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Written by Margaret B. Ingraham, MA, Executive Vice President, National Foundation to End Senior Hunger. Revised November 2018.

A problem with far-reaching consequences

Millions of older individuals in the United States face the threat of hunger each year.

These facts disturbing but so, too, are these: the general lack of awareness about the serious issue of senior hunger; the consequential relationship between food insecurity among seniors and poor health status and the incidences of disease; and the absence of focused public will and a coordinated national strategy to address this complex “senior hunger problem."

This page will offer information on what grantmakers are doing to address the issue, the trending topics surrounding senior hunger, and resources to guide further research.

Background

The first comprehensive national study to examine the issue of senior hunger in this nation was not undertaken until 2008. That research, carried out by Co-Principal Investigators Dr. James P. Ziliak of the University of Kentucky and Dr. Craig Gundersen of the University of Illinois, found that 5 million seniors, or 11.4 % of all seniors in the United States, faced the threat of hunger, that is, were marginally food insecure, in 2005. In addition to quantifying the problem, the report served as a springboard to national dialogue and a benchmark against which the results of a series of similar reports in the ensuing years could be measured and contextualized. In 2018 Ziliak and Gundersen reported that, by 2016 -- the most recent year for which data was available--8.3 million seniors, or 13.6% of the older population were negatively affected.  

The deleterious impact of food insecurity reaches far beyond the issue of hunger or lack of regular access to adequate amounts of nutritious food. While senior hunger is a serious societal concern – and thus this topic is placed here alongside such other issues as elder abuse and economic security – food insecurity among older persons is also indisputably a health issue. A wide array of negative health consequences is clearly associated with a lack of access to sufficient food, according to other research findings by Drs. Ziliak and Gundersen.

In reports released in 2014 and 2017, which examined data from the 1999-2010 and 1999-2014 National Health and Nutrition Examination Study (NHANES) respectively, the investigators found food insecurity to be an independent predictor of negative health and nutrition outcomes in 2014 and 2017 reports examining data from the 1999-2010 and 1999-2014 National Health and Nutrition Examination Study (NHANES). Their review of the NHANES data demonstrated the problem to be a growing one. That is, the incidence of those negative outcomes associated with many serious diseases and conditions grew significantly when the research sample was expanded to include data from 2011 through 2014. In other words, adverse health consequences affected a larger fraction of the food insecure older population over time. For example, in the first report food insecure seniors were found to be 50 percent more likely to be diabetic than their food secure peers. By 2014, they were 65 percent more likely. Similarly, the fraction of food insecure seniors negatively impacted grew from 60 to 66 percent for experiencing a heart attack, from 14 to 19 percent for having high blood pressure and from 50 to 91 percent to be more likely of having asthma.      

Without question, the consequences of these adverse health outcomes are serious for the older persons who experience them. But the impact of those consequences reaches beyond those individuals and their families. As the researchers have suggested “high rates of food insecurity among seniors will likely lead to additional public health challenges for our country.” Senior hunger is a national health issue. 

Food insecurity is tracked in and designated by three alternative measures: marginally food insecure, food insecure, and very low food secure. These characterizations can be confusing, particularly the “marginally food insecure” category, largely because the term “marginally” in common parlance would suggest that all the individuals in that category were only “slightly” food insecure. As relates to academic research, this is not the case at all. Marginally food insecure actually refers to the broad classification that includes the other two, more severe, categories -- namely food insecure -- and very low food secure, as subsets of that larger whole.  

The determination of the levels of food insecurity/security is based on a set of survey questions called the Food Supplemental Survey that is a module of the Current Population Survey conducted monthly by the U. S. Census Bureau. The number of queries to which a respondent answers in the affirmative indicates how severe their lack of food security is. Individuals residing without children in the household who answer "yes" to at least one question ("one or more") are deemed marginally food insecure. If they respond "yes" three or more times, they are considered food insecure; and if they answer in the affirmative to six or more questions, they are designated very low food secure. The explanation is a bit arcane but having a clear understanding of it is important.

While the rates – that is the percentage of seniors affected by all levels of food insecurity – change over time, both nationally and on a state-by-state basis, the risk factors for experiencing senior hunger remain the same. Race plays a significant role. African-American and Hispanic elders are known to be at particular risk. In 2016 white seniors demonstrated food insecurity rates that were significantly less than half of those of their African American peers. Food insecurity rates among Hispanic elders were generally twice those of non-Hispanic seniors. Because of the demographic make-up of the United States, however, the vast majority of those seniors facing the threat of hunger is white. 

Income below the federal poverty line is another risk factor for seniors. Of those at or below poverty in 2016, over 46 percent experienced marginal food insecurity and more than 31 percent were categorized as food insecure. Other documented risk factors include marital status, age, disability, and the presence of a grandchild in the home. (For specific findings see “The State of Senior Hunger in America 2016: An Annual Report.”)

The risk of hunger does not exist in isolation; it has a staggering negative impact on many aspects of a senior’s quality of life. Research has found that a senior at risk of hunger has the same chance of a limitation in Activities of Daily Living (ADL) as an individual 14 years older. (ADLs are activities such as eating, walking, toileting, and transferring.) This creates, in effect, a large disparity between actual chronological age and “physical” age. It is worthy of note that this hunger-aging-ADL connection affected individuals age 60 and older and was not found to be present in the 50-59 and younger age cohorts.

Because so little attention historically has been paid to the issue of hunger among seniors, and, regrettably, because that trend continues, there remains much to be learned both about its causes and about the full impact of its consequences on those who face its threat, their families, communities, and the nation as a whole. This we do know: the consequences of the senior hunger epidemic reach far beyond food insecurity itself.     

If food insecurity among seniors is not adequately and systematically addressed, and if effective interventions are not put into place to prevent it as the aging population continues to grow at an unprecedented pace, the strain on the American economy, felt primarily through the health care system, can be expected to be enormous, felt primarily through the health care system. 

How philanthropy has helped

Grantmakers have been involved in senior hunger issues in several ways:

The Walmart Foundation provided funding to the National Foundation to End Senior Hunger to pilot-test and implement its What A Waste® program in State Units on Aging, Area Agencies on Aging, and congregate nutrition programs. National Foundation to End Senior Hunger developed the technology-driven program to expand services to seniors in community settings, helping to save money by cutting down on avoidable food waste, exploring different nutrition options for reducing, and repurposing unavoidable food waste.

What A Waste has now been implemented in more than 80 congregate nutrition programs in 12 states. Numerous congregate nutrition programs across the United States have expressed the desire to implement the program but a lack of financial resources has prevented them from doing so.

Feeding America supports senior hunger through their Mobile Pantry Program and their Senior Grocery Program®. The Mobile Pantry Program serves many of the highest-need households by distributing food in pre-packed boxes or at farmers’ market settings. The Senior Grocery Program® provides seniors nutritious meals they can make at home.

AARP Foundation’s Drive to End Hunger campaign has been raising awareness about food insecurity among older adults since 2011 through a collaboration with NASCAR team owner Rick Hendrick, four-time Sprint Cup Champion Jeff Gordon, Hendrick teammate Kasey Kahne, and both public and private sector organizations. The Program has donated more than 37 million meals to help feed hungry seniors.

AARP also collaborates with partner and grantee organizations on evidence-based programs that address senior hunger. Programs include Baltimarket Program, The Campus Kitchens ProjectEatSF Food Voucher ProgramFlavor Harvest@HOME,  and Food on the Move.

National Council on Aging (NCOA) provides several resources that help eligible individuals find and apply for benefits that pay for food, such as their Senior SNAP Initiative. NCOA, with support from Walmart, has awarded over $2 million in grant funding to help older adults with SNAP. Explore their Advocate’s Guide to the Elderly Simplified Application Project for SNAP benefits.

Trending Topics

These are some of the key issues where research and program development are still ongoing and or where funders could provide key start-up support:

Hunger, health, and long-term care: Despite the work of Ziliak and Gundersen and others, the issue of the critical connection between hunger and health, between hunger and health care costs, and of the place of meal provision and nutrition education in the emerging long-term services and support system (LTSS) remains relatively unrecognized outside the academic community Additional research and public education efforts in this area could assist in the development of public policies intended to improve health and reduce social and economic costs to the nation. Efforts should be made to enhance or initiate new partnerships between insurers, health care providers, and the providers of nutrition services, particularly nutrition providers that operate in a community-based setting where the needs of at-risk individuals can be assessed and met that prevents their becoming homebound.  

Food waste reduction and food recapture: It is estimated that up to 40% of the food produced in the United States never gets eaten. The reasons for this are manifold and it seems that much time and attention are given to analyzing the reasons why. Some of that consideration is necessary, of course, in order to help direct prevention efforts. But waste reduction, which is only part of the puzzle, can never be completely eliminated but this is only part of the puzzle. In the face of that fact, more serious attention needs to be directed toward food recapture and reuse – particularly in the context of senior hunger. While some attention has been focused on the recapture of primarily nonperishable food and its distribution to individuals in need, few efforts have been devoted to the recapture and reserving of safe, healthy and nutritious food that has been prepared but not consumed. More attention and financial resources need to be focused on this activity as a way of saving or stretching current resources while expanding services to the hungry.

Obesity and hunger: The correlation between good nutrition and good health is well-accepted, and the direct impact of proper nutrition on specific diseases, such as diabetes, hypertension, and certain types of cancers, is well-documented. Also documented by the Centers for Disease Control and Prevention (CDC) is the fact that obese individuals are at greater risk of those and other diseases than are adults of healthy weight. While it may seem counterintuitive that many individuals facing the threat of hunger would be obese, the facts are to the contrary. Obesity rates are high among the food insecure. The significant U.S. medical costs attributable to diseases associated with obesity have been well documented by the CDC and others. The same attention has not been given to determining the national health care savings that could be realized by reducing the incidence of obesity through interventions designed to ensure that individuals at risk of hunger receive proper nutrition, not just food.       

New program models: Support is needed for programs that emphasize collaboration to achieve collective impact and programs that model and pilot test nontraditional nutrition programming aimed at locating and providing services to unserved and under-served at-risk populations. Such programs should collect data relating to the effectiveness of such efforts in terms of the number of individuals reached as well as document impediments to service that both hinder success as well as those that are overcome.

Immediacy and sustainability: Understandably, most hunger relief organizations and programs focus their efforts on the short term, that is, on addressing the immediate needs of individuals facing hunger. Other projects may concentrate on developing future-oriented approaches that will guarantee the sustainability and viability of hunger relief efforts in the future. More attention should be given to developing and testing programs and projects that combine present day interventions and delivery of immediate food assistance with long-term solutions that combine nutrition education and sustainable food production and preservation. Because of their complexity, and the several areas of expertise that they require, such projects would likely take the form of collaborations and therefore might require substantial commitments from the funder(s).       

Policy initiatives: The abilities of states, localities and programs to provide nutrition services to individuals in greatest need depend largely on the availability of financial resources. In many, if not most, cases the primary source of which is often of funding is the federal government. Often funds for these programs are distributed based on the overall population of certain age cohorts. This is true of Older Americans Act programs. Age and density of population are not, of themselves, necessarily the best indicators of need. Through research and experience, we have identified the risk factors for senior hunger. New pilot projects designed to test policy initiatives that will drive public funding to the areas of greatest need, foster a reexamination of current funding formulas, and tie resources to risk factors are needed.

Resources


Reports and Issue Briefs

"The State of Senior Hunger in America 2016", Research conducted by Dr. James P. Ziliak, University of Kentucky and Dr. Craig Gundersen, University of Illinois, released in 2018 jointly by Feeding America and the National Foundation to End Senior Hunger.

“The Causes, Consequences and Future of Senior Hunger in America,” 2008 report from the Meals On Wheels Association of America Foundation (now the National Foundation to End Senior Hunger). Research conducted by Co-Principal Investigators Dr. James P. Ziliak, University of Kentucky and Dr. Craig Gundersen, Iowa State University. First national study to look at the scope of senior hunger and the risk factors associated with hunger in the older population.  

"Food Insecurity and SNAP Participation in the LGBT Community" from the Williams Institute at UCLA School of Law, with support from ConAgra Foundation, offers analysis of all age groups including older people.

"Senior Hunger in the United States: Differences across States and Rural and Urban Areas" (2009). Research sponsored by the Meals On Wheels Research Foundation (now the National Foundation to End Senior Hunger), conducted by Co-Principal Investigators Dr. James P. Ziliak, Univ. of Kentucky, and Dr. Craig Gundersen, Univ. of Illinois. State-by-state breakdowns of the prevalence of senior hunger.

"Food Insecurity Among Older Adults" (2011). Conducted for the AARP Foundation by Dr. James P. Ziliak, Univ. of Kentucky and Dr. Craig Gundersen. Focusing on the 50-59 age group.

“One in Four Mississippi Residents Struggle to Afford Food,” a 2012 brief from Gallup that provides a quick view of food insecurity by state.

“Spotlight on Senior Health: Adverse Health Outcomes of Food Insecure Older Americans,” a report based on research by Dr. James P. Ziliak, Univ. of Kentucky and Dr. Craig Gundersen, Univ. of Illinois, released in 2014 jointly by Feeding America and the National Foundation to End Senior Hunger.

"The Health Consequences of Senior Hunger in the United States: Evidence from the 1999-2014 NHANES" (published 2017). Sponsored by the National Foundation to End Senior Hunger, conducted by Dr. James P. Ziliak and  Dr. Craig Gundersen.

Organizations Involved in Senior Hunger  

AARP Foundation: Hunger is one of the main programmatic emphases of the AARP Foundation, which focuses on creating social change. The web site provides access to research information, multimedia educational materials, information on community projects, and a national partnership with NASCAR, the Drive to End Hunger.

Feeding America: Research findings and facts about senior hunger that place the issue within the larger context of hunger in America.

Food Research and Action Center: A policy organization focusing on eradicating hunger and undernutrition, FRAC has information on senior hunger and the older population’s participation in SNAP (the food stamp program). Explore their interactive map of state and county use of SNAP benefits here

National Foundation to End Senior Hunger (NFESH): A national foundation, NFESH promotes senior hunger research and the formulation and implementation of innovative programs and policy approaches to reducing food insecurity among seniors. The site provides access to research findings on senior hunger as well as information on NFESH’s community – based What A Waste ® and REACH projects.

Meals on Wheels America: A national organization representing community senior nutrition programs. Meals on Wheels operates in virtually every community in America through our network of more than 5,000 independently-run local programs. 

National Association of States United for Aging and Disabilities (formerly the National Association of State Units on Aging): National organization supporting state systems for delivering home and community-based services. Use site search engine to identify policy materials and resources related to senior hunger.

 

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