Hidden Hunger Among Today's Elderly

How and Why Many Older Adults Are Malnourished -- and How All of Us Can Help

Have you ever heard the term hidden hunger? It's often used to describe an intake of calories without the nutrition needed to support mental and physical health. But it also applies to the increasing number of older adults who live alone and aren't getting the food they need for a variety of reasons, ranging from poverty to forgetfulness.

In 2013, 2.9 million households (9 percent) with seniors experienced food insecurity, which is being without reliable access to a sufficient quantity of affordable, nutritious food. Of those households, 1.1 million (9 percent) are made up of older adults living alone.

Why Is Hunger So Easily Hidden?

There are lots of factors that directly impact hunger in older adults, including loneliness, isolation, depression, medication interactions, sensory changes, dementia, financial hardships, and concern about what others think. "A hungry senior may still dress well yet not seek out help," says Lura Barber, senior program manager of Hunger Initiatives for the National Council on Aging (NCOA). "Pride may be a factor. Someone could be hesitant to reach out for help because she's embarrassed. It's a huge, hard jump if you've been independent your whole life and then have to admit you need assistance. Or there could be other reasons: a medication issue exacerbated by malnutrition, mobility issues stopping you from getting to the store, or cognitive decline that causes you to forget to eat and/or eat well."

Hunger Is a Growing Problem for Adults Living Alone

According to a recent National Foundation to End Senior Hunger (NFESH) study titled The Spotlight on Food Insecurity Among Senior Americans, the risk of hunger and food insecurity is growing among older adults. The number of food-insecure seniors is projected to increase by 50 percent when the youngest of the baby boom generation reaches age 60 in 2025. And the risk is worse if you live solo. "One of our studies noted that there were marked differences in the risk of hunger across family structure, especially for those living alone," says Enid Borden, president and CEO of NFESH. "Those living alone are twice as likely to experience hunger compared to married seniors. The reasons for this are readily apparent. Seniors living alone with health and mobility issues have a harder time cooking, preparing meals, and shopping." Some might try to save money, too, thinking that they can stretch their food out, eat fewer meals, water down their juice, and who will notice?

Causes and Consequences for Older Adults

Older adults are at risk for food insecurity due to several reason, including:

Common effects of aging. These include changing senses (e.g., fewer taste buds, decreased sense of smell, less ability to manage plates and utensils), isolation, disease, and depression.

Financial challenges. "Ultimately, hunger is a poverty issue," says Barber. "For many seniors, food becomes the fungible line item in the household budget, after housing, utilities, transportation, and medical care." In fact, 13 percent of U.S. citizens over age 65 live in poverty, according to the Kaiser Family Foundation.

Memory loss. Older adults with dementia and/or memory loss may not remember to eat or be able to manage nutrition on their own. No matter the reason, the consequences of malnutrition can be serious. Food-insecure older adults are more likely than those who are food secure to be at higher risk for a number of diseases and negative health conditions. Malnutrition can lead to a weakened immune system, increasing risk of infection, poor wound healing, and muscle weakness -- which, in turn, leads to falls and fractures.

7 Ways to Help Reduce Hunger Risks for Older Adults Living Alone

1. Raise Awareness

"The issue of hunger in America is unbelievably severe," says Ellie Hollander, president and CEO of the Meals on Wheels Association of America (MOWAA). "We have to be squeaky wheels. Get educated, then share what you know and advocate by making sure lawmakers know about senior hunger in their communities."

2. Learn About Causes and Implications

Studies have found that between 15 and 50 percent of all seniors suffer from poor nutrition or even malnutrition. Learn about ways your body needs nutrition as you age and the risks and consequences for older adults who don't get what they need.

"The implications to society are great when our older adults are food insecure or hungry," says Borden. "The healthcare costs associated with hunger are staggering. Seniors who are food insecure are 50 percent more likely to be diabetic, twice as likely to report fair or poor general health, three times more likely to suffer from depression, 30 percent more likely to report at least one ADL limitation, 14 percent more likely to have high blood pressure, nearly 60 percent more likely to have congestive heart failure or experience a heart attack, and twice as likely to report having gum disease or asthma."

3. Manage From Near and Far

If you're a caregiver or just a concerned neighbor, check on older adults living alone and make sure they seem healthy, alert, and well nourished. "Caregivers are a very important piece of the puzzle," says Borden of the ways in which caregivers can help manage hunger needs for an older, single loved one.

"If there is a caregiver present, he or she must be cognizant of health and well-being," she says. "The caregiver must look in the refrigerator and the cupboards to check food expiration dates and make sure that the senior is eating. Often a senior will say that she has eaten when she hasn't. If the caregiver notices that the senior is gaining or losing weight, is not practicing good hygiene, is lethargic, is becoming forgetful, or doesn't have an appetite, then something needs to be done. Perhaps a call to a local program and a visit from a caseworker is warranted."

For those managing care from a distance, "Skype and video technologies are helpful for checking on health," says Barber. "Whether over a webcam or in person, look for risk factors. Does your mom have a bruise on her hand that isn't going away? Your body's ability to heal is effected by nutrition. Has she lost muscle mass? There might be other causes, but these are some warning signs. Look at the whole person, from health to financial. Caregivers who check on finances can see if there are financial concerns that might be impacting hunger."

4. Look Into Meal Delivery Services and in-Home Preparation

Cost-conscious meal delivery services prepare and deliver meals to the homes of housebound older adults unable to prepare meals alone. The many options are operated by religious groups, senior centers, hospitals, and other organizations.

Many cite Meals on Wheels as a successful model. "We have an army of 2 million volunteers who provide meals to seniors at home or get seniors to places where they serve meals," says Hollander. "When I first started, my indoctrination was to go on a series of deliveries. You see the light in the eyes of the senior you're providing for, and you're moved for life. You're bringing more than just a meal -- it's good nutrition, a friendly smile, and a safety check, too."

If you're able to hire someone to come to your loved one's home to prepare meals, an elder companion or personal care assistant can prepare a number of meals in advance.

5. Explore Financial Assistance Options

If money is an issue and an older adult needs help paying for food, a number of programs can assist, including:

Supplemental Nutrition Assistance Program (SNAP). SNAP provides nutrition education and monthly monetary benefits for designated food items. A senior or caregiver can find out if they might be eligible by using NCOA's BenefitsCheckUp® screening tool.

"A lot of seniors are missing out on SNAP right now," says Barber. "Only two in five eligible older adults are enrolled. The minimum benefit is $15, but the average benefit for a senior living alone in 2012 was $119 per month, according to the USDA. This can be a significant boost to a fixed income and budget. You can also use SNAP benefits to pay for home-delivered meals and authorize someone else (a caregiver or friend) to use your SNAP card in the grocery store on your behalf."

Commodity Supplemental Food Program. This organization provides food directly to some low-income individuals over age 60 who live in one of the 40 states participating in the program. Check the group's website for information on eligibility and how to apply.

Senior Farmers' Market Nutrition Program. Some older, low-income adults may be eligible for voucher checks usable for fresh, nutritious, unprepared, locally grown fruits, vegetables, honey, and herbs from farmers' markets, roadside stands, and community-supported agriculture programs. For information about participating state programs, go to SFMNP's website.

6. Rally (and Coordinate) Friends and Family

Get a team in place to help alleviate an older adult's hunger. You can create a care calendar similar to those caregivers use to coordinate support after a surgery or illness. Ask friends and family to bring a meal once a week or once a month.

To manage it easily, opt for a free online calendar service such as LotsaHelpingHands, which shows you who's signed up for which day and what food they plan to bring. The tool also sends reminders to volunteers so they stick to their commitments.

7. Volunteer

How can all of us make sure that older adults don't go hungry? "My mantra is advocate, donate, and volunteer," says Hollander. "We need to keep building the pipeline of volunteers and encourage the younger generation to pay it forward." If you're not currently in a caregiving role, volunteer your time or money to local organizations in your community, such as Meals on Wheels, food banks, nonprofit organizations, senior centers, and churches. Or just be a great neighbor. "Too often older adults live alone behind closed doors and are either too ashamed to ask for help or don't know that help is available," says Borden. "Our role as good citizens of this great country is to open our eyes and our hearts. We need to pay attention to our neighbors and look for warning signs that an older person living alone among us might be hungry. We have to work together to stop the madness."

about 2 years ago, said...

This is a good reminder how important it is to consider the needs of our most frail elders - the home bound. Please think about donating to your local Meals on Wheels program. These services have been severely affected by the sequester, and are perennially under-funded considering the need.

about 2 years ago, said...

Such an important subject. Thanks for the well thought out article and recommended solutions.

about 2 years ago, said...

This is very helping Article thanks for your concern for older people. keep up a good works. bless be safe. Abood

about 2 years ago, said...

Great piece, Informative, substantial, important and actionable.