J Acad Nutr Diet. 2019 Oct;119(10):1687-1694. doi: 10.1016/j.jand.2018.04.009. Epub 2018 Jun 18.
Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.
To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults.
The cross-sectional study was conducted from February 2017 to May 2017.
PARTICIPANTS/SETTING: A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated.
Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form).
Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications.
Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04).
Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.
由于老年人具有独特的健康和社会需求，因此需要了解粮食不安全和身心健康状况不佳与营养状况之间相互关联的机制。
研究自理能力、抑郁症状、粮食不安全和营养状况之间在低收入老年人中的复杂关系。
这项横断面研究于 2017 年 2 月至 5 月进行。
参与者/设置：阿拉巴马州 372 名年龄在 60 岁及以上的低收入老年人参与了这项研究。
参与者完成了一项经过验证的调查，其中包括衡量粮食不安全（六项目美国粮食安全调查模块）、自理能力（自理能力量表）、抑郁症状（10 项老年抑郁量表）和营养状况（微型营养评估简短表格）。
使用广义结构方程模型在一个模型中同时包括联立方程和多个中介。进行了赤池信息量准则、贝叶斯信息量准则和似然比检验，以比较竞争模型规格的拟合度。
自理能力较低与粮食不安全程度更高（β[B]=0.11，优势比[OR]=1.11，P=0.03）和抑郁症状更严重（b=0.08，P=0.005）有关。较差的自理能力和较高的抑郁症状与较差的营养状况相关（b=0.24，OR=1.27，P<0.001；b=0.13，OR=1.43，P=0.001）。粮食不安全程度较高与抑郁症状加重有关（b=0.40，P<0.001）。自理能力与营养状况直接相关，也通过抑郁症状间接相关（b=0.04，P=0.048）。尽管粮食不安全与营养状况无显著相关性，但通过抑郁症状观察到粮食不安全与营养状况之间存在显著的间接相关性（b=0.02，P=0.04）。
研究结果表明，功能受损的低收入老年人面临更大的粮食不安全。无法负担食物加上自理能力有限，导致自我报告的抑郁症状增加，从而导致营养状况更差。
