USDA-administered food assistance programs and health outcomes among older adults in the United States: a systematic review

Abstract Background USDA-administered food assistance programs assist millions of Americans with low income and are of particular importance to the country’s aging population experiencing high rates of food insecurity. This systematic review examines the relationship between participation in the Supplemental Nutrition Assistance Program (SNAP) and health outcomes, behaviors, and health care utilization among older adults in the United States. Methods We conducted a systematic keyword search across three bibliometric databases (Academic Search Premier, PubMed, and Web of Science) using a defined search strategy for studies published after 2009. Title and abstract screening was performed by two independent reviewers. Full-text screening, data extraction, and assessment for risk of bias and study quality were completed by one reviewer. Results We screened 206 peer-reviewed studies and included 11 in the systematic review. Study methods varied primarily in terms of the timing, frequency, and methods used to define SNAP participation. SNAP participation was associated with lower healthcare facility usage, lower healthcare expenditures, and higher medication adherence. Evidence for effects on cognitive and physical health was weaker or null, although there was evidence for more rapid cognitive decline among SNAP-eligible nonparticipants compared with participants and ineligible older adults. Only one study examined SNAP participation and diet quality and reported no significant association. No studies found associations between SNAP participation and worse health outcomes or engagement with less favorable behaviors. Conclusions This review suggests that SNAP is generally associated with positive health outcomes and health behaviors in older adults. Congressional action to significantly cut food assistance programs from the federal budget may have cascading, wide-ranging effects for the overall health of vulnerable older adults.