Indicators of Material Hardship and Depressive Symptoms Among Homebound Older Adults Living in North Carolina

Abstract

This study used the concept of material hardship to understand how unmet needs related to food, housing, and health influence depressive symptoms among homebound older adults (N = 345) in North Carolina. Using data from the Nutrition and Function Study, 37% reported high levels of depressive symptoms and 17.4% indicated not receiving needed health care. Approximately 10% of respondents were food insecure; 30.7% were at risk for food insecurity; and 39.7% reported having to choose between either food and medication or food and paying bills. Adjusted logistic regression model revealed that food insecurity status (OR = 4.9) and age 60–74 y (OR = 2.4) were significantly associated with a greater number of depressive symptoms. Other indicators of material hardship, such as having a major financial difficulty, unmet health need, and inadequate housing, were not significant. By far, food insecurity was the most salient influence on depressive symptoms. These findings have important implications for service providers, researchers, and policymakers.

KEYWORDS:

• basic needs
• depression
• food insecurity
• health care
• health outcomes
• home-delivered meals
• housing
• material hardship
• older adults

Acknowledgments

This research was supported with funding from the National Institutes of Health (NIH)/National Center on Minority Health and Health Disparities (#5P20MD002295) and by Cooperative Agreement #1U48DP001924 from the Centers for Disease Control and Prevention (CDC), Prevention Research Centers Program through Core Research Project and Special Interest Project Texas Healthy Aging Research Network. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH and CDC. The authors wish to thank Dr. Paul Lewandowski for his helpful comments on prior drafts of this article.

Notes

*Items coded in reverse, 1 = no, 0 = yes.

^a Significant at the p ≤ 0.05 level.

^b Significant at the p ≤ 0.01 level.

^c Significant at the p ≤ 0.001 level.

*Mean ± SD.

†Referent category is non-Hispanic White older adults.

‡Referent category is male.

^§Referent category is not married.

^‖Referent category is lives with others.

^¶Highest level of education completed.

**Monthly income.

^††Referent category is not receiving food stamps (now referred to as Supplemental Nutrition Assistance Program, or SNAP).

^a Significant at the p ≤ 0.05 level.

^b Significant at the p ≤ 0.01 level.

^c Significant at the p ≤ 0.001 level.

¹GDS = Geriatric Depression Scale.

^a Significant at the p ≤ 0.05 level.

^b Significant at the p ≤ 0.01 level.

^c Significant at the p ≤ 0.001 level.

*Referent category is older adults ≥85 y.

†Referent category is non-Hispanic White older adults.

‡Referent category is not reporting major financial difficulty.

^§Referent category is being categorized food secure.

^‖Referent category is indicating yes, health needs met.

^¶Referent category is reporting condition of housing as excellent/very good, good, or fair.