Food insecurity in later life is linked to higher odds of probable dementia

An analysis of more than two decades of data from the Panel Study of Income Dynamics found that older adults who experienced food insecurity in later life had roughly twice the odds of screening positive for probable dementia, compared with those who had reliable access to food. People who experienced food insecurity only in middle age did not show a statistically significant increase in odds. The paper was published in the American Journal of Clinical Nutrition.

People who do not have reliable access to enough nutritious food are considered to be experiencing food insecurity. In the United States, food insecurity among households with older adults has nearly doubled over the past two decades.

Food insecurity is linked to a range of health problems, including poor diet quality, cardiometabolic disease, psychological distress, and worse mental health. Growing evidence also suggests that it may affect the brain, with food-insecure older adults showing poorer cognitive functioning and a higher risk of dementia. These associations tend to remain even after differences in education, income, and wealth are taken into account.

Researchers are increasingly interested in whether the timing of food insecurity matters. Studies in Burkina Faso, Malaysia, and China have found that older adults who recalled experiencing hunger or food insecurity in childhood were more likely to show cognitive impairment or dementia decades later. Food insecurity during middle adulthood may also be important, as the share of people experiencing food insecurity tends to be particularly high in this period of life.

Study author Cindy W. Leung of the Harvard T.H. Chan School of Public Health and the University of Michigan and her colleagues examined whether food insecurity in mid-life and in later life was associated with probable dementia among U.S. adults. They also wanted to see whether prolonged food insecurity, meaning food insecurity in both mid-life and later life, or repeated episodes of it, was linked to even higher risk.

The researchers analyzed data from the Panel Study of Income Dynamics (PSID), which they describe as the world’s longest-running nationally representative household panel survey. The study began in 1968 and has followed its original participants since then, with an oversample of low-income families that allows researchers to study poverty. Data were collected every year until 1997 and every two years since.

The analysis began with 2,685 respondents who completed the core survey in 1999, when they were between 43 and 59 years old. After excluding people with missing information on food security, dementia, or other key variables, the final sample included 2,051 participants. Fifty-six percent were women, and about three-quarters were non-Hispanic White.

Food security was measured every two years using a standard 18-item questionnaire from the U.S. Department of Agriculture, which asks about experiences such as being unable to afford enough food over the past year. It was assessed in 1999, 2001, and 2003, which the researchers treated as mid-life, and again in 2015, 2017, and 2019, which they treated as later life. The researchers defined food insecurity as low or very low food security and noted whether each participant experienced it in neither period, only one, or both. Participants averaged about 51 years old during the mid-life window and about 67 during the later-life window.

Dementia was assessed in 2019 and 2021 using the Eight Item Interview to Differentiate Aging and Dementia, a screening questionnaire that asks about changes over the past year in memory, judgment, orientation to time, and the ability to handle daily activities. The questions are designed to pick up early cognitive changes associated with Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and other forms of dementia. A score of 2 or more out of 8 was classified as probable dementia, and the questionnaire could be answered by the participant or by another member of the household.

Most participants (86%) were food secure in both periods. About 3% experienced food insecurity in mid-life only, 5% in later life only, and 5% in both periods. Those who experienced food insecurity at either point tended to have lower incomes and less education and were more likely to be women or Black or Hispanic. About 20% of the sample screened positive for probable dementia.

After accounting for factors such as age, sex, race and ethnicity, education, income, marital status, employment, home ownership, and prior diabetes, hypertension, and heart disease, participants who experienced food insecurity in both mid-life and later life had 2.18 times the odds of probable dementia compared with those who were food secure in both periods. Those who experienced food insecurity in later life only had 1.85 times the odds. In models that did not account for changes in these factors over time, the estimates were higher, at 2.96 and 2.52, respectively.

In terms of predicted probabilities, the typical estimated chance of probable dementia was about 11% for adults who were food secure in both periods and about 40% for those who were food insecure in both. People who were food insecure only in mid-life did not have significantly higher odds of probable dementia, although this group was small, at 88 people, so the estimate was imprecise.

The number of food-insecure years in later life also appeared to matter. Participants who were food insecure in two or three of the later-life surveys had about 2.6 to 3.2 times the odds of probable dementia, while repeated episodes in mid-life were not significantly associated with it. The results were similar for men and women and held when the researchers broadened the definition of food insecurity to include marginal food security.

“Food insecurity is an important social determinant of health that can impact cognitive impairment and probable dementia. Future research should investigate the roles of income and nutrition policies to alleviate food insecurity and to reduce the burden of cognitive impairment and dementias before older adulthood,” the study authors concluded.

The authors note that food insecurity is reversible and is the focus of programs such as food pantries, “Food is Medicine” initiatives that provide produce prescriptions or medically tailored meals, and the Supplemental Nutrition Assistance Program (SNAP). They raised concern that SNAP work requirements extended to adults aged 55 to 64 under a 2025 law could discourage participation among older adults and lead to more food insecurity.

There are some caveats to consider. The study was observational, so it cannot show that food insecurity causes dementia. Later-life food insecurity was measured close in time to the dementia screening, and because no cognitive data were collected in mid-life, the researchers could not rule out that early cognitive decline made it harder for some people to secure enough food, rather than the other way around. Unmeasured factors such as neighborhood conditions could also contribute to both.

The dementia measure was a screening tool rather than a clinical diagnosis, and food security was not measured between 2005 and 2013, leaving a gap in the middle of the study period. People excluded because of missing data tended to be poorer and less healthy, which the authors suggest may have made the associations appear weaker than they are. The study also included only people who lived long enough to be screened at age 65 or older, and it did not adjust for mental health, which is linked to both food insecurity and cognitive decline.

The paper, “Associations between mid-life and later-life food insecurity on probable dementia in a national sample of United States adults,” was authored by Cindy W. Leung, Noura E. Insolera, Heejin Lee, Julia A. Wolfson, Claire T. McEvoy, Esther M. Friedman, Steven G. Heeringa, and Wei Hao.