In a short time, Ms. D’s blood glucose level normalizes. She has no further admissions for diabetic ketoacidosis.
Older adults: Interplay of risk factors takes a toll
The USDA Economic Research Report on food insecurity1 states that older adults (≥ 65 years of age) report a lower rate of food insecurity—ie, 7.8% of households with an older adult and 8.9% of households in which the older adult lives alone—compared with the national average.1 The report is limited, however, in its ability to extrapolate data from older adults on food insecurity because its focus is on factors specific to adults and children.
Factors that contribute to food insecurity in the elderly include race and ethnicity, education, income, being a SNAP recipient, and severe depression.1,2,17,20,21 Older adult subgroups more likely to be food-insecure are Hispanic and black non-Hispanic—both significantly associated with being food-insecure, with Hispanic populations reporting the highest rates of food insecurity.20,21 This is a particularly interesting observation: Many traditional Hispanic homes are multigenerational and maintain a culture in which older adults are cared for by their children; that value system might be an indication of why many Hispanic households are disproportionately affected by food insecurity.
Adults in food-insecure homes are more likely to purchase cheap, calorie-dense food that lacks nutrition.
Other problems directly caused or exacerbated by food insecurity in the older population include a higher risk of malnutrition from periodontal disease, more frequent hospital admissions with longer length of stay, and an increased rate of falls and fractures. Polypharmacy, which can cause food–drug interactions that inhibit uptake of vitamins or create a higher demand for certain vitamins, is a noteworthy problem associated with food insecurity.
Problems with functionality might prevent older adults from performing physical tasks, such as shopping and preparing foods.21,22 Older adults who reported functional impairment in performing activities of daily living are more likely to report food insecurity.21,22 Last,older adults who live alone are more likely to have diminished nutritional intake than those who live with a spouse or partner.2,22,23
