Food insecurity, medication utilization, and medication adherence among low-income older adults

Abstract

Health disparities disproportionately affect the rapidly growing population of older Americans with a high burden of chronic diseases; however, little is known about the unique problems encountered by low-income, high-risk older adults in need of chronic disease management. This dissertation examines the relationships among food insecurity (FI), medication utilization, and medication adherence in a sample of low-income older adults in need of nutrition assistance. Three studies were conducted. Study 1 examined the relationships between longitudinal changes in FI and cost-related medication non-adherence (CRN) among low-income older Georgians. Study 2 systematically reviewed the literature to examine types and characteristics of pharmacy claims data derived medication (re)fill adherence measures used exclusively in older Americans aged 65+ years in preparation of study 3. Study 3 examined utilization of and adherence to oral hypoglycemic medications among food secure and insecure Medicare Part D beneficiaries with type 2 diabetes in Georgia. The findings from this research suggest the persistence and coexistence of FI and CRN in low-income older adults. Those persistently food insecure had 8.2 (95% CI: 5.4, 12.5) times higher odds of reporting higher levels of CRN compared to persistently food secure individuals. Thus, many food insecure older adults may experience a persistent gap between available resources and the demand for basic food and medication needs, predisposing them to poor chronic disease management. Indeed, this research found exceptionally poor diabetes management and health characteristics among food insecure Medicare fee-for-service beneficiaries despite high participation rates in Medicare and Medicaid health and prescription insurance subsidy support. Regardless of FI status, only one third of the sample (34.6%) showed optimal adherence to oral hypoglycemics, while 28% of the sample did not (re)fill any diabetes medication. Medication adherence levels in this population are insufficient to effectively manage type 2 diabetes. Mismanaged diabetes is associated with great human and economic cost. Thus, policies and programs promoting effective chronic disease management in low-income older Americans need to address difficulties meeting basic needs.