Seniors | University of Kentucky Center for Poverty Research

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).

2022

Aging into Medicare among a senior food pantry population: An assessment of food security, health, and food pantry use over time

Erline E. Martinez-Miller, Tammy Leonard, and Sandi L. Pruitt

We examined the association of Medicare eligibility with food security and food pantry visiting patterns among senior (aged ≥60 years) food pantry clients in Dallas, Texas. We used data from the pantry linked to electronic health records (EHR) from a safety-net healthcare system. Log-binomial regression was employed to calculate prevalence ratios of food insecurity by Medicare eligibility for all clients and separately for clients with various chronic conditions. We examined the impact of Medicare eligibility on food pantry visiting patterns among a non-disabled sample of clients using regression discontinuity. A member of each eligible household can visit once a month. Data from 604 households with 2,636 visits were analyzed for food security assessments. The majority were female (63%), average age was 68.5, many had less than a high school education (39%), and the majority were Black (60%) or Latino/a (29%). Of those with linked EHR data, 75% had at least one chronic condition. Medicare eligibility was associated with improved food security; this association was consistent among clients diagnosed with any chronic condition, but not among clients without any chronic condition. Additionally, we analyzed 119 households with 457 visits for the regression discontinuity analyses and observed that frequency of food pantry visits increased after becoming Medicare eligible. Overall, our findings highlight how Medicare eligibility may improve food security among seniors, potentially attributable to increased food pantry use after aging into Medicare. Future studies should examine underlying pathways of food pantry visiting patterns and their contributions to senior food security.

Examining experiences of food hardship and SNAP enrollment among near-old and older Americans: A multi-method approach

Stephanie Grutzmacher, Mark Edwards, Frida Endinjok, Leanne Giordono, David Rothwell, Dusti Linnell, and Maureen Quinn Lorres

This project examines reasons why food insecure older adults in the U.S. are under-enrolled in SNAP and why this pattern varies among older adults of different ages. Conventional wisdom suggests several explanations that discourage participation, ranging from older adults’ preferences to program limitations. We examine the topic with two approaches. First, using an administrative dataset from Oregon (n=95,467) including monthly observations over a five-year period, we analyze SNAP spells for near-old (51 years old in 2014) and older people (60+ in 2014). Second, we interview SNAP outreach workers (n=22) to examine program access barriers and lived experiences of food insecurity among older adults in Oregon. We find that while 43% of near-old and older adults (combined) exit SNAP after a short spell (1-12 months), those with long-term continuous SNAP receipt (>55 months) represent the majority (59%) of the near-old and older adult SNAP population at any given time. Moreover, we find higher proportions of long-term SNAP participation among the older cohort (ages 60-64) compared to the younger cohort (ages 51-55). The probability of exiting SNAP is lower among female and Asian older adults, as well as individuals with a previous SNAP spell. The probability of exiting SNAP is higher among near-old and older adults who are Hispanic, have earnings in the previous quarter, and live in households with more than one person. Preliminary interview results (delayed by COVID) describe program outreach deficits, challenges with web-based enrollment and application delays, gaps in services addressing complex needs, and transportation issues.

The impact of nutrition assistance programs on food insecurity among older adults

Jung Sun Lee, Vibha Bhargava, Travis Smith, and Temitope Walker

Using administrative data from Georgia covering January 2018-August 2020, we estimated the effect of services provided through the Older Americans Act (OAA) and the Supplemental Nutrition Assistance Program (SNAP) on food insecurity among older Georgians. Our sample included those who received services prior to and during the COVID-19 pandemic. For the entire sample period (i.e., pre-COVID and during COVID), we found home-delivered meals and other OAA services reduced food insecurity by roughly 3% and 4%, respectively. The effect of SNAP on reducing food insecurity significantly increased from 2.1% (pre-COVID) to 4.7% (during COVID). While we find no effect of congregate meals on food insecurity in the pre-COVID period, the loss of “traditional” congregate meals in a social setting during COVID increased food insecurity by 7%.

Understanding food-related hardships among older Americans: Evidence from the Panel Study of Income Dynamics

Debra Brucker, Katie Jajtner, and Sophie Mitra

Using data from the Panel Study on Income Dynamics (PSID), this small grant conducted three studies designed to increase understanding of food-related hardships among older Americans. Study 1 found that persons who had a work limitation or were food insecure in midlife (ages 40-54) had significantly increased odds (OR: 2.20, p<.05 and OR: 4.23, p<.01, respectively) of living in a food insecure household at age 60 to 69, holding all else constant. Those who worked more during midlife had significantly reduced odds (OR: 0.26, p<.01) of living in a food insecure household in their 60s. Study 2 found that older adults who were currently living in a food secure household had higher odds of healthy aging at age 60 to 69. Having higher midlife income or more time employed in midlife was associated with increased odds of healthy aging, while having a work limitation or a limiting health condition in midlife was associated with lower odds of healthy aging. Study 3 used an instrumental variable approach to examine the probability of living in a food insecure household among households as their family units receive Social Security at retirement age. Study 3 found limited causal evidence that receipt of Social Security at retirement age is associated with an increased probability of living in a food secure household among the full population. These findings were robust to changes of the dependent variable or the endogenous variable but were sensitive to some of the expansions or contractions of the sample.

Understanding food-related hardships among older Americans: Evidence from the Panel Study of Income Dynamics

Debra Brucker, Katie Jajtner, and Sophie Mitra

A comprehensive evaulation of the impact of SNAP on the health of seniors

James Marton, Charles Courtemanche, Jordan Jones, Augustine Denteh, and Rusty Tchernis

Senior participation in the Supplemental Nutrition Assistance Program (SNAP) has traditionally been lower than other groups, with historical estimates below 50 percent. We examine the relationship between state SNAP policy changes occurring over the 2001-2014 period and SNAP participation as well the relationship between SNAP participation and a variety of health-related outcomes for senior and non-senior households. Data from three separate sources, the 2001-2014 December Current Population Survey Food Security Supplement (CPS-FSS), the 2002-2014 Health and Retirement Study (HRS), and the 2001-2014 National Health Interview Survey (NHIS), are used to conduct our analyses. We construct simulated eligibility variables (SEVs) and SNAP policy indices to capture differences in state SNAP generosity. In both our CPS-FSS and our HRS samples, we find that eligibility expansions lead to increases in non-senior SNAP participation with some evidence of smaller increases in senior participation. Overall, seniors and non-seniors appear to respond differently to various policies, but this difference is not consequential enough to explain the large participation disparity between the two groups. We also find that SNAP participation is associated with worse health-related outcomes for all samples in all three datasets, which is likely due to negative selection into program participation. The signs of these relationships reverse when we use our SEVs as instruments for SNAP participation. However, these coefficient estimates are not statistically significant and the strength of the SEV as an instrument for senior SNAP participation depends on the dataset and sample used, as well as whether or not we use sampling weights.

Food Insecurity among seniors: The role of social insurance

Helen Levy

The goals of this program of research are to estimate (1) the sociodemographic predictors of food insufficiency among seniors ages 60 and older and (2) the causal impacts of Social Security, Medicare, and Medicaid on food insecurity and/or insufficiency among seniors. I use data from the Health and Retirement Study (HRS), Current Population Survey (CPS), National Health Interview Survey (NHIS) and American Community Survey (ACS). Analyses using HRS data show that, consistent with earlier studies, age, income, work status, disability, education, and race/ethnicity are all significant determinants of food insufficiency; neuroticism is also a significant predictor of food insufficiency. Exploiting the Social Security “notch” in benefits that resulted in lower payments to individuals born just after January 1, 1917 compared with those born just before, I find using HRS data from 1995 that lower income is associated with higher food insufficiency and SNAP use, but these results are imprecisely estimated. Next, using NHIS and HRS data from multiple years, I find no evidence that becoming age-eligible for Medicare at age 65 reduces food insecurity. Finally, a difference-in-difference analysis of the Affordable Care Act’s Medicaid expansion using ACS and CPS data shows that despite significant increases in Medicaid among seniors in states that implemented expansion compared with those that did not, food insecurity among seniors did not decline. These results suggest that public health insurance does not reduce food insecurity among seniors, perhaps because this benefit is not fungible.

Food insecurity and the senior-specific food security infrastructure

Kelly Stamper Balistreri

This project explores the correlates of geographic and temporal variation in food security using data from the 2008 to 2018 Current Population Survey’s Food Security Supplements. The focus is on the relationship between State-level availability and accessibility of congregate and home-delivered meal programs, as well as the Supplemental Nutrition Assistance Program (SNAP), the Senior Farmer’s Market Nutrition Program(SFMNP) and the Commodity Supplemental Food Program(CSFP) on food security among lower-income households headed by older adults (ages 60 and up). Results show some evidence that a State-level food security infrastructure plays a role in the food security outcomes of households headed by older adults.

Food insecurity among older adults in the US: The role of mortgage borrowing

Cazilia Loibl, Donald Haurin, Stephanie Moulton, Alec P. Rhodes, and Chrisse Edumunds

Housing wealth is the primary source of wealth for many older adults, particularly those with lower incomes, who are more at risk of severe forms of economic hardship such as food insecurity. For housing wealth to directly improve food insecurity, it first must be liquefied. Understanding the role of housing wealth requires careful consideration of home equity and mortgage borrowing. A primary contribution of our report is to model the financial mechanisms through which housing wealth and its components—home value, home equity, and mortgage debt—affect food insecurity in older age. We use panel data on households from the Health and Retirement Study and instrumental variable linear probability models with household fixed-effects to assess the effects of new mortgage borrowing on food insecurity (N=20,421 household-years). Trend analyses reveal that food insecurity increased from the 2008 recession until 2014 and that new mortgage borrowing peaked prior to the recession. The proportion of older homeowners facing credit constraints is highest for those age 65 to 69 in all years. Regression results show that mortgage borrowing has a substantial short-term negative effect on food insecurity. Each additional $10,000 borrowed is associated with reduction of food insecurity of 2.2 percentage points. The effect of new mortgage borrowing on food insecurity is distinct from changes in house prices or changes in home equity, neither of which are statistically significant factors. In a simulation of the effects of relaxing the debt-to-income borrowing constraint, we find that food insecurity is reduced by 2.1 percentage points for previous non-borrowers and by 1.6 percentage points for borrowers. Results support the importance of access to mortgage borrowing to reduce material hardship in older age.

2020

Food hardship during the Covid-19 pandemic and Great Recession

James P. Ziliak

I compare the extent of food hardships in the United States among all adults, and separately for seniors, in the two decades before and during the onset of the Covid-19 Pandemic. The data come from the 2001-2019 December Supplements of the Current Population Survey, as well as the newly released Census Household Pulse Survey. The results indicate that food insufficiency among all adults increased three-fold during the Covid period compared to 2019, and more than double that observed during the Great Recession. Over 1 in 5 Black adults were food insufficient in mid 2020, a rate double that of white adults. Food insufficiency among seniors increased 75 percent during the Covid period, but when broadening the definition to also include reduced variety of foods, the share of seniors food insufficient also more than doubled compared to 2019 and the Great Recession. Receipt of charitable foods among disadvantaged adults spiked over 50 percent in the Covid period, but the initial response among seniors was a sharp reduction, before rising. These patterns, which hold in richly specified regression models, are consistent with strong shelter-in-place and other social distancing measures enacted at the state and local levels in response to the Pandemic that were gradually relaxed over time.