Association Between Social Relationships, Depressive Symptoms, Food Security, Usual Protein Intake and Healthcare Utilization in Homebound Older Adults: A PATH Analysis

This study aimed to measure the direct and indirect relationships between food insecurity (FI), dietary intake (DI), social relationships (SR), depressive symptoms (DS) and their impact on healthcare utilization (HU) in older adults receiving home-delivered meals (HDM) using data from the national 2015–17 Outcomes Evaluation Study. The 2015–2017 Outcomes Evaluation Study is a multistage, clustered, longitudinal observational study of 641 older adults; 306 HDM recipients, and 335 matching controls. Study participants were homebound older adults aged 67 years and older. Measurements: Demographic, health-related, dietary and hospitalization data were obtained using a Client Outcomes Survey, 24-hour dietary recalls and Medicare files. Structural equation modeling was used to measure the direct and indirect relationships between FI, SR, DS, HU and DI (usual protein intake), estimated using the National Cancer Institute’s statistical modeling method. HDM recipients’ mean usual protein intake (34.0 grams) was significantly higher than controls (31.8 grams), but both groups had mean usual protein intakes that were lower than recommendations. FI prevalence in HDM recipients and controls was 25.1% and 16.0%; respectively. Greater severity of FI was associated with lower usual protein intake in both groups. Receiving instrumental social support was directly associated with lesser severity of FI in HDM recipients, and higher FI was associated with more DS only in controls. Eating alone was associated with lower usual protein intake and greater hospitalizations in the controls. HDM recipients and controls may be at a high risk for protein insufficiency, further underscored by the high prevalence of FI. Received instrumental social support can play an important role among HDM recipients and controls, both vulnerable populations. Findings also highlight the need for validated tools to measure different aspects of social relationships in older adults. No funding sources to declare.