Cognitive side-effects are commonly seen following electroconvulsive therapy which convey no therapeutic benefit but are troublesome to both patient and clinician. Various efforts have been made in the past to minimize these symptoms. Although modification of technical parameters related to ECT administration has led to some limited improvement in this regard, attention is now being increasingly focussed on pharmacological approaches. A number of agents have been explored in this context, however, as far as we are aware, the use of thiamine has not yet been investigated. We present three cases of elderly patients undergoing ECT for major depression in whom thiamine administration was associated with beneficial effects on post-ECT confusion. We review the evidence suggesting that thiamine deficiency may be implicated in the confusional state following ECT and recommend that consideration be given to its use in preventing and treating this problematic side-effect, especially in elderly patients.

In 2020, nearly 9.5 million (or about 8 percent of) adults ages 50 and older were food-insecure, meaning they had limited or uncertain access to adequate food. 1 The Supplemental Nutrition Assistance Program (SNAP) is the nation's largest antihunger program and helps millions of people who are at risk for food insecurity. SNAP provides financial assistance to many lowincome individuals and families to help buy the food they need. The program may also improve health and lower health care costs. Research shows that SNAP enrollment among older adults is associated with fewer hospital and emergency room visits and long-term care admissions. 2 Despite the program's potential benefits, eligible older adults have historically had much lower participation in SNAP than those in other age groups. The U.S. Department of Agriculture reports that in fiscal year 2018, only 48 percent of eligible adults ages 60 and older participated in the program under federal rules. 3 The percentage is substantially lower when calculated using state-specific eligibility rules. Although using federal eligibility rules is useful for state comparisons, using state-specific eligibility rules (which vary widely) better reflects the actual number of older adults eligible by state. Using that measure, we estimate a substantially lower participation rate of 29 percent among this age group.Qualitative research has identified common reasons for low participation in SNAP, such as a confusing and burdensome application process, stigma, and discomfort with technology. 4 Quantitative data help us understand who is not enrolling in SNAP and is important for addressing low program enrollment, yet little is known about the characteristics of eligible older nonparticipants. Using estimates from Mathematica, this Spotlight examines that question.

This is the second of three AARP Public Policy Institute Spotlights analyzing SNAP participation among older adults. This state-level analysis of SNAP access rates-or the share of lower-income people receiving SNAP-finds access rates are overall low but vary by state, age, household size, and income.