Perspectives on Food Security in Older Adults in the COVID-19 Era: What We Know, Where We Go

There are genuinely sufficient resources in the world to ensure that no one, nowhere, at no time, should go hungry.

—Ed Asner, actor, and social activist

The term “food insecurity”—limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways—is often used as a measure of where hunger can occur. The United States Department of Agriculture (USDA) defines hunger as a “potential consequence of food insecurity that, because of prolonged, involuntary lack of food, results in discomfort, illness, weakness or pain that goes beyond that usual uneasy feeling.”

Some population groups—including older adults, as well as Black, Indigenous and other racial/ethnic minority groups—can experience food insecurity and hunger at higher rates than others.

Being food insecure for older adults means that they may have enough food to keep them full but are not able to access and consume the foods they need to meet nutritional and dietary standards. Older adults experiencing food insecurity have been shown to have significantly reduced intakes of vital nutrients, which puts them at greater risk for conditions like depression, asthma, heart disease and diabetes. With chronic food insecurity, older adults are also at risk of malnutrition that can further exacerbate existing chronic diseases and contribute to higher healthcare costs than those with the same conditions who are food secure. A 2018 study found the presence of food insecurity among older adults with chronic conditions added 11% to healthcare costs. Incremental annual total healthcare costs among older adults with a specific chronic condition ranged from $530 (cancer) to $1,740 (arthritis).

In 2019, the University of Michigan National Poll on Healthy Aging found that among U.S. adults ages 50 to 80, one in seven (or 14%) had experienced household food insecurity in the past year. Earlier that year, the USDA found that 7.2% (or 1,842,000 households) with older adults were food insecure. Despite this clear need even prior to the COVID-19 pandemic, it is also well-documented that a relatively small portion of eligible older adults were receiving services from community-based nutrition assistance programs such as meals offered in a community or senior center, home-delivered meals (i.e., Meals on Wheels) or receiving Supplemental Nutrition Assistance Program (SNAP) benefits. Barriers to participation (e.g., inadequate federal funding, lack of awareness, stigma, limited access to transportation, functional limitations, etc.) can limit elders’ knowledge and use of these effective community-based nutrition assistance programs.

Impact of COVID-19 on the Food Security Status of U.S. Older Adults

While food insecurity and malnutrition were already prevalent and detrimental in the older adult population prior to COVID-19, the pandemic exacerbated their effects. Five main factors facilitated the impact of COVID-19 on food insecurity worldwide: income losses and demand shocks; food supply chain disruptions; consumer responses (e.g., hoarding, food waste and dietary shifts); short-sighted policy responses (country-level food export bans); and insufficient fiscal stimulus.

While no one was untouched, the pandemic had a particularly significant and adverse impact on older adults, who were among those at highest risk for the virus. At the pandemic’s onset, many older adults, particularly those with physical limitations, had to quickly learn how to contend with new ways of procuring food, adhere to stay-at-home orders, navigate job and transportation loss and other disruptions—all while avoiding exposure to COVID-19.

Early data reported in July 2020 by Schanzenbach and colleagues suggested that 13.5% of older adults were food insecure, an increase of 60% from pre-COVID-19 levels. Additional household food security data released later that year reported that an astonishing fifth (20.6%) of all U.S. households with older adults were found to be food insecure.

Comparison of COVID-19’s Impact on Older Adult Food Security Status at Home and Abroad

Since COVID-19 took hold in 2020, world hunger has increased significantly: It is projected that between 720 and 811 million people across the globe faced hunger in 2020, approximately 161 million more people than in the prior year. While the global prevalence of moderate or severe food insecurity as measured using the Food Insecurity Experience Scale (FIES)—an internationally validated global tool—has been slowly increasing since 2014, the estimated increase in 2020 was equal to that of the previous five years combined. In 2020, documented food insecurity increased for the first time since 2014 in the United States and Europe, and moderate or severe food insecurity rose to 30.4 percent globally—meaning approximately one in three people (2.37 billion) in the world did not have access to adequate food during the first year of the pandemic.

Figure 1. Prevalence of food insecurity at severe level only, and at moderate or severe level, based on the Food Insecurity Experience Scale, 2014–2020

The pandemic also has exposed systemic health and social inequities across the world. Chronic and acute hunger were already on the rise prior to the pandemic due to myriad factors, including conflict, socioeconomic conditions, natural disasters, climate change, population displacement and growing pestilence. COVID-19 further impacted global supply chains and household income, and it is likely that many of these existing issues will continue to exacerbate pandemic-associated food insecurity into the future.

Low levels of moderate or severe food insecurity at the national level can obscure its impact on vulnerable populations like older adults. Few comparative analyses have been conducted to examine the specific impact of COVID-19 on the food insecurity status of older adults across the globe, but, we can glean important insights from a 2021 comparative analysis conducted by the Commonwealth Fund.

This report found that during the height of the pandemic, older adults in the United States suffered the most economically when compared to their peers around the globe due to higher levels of job loss and savings depletion. This suffering resulted in considerable social and economic hardship, limiting their ability to secure needed supportive resources—perhaps even including food. Taken together, both at home and across the globe, it is clear that those who were uniquely vulnerable to health inequities, including older adults, proved to be most impacted by the COVID-19 public health pandemic.

Now That We Know, Where Do We Go?

It is unlikely that pandemic-driven food insecurity and hunger in older adults will be resolved quickly. Even as COVID-19 restrictions begin to lift, adults will continue to need responsive, safe, person-centered access to services that can support their ongoing nutrition and wellness needs.

Recent data from Meals on Wheels America revealed that most local programs (82%) agreed that new clients they took on during the pandemic were there to stay moving forward. As we look to the future, those of us in the aging sector can harness older adult–specific lessons learned domestically and internationally during the pandemic, and benefit from the diversity of efforts to shore up food access and availability for elders. Below are three simple ways we can all transition into the “next normal” and adequately address the food security needs of the older adults we serve:

Learn from the past and lift up what works

Pre-COVID-19, several logistical strategies were initiated across the country to address food insecurity, such as improving public transportation; increasing availability of high quality, affordable foods in local grocers; and decreasing barriers to participation in food programs among food insecure individuals.

Policy and program leaders also previously had sought to address food insecurity following national crises by modifying food programs to improve access and mitigate against negative health outcomes, including adjustments like increasing eligibility and enrollment; increasing benefits; decreasing administrative burden; and making programmatic changes that facilitate greater access to food. Similar approaches have been shown to work well throughout the pandemic (e.g., making emergency funding available to aging services providers; establishing flexibilities and waivers for federal senior nutrition programs to improve food security; providing funding to seed and scale meal delivery partnerships, etc.). In the future, it would benefit aging services providers to maintain focus on pursuing strategies that have been successful in supporting the nutrition needs of older adults.

Build more bridges to build a bigger table

Expanding connections to community-based senior nutrition programs and increasing screening for food insecurity mediated by healthcare providers systems remain viable strategies for combating food insecurity among older adults. Healthcare providers are an important part of the solution to hunger and malnutrition; they are in a position to regularly monitor the food security status of older adult patients, ask important questions regarding dietary behavior and food access, and connect older adults to additional community-based services that may benefit them. Other key community members—clergy, postal workers, police officers, firefighters, emergency response personnel, food retailers, dental professionals, and hospital workers—also can play a crucial role in helping to identify at-risk adults.

Prioritize nutrition security to mitigate malnourishment

The USDA has described nutrition security as “having consistent access to nutritious foods that promote optimal health and wellbeing for all Americans, throughout all stages of life.”

The impact of COVID-19 on the nutritional well-being of older adults is well-documented, and older adults in minority populations—as well as people living in rural and lower income areas—have been most likely to experience disparities in nutrition quality, food insecurity and corresponding diet-related diseases. Aging services providers can prioritize nutrition security by keeping their focus on programs and policies that support nutrition-relevant interventions, including the provision of medically tailored meals; offering evidence-based nutrition education programming; supporting local food sovereignty movements; adopting a nutrition and equity lens to examine program participation and meal production efforts; and advancing cross-sector partnerships that can boost and expand high-quality meal services.

Conclusion

Our country has sufficient resources to address the scourge of food insecurity and provide responsive, culturally proficient, client-centered and wholistic support for America’s older adults in meeting their nutrition needs. Over the past few years, the pandemic has tested the aging and nutrition service provider networks, exposing our collective spirit of innovation and resolve, revealing opportunities to strengthen safety net food programs targeted at older adults, and build upon lessons learned. Older adults remain uniquely susceptible to food insecurity due to myriad age-related biological, societal, functional and economic reasons, but an array of effective and scalable practice- and research-informed solutions abound.

Ucheoma O. Akobundu, PhD, is senior director for Nutrition Strategy and Impact at Meals on Wheels America, in Arlington Va.

Photo: Members of St. John's Christian Methodist Episcopal Church in Sherman, Texas, host a drive-up food pantry, April, 2020.

Photo credit: Sara Carpenter, Shutterstock