Editorial Board:
Editor:
George H. Conklin,
 Emeritus, North Carolina
 Central University

Robert Wortham,
 Associate Editor,
 North Carolina
 Central University

Board:
Rebecca Adams,
 UNC-Greensboro

Bob Davis,
 North Carolina
 Agricultural and
 Technical State
 University

Catherine Harris,
 Wake Forest
 University

Ella Keller,
 Fayetteville
 State University

Ken Land,
 Duke University

Steve McNamee,
 UNC-Wilmington

Miles Simpson,
 North Carolina
 Central University

William Smith,
 N.C. State University

Editorial Assistants

John W.M. Russell,
 Technical
 Consultant

® 

Volume 10, Number 2

Fall/Winter 2012
 

The Impact of Emotional Social Support on Elders' Food Security

by

Jennifer Woltil

University of Florida

    Food insecurity is a persistent problem in the United States (Nord,  Andrews, and Carlson 2008). Despite national economic prosperity and significant improvements to public health over the past century, hunger and the fear of hunger remain problems among many U.S. households (Nord et al. 2008). In fact, rates of food insecurity have increased in recent years (Coleman-Jensen, Nord, Andrews, and Carlson 2011; Andrews, Nord, Bickel, and Carlson 2000). Much of the research on food insecurity focuses on young and middle-aged adults and with-children households. Resulting findings, definitions and measurements are therefore a reflection of these populations. Because of this focus, food insecurity among elderly households remains poorly understood. With the growing population of those 65 and older, food insecure elderly households are likely to grow in number. Therefore, increased understanding of elderly food insecurity is needed.

    Being food secure is defined as the "access by all people at all times to enough food for an active, healthy life and includes at a minimum: (a) the ready availability of nutritionally adequate and safe foods, and (b) the assured ability to acquire acceptable foods in socially acceptable ways (i.e., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies)" (Anderson 1990:1560). Food insecurity is, therefore, described as the state when the availability of or ability to acquire nutritionally adequate and safe foods in socially acceptable ways is limited or uncertain. Hunger and malnutrition may fall under the broader definition of food insecurity, but are not requisites of being food insecure (Anderson 1990). Food insecurity has been shown to negatively impact, directly and indirectly, an individual's health status and quality of life (Lee and Frongillo 2001b; Stuff et al. 2004). However, food insecurity can be particularly detrimental to the health of an older citizen (Sahyoun and Basiotis 2001). Given that many elders already experience waning health and have more health and nutritional needs than the general population, food insecurity may exacerbate existing health complications in addition to added emotional and economic distress (Lee and Frongillo 2001b).

    Many factors contribute to food security among the elderly population, one of which is social support (Lee and Frongillo 2001a; Quandt, Arcury, McDonald, Bell, and Vitolins 2001; Wolfe, Olson, Kendall, and Frongillo 1996). These studies have found that the availability and support provided by an elder's family and friends, as well as professionals can reduce the risk of food insecurity by offering the elder a social safety net. However, few studies have distinguished between instrumental and emotional social support when studying elderly food security and social support. Further, the breadth of the social support network and types of support sources within the network may impact the severity of food insecurity experienced by the senior. The purpose of this study is to examine the relationships between food insecurity and emotional social support receipt, number of emotional support sources, and types of emotional support sources among those 65 and older using data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES). This study contributes to existing literature on the persistent problem of food insecurity in the US, focusing on the under-researched elderly population. 

    As of 2010, just over 40 million Americans were 65 or older, representing 13% of the population; by 2050, the same age group is expected to grow to 81 million and represent 19% of the population (U.S. Census Bureau 2011; Passel and Cohn 2008). Such a rapidly expanding aging population presents a multitude of challenges and, as such, increased attention has been paid to the quality of lives among the elderly. Food insecurity is one of those challenges to which increasing attention is being paid. The most recent USDA data indicate that, as of 2010, 7.9% of households with elders 65 and older report being food insecure and 8.0% of households with elders living alone report food insecurity; studies among smaller populations have reported higher rates ranging from 12% to nearly 19%  (Coleman-Jensen et al. 2011; Dean, Sharkey, and Johnson 2011; Quandtet  et al.  2001). These rates have increased over the 1999 measurements: 5.8% of household with elders and 6.3% of households with elders living alone (Andrews et al. 2000). For comparison purposes, 14.5% of general population households report being food insecure as of 2010, an increase from the 10% rate in 1999 (Coleman-Jensen et al. 2011; Andrews et al. 2000). Although elderly households typically report a higher rate of food security than non-elderly households, the growing population of those 65 and older could present problems in the number of food insecure households, thus impacting the quality of life among the elderly in the future (Bickel, Carlson, and Nord 1999). Further, the difference in reported rates of food insecurity between the elderly and the general population may reflect insufficient methods to measure food insecurity among the elderly. Current methods tend to measure food insecurity based on problems faced by younger households, primarily economic hardship, without taking into consideration the special circumstances that the elderly face, such as physical limitations that might impair access to and the ability to prepare and consume food (Lee and Frongillo 2001a; Sharkey 2003). 

    Being food secure contributes to an elder's health and overall quality of life. Food security is positively associated with overall quality of health, while food insecurity is associated with nutritional risk and poorer overall health (Lee and Frongillo 2001b). Maintaining good nutritional health is essential to improving, preventing and/or managing chronic illness, physical and cognitive functioning, and overall health related quality of life for elders (Institute of Medicine 2000). Not having enough food, access to food, or money with which to purchase food in the household can negatively contribute to one's overall quality of life, particularly in terms of health. Food insecure elderly adults have lower and poorer nutrient intakes than their food secure peers (Lee and Frongillo 2001b; Sahyoun and Basiotis 2001). Inadequate access to food is associated with poor nutrition and poor overall health among the elderly (Sahyoun and Basiotis 2001). Further, age has been shown to aggravate the effects of poor nutrition, highlighting the significance of food security among the aging population (Sahyoun and Basiotis 2001). Because the elderly often need to meet more stringent nutritional demands to maintain good overall health, food insecurity can exacerbate current and ongoing health issues, thus incrementally deteriorating their overall health status (Sahyoun and Basiotis 2001). For these reasons, food insecurity may be particularly hazardous to the health of an elder. 

    It should additionally be noted that food insecurity among elders is not experienced equally among racial groups nor by gender. Minority elders experience a disproportionate degree of food insecurity, a result of culminating factors including limited life course opportunity, cumulative disadvantages as well as current neighborhood environment (Lee and Frongillo 2001a; Sharkey 2011). In terms of gender, elderly women report higher levels of food insecurity than elderly men (Dean  2011).

    According to Frongillo and Horan (2004:28) "food insecurity is determined by economic and social resources, functional status, and environmental context." Several past empirical studies focused on the elderly population have reflected these determinants, finding that multiple factors contribute to food insecurity among elders, including physical and cognitive health problems, limited resources, limited mobility, living situation and neighborhood environment, food management skills, and the availability of reliable social support (Frongillo, Valois, and Wolfe 2003; Lee and Frongillo 2001b; Locher et al. 2005; Wolfe et al. 1996). In one of the first studies attempting to understand food insecurity as experienced by elders, Wolfe et al. (1996) used data collected from in-depth, open-ended personal interviews with 41 elders to construct a conceptual framework depicting the causes of and methods used to cope with food insecurity. Factors that contributed to the experience of food insecurity among this sample included limited incomes, poor health and physical disabilities, high medical bills and medicine costs, and unexpected expenses such as house repairs or medical emergencies (Wolfe et al. 1996). In the same study, researchers found that public and private food programs, personal savings, proximity of children or other family members, and inventive food management strategies, (i.e. creative ways of acquiring and storing food that are not socially typical) tempered the risks of food insecurity (Wolfe et al. 1996). Other factors found to reduce or exacerbate food insecurity included community characteristics, such as transportation availability and proximity to grocery stores, and the elder's perception of his or her food insecurity severity and world view, particularly religious beliefs (Wolfe et al. 1996). Locher et al. (2005) found similar results when examining social isolation, social support and social capital in relation to food insecurity among 1000 community-dwelling elders. Social isolation, resulting from a lack of reliable transportation or limited independent life space (a measurement of functional mobility that assesses the distance a person has moved in the four weeks prior to the interview and whether or not assistance was needed) and lower incomes were identified as significant predictors to food insecurity for white and black women and white men by restricting the elder's access to food and community resources (Locher et al. 2005). For black men, the same study found reduced social support, reduced social capital, and perceived racism and discrimination to be predictors of increased nutritional risk. These predictors appear to be cross-cultural. In an Australian study, Quine and Morrell (2005) found that, among community-dwelling elders 65 and older, those at risk of food insecurity were more likely to report poor health, limited financial resources, lack of home ownership and living alone. 

    Particularly problematic for elderly population in managing and preventing food insecurity are chronic disease, physical disabilities, and functional and cognitive impairments (Frongillo and Horan 2004; Lee and Frongillo 2001a; Wolfe et al. 1996). Although not unique to the elderly population, elders tend to face these problems at higher rates. Health-related problems contribute to food insecurity through cost, such as medical costs, and limited mobility or functioning, which may interfere with the ability to find, prepare and eat food (Wolfe et al. 1996). Lee and Frongillo (2001a) found that, even after other significant contributors such as income, minority status, and social isolation, were controlled for, functional impairments were still significantly related to food insecurity among the elderly. These results indicate that food insecurity among the elderly is not only a result of a lack of affordability, availability, and accessibility, but that the impaired ability to use (i.e. prep and cook) food also contributes to the food insecurity experienced by the elderly (Lee and Frongillo 2001a). Physical disabilities and poor health also restrict any food management strategies or unconventional food acquisition techniques, such as food pantries or discount stores, that an elder might have previously implemented (Wolfe et al. 1996). For example, an elder might become reliant on a grocery shopping aide as a result of a disability or poor health. That aide might not be willing to use coupons, go to less expensive stores or go to food banks, as the elder might have done for him- or herself, thereby restricting the elder's purchasing ability. Lastly, chronic illness can necessitate a more restricted or specific diet, such as diabetes and the control of sugary products (Wolfe et al. 1996). Increased dietary restrictions or necessitations can lead to accrued cost or reduced availability, putting a food insecure household in even greater risk. In general, health-related problems are more likely to be faced by elders than younger households. Receiving reliable social support becomes even more important among this population to reduce food insecurity by mediating physical and health impairments. 

    Social support refers to the emotional and/or instrumental assistance provided to individuals, the frequency of contact with others, and the perceived adequacy of such support by the receiver (Hooyman and Kiyak 2002). It is defined as the extent to which individuals believe that family, friends, and others provide material aid, emotional relief or comfort, and timely information when needed. More specifically, instrumental social support refers to tangible aid and services while emotional social support refers to empathy, love and care (Heaney and Israel 2008). The individuals who provide the social support make up the social network (Berkman 1984). An individual's social network can be divided into categories, such as family, friends, neighbors, and professionals and support can come from multiple sources simultaneously. Past studies have found that different network members are likely to provide differing amounts and types of social support (McLeroy, Gottleib, and Heaney 2001). For example, family is more likely to provide long-term assistance, while friends and neighbors are more likely to provide short-term support (McLeroy et al. 2001). Past research has found that professional staff are most effective at providing instrumental support (Broese van Groenou and Van Tilburg 1996). Because the most effective social support sources are socially similar to the recipient, family often serves as the most effective and enduring source, providing both instrumental and emotional social support (Litwak 1985; Thoits 1995). The support received from one's personal network may, therefore, differ depending on the size and composition of the network. 

    No matter what source the support comes from, past studies have illustrated the importance of social support in alleviating food insecurity. Among the general population, past research has found significant relationships between food insecurity and a lack of social support (Martin, Rogers, Cook and Joseph 2004). Among the elderly population, Sahyoun and Zhang (2005) found that frequency of social contacts and nutritional activity were positively associated with each other. In a study of 145 multiethnic rural elders, Quandt et al. (2001) found that informal support from family, friends, and community members served as a necessary component in maintaining food security, often through food gifts of prepared meals or bags of groceries, a form of aid considered by these seniors to be socially acceptable. Wolfe et al. (1996) found that an elder's risk of food insecurity could be tempered by availability and access to children or other family members as sources of social support. And, despite the significant role of functional impairment in their experience of food insecurity, elders with social support to help prepare and cook meals may maintain adequate food acquisition and use (Lee and Frongillo 2001a). 

    As more is understood about the role of social support in moderating food insecurity, it is important to consider the differences between instrumental and emotional social support and from which sources each type of support comes. With only a few exceptions, past studies have not tended to make the distinction between instrumental and emotional social support, either focusing on instrumental support or grouping the two together. One such exception is the small-scale qualitative study conducted by Pierce and colleagues (2002) among elderly widows ages 75-90 living in government-assisted housing. Using data gathered in focus groups and in-depth interviews, researchers found that these women described instrumental support for help with food acquisition and emotional support for help following modified diets. The emotional support helped them to follow modified diets through encouragement and self-disclosure. This support boosted the women's confidence and reassured them without a sense of being judged or given advice. This study's results suggest the importance of emotional support in ensuring elders' food security, not through the acquisition of food but in the assistance of actually following a modified diet. Given elders' unique needs in terms of diet requirements in addition to physical impairments, emotional social support may play an important role in moderating food insecurity among this population by fulfilling needs unmet by instrumental support. In an effort to better understand this relationship, the present study explores the influence of emotional social support on food security among elders. Specifically, this study examines the relationships between food security among elders 65 or older and a) the perceived receipt of emotional social support, b) number of emotional social support sources, c) the types of emotional support sources (e.g. spouse, children, professionals, etc.). Based on the existing literature, the study's author has formed the following hypotheses:  a) that elders who report receiving emotional social support will report higher levels of food security, b) that one's reported food security will increase incrementally with an increase in number of emotional support sources reported, and c) that those with support from immediate family (spouse or children) will report higher levels of food security while those receiving support from professionals or "other" will report lower levels of food security. 

    This study used data collected in the 2007-2008 NHANES. The sample was restricted to those 65 and older to be consistent with past research on elders and food security. NHANES is conducted to determine the health status of the children and adults in the United States, using both in-person interviews and physical examinations (CDC/NCHS 2012). As of 1999, NHANES became a continuous program examining a nationally representative sample of about 5,000 people per year. Although interviews are collected continuously, data are organized into biannual datasets. The survey is broken down into several components: demographics, dietary, physical examination, questionnaire and laboratory. The present study used information collected in the demographics and questionnaire portions of the survey. Results were analyzed using OLS linear regression. Four models were fit to determine relationships between emotional social support and food security among the elderly using the measures discussed below.

Food Security Measure

     The present study utilized the adult food security scale constructed by NHANES. This scale measures food security on a scale of "1" to "4", with "4" indicating full food security and "1" indicating very low food security. This scale was reversed from the original to reflect a more intuitive measurement. The NHANES adult food security scale was constructed based on affirmative responses ("often true" or "sometimes true", "yes", and "almost every month" or "some months but not every month") to the following questions: In the last 12 months…

• Respondent was worried that household would run out of food before had money to buy more (often true, sometimes true, never true)
• Food respondent bought just didn't last and didn't have the money to get more (often true, sometimes true, never true)
• Respondent couldn't afford balanced meals (often true, sometimes true, never true)
•  Respondent cut size of meal or skipped meal because not enough food (yes, no)
• How often adults in household cut size of meal or skip meal (almost every month, some months but not every month, only 1 or 2 months)
• Respondent ever eat less than should because not enough money to buy food (yes, no)
• Respondent ever hungry but didn't eat because couldn't afford enough food (yes, no)
• Respondent lost weight because didn't have enough money for food (yes, no)
• Respondent or other adult in household ever not eat for a whole day because there wasn't enough money for food (yes, no)
• How often adults not eat for whole day (almost every month, some months but not every month, only 1 or 2 months)

    Emotional social support measures used in this study are receipt of emotional social support, number of support sources and type of support sources. Receipt of emotional social support measures whether or not the respondent felt he/she had anyone at all who provided emotional social support. This measure was asked in the original survey as yes/no; the data were recoded so that 'no' served as the reference.

    Number of support sources was computed by this study's author based on the number of sources cited as primary support sources by the respondent. This number could range from 0 to 13 based on the possible number of support sources from which respondent could select. Respondents were able to select as many or as few sources of support as they wanted with a minimum of zero choices and maximum of 13 choices. These choices were provided by the original survey: spouse, daughter, son, sibling, parent, other family member, friend, neighbor, co-worker, church member, club member, professional, and other.

    Type of support source indicates from whom, in the last 12 months, the respondent felt he/she received the most emotional social support. Respondents were able to select from the thirteen categories referred to above, selecting as few or as many as desired. To be able to use this information in the analysis of the present study, the author first consolidated the original 13 sources to six sources: spouse, children (daughter and/or son), other relative (parent, sibling or other family member), fictive family (friend, neighbor, co-worker, church or club member), professionals, and other. Recoding the variables in this way encouraged focus on the general type of support instead of allowing the study to be weighed down in unnecessary detail. Secondly, the author transformed each of the consolidated source types into a dichotomous variable. Those who did not select the support source served as the reference. Future studies might find it useful to differentiate even further between sources of support; however, that is beyond the scope of this project. 

Control Measures

    Several variables were controlled for when examining the impact of social support receipt and food security. These variables were: annual household income, gender, race, marital/partnership status, whether living alone or within someone else, and current reported health status. Annual household income was measured ordinally with a range from $0 to $100K plus. The twelve household income categories, retained from the original variable, are as follows: 

(1) $0-4,999 
(2) $5,000-9,999
(3) $10,000-14,999
(4) $15,000-19,999
(5) $20,000-24,999
(6) $25,000-34,999
(7) $35,000-44,999
(8) $45,000-54,999
(9) $55,000-64,999, 
(10) $65,000-74,999
(11), $75,000-99,999
(12) $100,000+. 

Gender was measured as a dichotomous variable and male served as the reference. Race was recoded to include three binary variables: white, black and Mexican American with white serving as the reference for this study. Other Hispanic and Other, included in the original variable, were coded as missing due to sample size and because of ambiguity in the application of results. Marital/partnership status was also recoded to be binary: married or living with partner and divorced, widowed, separated or never married, with the latter serving as the reference. Household composition was measured as whether the elder was living alone or with one or more people. This variable was recoded to be binary and living alone served as the reference. Current health status was reported by respondents on a scale of "1" to "5", "1" representing poor health and "5" excellent.  This variable was reversed from the original scale to be more intuitive: the higher the score the better the health. Controlling for these demographic characteristics enabled the author to uncover the importance of emotional social support in maintaining food security among the elderly. 

    This study examined relationships between food security and a) the receipt of emotional social support, b) number of emotional social support sources, c) the types of emotional support sources. The study's author hypothesized that  a) elders who reported receipt of emotional social support would report higher levels of food security, b) an elder's reported food security would increase incrementally with an increase in the number of sources reported, and c) elders who reported receiving support from a spouse or children would report higher levels of food security, while those who received support from a professional or "other" would report lower levels of food security. 

Sample Characteristics

    The majority of the sample, 85% (n= 1314), reported being fully food secure "4", on a scale of "1" to "4" with "4" being fully food secure and "1" representing very low food security; the mean reported was 3.7. The rest of the sample was distributed fairly evenly among the remaining three categories: marginal food security 7% (n= 107), low food security 5% (n= 74), and very low food security at 3% (n= 50). These rates are consistent with national rates. Most of the sample, 89% (n= 1389), reported receiving some sort of emotional social support with an average of 1.7 sources per respondent. 

    The average age of the sample was 74. Just over half of the sample, 52% (n=810), was represented by women. The average reported household income category was $25,000 to $34,999. In regards to race, 69% (n= 945) of the sample was represented by whites, 20% (n= 270) by blacks and 11% (n= 152) by Mexican Americans. Slightly more than half, 53% (n= 831), reported being married or living with a partner; 72% (n= 1112) reported living with at least one other person. Overall reported health status was distributed along a five point range: 6% (n= 83) reported excellent health, 25% (n= 341) reported very good health, 37% (n= 503) reported good health, 26% (n= 351) reported fair health, and 6% (n= 81) reported poor health. The sample characteristics are summarized in Table 1. 
 

Bivariate Results

    Bivariate results, presented in Table 2, indicated a significant association between the receipt of emotional social support and food security. 

 To view the correlation matrix, click here.

Those who reported receiving emotional social support were significantly more likely to also report being more food secure (p<.01) than those who reported having no emotional social support. Based on the bivariate correlations, number of sources does not seem to make a significant impact on food security nor do support sources besides spouse or "other." The author found two bivariate relationships between types of support sources and food security. Those who reported receiving emotional support from a spouse were significantly more likely to report higher levels of food security than those who did not report support receipt from a spouse (p<.01).  Those who reported receiving their primary emotional support from an "other" source were significantly more likely than the general sample to report lower levels of food security (p<.05). Therefore, the study's hypotheses were partially supported. 

    When examining food security in relation to the demographic characteristics outlined in this study, household income and food security were significantly and positively associated (p<.01). Thus, those with higher incomes were likely to experience higher levels of food security, supporting past research results. Those who were married or living with a partner were also significantly more likely to report higher levels of food security (p<.01), again supporting past research. However, it appears that there is something inherently important about living with a spouse or partner and not just another person, as no significant relationships were found between living with someone and food security. Race also plays a role in food security: whites were significantly more likely to report higher levels of food security (p<.01) than the general sample while Mexican Americans were significantly more likely to report lower levels of food security (p<.01) than the general sample; no significant associations were found between being black and reported food security. Finally, based on these results, better perceived health is significantly correlated with higher levels of food security (p<.01) supporting past research.

Multivariate Results

    Illustrated in Table 3a Model 1, receipt of emotional social support was significantly and positively associated with food security. Results indicated that those who report receiving emotional social support have an increased likelihood of being food secure. This relationship was highly significant (p<.001) and supported the study's hypothesis as well as past research. Model 2 in the same table examined the same relationship between social support receipt and food security, but controlled for demographic characteristics. While the relationship between receiving social support and food security remained positive and significant, the significance level decreased to p<.01 and the coefficient decreased by close to half, suggesting that one or more of the demographic variables added to the model have a significant impact on food security. This can additionally be seen in the increase of the R^2 from .03 to .15, now explaining 15% of the variation, and the significance of the R^2 change (p<.001). Examining these demographic characteristics more closely, the impact of household income was significant (p<.001): as household income increases, so too does one's food security. Being married or living with a partner also emerged as a significant characteristic in increasing one's reported food security (p<.001). However, living with one or more persons suggested the opposite relationship. These respondents were significantly more likely to report lower food security (p<.001). Mexican Americans also emerged as a potential risk group for food security in this model. Mexican American respondents reported lower levels of food security than whites (p<.001). And finally, a better health status correlates to a higher level of food security (p<.01), supporting past research. No significance was found between gender and food security, in contrast to previous studies. Additionally, no significant difference was found between the reported food security of blacks in comparison to whites. 
 
 
 

    Model 4 of Table 3b examined the types of emotional social support sources in relation to food security. These results suggested that, while number of sources does not matter, type does. Those who identified a spouse as a primary source of social support were significantly more likely to report higher levels of food security than those who do not (p<.001), supporting past research and this study's hypothesis. Reporting "other" as a primary source of social support had the opposite impact, as seen in the bivariate results. Those who reported "other" were significantly more likely to report lower levels of food security than those who did not report "other" as a primary source of social support (p<.05), supporting this study's hypothesis. No other relationships between types of emotional social support sources and food security were found. 

    The results from this study fully or partially supported two of the three initial hypotheses that were developed based on past research. Receiving emotional social support does contribute to food security among the elderly and, although number of sources does not play a significant role, the type of support source does matter. These findings uniquely contribute to the existing literature given that many past studies have not differentiated between instrumental and emotional social support. These results also bring to light an important finding: that emotional social support may be able to help mitigate food insecurity among the elderly. Even when demographic characteristics and health status were controlled for, the receipt of emotional social support remained significant. Although its significance was reduced when the demographic variables were added to the model, indicating the well-documented importance of income, health status, and spousal/partner support in food security, that emotional social support did remain significant suggests that it may play a previously unconsidered role in preventing or reducing food insecurity among this population. Reasons for this significance could reflect Pierce et al.'s (2002) findings that emotional social support aids elders in following their modified diets through encouragement and self-disclosure. Further research is needed to better understand this relationship. 

     Being married or living with a partner, according to this study, also aids in preventing or reducing food insecurity. Those who reported being married or living with a partner reported higher levels of food security. Similarly, those who reported receiving the majority of their support from a spouse were significantly more likely to report higher levels of food security. These findings support this study's hypothesis that receiving emotional support from a spouse will contribute to higher levels of food security. These results also support past research that suggest the importance of a spouse or partner in maintaining health, as argued in the marital resource model which posits that marriage provides social, psychological, institutional and economic benefits that cannot be obtained through other relationships and that promote physical health and greater longevity (Waite and Gallagher 2000). In contrast, those who reported living with another person(s) and those who reported that the majority of their support came from an "other" source were more likely to report being food insecure. These results support past findings. Specifically, Lee and Frongillo (2001a) found that living with another person(s) was associated with food insecurity. However, it should also be noted that living with another person and food security were not significantly correlated in the bivariate results of the present study, indicating an interaction among other variables included in Model 2, Table 3a. Second, in terms of reporting "other" as one's primary support source, this may indicate the absence of a reliable emotional social support source. More research is needed to understand the relationships between food security and living with someone other than a spouse or partner and reporting "other" as a primary support source. However, these findings suggest the importance of a reliable emotional support system in maintaining food security among the elderly. 

    Results from this study reflect prior findings that signify the importance of health in food security and vice versa. Those who reported poorer health were more likely to report lower levels of food security. This is particularly dangerous because food insecurity can exacerbate existing health conditions, thus potentially initiating a downward spiral (Sahyoun and Basiotis 2001). Further compounding the problem, household income and food security were significantly correlated in the bivariate results, as were household income and health status. These results suggest that those who need help may be the least likely to be able to afford help or obtain resources that would help to improve or alleviate their food insecure situations. This finding is of particular importance for future research seeking to understand how emotional social support, in addition to other support services, can contribute to reducing food insecurity among elders, particularly those with poor health status and lower income levels. 

    Clearly indicating the importance of financial resources in mediating food insecurity, annual household income was significantly and positively correlated with food security. This finding is not surprising given that many past studies have found similar results. However, it should be noted that household income alone does not explain food security. Other elements, such as health and social support, also contribute to the experience of food security, according to this study. 

    Finally, a relationship worthy of discussion is the rate of food insecurity among elderly Mexican Americans. Mexican American elders reported the highest levels of food insecurity among this sample. Mexican American elders were also more likely to live with other people than were blacks and whites and were negatively correlated with household income. Further, this population was also significantly more likely to report receiving no emotional social support. These results all suggest an unreliable support system in addition to limited resources, putting this population at an especially high risk for food insecurity. More research is needed to better understand  food insecurity among the Mexican American elderly population, particularly since past research has also found this population to be at high risk (Sharkey, Dean, and Johnson 2011). 

    A potential limitation to this study is the method of data collection: self-reporting. Any data collected using self-reporting methods is potentially prone to bias, particularly when the data being collected are of a more personal nature such as food security. However, the direction of the self-reporting bias, if any, is unknown and responses could be under-reported or over-reported. A second limitation to be noted is the lack of data availability on wealth beyond annual household income. Because many in the sample were presumably retired, many might be subsidizing expenses with savings. Therefore, a measurement of wealth in addition to income might prove valuable in future research. Such a measure was not available in the data used for the present study. 

    The results from this study suggest that emotional social support should not be underrated as a method for the intervention and reduction in elderly food insecurity. Limited income and the inability to procure food clearly contribute to the experience of food insecurity. However, the inability to acquire food does not fully explain food insecurity problems among elders, particularly given the health issues faced by this population and the significant contributions of health and physical impairments to food insecurity. It is often presumed that instrumental social support is the most effective method to prevent or reduce food insecurity. However, as this study suggests, instrumental social support might not completely meet elders' needs in preventing food insecurity. Additional help in the form of emotional social support may be necessary. Policies or programs intended to reduce food insecurity among the elderly should recognize that donations or delivered meals alone may not suffice. While the importance of instrumental social support in maintaining food security should not be downplayed, results from this study suggest that emotional social support should be considered in tandem when researching or planning methods for prevention and intervention of food insecurity among elders. As the elderly population in the U.S. continues to grow, social scientists should continue to examine the relationships between emotional social support, resources, health and food security to ensure our elderly community is properly and respectfully cared for. 

Anderson, Sue A. 1990. "Core Indicators of Nutritional State for Difficult-to-Sample Populations." Journal of Nutrition 120:1559-1599.

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