Seniors

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 our awardees funded in 2020

Irma Arteaga, University of Missouri-Columbia (PI), Leslie Hodges, University of Wisconsin-Madison (co-I), Colleen Heflin, Syracuse University (co-I), Chinedum Ojinnaka, Arizona State University (co-I). Food insecurity and chronic diseases in low-income older Americans: The role of SNAP receipt in medication underuse. This project will investigate how SNAP benefits affect medication and health care use for seniors with chronic conditions. Using a unique linked state administrative dataset from Missouri that contains both the universe of Medicaid claims and SNAP data among adults ages 60 and older from 2006 to 2014, the authors propose four inter-related questions. First, are Medicaid claims for diabetic and hypertensive emergencies that result in emergency department (ED) visits and hospitalizations less likely among SNAP recipients? Second, do SNAP recipients have lower rates of medication non-adherence for these conditions than non-SNAP recipients? Third, is medication non-adherence for these conditions more likely to result in ED visits and hospitalizations among SNAP recipients compared to non-SNAP recipients, and what is the relation to the amount of SNAP benefits? Fourth, is medication non-adherence related to the timing of SNAP benefit disbursement? For these conditions, is the rate of claims for ED visits and hospitalizations related to the timing of SNAP benefit disbursement? The findings of this analysis will inform policymakers about the extent to which SNAP produces health benefits among older Americans by promoting disease control and reducing diabetic and hypertensive emergencies.

Joshua Berning, (PI), Jude Bayham (co-I), Alessandro Bonnano (co-I), Rebecca Cleary (co-I), Colorado State University. How older households manage food insecurity with food production activities. The investigators will conduct an analysis of how food insecurity and food production activities change for elderly households as they age. They hypothesize that elderly households may spend more time on food production activities to maintain food security into retirement, while the intensity of activities is likely to decline. Using the CPS American Time Use Survey linked to the CPS Household Food Security Supplement, the researchers will look at meal preparation, grocery shopping, non-grocery food acquisition, and eating time. They will examine how food production activities are related to food insecurity across different household types and explore differences between age cohorts for single and couple households. Researchers will analyze the causal effect of food production activities on household food insecurity. The results of this analysis will provide greater insight into understanding which behaviors are more effective for minimizing food insecurity and which activities may need to be supported to help improve food security for elderly households.

Barbara Butrica (PI), Stipica Mudrazija (co-I), Urban Institute. The relationship between food insecurity and poverty among older adults. The project will examine the determinants and dynamics of food insecurity over time using the Health and Retirement Study. The aim is to better understand what drives the gap between food insecurity and poverty rates, and how to better align the two measures of economic hardship using alternative measures of poverty, namely, the official poverty measure (OPM) and the supplemental poverty measure (SPM). They hypothesize that factors not captured by the OPM such as food assistance and out-of-pocket medical spending are important determinants of senior food insecurity and the discrepancy between food insecurity and existing measures of poverty among older adults has increased. The research will examine how the risk of experiencing food insecurity and remaining food insecure increase as seniors age. The implication is that an increasing number of older adults, even those not deemed poor, may be at risk of food insecurity. The researchers hope these findings will inform policymakers about how to improve the criteria for determining SNAP eligibility among older adults by determining a set of key predictors that define food insecurity.

Heather Eicher-Miller (PI), Regan Bailey (co-I), Purdue University. Total nutrient intake, dietary nutrient intake, and dietary quality of U.S. seniors using federal and non-federal food assistance. This project will use data from the National Heath and Nutrition Examination Survey to determine and compare the national estimates of mean usual intake of nutrients from food, total nutrients (from food and supplements) and dietary quality of U.S. seniors age 60 and older who use food assistance from public and private food networks. The proportion of seniors meeting the Dietary Reference Intake (DRI) recommendations by program will also be provided to inform policy. About 66 percent of seniors 71 and older and at or below 130 percent of the poverty threshold use dietary supplements. Determining nutrient and dietary gaps/excesses and comparisons by food assistance program use is critical to inform nutrition planning for food assistance programs (some specifically directed to seniors) and senior ability to achieve DRI recommendations. Recent suggested provisions in the farm bill would allow SNAP benefits to be used to purchase dietary supplements such as multivitamins, and the results of this study should inform policy on the potential implications for diet quality of seniors.

Colleen Heflin, Syracuse University (PI). Changing patterns of eligibility and take up in SNAP and the role of out-of-pocket medical expenses. While national SNAP caseloads peaked in fiscal year 2013 and have declined since then, participation among older adults has continued to rise. With increased health care expenditures and out-of-pocket costs, medical expenses have become a major contributor to the household financial instability of older adults. The impact of out of pocket medical expenses has not been the subject of previous research in relation to SNAP participation, especially among seniors. Using a long panel of seniors from the Health and Retirement Study, the first objective of this project is to explore the temporal dimension of SNAP eligibility and take-up for older adults and their policy implications. Researchers will focus on the age pattern of SNAP eligibility and take-up, the period pattern of individuals’ SNAP eligibility and take-up within economic and policy contexts, and the demographic pattern of how the age and period patterns differ by demographic characteristics. The second objective is to examine the role of out-of-pocket medical expenditures on SNAP participation. Given the increase in out of pocket medical expenses for older adults, the authors will ask whether these expenses increase eligibility but not participation, or whether participation also increases. Results will provide policymakers with information on seniors families burdened by out-of-pocket health care expenditures and the eligibility guidelines for food assistance programs.

Carla Pezzia, University of Dallas (PI); Tammy Leonard, University of Dallas (Co-I). Food security status in seniors over their life course. Despite multiple social safety net systems, seniors over 60 are at risk for food, economic, and material hardship, complicating health challenges. Little is known about the ways early and mid-life experiences moderate and mediate senior experiences of food-related hardship and health. The project will utilize mixed qualitative and quantitative methods to evaluate the impact of household dynamics on food insecurity, economic and material hardship, and household health over the life course. The project will describe current and past hardships and health characteristics of food insecure households with older adults to determine if food insecurity is more likely associated with some individual/household characteristics, particularly related to health outcomes. The project will also determine what individual/household characteristics and life circumstances affect the likelihood of senior food insecurity. Researchers will also use interviews to examine the relationships between household characteristics, food insecurity (alone or in combination with other material hardships), and quality of life among seniors over a 12-month period. Study results will inform programming and outreach to relieve food insecurity and other hardship among seniors, as well as potentially formulate preventive approaches to address earlier life course events found to exacerbate senior hardships.

Perry Singleton, Syracuse University (PI). The effect of Social Security retirement benefits on food-related hardship among older Americans. This project examines the effect of Social Security retirement benefits on food-related hardship, particularly at the early retirement age of 62, when Social Security claims spike. One study links this spike to individuals with limited wealth and private pensions who are unable to retire before age 62. This implies that individuals who claim Social Security benefits at the early retirement age are more likely to face food-related hardship and that Social Security benefits may reduce food-related hardship at age 62 and beyond. This project uses data from the CPS Food Security Supplement and Health and Retirement Study to first examine whether the prevalence of food-related hardship decreases precipitously at age 62. Next, it examines whether the persistence of food-related hardship decreases at age 62, since income from Social Security is more stable across periods. Finally, the author plans to test whether the effect of Social Security benefits on food-related hardship was larger during the Great Recession, which sharply increased food insecurity among the population. The policy implications of the results reach to the wider safety net of seniors, especially potential unintended food insecurity consequences of changing age eligibility for Social Security.

Geetha Waehrer, Pacific Institute for Research and Evaluation (PI). Effects of higher SNAP benefits on low-income seniors. This project will use data from the Current Population Survey and the Consumer Expenditure Survey to investigate whether higher SNAP benefits can increase participation among eligible seniors, along with the effects of changes in SNAP benefits on the food and non-food expenditures of elderly SNAP participants. To estimate the effects of benefit changes, the project will use the natural experiments provided by the increase in SNAP benefits as a result of the 2009 American Recovery and Reinvestment Act and the decrease in 2013 following the sunset of this benefit expansion. By estimating the effect of benefit changes on participation and spending, findings will add to information about the adequacy of SNAP benefits. Results will inform policy by revealing the spillover effects, if any, on other types of expenditures to show the full impact of SNAP on the health and well-being of older Americans, beyond its support of food spending. The research will also inform policy on whether SNAP’s emphasis on home preparation discourages participation.

Tara Watson (PI), Lara Shore-Sheppard (co-I), Lucie Schmidt (co-I), Williams College. Living arrangements and food hardship among seniors. Researchers will investigate how senior living arrangements – particularly living with grandchildren or in an institution - affect food insecurity and SNAP participation. The project will investigate how living arrangements of seniors have been changing over the past two decades and how patterns of food insecurity and SNAP participation among seniors vary based on living arrangements. The project, using data from the American Community Survey, Current Population Survey, and Health and Retirement Study, will estimate the effect of co-resident grandchildren on food insecurity and program participation, by examining transitions for seniors who experience an entry or exit of a grandchild from their household. Researchers will analyze state welfare policies, county opioid rates, and county female incarceration, which predict grandparents serving as caregivers. Understanding how caregiving responsibilities impact food insecurity and SNAP can help guide policymakers as they develop safety net guidelines for increasingly complex family structures and can highlight spillovers from other policy decisions onto the SNAP program. The project will also examine how aging in place rather in institutions, affects food insecurity and SNAP participation.

Following are projects funded in 2019.

Stephanie Grutzmacher (PI), Mark Edwards (co-I). Oregon State University. Examining experiences of food hardships and SNAP enrollment among young-old and older Americans: A multi-method approach.
The research will use longitudinal administrative data, in-depth qualitative interviewing, and participant observation to understand program participation and describe households with food insecure seniors. These analyses will enable the careful description of patterns of SNAP under-enrollment, food insecurity risk, resilience factors, and contextual characteristics of food insecure seniors. The project will, 1) use SNAP administrative data to estimate age-specific patterns of SNAP use among people progressing through older age, 2) evaluate competing explanations for senior under-enrollment in SNAP by combining administrative data analysis and in-depth qualitative methods, and 3) explore the lived experiences of food hardship among older adults using in-depth qualitative methods. Study objectives include, 1) a systematic description and evaluation of competing explanations for under-enrollment and appraisal of their relative validity, 2) articulation of within-group differences across the later life course, and 3) identification of other relevant personal and contextual factors that influence both SNAP enrollment and resilience/vulnerability to food hardships. The research will result in policy and program implementation recommendations for the USDA Food and Nutrition Service (FNS), for state agencies that administer SNAP and SNAP-Ed, and local private and public agencies serving the needs of older adults. Results will also inform theory about vulnerability to material hardship, the process of aging in hardship, and the importance of context in understanding safety net program usage.

Jung Sun Lee (PI), Vibha Bhargava (co-I), Travis Smith (co-I), University of Georgia. The impact of nutrition assistance programs on food insecurity, food acquisition, and health outcomes among older adults.
The proposed research will examine, 1) temporal and spatial usage patterns of assistance programs and health care among older adults, and 2) the effect of nutrition assistance program participation (SNAP, OAA, and dual participation) on food insecurity, food acquisition (quantity and quality), and health outcomes in older adults. Researchers will document usage patterns of public nutrition, aging, and health care programs and estimate the impact of program participation on food insecurity, food acquisition, health status, health care utilization, and expenditure in low-income older adults. Researchers will utilize two datasets: 1) a comprehensive Georgia statewide longitudinal dataset with information on food insecurity, administrative data on SNAP and Older Americans Act Title III programs and Home and Community-based Services, health status, and health care utilization and expenditure; and, 2) the National Household Food Acquisition and Purchase Survey (FoodAPS). State-level administrative data will allow researchers to track individuals over time for program participation and food insecurity. FoodAPS data will enable a potential confirmation of state-level findings. The findings from this project hold potential for research and nutrition assistance program and policy innovations for older Americans. The approaches will provide methodological guidance on linking and utilizing data from complementary data sources and suggest best-practices to leverage existing administrative data sources for nutrition assistance and aging programs in establishing timely and reliable researchable databases. The findings from this study will fill in the gap in the literature on the causal relationship of nutrition assistance programs with food insecurity, food acquisition, health, and healthcare utilization/expenditures in low-income older adults.

Helen Levy (PI), University of Michigan. Food insecurity among seniors: The role of social insurance.
The project has four objectives: 1) estimate the economic, demographic, health-related, and psychosocial predictors of food insecurity among seniors using data from the Health and Retirement Study (HRS); 2) estimate the causal impact of Social Security income on food insecurity among seniors using data from the HRS and the Current Population Survey (CPS); 3) estimate the causal impact of Medicare on food insecurity among seniors using data from the HRS and the National Health Interview Survey; and, 4) estimate the causal impact of Medicaid on food insecurity among seniors using data from the CPS. Objective one is a descriptive analysis of the determinants of food insecurity among seniors using both cross-sectional and individual fixed-effect models. Objective two relies on the Social Security “notch” – a discontinuity in the generosity of benefits for individuals born before or after Jan. 1, 1917 – to estimate how much Social Security income reduces food insecurity among seniors. Objective three relies on the sharp discontinuity in Medicare eligibility at age 65 to estimate the effect of that program on food insecurity among seniors. Objective four analyzes states that have or have not utilized Medicaid expansion under the Affordable Care Act to estimate the impact on food insecurity. Among seniors the major social insurance and transfer programs studied in this proposal – Social Security, Medicare, and Medicaid – may hold the key to reducing food-related hardships because most elderly who experience food insecurity are ineligible for means-tested nutrition assistance programs. Findings will also increase understanding of the full range of benefits that Social Security, Medicare, and Medicaid deliver to older Americans.

James Marton (PI), Augustine Denteh (co-I), Rusty Tchernis (co-I) Georgia State University, Charles Courtemanche, University of Kentucky (co-I). A comprehensive evaluation of the impact of SNAP on the health of seniors. Researchers will use data from the December Current Population Survey Food Security Supplement to examine the effect of SNAP on household food insecurity and food expenditures, comparing estimates for the full sample to those for a restricted sample of respondents aged 60 and older. Next, data from the National Health Interview Survey (NHIS), will be used to explore how SNAP influences a wide range of senior health-related outcomes, including global self-assessments of physical and mental health, current health conditions, activities of daily living, body mass index, risky behaviors, and health care utilization. The project will also utilize data from the Health and Retirement Study to analyze a similar range of SNAP’s effects, such as how they change with repeated exposure. The researchers will address the issue of endogeneity from the non-random nature of SNAP participation using a strategy that exploits cross-state, over-time variation in a number of state policies related to SNAP eligibility. They also address the measurement error in survey-based SNAP participation measures with an estimator that jointly models both true SNAP participation status and the probability of misreporting. Project results will provide a comprehensive view of the causal effect of SNAP on seniors’ food security and health. Finding that SNAP generally improves seniors’ food security and health outcomes would mean that developing effective methods to improve senior take-up of SNAP would increase their well-being. Finding that SNAP harms or has no effects on these outcomes would highlight the potential for program changes aimed at improving senior outcomes.

Kelly Stamper Balistreri (PI). Bowling Green State University. Senior hunger and the food security infrastructure. The project seeks to identify several broad state-level components of senior-specific food assistance programs, such as the availability and accessibility of federal nutrition programs for seniors, policies that influence the economic well-being of seniors, and the economic and social characteristics of the community. By combining this information with population-based data, this project will aid in a better understanding of the economic, social, and policy context in which senior hunger occurs. The project has three objectives: 1) identify the relationship between the senior-specific food security infrastructure and patterns of food hardship among the population ages 60 and older; 2) evaluate whether the contextual characteristics of the infrastructure moderate the detrimental impact low income on seniors; and, 3) examine the differential associations between senior food supports and various demographic groups among the nation’s elderly. The research will present a descriptive portrait of seniors (ages 60 and older) across multiple levels of food hardship, as well as across levels of the senior-specific food security infrastructure. To address the research questions, multilevel models will be constructed that encompass sociodemographic and senior food security infrastructure characteristics. This project integrates multiple measures of contextual information that are specific to the senior population with recent population-based data measuring senior food hardship. This study considers how state-level food security context may protect or perhaps generate risk for America’s seniors. The long-term goal is to inform policies that are designed to eliminate hunger among the elderly and thus improve population health.

Debra Brucker (PI), Sophie Mitra (co-I), University of New Hampshire. Understanding food-related hardships among older Americans: Evidence from the Panel Study of Income Dynamics. This project has three objectives: 1) identify mid-life predictors of living in a food insecure household at age 60 and older; 2) determine whether living in a food insecure household in mid-life is associated with reduced odds of wellbeing or healthy aging among persons age 60 and older; and, 3) examine changes in the odds of living in a food insecure household among adults as they transition onto Social Security retirement benefits. Researchers will use data from the Panel Study of Income Dynamics, a nationally representative study which has tracked over 18,000 individuals living in 5,000 families since 1968, to conduct multivariate methods to address the three objectives. This project will identify midlife predictors of food insecurity among older adults, the association between midlife food insecurity and aging outcomes, and the relative effect of transitions onto Social Security retirement benefits on food security for older adults. Information about midlife predictors of food insecurity can be used to identify younger subpopulations at greatest risk of developing food insecurity in old age, providing opportunities for early intervention and more targeted outreach. This information can be used at the federal, state and local levels by a variety of agencies and organizations. The USDA Food and Nutrition Service, for example, can use such information as they guide the development of state-level outreach programs for certain subpopulations to encourage SNAP participation. The U.S. Department of Health and Human Services’ Administration on Community Living, which provides nutrition services to seniors as authorized by the Older Americans Act, can use such information to guide service delivery as well.

Cäzilia Loibl (PI), Donald Haurin (co-I), Stephanie Moulton (co-I), The Ohio State University.The impact of financial and housing wealth on food insecurity. The goal of this project it to develop an improved understanding of the effectiveness of financial and housing wealth for food security in older age. The research uses Health and Retirement Study data to achieve three objectives: 1) document trends in age-adjusted food insecurity, mortgage debt, and borrowing constraints among older adults from 2000 to 2016 and identify the extent to which disparities in food hardship for black and white older adults are associated with components of financial and housing wealth; 2) identify the mechanisms through which financial and housing wealth influence food insecurity, and estimate differences by race; and, 3) simulate how policy innovations in access to housing wealth and the burden of mortgage debt affect food insecurity and quantify the impact of such policies on reducing disparities in food hardship by race. This research contributes to public policy for the design of interventions that may affect food hardship, investigating modes by which older adults may liquefy home equity, such as through federally insured reverse mortgages. This project isolates the mechanisms that underlie the relationship between housing wealth and food security by directly measuring the impact of mortgage payments, new mortgage borrowing, and borrowing constraints. Researchers also compare the impact of housing wealth to financial wealth on food insecurity. Based on these findings, the investigators simulate the impact of specific policy changes on food security outcomes for black and white older adults, and thus the expected policy impact on racial disparities.

Erline Martinez-Miller (PI), Eric Borton (co-I), Tammy Leonard (co-I), Sandi Pruitt (co-I) University of Texas Southwestern Medical Center. Aging into Medicare among a foodbank population: A longitudinal assessment of foodbank use, food insecurity, and health The study addresses gaps in knowledge about longitudinal assessments of food insecurity and the impact of Medicare eligibility on senior hunger with administrative data from senior foodbank clients (aged ≥60 years) in Dallas County, Texas, and records drawn from a community services organization. The research has three objectives related to foodbank use and food insecurity: 1) describe longitudinal trends and socio-demographic and health correlates; 2) investigate the impact of aging into Medicare eligibility at 65; and 3) determine whether pre-existing health conditions lead to differential impacts of aging into Medicare. Data from more than 1,000 foodbank clients aged 60 and older will be utilized to identify socio-demographic, economic, social and health correlates. Researchers will investigate the impact of Medicare eligibility at 65 years of age on foodbank use and food insecurity and examine whether pre-existing health conditions lead to differential impacts of Medicare eligibility on foodbank use and food insecurity. The project will reveal the unexplored connections between aging into Medicare, food insecurity, and foodbank use among seniors. Results will inform local stakeholders and the national evidence-base for health researchers, economists, policymakers, and community organizations. Findings will, 1) identify senior populations vulnerable to food insecurity in Dallas County for targeted interventions, planning, and resources, 2) inform similar studies and programs nationally, 3) add to the evidence-base of federally-funded health insurance as a policy to ameliorate socioeconomic and health disparities, and 4) Guide future Feeding America health assessments by identifying prevalent pre-existing conditions among food insecure seniors.