Food Insecurity, Vision Impairment, and Longitudinal Risk of Frailty and Falls in The National Health and Aging Trends Study

Background: Both food insecurity (FI) and vision impairment (VI), which are linked, have been independently associated with frailty and falls. Objectives: Understand how FI and VI may together contribute to frailty and fall risk could improve insight into these growing public health challenges. Design, Setting, Participants, Measurements: This study included 5,963 participants aged 65 and older enrolled in the National Health and Aging Trends Study. Participants were divided into four exposure groups (“No FI or VI,” “FI, no VI,” “VI, no FI,” and “Both”) based on self-report. The Fried Frailty Index and self-reported falls were assessed annually. We used adjusted logistic and Poisson regression models to examine cross-sectional associations and generalized estimating equations to examine longitudinal associations between FI/VI status and falls and frailty outcomes. Results: Most study participants reported neither FI nor VI (n=5169, 86.7%); however, having both FI and VI (n=57, 1%) was cross-sectionally associated with higher frailty score and higher odds of falling multiple times in the last year. FI and/or VI were longitudinally associated with higher frailty score and increased frailty risk, with the strongest association for Both (RRR=1.29, 95% CI 1.23, 1.58; OR=3.18, 95% CI 1.78, 5.69), and with falling, again highest among those with Both, for one (OR=2.47, 95% CI 1.41, 3.96) and multiple (OR=2.46, 95% CI 1.50, 4.06) falls in the last year. Conclusion: Clinical and public health interventions could address the intersection of FI and VI with the aim of ameliorating the impact of these risk factors and health outcomes.