Relationship between dietary diversity and food access among elderly living alone in Saitama Prefecture

OBJECTIVES: To examine the relationship between dietary diversity and food access among elderly living alone.

METHODS: In September 2013, a cross-sectional study using a self-administered questionnaire was conducted with 4,348 elderly aged 65-89 years, living in A city in Saitama Prefecture. The subjects answered about their health conditions, frequency of food consumption, difficulty of food store access, social support, food preparation, and so on. The response rate was 59.6%. The dietary diversity score (DDS) was calculated as the number of food groups consumed in a day (0 to 10). The DDS was validated by its association with independence and health status of the elderly. As indicators of food access, objective food access was measured using a geographic information system (GIS), and subjective food access was measured by the questionnaire. Responses of 1,043 subjects (452 male and 591 female) were analyzed after excluding those who live with others in an actual household composition. We classified the subjects into two groups according to the DDS: low group (three or less) and high group (four or more). Multiple logistic regression analyses were conducted using the DDS groups as the dependent variable, and subjective food access and other factors as independent variables, adjusting for age, income, subjective economic status, education, and frailty status.

RESULTS: The number of subjects in each group were as follows: low=107 (23.7%), high=345 (76.3%) for males, high=263 (44.5%), low=328 (55.5%) for females. A multiple logistic regression analysis showed that the difficulty in subjective food store access was associated with a low DDS in males [OR=4.00, 95% CI (1.36-11.82)] as well as in females [OR=2.24, 95% CI (1.11-4.51)]. Further, for females, social support and preparation of supper by oneself were significantly associated with their DDS. No significant relationships were found between objective food store access and DDS in both males and females.

CONCLUSION: The DDS was strongly associated with subjective food store access among the elderly living alone. For females, social support and meal preparation skills were also suggested as important factors affecting their DDS.