Campus News

Costly decisions

Jung Sun Lee

Two UGA studies find strong links between food insecurity, health care among elderly Georgians

A fear of going hungry may be leading many older Georgians to skip medications and cancel doctors’ appointments as they juggle limited incomes with prescription costs and out-of-pocket copayments required by Medicare, according to two new studies by UGA researchers.

The first study, published in the March issue of the Journal of Nutrition in Gerontology and Geriatrics, looked at older Georgians who skip needed medications or manipulate their doses. The second found that those who are food insecure tend to have lower Medicare expenses. Both focused on food insecurity-uncertain, insufficient or unacceptable access or use of food.

The studies were led by Jung Sun Lee, an associate professor of foods and nutrition in the College of Family and Consumer Sciences. To determine cost-related medication non-adherence, researchers asked study participants if the cost of prescriptions had caused them to skip doses, take a smaller dose, delay refills, stop taking medications or avoid new prescriptions.

Among the entire sample, 30 percent fell into the persistent non-adherence category during the study period, regardless of whether they were food secure or insecure. Among those who were persistently food insecure, however, that percentage of persistent non-adherence jumped to 48.7 percent.

“Engaging in medication restriction behaviors, such as skipping doses, creates problems for both the individuals and society,” Lee said. “The exacerbation of diseases, adverse health events and avoidable hospitalizations result in increased health care costs for all of us.

“However, when you’re not sure you’ll have enough money to refill your prescription and buy groceries, it’s easy to understand why someone will choose to skip a dose of medication needed to control diabetes or split a heart medication in half,” she added.

Issues of cost-related medication non-adherence existed despite the fact more than 83 percent of participants were enrolled in a prescription medication insurance plan. However, most plans require some sort of copayment.

The second study, published in the October 2012 issue of the Journal of Nutrition, is the first to examine the relationship between food insecurity, health status and health care expenditures in older adults.

Lee and her colleagues looked at surveys that compared Medicare and out-of-pocket expenses of 1,377 older Georgians with a mean age of 77 years, half of whom were food insecure.

In examining the Medicare expenditures, Lee found Medicare expenses were $1,875 lower for the food insecure. Similarly, out-of-pocket payments for the food insecure were $310 less than for the food secure. These differences are not small, Lee noted, and translate into 20 percent of the mean Medicare spending per beneficiary and 7 percent of mean out-of-pocket payments per beneficiary in Georgia in 2008.

“Our findings suggest complex problems in access, choice and actual use of different types of needed medical care among food insecure compared with food-secure older adults,” Lee said.

Other researchers on the project included Rahul Jain, an assistant professor in the College of Pharmacy, and Vibha Bhargava, an adjunct faculty member in the College of Family and Consumer Sciences’ housing and consumer economics department.