Although there are many important factors that can jeopardize the nutritional status of older adults, inadequate financial resources to buy sufficient good quality food can have a profound impact on the diets of low income seniors. This is illustrated by the passages below, again from Wolfe et al.
“Usually around this time [of the month] I don’t have enough. Right now I don’t have any groceries here.“
“I’ve gone a couple of days without eating & I’ve had to put a little brown sugar into some water and I drank that both days, a couple of times.“
“My doctor tells me to drink lots of milk and eat cheese and fruits, but it becomes hard to get enough fruit, because I have to choose between buying fruit, milk and cheese. If I buy fruit, I won’t have enough for milk and cheese.“
These passages illustrate the impact of low income on access to food. The last passage illustrates how limited financial resources may force seniors to make difficult decisions about which foods to buy. Similarly, medication and other health related expenses, since they are likely to be a priority, may leave less money for an adequate diet.
An appreciation of the importance of good nutrition for promoting health and preventing disease, and an awareness of the prevalence of food insecurity in older adults will be an important first step in identifying patients at nutritional risk. In addition, the following items from the Nutritional Screening Initiative Checklist, a validated tool for assessing nutritional risk, highlight some important questions to ask.
Do you eat less than one meal a day with fruit? with vegetables? with milk?
Has there been a change in your diet due to health problems?
Do you have any problems with your teeth or oral health?
Are you able to shop, cook and feed yourself?
Have you lost or gained any weight without meaning to?
Do you use more than three medications per day?
Do you consume more than 3 alcoholic beverages a day?
Do you eat alone?