Food insecurity: How to recognize &amp; address it

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Applied Evidence

Food insecurity: How to recognize & address it

J Fam Pract. 2020 March;69(2):74-78,80-81

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References

1. Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household Food Security in the United States in 2016, ERR-237. Washington, DC: US Department of Agriculture, Economic Research Service; September 2017. www.ers.usda.gov/webdocs/publications/84973/err-237.pdf?v=0. Accessed January 10, 2019.

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27. Pooler J, Levin M, Hoffman V, et al; AARP Foundation and IMPAQ International. Implementing food security screening and referral for older patients in primary care: a resource guide and toolkit. November 2016. www.aarp.org/content/dam/aarp/aarp_foundation/2016-pdfs/FoodSecurityScreening.pdf. Accessed January 10, 2020.

Legislation enacted in 2010 under the existing Older Americans Act provided home-delivered meals, nutritional screening, and education counseling to Americans > 60 years of age. That provision was not based on an income test, however, and served only 18% of the older population.²³ (Other programs, such as SNAP, are utilized to a greater degree: 30% of eligible older adults participate, 75% of whom live alone.²³) Possible reasons for underutilization include restricted funding, lower education level, lack of outreach, a confusing application process, and the impression that the process is intrusive.^24-26

What you can do. To improve the nutritional intake of older adults, reconcile the patient’s medications at each visit to ensure that polypharmacy does not play a role in causing or exacerbating underlying conditions that can lead to poor nutritional intake. AARP (formerly the American Association of Retired Persons) recommends devising and conducting a survey of food insecurity with older adults that includes the 2-question American Academy of Pediatrics survey described earlier²⁷(TABLE 2^15,27).Such a survey, which can be administered by office staff, should also include a screen for depression, financial stability, ability to perform activities of daily living (eg, shopping and driving), and changes in diet that are a result of periodontal disease. The survey should also inquire about the effects of current or chronic disability on day-to-day life.

For all patients: Refer to community resources

The problems of food insecurity presented here only broadly address what each of these 3 groups face. Although the overall trend in food insecurity has been downward since 2011, deeper issues of food insecurity need to be studied more within each population. This is particularly true among the geriatric population, whose numbers are increasing, and among ethnic minorities, including black non-Hispanics, and Hispanics, who face additional daily stressors because of implicit biases in society.

Ask older adults about any decline in performing activities of daily living, which can lead to food insecurity and poor nutritional intake.

More study is needed to decrease the rate of food insecurity across all populations in the United States. In the interim, family physicians should take advantage of their role in the care of families, children, and older people to address the problem of food insecurity in their patient population by applying the interventions we’ve outlined, with an emphasis on referral to resources in the community.

CORRESPONDENCE
Lillian Amèzquita, BS, The Warren Alpert Medical School, Brown University, Box G-9999, 222 Richmond Street, Providence, RI; lillian_amezquita@brown.edu.