BACKGROUND 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. OBJECTIVE To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults. DESIGN 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. MAIN OUTCOME MEASURES 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). STATISTICAL ANALYSES PERFORMED 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. RESULTS 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). CONCLUSIONS 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.

中文翻译：

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低收入老年人的营养状况不佳：检查自理能力、粮食不安全和抑郁之间的相互关系

背景 由于老年人独特的健康和社会需求，需要了解他们的粮食不安全和身心健康状况不佳与营养状况之间的相互关系的机制。目的 研究低收入老年人的自理能力、抑郁症状、粮食不安全和营养状况之间的复杂关系。设计 横断面研究于 2017 年 2 月至 2017 年 5 月进行。 参与者/环境 共有 372 名居住在阿拉巴马州的 60 岁及以上的低收入老年人参与了研究。主要结果测量参与者完成了一项经过验证的调查，测量粮食不安全（美国食品安全调查模块六项）、自我照顾能力（自我照顾能力量表）、抑郁症状（10 项老年抑郁量表）、和营养状况（迷你营养评估简表）。执行的统计分析 广义结构方程建模用于在一个模型中包括联立方程和多个介体。进行了 Akaike 信息准则、贝叶斯信息准则和似然比检验以比较竞争模型规范的拟合。结果 较低的自我照顾能力与更大的粮食不安全（β[b]=.11，优势比 [OR]=1.11，P=0.03）和更高的抑郁症状（b=.08，P=0.005）相关。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（分别为 b=.24，OR=1.27，P<0.001；b=.13，OR=1.43，P=0.001）。较高的粮食不安全感与抑郁症状的增加有关（b=.40，P<0.001）。自理能力通过抑郁症状与营养状况直接或间接相关（b=.04，P=0.048）。尽管粮食不安全与营养状况没有显着相关性，但观察到粮食不安全与营养状况之间通过抑郁症状存在显着的间接关联（b=.02，P=0.04）。结论 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问题。无法负担食物加上照顾自己的能力有限，导致抑郁症状的自我报告增加，导致营养状况不佳。通过抑郁症状观察到粮食不安全与营养状况之间存在显着的间接关联（b=.02，P=0.04）。结论 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问题。无法负担食物加上照顾自己的能力有限，导致抑郁症状的自我报告增加，导致营养状况不佳。通过抑郁症状观察到粮食不安全与营养状况之间存在显着的间接关联（b=.02，P=0.04）。结论 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问题。无法负担食物加上照顾自己的能力有限，导致抑郁症状的自我报告增加，导致营养状况不佳。