UI researcher finds faster decline in cognitive ability for those living without healthy food

When University of Iowa researcher and assistant professor Boeun Kim worked as a nurse, some of the older adults she treated would have problems that no health care professional can solve — low income, a small or nonexistent support network and less access to healthy food.

Pair any of these issues with growing older and many patients were experiencing cognitive decline in some way, Kim said. A study from the researcher and colleagues at John Hopkins and Columbia universities found that people over the age of 65 living in urban areas lacking healthy food options saw a faster decline in cognitive abilities than their peers.

Kim said she hopes to expand her study to different living situations and geographical areas, and hopes the information will eventually lead to changes in policy and practice in places where healthy food is harder to find.

“I really want to support them, but I feel like … I could not provide the optimal care for them because of issues with communication and other symptoms, but at the same time I also felt frustrated, because there is no cure for dementia for now,” Kim said. “So I felt like I should intervene at the prevention level, like at the community (level,) before they come into the hospital.”

It was during her time as a nurse when Kim first became interested in cognitive functions, she said, as people would come in with a cognitive impairment and have difficulties communicating with staff, made worse by additional symptoms like anxiety and delirium.

Kim said she was unable to help patients with the factors leading to their decline, namely poverty and lack of resources where they lived. While specific medical needs could be addressed, Kim said she couldn’t solve their food insecurity or the chronic stress that can develop as a result.

Having an unhealthy diet can lead to greater risks of developing diabetes and other conditions that can contribute to cognitive decline, Kim said, including obesity and hypertension.

Using datasets from the U.S. Department of Agriculture and National Health and Aging Trends Study, the research team narrowed their search to people 65 or older, living in urban areas also designated as “unhealthy food environments.” These locations were described by Kim as areas without a grocery store or supermarket that also have a lower-income population.

“We found that individuals living in both high poverty level and then low food (options) in the area experience faster declines in cognitive function over time, among all those who live in the urban communities,” Kim said.

People with disabilities, who have a low income and who are marginalized are more likely to be living in these areas, Kim said, and are experiencing other structural barriers and hardships in addition to food insecurity. This problem worsens health disparities for these populations, she added, and she wants to make these environments more equitable.

In the future, Kim said she wants to look at the same age group but in rural areas, to see how food deserts in Iowa and their impact on older adults compares to what she found in urban areas across the U.S. She also wants to introduce other variables, like transportation capabilities and price of food, to further study the issue.

While the study itself does not identify solutions that would combat this problem best, Kim said the findings will hopefully prompt conversation among community leaders and lawmakers about how to solve urban healthy food insecurity. There won’t be any catch-all fix, she said, but expanding community food assistance and delivery programs and incentivizing people with healthy food businesses like grocery stores to settle in the area could be a good start.

Teaching people about better behaviors, like eating healthy and exercising, can only go so far when there are structural barriers to improving a lifestyle, she said.

“I really feel like we should make the environment better first, then emphasize that you should improve your behaviors,” Kim said.