Food insecurity and geriatric syndromes in community-dwelling older adults

Abstract

Food insecurity is a social determinant of health in older adults, particularly those economically deprived ones in the community. Geriatric syndromes are common in older adults that burden the health care system. Epidemiological studies have linked food insecurity with geriatric syndromes, but these relationships have not been fully explored. The Household Food Security Survey Module (HFSSM) is an instrument for measuring food insecurity, but the existing versions are not suitable for evaluating food assistance services in Hong Kong; thus, a newly modified six-item Chinese-version HFSSM (three-month reference period) has been proposed, but its psychometric properties are unknown. This thesis aims to: 1) systematically review the current evidence on the associations between food insecurity and geriatric syndromes in community-dwelling older adults, 2) evaluate the validity and reliability of the modified HFSSM in the economically deprived community-dwelling Chinese population, and 3) examine the associations between the severity level of food insecurity and different types and number of geriatric syndromes in the economically deprived community-dwelling Chinese older adults.

A systematic review with narrative synthesis of the relationships between food insecurity and geriatric syndromes was performed. A psychometric study of the modified HFSSM was conducted using baseline data from an evaluation study of the Jockey Club Food Assistance Program. Community-dwelling Chinese adults aged ≥18 years with household income <75% of the population median were included. The modified HFSSM was examined for construct validity, scale targeting, convergent validity, known-group validity, internal consistency, and test-retest reliability. Next, an analytical cross-sectional study on the associations between food insecurity and geriatric syndromes was conducted using the same dataset with an additional inclusion criterion of age ≥65 years. Binary and ordinal logistic regressions were applied to examine the associations between food insecurity scores and geriatric syndromes (malnutrition, possible sarcopenia, frailty, falls, visual impairment, and hearing impairment) and number of geriatric syndromes, adjusted for sociodemographic, health condition, and lifestyle variables.

The systematic review showed that food insecurity was associated with cognitive outcomes, fall-related outcomes, hearing impairment, visual impairment, sarcopenia-related outcomes, malnutrition plus its phenotypes, and frailty; however, except malnutrition, other geriatric syndromes were less studied. The results from the psychometric study (n=512) showed that the modified HFSSM had acceptable validity and reliability in economically deprived Chinese families, which was particularly suitable for those with higher food insecurity. The analytical cross-sectional study (n=281) demonstrated that food insecurity was significantly associated with higher odds for malnutrition, possible sarcopenia, falls, and frailty among economically deprived community-dwelling Chinese older adults, but the associations were not significant for visual impairment and hearing impairment. Moreover, food insecurity was significantly associated with higher odds of having more geriatric syndromes.

The findings supported that food insecurity is associated with geriatric syndromes in the older population. In order to reduce the health care burden associated with geriatric syndromes, a stronger medical and social collaboration is needed to tackle food insecurity. The recommended first step for tackling this issue in Hong Kong is to perform food insecurity screening in the community using the modified HFSSM.

(495 words)