The association between food insecurity and functional disability among older adults: the mediating effects of childhood and adult socioeconomic status in a ten-year follow-up longitudinal study in Ghana and South Africa.

OBJECTIVES: This study examined the association between food insecurity (FI) and functional disability (FD) among older adults over time in Ghana and South Africa (SA), and the mediating roles of childhood parental employment (CPE) and adult education (AE) statuses. METHODS: Data were from 6,569 and 4,663 older adults (60+years) who participated in WHO-SAGE Ghana and SA (Waves 1-3), respectively, between 2007-2019. Multivariable-adjusted logistic mixed effects models were performed to examine the roles of CPE and AE statuses on the associations between FI, in general, and its measures - hunger and food insufficiency - with FD in older adults. RESULTS: After adjusting for significant covariates, older adults who reported being food insecure (Ghana: aOR = 1.20, 95%CI: 1.03, 1.41, p = 0.024; SA: aOR = 1.98, 95%CI:1.54, 2.56, p < 0.001) and those who reported consuming insufficient food (Ghana: aOR = 1.21, 95%CI: 1.03, 1.42, p = 0.018; SA: aOR = 1.96, 95%CI:1.52, 2.53, p < 0.001) had higher odds of FD over time, compared with those who were food secure. For both Ghana and SA, hunger was associated with higher odds of FD. However, the association remained statistically significant only for SA. CPE and AE statuses proved to be relevant pathways through which FI was associated with increased odds of FD among older adults in Ghana and SA. CONCLUSION: CPE and AE statuses mediated the associations between FI and FD among older adults in Ghana and SA. This highlights the importance of adopting early--late-life interventions to support the health and economic wellbeing of families to accumulate wealth for food security and functional wellbeing in later life.