Later Life Food Insecurity and Social Isolation in Ghana: The Importance of Psychological Factors.

BACKGROUND: Social isolation (SI) and food insecurity (FI) are important social determinants of health that can negatively impact well-being in old age. While research on the association between FI and SI is limited in LMICs, the mediators of this association are largely unknown. This cross-sectional study examined whether FI is associated with SI among older adults in Ghana and whether psychological factors (i.e., depression, anxiety, and sleep problems) mediated the association. METHODS: Our study consisted of adults aged ≥50 years in the Aging, Health, Well-being, and Health-seeking Behavior Study. SI was assessed with the Berkman-Syme Social Network Index, while FI was assessed with dietary inadequacy-related items. We used an ordinary least squares regression (OLS), logistic regressions, and bootstrapping modeling approach to examine our hypotheses with p < 0.05. RESULTS: The analysis included 1201 individuals (Mage = 66 [SD = 12], women = 63%). In the full sample (ß = 0.21; p < 0.001) and in women (ß = 0.30, p < 0.001) but not in men, FI was independently associated with SI. FI was comparably associated with increases in SI for the 50-64 age group (ß = 0.21, p < 0.001) and ≥65 age cohort (ß = 0.19, p < 0.01). Moreover, FI showed differential associations with specific domains of SI (OR = 1.81 to 1.45, p < 0.001). Finally, the FI-SI association was mediated by depressive symptoms (65.16%), anxiety symptoms (30.16%), and sleep problems (9.50%). CONCLUSIONS: Our data highlight the fundamental role of FI in SI among older adults, and the effect is explained by psychosocial factors. Interventions targeted toward strengthening interpersonal ties in old age should include addressing FI and older adults' psychosocial outcomes.

Food insecurity and mobility difficulty in middle-aged and older adults: The importance of bio-psychosocial factors.

OBJECTIVE: Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. METHODS: Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; Mage = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. RESULTS: Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from ß = 0.33 to ß = 0.42, p < .001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. CONCLUSIONS: Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life.