Food Insecurity Among Older Adults In The United States: A Systematic Review Through The Gerontological Public Health Framework

Abstract

Background:Food insecurity is a concerning public health problem and is linked to poor physical, psychological, and social health outcomes among older adults in the United States. Despite studies on food insecurity among older adults, the evidence has not been fully synthesized through the Gerontological Public Health Framework. The framework highlights the interplay of biological, social, economic, environmental, and healthcare determinants of healthy aging. Objective:To systematically synthesize evidence on the structural and sociocultural determinants, health outcomes, and intervention strategies about food insecurity among older adults in the United States, using the Gerontological Public Health Framework. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review question guided the search method. Searches were conducted in CINAHL Ultimate, PubMed, Scopus, Web of Science, PsycINFO, and Google Scholar for peer-reviewed studies published between 2010 and 2025. Quantitative, qualitative, and mixed-methods studies that met the eligibility criteria were included. The Joanna Briggs Institute's critical appraisal instruments were used to evaluate study quality. Thematic analysis was used to synthesize 19 studies that satisfied the eligibility requirements. Results: The pooled evidence identified financial hardship, social isolation, transportation barriers, chronic disease burden, and poor access to healthcare as the main determinants of food insecurity among older adults. Across the studies, poorer nutritional status, diabetes, obesity, hospitalization, depression, anxiety, and a lower quality of life were all linked to food insecurity. The pooled evidence showed that food security experiences depended on sociocultural factors, including protective community support networks and traditional dietary habits. Further reports highlighted the effectiveness of healthcare-based food interventions, community-based nutrition services, and nutrition assistance programs in alleviating food insecurity and improving health in older adults. Conclusions:Food insecurity is a complex public health problem influenced by various interrelated structural, social, and sociocultural factors. The Gerontological Public Health Framework provides a useful lens for understanding these interrelated factors. It facilitates the development of integrated, culturally responsive interventions that promote food security, encourage healthy aging, and reduce health disparities among older adults.