Diet and lifestyle are vital in maintaining good health and independence for older adults. Older adults living in rural areas are at risk for chronic disease, poor diet quality, and limited accessibility to healthy foods, compared to their urban counterparts.
To assess rural and urban older adults’ diet quality, food insecurity, and self-efficacy for overcoming barriers to making informed nutrition-related decisions.
Study Design, Setting, Participants
From April-August 2019, a cross-sectional design was used to administer a self-reported survey to adults ≥50 years, in Maryland, participating at senior/community sites. Using convenience sampling, 475 participants (Urban, n = 215; Rural n = 260) were recruited prior to a nutrition education program (44 sites, 19 counties).
Participants completed a self-administered survey (41 items). Measurable constructs included diet quality assessed by the validated Dietary Screening Tool (DST), which evaluates nutritional risk in older adults. Perceived self-efficacy for healthy eating behaviors, food insecurity, and sociodemographic factors were also measured. Data were analyzed using SPSS version 24.0 (t-test, chi-square, and multiple linear regression).
Participants were predominantly women (83.6%), white (54.0%), who lived alone (53.6%), with a median age of 74.5 (SD ± 8.5), and reported their health as somewhat good/very good (53.1%). Those in rural areas had significantly lower DST scores (P = .024), higher average number of chronic diseases (P = .004), and lower self-efficacy for changing health behaviors (P = .001) compared to urban/suburban counterparts. After controlling for other variables, rural and urban dwelling was not a significant predictor of diet quality. However, DST scores were significant predictors of food insecurity (B = −3.097, P < .05) and perceived self-efficacy (B = 1.145, P < .001) among older adults.
Although previous research reported rural dwellers were more at risk for poor diet quality than urban dwellers, our findings did not support this. However, our results did support the need for nutrition interventions addressing food insecurity and barriers to self-efficacy for improving diet quality of all older adults.