No abstract

Background In 2018, 14.3 million US households experienced food insecurity, which has been linked to negative health outcomes such as depression and anxiety, diabetes, and hypertension. This connection is particularly important for older adults, who are at greater risk than younger adults for developing certain health conditions. Objective We estimated the association between food insecurity and the use of health services for adverse health events over a 12-mo observation period following survey interview for a nationally representative group of older adults participating in the congregate meal (CM) and home-delivered meal (HDM) programs. Methods We analyzed data from the Nutrition Services Program (NSP) Outcomes Survey matched to Medicare claims and enrollment data in 2015–2016 for a nationally representative sample of 626 CM or HDM recipients ages 67 y and older. We used logistic regression analysis controlling for demographic characteristics, prior health events, and geography to estimate the association between food insecurity and use of health services, including emergency department visits, inpatient stays, skilled nursing facility stays, and home healthcare episodes. We used ordinary least squares regression analysis to estimate the association between food insecurity and Medicare spending. Results Food insecurity was associated with an average increased likelihood of using health services for adverse health events of 16% (95% CI: 1%, 32%) for HDM participants. Food insecurity was associated with an average increased likelihood of emergency department visits of 24% (95% CI: 6%, 41%) for CM participants and 20% (95% CI: 5%, 36%) for HDM participants. There was no observed increase in likelihood of using the other health services. Food-insecure participants were less likely to have a skilled nursing facility stay. Conclusions Food insecurity is associated with an increased likelihood of use of health services for adverse health events in older adult participants in meal service programs.

Working-age people with disabilities are a large and growing segment of the U.S. population. Expenditures for a variety of federal and state safety-net programs to support these individuals—such as Social Security Disability Insurance, Supplemental Security Income, Medicare, Medicaid, and numerous others—are also growing. However, because expenditures are fragmented across so many programs, the full size and the extent of their growth have been obscured. For this study, we estimated how much the federal government spent on programs in 2014 to support working-age people with disabilities, and we assessed how the size and composition of those expenditures changed during the two 6-year periods preceding 2014. We found that in 2014, the federal government spent US$498 billion on programs to support the working-age population with disabilities, which represents 14% of all federal outlays. States contributed another US$94 billion under federal–state programs. From 2008 to 2014, inflation-adjusted federal expenditures for this population grew by 30%, nearly the same as observed from 2002 to 2008. Expenditures for health care accounted for half of all expenditures in 2014, up from 47% in 2008 and 46% in 2002, and replacing income assistance as the largest expenditure category.

Objectives This paper examines the health, work, and financial experiences of older adults with disabling conditions during the COVID-19 pandemic. It also explores the role of county- and state-level conditions in these experiences. Methods Using data from the 2020 Health and Retirement Study, we estimated regression models to assess differences in outcomes between those with and without disabling conditions and by race/ethnicity. We used multilevel modeling to assess whether and how county or state factors might be associated with the differences in these effects. Results Older adults with disabilities were more likely to report experiencing financial hardships, delaying health care, and experiencing effects on work than those without disabilities; these differences are heighted between race and ethnicity. Older adults with disabilities were more likely to live in counties with greater social vulnerability. Discussion This work underscores the importance of developing a robust, disability-inclusive public health response that protects older adults.

No abstract