Food Insecurity and Dietary Quality in Older Adults: Do Nutrition Assistance Programs Play a Protective Role?

Objectives
The emergence of food insecurity as a primary nutrition-related health issue among older adults suggests a need to examine how nutritional assistance programs are related to food insecurity and dietary quality in aging populations. This project examines food insecurity and dietary quality in US adults age 65 and older and the impact of nutrition assistance programs.

Methods
The sample was drawn from the 2012 Health and Retirement Study and 2013 Health Care and Nutrition Study and included 3779 respondents representing a population of 37,217,566 adults aged 65 and older. Food insecurity was a binary measure based on the USDA six-item US Adult Food Security Survey Module. Two forms of nutritional assistance included receipt of supplemental food from sources such as food banks and Meals-on-Wheels (1 = yes, 0 = no) and reported receipt of SNAP benefits (1 = yes, 0 = no). Dietary quality was measured using the Alternative Healthy Eating Index-2010 based on a food frequency questionnaire. General linear modeling adjusting for covariates and complex sampling design was used to test if nutritional assistance moderated the association between food insecurity and AHEI-2010.

Results
Around 10% of the sample was food insecure, 14% reported receipt of supplemental food, and 6.4% were SNAP benefit recipients. In covariate-adjusted models, food insecurity and receipt of SNAP benefits were not associated with AHEI-2010, but receipt of supplemental food was (b = −1.39, SE = 0.67, P = 0.038). Receipt of supplemental food moderated the association between AHEI-2010 and food insecurity (P = 0.001). Simple effect estimates suggested that among those not receiving supplemental food, the food insecure had lower AHEI-2010 scores than the food secure (b = −2.15, SE = 0.88, P = 0.014). Among those receiving supplemental food, the food insecure had greater AHEI-2010 scores than the food secure (b = 2.62, SE = 1.25, P = 0.035) and similar AHEI-2010 scores as the food secure not receiving supplemental food.

Conclusions
Preliminary analysis suggests that receipt of supplemental food appears to be associated with better dietary quality among food-insecure older adults and confirms the importance of food assistance programs in combating the negative effect of food insecurity on dietary quality.