(P07-001-25) Food, Water and Healthcare Access Insecurities of Older Adults in the Context of Economic Crisis: A Nested-Cross Sectional Study

Objectives: Food, water and healthcare access insecurities (FI, WI and HI) are associated with poor physical and mental health, including in older adults. Often examined separately, they are under-studied in combination in older adult populations in low- and middle-income countries (LMIC). In Lebanon, an LMIC experiencing severe economic crisis, we examine the association between reported impact of crisis and both individual and multiple material need insecurities among older adults.

Methods: We use baseline data of an ongoing cohort of older adults (≥60y) collected in Oct 2023-Sep 2024 (n=2551). Self-reported impact of economic crisis was categorized as minimal, mild, moderate and severe. The Household Food Insecurity Experiences Scale and short-form Household Water Insecurity Experiences Scale categorized older adults as FI and WI at scores ≥4. HI refers to the inability to see a doctor or be hospitalized when needed. Logistic regression models assessed the association between the impact of crisis and FI, WI, HI, and ≥2 insecurities, adjusting for age, sex, education, nationality, marital status, wealth, employment and urbanicity. The interaction between wealth and impact of crisis was tested.

Results: The prevalence of FI, WI, HI and ≥2 insecurities among older adults (median [IQR] age: 68y [63-75y]) was 37%, 45%, 47% and 33% respectively. After accounting for socioeconomic and demographic variables, older adults who reported being severely impacted by crisis had higher odds of FI (adjusted Odds Ratio (AOR): 4.9[95%CI:2.6-9.2], WI (1.9[1.1-3.5], HI (3.4 [2.1-5.4], and ≥2 insecurities (4.8 [2.3-9.8]). Odds of FI and ≥2 insecurities in the poorest quintile of older adults experiencing severe impact of crisis were 86.2[11.4-648.2] and 4.3 [2.6-6.9] compared to the wealthiest reporting minimal impact of crisis. Even among the wealthiest, those severely impacted by crisis had elevated odds of FI (19.4[2.5-147.6], but not of ≥2 insecurities.

Conclusions: Reported impact of crisis was most strongly associated with FI in older adults in Lebanon with large disparities by wealth. While the poorest households fared worst on individual and multiple material need insecurities, a subset of the wealthiest quintile who reported being impacted by crisis also had elevated odds of FI but not of multiple insecurities.

Funding Sources: National Institute on Aging