Investigating senior hardships and food insecurity

UKCPR, with underwriting from the Food and Nutrition Service (FNS) in the U.S. Department of Agriculture, currently oversees 17 research projects that focus on American seniors, ages 60 and older. The projects comprise three topical domains: (1) Describing households with food insecure seniors, including, but not limited to, factors such as functional status and ability to live independently, access to transportation, mental function, spousal health status, and social network and family connections; (2) Understanding factors underlying participation and re-certification in food assistance and other safety net programs; and (3) Evaluating the causal impact of food and non-food assistance programs on health and nutrition outcomes, as well as related outcomes such as consumption trade offs.

The funded projects were awarded through two competitive rounds, with eight awarded in 2019 and nine more in 2019. In total, UKCPR awarded $2.4 million in research contracts..

The impetus for this new research initative is recognition that Increasing numbers of seniors in the United States are going without enough food due to economic constraints, and this has not abated in recent years even in the midst of an improving economy and financial markets. Begininng with the pathbreaking 2008 study, The Causes, Consequences, and Future of Senior Hunger in America, UKCPR Director James Ziliak and Craig Gundersen of University of Illinois, have conducted a series of studies with the support of the National Foundation to End Senior Hunger (NFESH), Feeding America, AARP Foundation, Merck Foundation, and the Meals On Wheels Association of America. As reported in the recent "The State of Senior Hunger in America 2016: An Annual Report," in 2016 13.6% of persons age 60 and older were marginally food insecure, 7.7% were food insecure, and 2.9% were very low food secure, which translates into 8.6 million, 4.9 million, and 1.8 million seniors, respectively. As depicted in the figure, this is an increase of 45% since 2001 in the fraction food insecure, and a doubling of those classified as very low food secure.


Following are reports produced for UKCPR's research initiative, funded by the USDA Food and Nutrition Service under contracts 12319818C0010 (Round 1 papers published under series 2022) and 12319819C0006 (Round 2 papers published under series 2023).


The complex relationship between poverty and food insecurity among older adults

This paper examines the characteristics associated with poverty and food insecurity among households ages 55 and older to better understand what drives the gap between these measures of hardship. The analysis uses data from the 2002 through 2018 Health and Retirement Study to assign households one of four outcomes: poor and food insecure, poor and food secure, nonpoor and food insecure, and nonpoor and food secure. Multinomial logit regressions of the likelihood that households will fall into one of these four outcomes show that poor health is associated with an increased likelihood that both poor and non-poor households will be food insecure, and a reduced likelihood that households will be nonpoor and food secure. These results highlight the strong correlation between food insecurity and health that goes beyond sociodemographic and economic factors. This information is important for policymakers, Federal agencies, such as the U.S. Department of Agriculture Food and Nutrition Service, nonprofits, food banks, and other community-based organizations that serve food insecure households.

Living arrangements and food insufficiency among seniors

This study investigates recent trends in living arrangements among older Americans and how they relate to nutrition assistance program participation and food insufficiency. We specifically focus on the rising propensity for older adults to live with children under 18 and the decline in living in institutions. We find that both of these living arrangements are associated with SNAP participation and with patterns of food insufficiency. Using an event study design, we find suggestive evidence that living in an institution may alleviate food insufficiency. Seniors living with children under 18 appear to have rising rates of food insufficiency even before the period of co-residence, suggesting that other factors may be driving both food hardship and living arrangements.

Benefit changes and SNAP participation and expenditures among low-income seniors

This study examined changes in senior Supplemental Nutrition Assistance Program (SNAP) participation and household food and non-food expenditures following the 2009 American Recovery and Reinvestment Act (ARRA) expansion in SNAP benefits and the 2013 sunset of the benefit expansion. Using data from the 2008, 2010, 2012, and 2014 Food Security Supplements of the Current Population Survey, we find that senior SNAP participation increased significantly from 2008, prior to the implementation of the ARRA to 2010 post-ARRA, with the largest change among the oldest seniors aged 80 years and older. Seniors using meal services like home-delivered meals or congregate meals at senior centers saw larger increases in SNAP participation than those who did not use these services. There were no significant changes in senior SNAP participation following the 2013 sunset of the ARRA benefit expansion. Expenditure data from the 2007-11 and 2012-14 Consumer Expenditure Surveys shows that, in contrast to younger adults, seniors did not appear to significantly alter their food expenditures in response to changes in SNAP benefits. Among non-food categories, the 2009 increase in benefits resulted in a significant increase of $164 in transportation spending among seniors but also a decrease of $87 in their spending on utilities. Unlike younger age groups, the benefit changes did not shift seniors’ Engel curve for food-at-home spending suggesting that, on average, SNAP benefits are equivalent to cash income for seniors. Overall, our results verify that SNAP has spillover effects on transportation, utilities, healthcare and other spending among eligible adults, well beyond its stated goal of supporting food spending.

The effect of Social Security benefits on food insecurity at the early retirement age

This study examines the effect of Social Security benefits on labor supply and food security at the early entitlement age (EEA). The data come from the supplements of the Current Population Survey, years 2001 to 2017. The results show that Social Security benefits decreased food insecurity near the EEA, particularly during and after the Great Recession. The effects are evident for both low food security and very low food security and are especially large and robust for widowed householders.

Total nutrient intake, dietary nutrient intake, and dietary quality of U.S. older adults using various food assistance

This project determined and compared the dietary and total (food and dietary supplements) mean usual nutrient intake and proportion meeting recommendations, and dietary quality of U.S. older adults (≥60 years) who use food assistance, including the Supplemental Nutrition Assistance Program (SNAP); emergency foods; and community meals or meal delivery; and income-eligible non-participants. Usual nutrient intake among older adults using food assistance and income-eligible non-participants was low with high risk of inadequacy for over 50% of older adults from dietary sources for vitamins D, E, A, C, calcium and magnesium, and total sources for vitamin D, calcium and magnesium. SNAP participants had a higher risk of not meeting the Estimated Average Requirement for vitamin E from diet compared to other non-SNAP program participants (P = 0.001). Dietary quality did not align with the Dietary Guidelines for Americans, with Healthy Eating Index-2015 scores ranging from 56 to 61 out of 100; SNAP-only participants had higher dietary quality compared to multiple program participants (P = 0.02).  Usual nutrient intakes were inadequate and dietary quality was poor among U.S. older adults eligible for food assistance.  Risk for inadequacy was lower after inclusion of dietary supplements.

Food security status in seniors over their life course

The potentially complex relationships between senior hunger and the constellation of lifetime social, economic, and health statuses are not well understood, or even described. The primary purpose of this study is to assess patterns and associations among lifetime experiences of social, economic, food, and health hardship for food insecure seniors. A central feature of our work is the incorporation of a life stories approach in addition to longitudinal surveys. From June 2020- February 2021, we collected life history interviews from 107 participants. We conducted bimonthly follow-up interviews starting in August 2020 (continuing until March 2022). Interview guides for life histories and follow-up interviews included open-ended questions and survey style assessments, including the USDA Household Food Security Survey Module, the Survey of Income and Program Participation Adult Well-being Module, the WHO Quality of Life instrument, and the Mental Health Inventory 18. We conducted inductive analysis and content analysis of all qualitative data and estimated descriptive statistics of all quantitative data. Our primary themes for qualitative analysis relate to history of food insecurity, economic insecurity, and household health challenges. Additionally, the following themes emerged from our inductive analysis: violence, sexual and physical; traumatic events; racism, individual and systemic; perceptions of age discrimination; early experiences of sharecropping or leased land; and home gardens. The life course narratives reflect a complex experience of food and other material hardships throughout the lifetime, yet thus far in our analysis, previous experiences of food insecurity, particularly in middle age, have been the most notable predictor variable for senior hunger.

Food insecurity and chronic diseases in low-income older Americans: The role of SNAP receipt in medication under use

We are interested in exploring how SNAP participation is related to the health of older adults. We used Supplemental Nutritional Assistance Program (SNAP) administrative records, Medicaid medical claims records for diabetes, and hypertension, and Medicaid pharmacy claims records related to treatment plans for these disease conditions for the period 2006 to 2014 for older adults aged 60 and older in one Midwestern State. First, using only the SNAP administrative records, we investigated the characteristics of older adult participants in SNAP who experience administrative churn, a short-term disruption in benefits lasting up to four months and often occurring when participants are required to recertify their eligibility for benefits. Second, using the SNAP records linked to the Medicaid records, we documented rates of hypertension or diabetes diagnoses and rates of medication adherence to antihypertensives and antidiabetics for SNAP participants overall as well as by age group and race/ethnicity. Third, we examined the relationship between concurrent SNAP and Medicaid enrollment, pattern of SNAP participation, and medication non-adherence among low-income Medicaid-insured older adults living with hypertension.  Finally, we estimated the causal effects of small changes in SNAP benefit size on chronic disease medical claims, Emergency Room (ER) claims, and medication adherence.


Changing patterns of take up and participation in SNAP and the role of out-of-pocket medical expenses

SNAP eligibility and participation rates have been increasing for adults 50 years and older since 2008. At the same time, SNAP participation continues to fall over the life course, with the lowest rates concentrated among individuals 85 years and above. We use longitudinal data from the nationally representative Health and Retirement Survey from 2002 to 2016 to document how SNAP eligibility, participation, and take-up changed over time for older adults. Then, we investigate the role that out-of-pocket medical expenses have played in these changing patterns.  We rely upon the state adoption of the Medicaid Expansion in 2014 as a source of exogenous variation. 

The dynamic nature of poverty and food insecurity among older adults: Evidence from the Health and Retirement Study

This paper examines the dynamic of food insecurity for older adults over the past two decades and how it relates with different poverty measures, including the official poverty measure, Supplemental Poverty Measure, and Supplemental Poverty Measure enhanced with imputed rent. It further examines how age, birth cohort, and the Great Recession shape the relationship of food insecurity and poverty. The analysis uses data from the 2002 through 2018 Health and Retirement Study and assesses the risk of becoming food insecure as a function of various poverty measures across different age groups and birth cohorts before and following the Great Recession. The results show that compared with the official poverty measure, alternative poverty measures are stronger predictors of the onset of food insecurity. Beyond poverty, many factors, including demographic, economic, and health characteristics, also determine food insecurity. Moreover, there is no clear evidence that the impact of poverty on food insecurity declines at advanced ages or that the impact of the Great Recession on the onset of food insecurity has been smaller among the oldest older adults. Instead, more recent cohorts of older adults exhibit a greater discrepancy between food insecurity and poverty.

How older households manage food insecurity with food production activities

Household food insecurity is a concern in the U.S. given the negative effects associated with food insecurity. An interesting finding is that elderly households tend to be more food secure than younger households, even though many are on a fixed income. A relevant question is what might elderly households be doing that is resulting in greater food security? One potential explanation is that in retirement, elderly households can invest in more time-intensive activities that provide greater food security. In this study, we combine time-use diaries with food security surveys to examine whether time spent on food production is associated with lower levels of food insecurity for elderly households. The data show that time spent in meal preparation and eating is increasing with older age cohorts. At the same time, food insecurity is declining steadily with older households. Grocery shopping and non-grocery food shopping do not show any relevant trends. We also compare food insecurity of households that are pre and post retirement eligible to see if food production explains the gap in food insecurity between these household types. We find that time spent on meal preparation and time spent eating explain some of the gap in food insecurity between these households and the results vary by marital status. Finally, we specify a two-stage model to estimate whether time spent on food production causes greater food security. Our specification fails to identify a strong relationship. One potential explanation is that older households in our sample generate bias as we only observe households that still live independently and alone.