Food Insecurity and Depression Among Older Adults with Dementia In the United States: The Mediating Role of Social Connections

Background: Older adults with dementia are highly vulnerable to depression. Food insecurity and limited social connections are recognized as key contributors. Prior research suggests that inadequate nutrition and social isolation are determinants of depressive symptoms, but their interrelationships remain understudied. Investigating whether social connections mediate the association between food insecurity and depression in this population could address a gap in understanding how these risks interact. Furthermore, examining these relationships in a nationally representative sample offers insight into disparities and unmet needs among older adults with cognitive impairment across diverse socioeconomic and demographic subgroups in the United States (US).

Objective: This study examines the association between food insecurity and depression among U.S. adults aged 65 and older with dementia and evaluates whether social connections mediate this association. (H1) Food insecurity is positively associated with depression; (H2) food insecurity is negatively associated with social connections; (H3) social connections are negatively associated with depression; and (H4) social connections mediate the association between food insecurity and depression.

Methods: Data were drawn from the 2022 National Health Interview Survey, yielding a weighted sample of 255 older adults aged 65 and older with dementia. Depression was modeled as a latent construct using the Patient Health Questionnaire-8 (PHQ-8). Confirmatory factor analysis (CFA) supported the PHQ-8 as a unidimensional measure of depression. Structural equation modeling (SEM) tested the direct and indirect effects of food insecurity and social connections on depression. Survey weights were included in analyses, and significance was set at p < 0.05. The analytic strategy accounted for the complex survey design, enhancing external validity and ensuring that the findings are generalizable to the U.S. population of older adults with dementia.

Results: The mean depression factor score was 0.60. CFA supported a single-factor structure for the PHQ-8, with strong loadings and acceptable fit (χ²(83) = 5111.42, p < .001; CFI = 0.94; RMSEA = 0.07; SRMR = 0.11). SEM showed similarly strong fit (χ²(34) = 5089.55, p < .001; CFI = 0.94; RMSEA = 0.07; SRMR = 0.04). Food insecurity was associated with higher depression (β = 0.14, p < .001), and social connections were associated with lower depression (β = 0.53, p < .001). Food insecurity was not related to social connections (β = 0.08, p = .20), and the indirect effect was nonsignificant, indicating no mediation. These findings highlight that structural and psychosocial determinants independently influence mental health outcomes rather than operating through a single mediating pathway.

Conclusion: Among older adults with dementia, both food insecurity and limited social connections independently contribute to depressive symptoms, but social connections do not mediate the effect of food insecurity. These findings underscore the need for dual-focused interventions that address nutritional hardship and promote social engagement to mitigate depression in this vulnerable population. Future research should prioritize longitudinal and intervention-based designs to clarify causal mechanisms and identify strategies to reduce depression and improve quality of life.

Keywords: Food insecurity, depression, dementia, older adults, social connections, structural equation modeling