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Pictured, a person receiving food at a food bank on April 28, 2020, in the Brooklyn borough of New York City. Image credit: Spencer Platt/Getty Images.
  • A new study has found that food insufficiency is associated with more rapid cognitive decline.
  • Researchers analyzed data for thousands of individuals regarding their level of food insecurity, cognitive health, and whether they benefitted from the United States federal government’s Supplemental Nutrition Assistance Program.
  • Cognitive decline in people without enough food may be a result of poorer nutrition, or of the stress of experiencing financial hardship severe enough to keep them from buying the food they need.

The proportion of older people who lack food, often because of limited financial resources, more than doubled in the United States over the decade from 2007 to 2016 — from 5.5% to 12.4%.

Programs such as the U.S. Supplemental Nutrition Assistance Program (SNAP) have reduced the number of younger people going hungry. However, research suggests that such efforts have been less successful for the elderly, and for older women living alone in particular.

Older people experiencing food insufficiency are more likely to have physical limitations and are at risk of malnutrition and depression.

A new analysis of SNAP data finds that there is also an association between older people with food insufficiency and more rapid cognitive decline.

People who were economically eligible for SNAP but who did not participate in the program experienced a faster cognitive decline rate, equivalent to what might be expected if they were 4.5 years older than their actual age.

For an older person, 4 years of brain aging can be significant. Compared with people who were food sufficient, those who were food insufficient exhibited a greater cognitive decline, equivalent to being 3.8 years older.

People who had sufficient food experienced the slowest rate of mental aging.

The study findings appear in The Journal of Nutrition.

The authors of the study analyzed data for 4,578 Medicare beneficiaries aged 65 or older who participated in the National Health and Aging Trends Study 2012-2020, or NHATS.

NHATS followed participants on a yearly basis, collecting information regarding their sociodemographic status, social, physical, and technological environments, medical comorbidities, and cognitive function.

As part of NHATS, people were identified as food sufficient or food insufficient based on their replies to questionnaires regarding food insecurity, and their SNAP status was recorded.

Individuals in the new study were assessed based on their membership in one of three groups:

  • SNAP participants
  • SNAP-eligible nonparticipants — that is, nonparticipants who were living at equal to or less than 200% of the federal poverty line
  • SNAP-ineligible nonparticipants — meaning those living at more than 200% of the federal poverty line.

Boston University’s Dr. Daniel P. Miller, who specializes in poverty and food insecurity, and who was not involved in this research, explained the important difference between “food insecurity” and “food insufficiency”:

“Unlike food insecurity, which is a condition of hardship where families cannot get the right kinds of food on the table because of limited [money] or other financial resources, food insufficiency is just a statement about not having enough food to eat.”

He noted that the current study was primarily concerned with food insufficiency rather than food insecurity in its classic sense.

Dr. Miller put most of the blame for food insecurity on economic hardship. He pointed out that older adults on a fixed income in times of rising costs, including food and medicine, are at the greatest risk.

Dr. Colleen M. Heflin of Syracuse University — not involved in this study — noted that NHATS’ definition of food insecurity also included “non-financial barriers such as poor functional status, lack of social resources, and lack of access to food.”

“These measures of access,” said Dr. Heflin, “are likely to be particularly important for older adults who may require assistance accessing food because of health limitations, limited ability to drive, and geographic isolation.”

While the study established an association between food insufficiency and cognitive decline, its longitudinal nature means it cannot establish whether a lack of food leads to cognitive impairment or the other way around.

“Unfortunately,” said Dr. Heflin, “my own work suggests that cognitive decline can act as a barrier to SNAP participation among older adults eligible for the program, due to the difficult administrative processes associated with demonstrating program eligibility.”

Drs. Heflin and Miller agreed that there are two plausible causal pathways from food insufficiency to cognitive decline.

The first is a lack of sufficient important vitamins and micronutrients that support overall health, including brain function. “We might expect older adults who experience food insecurity to experience steeper cognitive declines over time,” Dr. Miller offered.

Nonetheless, he also said that there have been conflicting conclusions in studies investigating connections between nutrition and cognitive decline.

The second likely causal pathway, both experts noted, could be finding oneself in a prolonged state of financial stress. “And exposure to stress is associated with faster cognitive decline,” said Dr. Heflin.

SNAP provides financial assistance via an “electronic benefits transfer” card with which its participants can purchase food at authorized stores.

“SNAP participants,” said Dr. Heflin, “consume both higher quality and more food at home than non-participants.”

Dr. Miller explained that non-participation in SNAP is a “particularly important” predictor of food insecurity. Unfortunately, he added, participation in the program is less than it could be, especially for the elderly.

Dr. Miller noted that in 2020, while 78% of people of all ages who were qualified for SNAP participated in the program, only 47% of eligible older adults past the age of 60 years enrolled.

“Given the widespread evidence of the effectiveness of SNAP — including in this paper, somewhat — this is an important location to target efforts to reduce food insecurity and improve health for older adults,” said Dr. Miller.