Food insecurity and mobility difficulty in middle-aged and older adults: The importance of bio-psychosocial factors

Objective: Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. Methods: Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; M_age = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. Results: Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from β = 0.33 to β = 0.42, p < .001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. Conclusions: Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life.