Food insecurity and geriatric functional limitations: Observational analysis from the AgeHeaPsyWel–HeaSeeB Survey

Background: International literature suggests that food insecurity is linked with increased risks of functional impairment. However, data on the mediational mechanisms underlying this association are largely lacking. This study investigates the indirect relationship (via mental distress) between food insecurity and functional limitations among older adults in Ghana and evaluates the moderating effect of age, sex, and physical activity in this association. Methods: The analytic sample comprised 1201 adults aged ≥50 years from the AgeHeaPsyWel–HeaSeeB study 2016–2017. We assessed food insecurity using hunger and skipped breakfast-related items. Seven mobility and activities of daily living-related difficulties assessed functional limitations. We used a moderated mediation analysis with the Hayes' PROCESS Macro v3.5 to model the hypothesized associations. Results: About 36% of the sample were functionally limited, and 44% and 9% revealed moderate and severe food insecurity respectively. Food insecurity was associated with increased odds of having functional limitations after full adjustment for potential confounders (OR = 1.25, 95% CI: 1.05–1.50). However, this association was buffered by physical activity; those who engaged in physical activity were 23% less likely to suffer food insecurity-induced functional limitations compared to physically inactive (OR = 0.77, 95% CI: 0.67–0.88). Mental distress significantly mediated the food insecurity-functional limitations association and explained 86.9% of the association (total effect: OR = 2.85; 95% CI: 1.42–2.71; direct effect: OR = 1.05; 95% CI: 1.21–1.87; indirect effect: OR = 1.34; 95% CI: 1.36–2.24). Conclusions: Food insecurity is a risk factor for functional limitations in old age. Interventions to address food insecurity may benefit functional abilities via regular physical activity and improved mental health outcomes.