Carney, MD

Abstract

Objective: The literature shows that food insecurity (FI) can negatively affect the trajectory of many chronic illnesses. FI can be acutely severe for older adults, but screening for FI is not regularly performed in the hospital setting. Our goal was to develop a tool to screen for FI upon hospital discharge to identify patients who may require community food resources. This is the first attempt to build such a tool for implementation in our health system.

Methods: In two university hospitals and one community hospital, patients 65 years old and older were admitted to the Internal Medicine service who would approach discharge within 2 days. We screened patients meeting our criteria using an FI tool (FIT), which addressed patterns associated with FI. All of the patients screened were offered a list of community resources.

Results: Of the patients recruited, 69 met the study criteria. The majority of patients screened displayed some FI, with 56% having ≥3 food insecurities. Statistically significant relationships were established for individual FIT questions with age, admission albumin level, body mass index, length of stay, and median household income based on ZIP code.

Conclusions: Use of the FIT can help identify vulnerable patients and connect them to food resources. The FIT was easy to use, well tolerated, and time-efficient, leaving it poised for use in the busy environment of inpatient services.

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Download Image

Download Image

References

1. Coleman-Jensen A, Rabbit MP, Gregory C, et al. Household food security in the United States in 2014. https://www.ers.usda.gov/webdocs/publications/45425/53739_err194_summary.pdf?v=42515. Published 2015. Accessed October 2017.
2. Silverman J, Krieger J, Kiefer M, et al. The relationship between food insecurity and depression, diabetes distress and medication adherence among low-income patients with poorly-controlled diabetes. J Gen Intern Med 2015;30:1476-1480.
3. Roncarolo F, Bisset S, Potvin L. Short-term effects of traditional and alternative community interventions to address food insecurity. PLoS One 2016;11:e0150250.
4. Herman D, Afulani P, Coleman-Jensen A, et al. Food insecurity and cost-related medication underuse among nonelderly adults in a nationally representative sample. Am J Public Health 2015;105:e48-e59.
5. Franklin B, Jones A, Love D, et al. Exploring mediators of food insecurity and obesity: a review of recent literature. J Community Health 2012;37:253-264.
6. Afulani P, Herman D, Coleman-Jensen A, et al. Food insecurity and health outcomes among older adults: the role of cost-related medication underuse. J Nutr Gerontol Geriatr 2015;34:319-342.
7. Bhargava V, Lee JS. Food insecurity and health care utilization among older adults in the United States. J Nutr Gerontol Geriatr 2016;35:177-192.
8. He W, Goodkind D, Kowal P. An Aging World: 2015. International Population Reports. Washington, DC: US Government Publishing Office; 2016.
9. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. Population Estimates and Projections. Current Population Reports. Washington, DC: US Government Publishing Office; 2014.
10. Oemichen M, Smith C. Investigation of the food choice, promoters and barriers to food access issues, and food insecurity among low-income, free-living Minnesotan seniors. J Nutr Educ Behav 2016;48:397-404.e1.
11. Caspi CE, Davey C, Friebur R, et al. Results of a pilot intervention in food shelves to improve healthy eating and cooking skills among adults experiencing food insecurity. J Hunger Environ Nutr 2017;12:77-88.
12. Feeding America. Hunger in America 2014. Executive summary. http://www.feedingamerica.org/research/hunger-in-america/hia-2014-executive-summary.pdf. Accessed June 9, 2019.
13. Bazerghi C, McKay FH, Dunn M. The Role of food banks in addressing food insecurity: a systematic review. J Community Health 2016;41:732-740.
14. Carney MT, Fujiwara J, Emmert BE, et al. Elder orphans hiding in plain sight: a growing vulnerable population. Curr Gerontol Geriatr Res 2016;2016:4723250.
15. Economic Research Service, US Department of Agriculture. US adult food security survey module: three-stage design, with screeners. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools/#adult. Published 2012. Accessed June 9, 2019.
16. Anyanwu UO, Sharkey JR, Jackson RT, et al. Home food environment of older adults transitioning from hospital to home. J Nutr Gerontol Geriatr 2011;30:105-121.
17. Cannon M. Screening and interventions for food insecurity in health care settings: state strategies to increase an underutilized practice in California. https://cfpa.net/CalFresh/CFPAPublications/CFPA-FIScreeningsWhitePaper_FINAL.pdf Published September 2016. Accessed June 9, 2019.
18. Sattler EL, Lee JS, Bhargava V. Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes. J Nutr Gerontol Geriatr 2014;33:401-417.
19. Frith E, Loprinzi PD. Food insecurity and cognitive function in older adults: brief report. Clin Nutr 2018;37:1765-1768.
20. Redmond ML, Dong F, Goetz J, et al. Food insecurity and peripheral arterial disease in older adult populations. J Nutr Health Aging 2016;20:989-995.
21. US Census Bureau. Quick Facts, Nassau County, New York. https://www.census.gov/quickfacts/fact/table/nassaucountynewyork/LND110210. Accessed June 9, 2019.
22. Guzman GG. American Community Survey Briefs. Household income: 2017. https://www.census.gov/content/dam/Census/library/publications/2018/acs/acsbr17-01.pdf. Published September 2018. Accessed June 9, 2019.
23. Sperling's Best Places. Cost of living in Nassau County, NY. https://www.bestplaces.net/cost_of_living/county/new_york/nassau. Accessed June 9, 2019.
24. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Affairs 2015;34:1830-1839.
25. Steiner JF, Stenmark SH, Sterrett AT, et al. Food insecurity in older adults in an integrated health care system. J Am Geriatr Soc 2018;66:1017-1024.