A Method for Assessing the Prevalence of Food Insecurity in Older Adults Based on Resource Constraints and Food-Related Physical Functioning Limitations

Background: Older adults with food-related physical functioning limitations often face food insecurity because of challenges that go beyond resource constraints. Difficulties with food acquisition at retailers, and food preparation and consumption are not captured by the United States Department of Agriculture's food security measure. Objectives: The objective of this study was to develop a method to assess the overall prevalence of food insecurity regardless of underlying cause using validated measures that capture both food-related physical functioning limitations and resource-constraint food hardships. It also aims to examine the validity of this method in relation to sociodemographic characteristics, health, appetite, and dietary outcomes. Methods: Using information from National Health and Nutrition Examination Surveys (2007-2018), 10,237 adults aged 60 y and older with complete food security and food-related physical functioning limitations data were included in the study. Comparisons of the cross- classification method and the standard food security methods are made and their relationships with depression, self-reported health, and healthy eating index 2015 are examined using multiple linear regression models. Results: Using the cross-classification method, prevalence of low and very low food security because of resource constraints and food- related physical functioning limitations was found to be higher (13.6% and 7.3%, respectively) compared with food insecurity based solely on resource constraints (4.7% and 3.3%, respectively) or food-related physical functioning limitations (11.4% and 4.4%). Low and very low food security levels using the cross-classification method were associated with higher odds of depression and poor self-reported health, compared with the standard United States Department of Agriculture (USDA) resource-constrained food security measure. Conclusions: The cross-classification method enables the identification of potentially food insecure older adults who might be classified otherwise if only each measure is used alone. This method serves as guidance for using both measures jointly to estimate food insecurity, regardless of its cause.