Later Life Food Insecurity and Social Isolation in Ghana: The Importance of Psychological Factors

Background: Social isolation (SI) and food insecurity (FI) are important social determinants of health that can negatively impact well-being in old age. While research on the association between FI and SI is limited in LMICs, the mediators of this association are largely unknown. This cross-sectional study examined whether FI is associated with SI among older adults in Ghana and whether psychological factors (i.e., depression, anxiety, and sleep problems) mediated the association. Methods: Our study consisted of adults aged >= 50 years in the Aging, Health, Well-being, and Health-seeking Behavior Study. SI was assessed with the Berkman-Syme Social Network Index, while FI was assessed with dietary inadequacy-related items. We used an ordinary least squares regression (OLS), logistic regressions, and bootstrapping modeling approach to examine our hypotheses with p < 0.05. Results: The analysis included 1201 individuals (M-age = 66 [SD = 12], women = 63%). In the full sample (beta = 0.21; p < 0.001) and in women (beta = 0.30, p < 0.001) but not in men, FI was independently associated with SI. FI was comparably associated with increases in SI for the 50-64 age group (beta = 0.21, p < 0.001) and >= 65 age cohort (beta = 0.19, p < 0.01). Moreover, FI showed differential associations with specific domains of SI (OR = 1.81 to 1.45, p < 0.001). Finally, the FI-SI association was mediated by depressive symptoms (65.16%), anxiety symptoms (30.16%), and sleep problems (9.50%). Conclusions: Our data highlight the fundamental role of FI in SI among older adults, and the effect is explained by psychosocial factors. Interventions targeted toward strengthening interpersonal ties in old age should include addressing FI and older adults' psychosocial outcomes.