Food Insecurity, Service Awareness, Social Factors, and Quality of Life in Community-Dwelling Older Adults

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Older adults are at risk for food insecurity due to financial constraints, physical difficulties, social isolation, and the resulting limitations on food access. Social isolation has two components – objective, such as social contacts, and subjective, such as loneliness – and each may have a unique relationship with food insecurity. Unmet needs exist for services that aim to improve food access in older adults, and research is limited on how those who do use the services find out about them. Additionally, these services aim to improve quality of life (QOL), and yet this impact cannot be quantified because current tools do not capture the ways food affect QOL beyond nutritional status. This dissertation uses qualitative methods to understand (1) how food and eating impact QOL in community-dwelling older adults, (2) how individuals become aware of the services they use to address barriers to food and eating, and (3) the interaction between food security, loneliness, and QOL. In-depth interviews were conducted with 25 urban- and suburban-dwelling older adults. Interview scripts were transcribed and themes identified in the data using grounded theory methods. The first study showed that health and vitality, independence, mental and emotional well-being, socialization and support, and activities, both inside and outside the home, affected participants’ QOL. Food and eating affected QOL through access and choice, health and vitality, enjoyment of food, and food preparation. The second study showed that participants primarily found out about the resources they use through encounters in their daily lives, rather than service outreach. The final study showed that, compared with those who were food secure, those who were food insecure were more likely to report a negative effect of loneliness on their QOL, primarily experienced as depressive symptoms. This dissertation shows that food and eating affect older adults through not only the physiological effects of good nutrition, but also through social, psychological, and sensory effects on QOL. Additionally, the results point to the importance of social factors for both service awareness and mental health in those who face barriers to food and eating. Future studies and new tools are needed to quantify these impacts.