Food Insecurity and Perceived Diet Quality Among Low-Income Older Americans with Functional Limitations

Objective: To evaluate how functional limitations are associated with food insecurity and perceived diet quality in low-income older Americans.

Design: Nationwide repeated cross-sectional surveys regarding health and nutritional status.

Setting: The National Health and Nutrition Examination Surveys, 2007-2008, 2009-2010, and 2011-2012.

Participants: Individuals aged ≥65 years with household incomes ≤130% of the federal poverty level (n = 1,323).

Main outcome measures: Dependent variables included dichotomous indicators of food insecurity and poor-quality diet, measured with the household food security survey module and respondents' own ratings, respectively. Independent variable was presence of limitations in physical functioning.

Analysis: Weighted logistic regressions with nested controls and interaction terms.

Results: Functional limitations in low-income older adults were associated with 1.69 times higher odds of food insecurity (P < .01) and 1.65 times higher odds of poor-quality diet (P < .01) after accounting for individuals' health care needs and socioeconomic conditions. These associations were greatest among those living alone (odds ratio = 3.38 for food insecurity; 3.07 for poor-quality diet; P < .05) and smallest among those living with a partner.

Conclusions and implications: Low-income older adults who live alone with functional limitations are exposed to significant nutritional risk. Resources should be directed to facilitating their physical access to healthful foods.