Shaunna Caouette1, Lisa Boss, Monika Lynn. 1. Shaunna Caouette and Monika Lynn are adult gerontology NPs working in the greater Houston area. Lisa Boss is an assistant professor of nursing at the University of Texas Health Science Center at Houston. Contact author: Shaunna Caouette, scaouette@live.ca. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Abstract
BACKGROUND: Food insecurity, which can be defined as having limited access to nutritional and safe foods as a result of a lack of financial resources, is believed to adversely influence health outcomes. Older adults, in particular, face rising health care costs and may be forced to choose between purchasing prescribed medications or using their limited financial resources for basic needs, such as food. PURPOSE: The purpose of this systematic review was to examine the relationship between food insecurity and cost-related medication nonadherence (CRN) in older adults living in a community setting. METHODS: A comprehensive electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, written in English, involving community-dwelling U.S. adults 60 years of age and older. RESULTS: Six studies met all criteria and were included for analysis. Two studies reported a significant dose-response relationship between food insecurity and CRN, and a third reported an increased risk of CRN in subjects with persistent food insecurity. Three key predictors of food insecurity and CRN in older adults were identified: low income, health insurance gaps, and higher out-of-pocket prescription costs. Most studies reported that subjects with higher food insecurity and CRN were more likely to be young-old (ages 60 to 84), have lower income, and have relatively more chronic conditions. CONCLUSION: Overall, the findings indicate that older adults who have multiple chronic conditions and only receive Medicare are at increased risk for food insecurity and CRN. Finding ways for health care providers and organizations to help manage these risks is critical to improving health outcomes and reducing use of health care services. Nurses can be pivotal in taking the lead to develop appropriate interventions and programs for patients, and to advocate better government-funded health care and policy reform in order to improve outcomes in this vulnerable population.
BACKGROUND: Food insecurity, which can be defined as having limited access to nutritional and safe foods as a result of a lack of financial resources, is believed to adversely influence health outcomes. Older adults, in particular, face rising health care costs and may be forced to choose between purchasing prescribed medications or using their limited financial resources for basic needs, such as food. PURPOSE: The purpose of this systematic review was to examine the relationship between food insecurity and cost-related medication nonadherence (CRN) in older adults living in a community setting. METHODS: A comprehensive electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, written in English, involving community-dwelling U.S. adults 60 years of age and older. RESULTS: Six studies met all criteria and were included for analysis. Two studies reported a significant dose-response relationship between food insecurity and CRN, and a third reported an increased risk of CRN in subjects with persistent food insecurity. Three key predictors of food insecurity and CRN in older adults were identified: low income, health insurance gaps, and higher out-of-pocket prescription costs. Most studies reported that subjects with higher food insecurity and CRN were more likely to be young-old (ages 60 to 84), have lower income, and have relatively more chronic conditions. CONCLUSION: Overall, the findings indicate that older adults who have multiple chronic conditions and only receive Medicare are at increased risk for food insecurity and CRN. Finding ways for health care providers and organizations to help manage these risks is critical to improving health outcomes and reducing use of health care services. Nurses can be pivotal in taking the lead to develop appropriate interventions and programs for patients, and to advocate better government-funded health care and policy reform in order to improve outcomes in this vulnerable population.
Authors: Alex Estrella; Joy Scheidell; Maria Khan; Donna Castelblanco; Tod Mijanovich; David C Lee; Lillian Gelberg; Kelly M Doran Journal: West J Emerg Med Date: 2021-07-14