Food insecurity is linked to a more rapid decline in executive function in older adults, a new study shows.
The findings were reported just weeks after a pandemic-era expansion in Supplemental Nutrition Assistance Program (SNAP) benefits ended, leading to less food assistance for about 5 million people over age 60 who participate in the program.
“Even though we found only a very small association between food insecurity and executive function, it’s still meaningful because food insecurity is something we can prevent,” lead investigator Boeun Kim, PhD, MPH, RN, postdoctoral fellow at Johns Hopkins University School of Nursing, Baltimore, Maryland, told Medscape Medical News.
The findings were published online March 24 in JAMA Network Open.
The number of Americans over 60 with food insecurity has more than doubled since 2007, with an estimated 5.2 million older adults reporting food insecurity in 2020.
Prior studies have linked malnutrition and food insecurity to a decline in cognitive function. Participating in food assistance programs such as SNAP is associated with slower memory decline in older adults.
However, to date, there has been no longitudinal study that has used data from a nationally representative sample of older Americans, which, Kim said, could limit generalizability of the findings.
To address that issue, investigators analyzed data from 3037 participants in the National Health and Aging Trends Study, which includes community dwellers age 65 and older who receive Medicare.
Participants reported food insecurity over 7 years from 2012 to 2019. Data on immediate memory, delayed memory, and executive function were from 2013 to 2020.
Food insecurity was defined as going without groceries due to limited ability or social support; a lack of hot meals related to functional limitation or no help; going without eating because of the inability to feed oneself or no available support; skipping meals due to insufficient food or money; or skipping meals for 5 days or more.
Immediate and delayed recall were assessed using a 10-item word-list memory task and executive function was measured using a clock drawing test. Each year’s cognitive functions were linked to the prior year’s food insecurity data.
Over 7 years, 417 people, or 12.1%, experienced food insecurity at least once.
Those with food insecurity were more likely to be older, female, part of racial and ethnic minority groups, living alone, obese and have a lower income and educational attainment, depressive symptoms, social isolation and disability compared to those without food insecurity.
After adjusting for age, sex, race/ethnicity, educational level, income, marital status, body mass index, functional disability, social isolation, and other potential confounders, researchers found that food insecurity was associated with a more rapid decline in executive function (mean difference in annual change in executive function score, −0.04; 95% CI, −0.09 to −0.003).
Food insecurity was not associated with baseline cognitive function scores or changes in immediate or delayed recall.
“Clinicians should be aware of the experience of food insecurity and the higher risk of cognitive decline, so maybe they could do universal screening and refer people with food insecurity to programs that can help them access nutritious meals,” Kim said.
A Sign of Other Problems?
Commenting for Medscape Medical News, Thomas Vidic, MD, said food insecurity often goes hand-in-hand with lack of medication adherence, lack of regular medical care, and a host of other issues. Vidic is a neurologist at the Elkhart Clinic, Elkhart, Indiana, and an adjunct clinical professor of neurology at Indiana University.
“When a person has food insecurity, they likely have other problems and they’re going to degenerate faster,” said Vidic, who was not part of the study. “This is one important component, and it’s one more way of getting a handle on people who are failing.”
Vidic, who has dealt with the issue of food insecurity with his own patients, said he suspects the self-report nature of the study may hide the true scale of the problem.
“I suspect the numbers might actually be higher,” he said, adding that the study fills a gap in the literature with a large, nationally representative sample.
“We’re looking for issues to help with the elderly as far as what can we do to keep dementia from progressing,” he said. “There are some things that make sense, but we’ve never had this kind of data before.”
The study was funded by the National Institute on Aging. Kim and Vidic have reported no relevant financial relationships.
JAMA Netw Open. Published online March 24, 2023. Full text
Kelli Whitlock Burton is a reporter for Medscape Medical News covering psychiatry and neurology.
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