The importance of social financial support in reducing food insecurity among elderly people

The growing number of elderly people who are at increased risk of food insecurity for a variety of reasons, including financial ones, requires the current situation to be monitored. The purpose of this research was therefore to determine: (1) how older people perceive their situation in terms of food security; (2) whether older people use any form of external financial support; and (3) the relationship between people’s perception of their food security and the use of financial support from social services and their family. The survey was conducted on a group of 1150 people aged 65 years and above at the end of 2018 and the beginning of 2019. In total, 762 questionnaires were analysed for the study. The study was conducted in the Świętokrzyskie and Śląskie voivodeships (provinces). Multivariate correspondence analysis (MCA) and the chi-square test were used to compare qualitative variables describing food security, financial assistance and socio-demographic features. Over two thirds of the respondents declared that they had no need of financial assistance from the social services or their family. Two categories of variables were selected using the MCA method: people who declared that their household had food security and that they had no need for financial assistance from social services or their family, and people who said they did not have food security and simultaneously used financial assistance or did not use such assistance but had financial problems. Place of residence and household composition were features that significantly distinguished the opinions about the lack of food security. Financial social programmes and the social education of families should be improved to minimize the risk of food insecurity in households of elderly people, especially those not benefiting from financial social support.


Introduction
Aging is a global demographic trend that has been growing in recent decades as the result of an increase in life expectancy and a decrease in the fertility rate (UNPD 2013). The increase in the percentage of people aged 65 and over (GUS 2016; Eurostat 2020) may constitute a large socio-economic burden in providing support and care to the elderly due to their poor health, including disability (Rodriguez-Blazquez et al. 2012;Luthy et al. 2015). Thus, a great challenge for the elderly is maintaining good health and well-being for as long as possible (Lau et al. 2019). For this reason, there is a need to identify, in a systematic way, the risk factors for the deterioration of health with age (Wang and Bishop 2019). One such factor is food insecurity, defined as the "limited or uncertain availability of nutritionally adequate and health-related food safety or uncertain capacity to obtain acceptable food in a socially acceptable way" (Anderson 1990). Food insecurity is associated with numerous harmful health effects in the elderly (Ziliak and Gundersen 2014;Bishop and Wang 2018).
There is a risk of food insecurity in households of older people (Gregório et al. 2018;Tarasuk et al. 2019). Food security in this age group is determined by, among other factors, physical functioning and physical activity (Thompson et al. 2011), the distance of shops or hypermarkets from the place of residence (Caspi et al. 2012;Ishikawa et al. 2013), socio-economic status (Dean and Sharkey 2011;Conklin et al. 2013), and social relations, social capital and social support (Davis et al. 2016;Sharifi et al. 2017). The group of older people struggling with economic difficulties is in need not only of financial support but also of emotional and information support (Huang et al. 2012;Na et al. 2019).
Evidence that social support directly reduces the risk of food insecurity appears to be inconsistent (Wang and Bishop 2019). Some previous studies have shown that social isolation contributes to food insecurity (Lee and Frongillo 2001) and poor social support (Davis et al. 2016;Sharifi et al. 2017). However, other studies do not provide evidence of such a relationship (De Marco and Thorburn 2009), or indicate a negative relationship between these variables (Anderson et al. 2014).
In households of the elderly, the risk of food insecurity is directly related to their financial resources (Wang and Bishop 2019). Their income shows a strong negative correlation with the lack of food security (Huang et al. 2010;Tarasuk 2017). The Canadian Community Health Survey -Healthy Aging 2008/2009 study showed that older people with less financial support were exposed to a nutritional risk (Ramage-Morin and Garriguet 2013). In the case of insufficient financial resources, social financial support can significantly affect food security. According to Wang and Bishop (2019), social assistance can act as a buffer for the harmful impact of reduced cash resources on food security. In Poland, community social assistance was relevant for almost 2.5 million people (6.53%) in 2016 (GUS 2017b). At that time, as many as 17% of Poles aged 60 and over benefited from financial social assistance, while 46% of people in that age group expected such assistance (CBOS 2016). Moreover, it is expected that the number of older adults who could benefit from community-based supports and services will increase in the near future (Siegler et al. 2015).
For the elderly, the family is the most important guarantee of safety and social support (White et al. 2009;You et al. 2020). Some research results suggest that family-related food support, such as help with cooking and shopping and the exchange of food between relatives, safeguards proper food consumption and significantly reduces the risk of food shortage (Fukuda et al. 2017;CBOS 2016).
Longer life expectancy means that there is a growing number of elderly people, who are at increased risk of disease and disability. Thus, food insecurity in this group requires constant monitoring, as well as focus on its perception by individuals. The relationship between the experience of food insecurity of the elderly and the use of social assistance in order to prevent the lowering of the quality of life is confirmed in previous studies (Wang and Bishop 2019;Sharifi et al. 2017). This is basically self-evident assuming that food insecurity is caused by a lack of money and the income criterion is a condition for receiving social assistance. However, apart from the quantitative dimension of food insecurity, its psychological and social dimensions are also important, especially in the context of using both social and family assistance. When assessing the importance of social assistance for elderly people experiencing food insecurity, it is important to know whether they feel the need to use such assistance. The knowledge on this subject so far is poor. Hence the purpose of this research was to determine: (1) how older people perceive their food insecurity, (2) whether older people use social financial support, and (3) what the relationship is between an older person's perception of their food insecurity and their use of financial support from social assistance and their family.

Material and methods
The survey was carried out at the end of 2018 and the beginning of 2019 in a group of people aged 65 and over. The sample was selected using the snowball method. A total of 1150 questionnaires were distributed in 16 clubs or senior circles (nine Senior Clubs in Kielce, two Senior Clubs in Częstochowa, the Association of Retirees and Pensioners in Częstochowa, the Senior Club in Sandomierz, three Rural Housewives' Circles in the Kielce powiat (district) and one in the Częstochowa powiat). People who agreed to participate in the study were asked to help in the further recruitment process by giving a questionnaire to people from their neighborhood who met the age criterion. In all, 798 questionnaires were collected, and after their verification 36 questionnaires were eliminated because they had missing answers. The criteria for inclusion in the study were that the respondent was aged 65 or above, and that each participant represented one household. The examined group consisted of 762 people, with 445 people from the Świętokrzyskie Voivodeship and 317 from the Śląskie Voivodeship. The characteristics of the study sample, including their socio-demographic characteristics, are presented in Table 1.
The questionnaire was developed by the authors. Before starting the investigation, it was checked in a group of 20 people aged 65 and over. After analyzing the responses and comments received, only minor corrections were made in the questionnaire to improve its comprehensibility.
The questionnaire included a question about food security concerns in the previous month because of limited financial resources (Worries about food availability -W_F) (In the last month, did you fear that you would run out of food in your household due to limited funds to buy it?). In addition, the respondents answered questions about whether certain situations had occurred in the previous month because of having limited funds, such as: (1) lack of basic foods (e.g. bread, butter, milk, eggs) (Change in basic food availability -C_F); (2) changes from previous meals, i.e. smaller portions or lower frequency of consumption (Change in meals -C_M); (3) skipping a meal (Change -skipping meals -C_SM). The nominal scales ('yes' or 'no') were applied to answer these questions. If the answer was 'yes', the study participant answered a question about the frequency of the situation using an ordinal scale, i.e. a 5-point scale, where 1 meant daily, 2 -several times a week, 3 -once a week, 4 -several times a month, and 5 -once a month. For the purposes of analysis, the responses were aggregated into 'often' (several times a week or more often) and 'rarely' (once a week or less often).
In addition, the respondents were asked about the use of social financial support (Social Assistance -SA) (Did you use financial assistance from a social assistance centre because of financial problems?) and about the use of financial assistance from their family (Family Assistance -FA) -(Have you obtained financial help from your immediate family (including help from a family member with whom you live in one household?). Both questions were answered on nominal scale where: 1 -there is no need, because I am satisfied with my financial situation; 2 -no, although I have financial problems; or 3 -yes, because I have financial problems.
The questionnaire also included questions about sociodemographic characteristics (gender, age, place of residence, region of residence and household composition).
Descriptive statistics, including frequency distributions and cross-tabulations, were performed. The chi-square test was used to examine the differences between categorical variables.
Multidimensional correspondence analysis (MCA) was used to identify the relationship between the categorical variables describing perceived food insecurity and the use of financial support from social assistance and the respondent's family. A Burt matrix was used in the analysis, and the cumulative percentage of inertia and the scree criterion were taken as the criteria for choosing the number of dimensions of the projection space of the variables (Stanisz 2006). Twodimensional projection was used for the graphical presentation. In order to interpret the results, a hierarchical classification of variables was performed using the Ward method (Stanisz 2006) - Fig. 1.
Multidimensional correspondence analysis (MCA) was used to identify the relationship between the variables describing perceived food insecurity (W_F; C_F; C_SM; wW_Fwithout worries about food availability; wC_F-without a change in basic food availability; wC_SM-without a change-skipping meals) and the use of financial support from social assistance (nnSA -no need for social assistance; nnSA_F -no need for social assistance despite financial problems; nSA_F -need for social assistance due to financial problems) and the respondent's family (nnFA -no need for family assistance, nnFA_F -no need for family assistance despite financial problems; nFA_F -need for family assistance due to financial problems). A Burt matrix was used in the analysis, and the cumulative percentage of inertia and the scree criterion were taken as the criteria for choosing the number of dimensions of the projection space of the variables (Stanisz 2006). The percentage of inertia for the first and  Fig. 1 Dendrogram presenting the hierarchical classification of the variables describing food security and external assistance. **W_Fworries about food availability, wW_F -without worries about food availability. C_Fchange in basic food availabilty, wC_Fwithout change in basic food availabilty. C_Mchange in meals, wC_Mwithout change in meals. C_SMchangeskipping meals, wC_SMwithout changeskipping meals. nnSA -no need for social assistance, nnSA_ F -no need for social assistance despite financial problems, nSA_F -need for social assistance due to financial problems, nnFA -no need for family assistance, nnFA_F -no need for family assistance despite financial problems, nFA_F -need for family assistance due to financial problems.
second dimensions was 55.69 and 13.13, respectively. On the scree diagram, a clear collapse of the straight line occurred at the second point, which indicates the number of projection space dimensions. The own value for the two dimensions was 0.41. Based on both criteria, a two-dimensional projection was used for graphic presentation. In order to interpret the obtained results, a hierarchical classification of variables was made using the Ward's method, which estimates the distance between sets (clusters) of variables using the analysis of variance (Stanisz 2006)- Fig. 1. The Pearson s contingency coefficient C was used as a measure of the relationship between the variables (Stanisz 2006a). The following categories of Pearson's contingency coefficient C were used to interpret the measure of the relationship between the variables: value <0.3poor relationship; 0.3 < value <0.5 -medium relationship; value >0.5 -high relationship (Stanisz 2006).

Results
The results on the relationship between using financial assistance and selected socio-demographic characteristics are shown in Table 2. More than two thirds of the respondents declared that they had no need for financial assistance from either the social services or their family. About a fifth of the respondents reported that they did not use such assistance, despite having financial problems (21.4% and 20.1% respectively). More people benefited from financial assistance from their family (12.1%) than from social assistance (7.0%). More people who declared that they had no need for financial assistance from the social services or their family lived in cities of over 100,000 residents. More people from the Śląskie Voivodeship benefited from social assistance, and more people from the Świętokrzyskie Voivodeship benefited from family assistance. More people living without partner (either alone or with family) benefited from social and family assistance than those living with partner. Gender and age did not differentiate the use of financial assistance from social or family assistance.
The differences in using financial assistance between participants living in both regions are presented in Table 3. There were no differences in the use of both social and family assistance among people living in rural and urban areas in the Świętokrzyskie Voivodeship. However, in the Śląskie Voivodeship, more inhabitants of small towns (36.7%), but also villages (26.2%) than inhabitants of large cities (16.1%) did not use social assistance despite experiencing financial problems. In this region, however, there were no differences in using family assistance between people living in rural and urban areas.
Opinions on food insecurity in participants' households are shown in Table 4. Worries about food availability (W_F) were declared by 28.7% of people. On the other hand, around 24% of the people stated that they had changed their current food consumption because of financial problems (change in basic food availability (C_F) and change in meals (C_M)). Slightly fewer people (21.5%) declared that they had made changes involving skipping meals (C_SM). Gender, age and region of residence did not affect the answers presented. By contrast, fewer people living in cities with over 100,000 residents, in comparison with those living in other areas, declared that they were worried about food availability (W_F) or about changes in basic food availability (C_F), in meals (C_M), and in skipping meals (C_SM). In addition, more people living alone or with family but not with a partner, declared that they were worried about food availability (W_F), changes in basic food availability (C_F), and changes in meals (C_M). Skipping meals (C_SM) was reported by the largest proportion of people living alone, and by the smallest living only with a partner or with a partner and family.
The relationship between the variables describing food insecurity and the use of financial assistance (social or family) is shown in Fig. 2. Using the hierarchical classification of variables, the Ward method selected two sets of categories of variables. One set defines the respondents who stated that there was a lack of food security in their households (W_F, C_F, C_M, C_SM) and that they did not use social or family financial assistance despite having financial problems (nnSA_F, nnFA_F) or did use social or family financial assistance (nSA_F, nFA_F). The second set describes those people who declared that they had food security in their households (wW_F, wC_F, wC_M, wC_SM) and that they had no need for social or family financial assistance (nnSA, nnFA).
The relationships between the use of financial assistance and opinions on food insecurity are shown in Table 5. The strongest correlation was observed between worries about food availability and reporting no need for financial social assistance. At the same time, the weakest correlations were observed between all opinions on food safety and the using of financial social assistance. Table 6 shows that only about 20% of the respondents who declared that they were concerned about the availability of food in their household, the changes in the availability of basic products, the changes in meals and skipping meals declared that they received financial assistance from social assistance because of their experience with financial problems (26.0% - 20.1%). On the other hand, slightly more than 50% of these people (51.4% -57.7%), despite having financial problems, did not benefit from financial assistance from social welfare; in particular, this applies to people who stated that they changed the meals they consumed. More people used financial assistance from their family than from social assistance if they had financial problems. More people benefited from family assistance when they declared their concerns related to food availability (32.2%) and changes in meals consumed (35.8%). About half of the respondents reporting food insecurity did not use financial assistance from their family even though they had financial problems.   The relationships between financial assistance and opinions on the frequency of experiencing food insecurity are shown in Table 7. More people experiencing at least several times a week (often) worries about food availability (W_F); changes in basic food availability (C_F), changes in meals (C_M), and changes in skipping meals (C_SM) benefited from financial social assistance (SA) compared to those who rarely experienced them. A reverse relationship was observed in the case of people declaring no need to use such assistance. In addition, more people experiencing at least several times a week (often) worries about food availability (W_F) benefited from financial family assistance (FA) compared to those who rarely experienced them. On the other hand, a reverse relationship was observed for all symptoms of food insecurity when the need for family assistance was not declared.

Discussion
The existence of financial problems has many consequences for the individual, including those related to a lack of food security, which reduces the individual's quality of life. In our study, the problem of security related to financial problems was addressed by looking at the availability of food and about how to deal with this situation through using two forms of financial assistance, i.e. from the family and social assistance.  Our results showed that a lack of food security was experienced in over a quarter of the respondents. Slightly more people declared that they had concerns about the availability of food, and fewer respondents informed about specific changes in their current consumption, which can be explained by the fact that some people use financial assistance, which protects against decreasing food availability (Li et al. 2016). Lack of food security was experienced by more people living alone or with family without partner and those from rural area, which is also confirmed in studies carried out in other populations (Freedman and Bell 2009;Huang et al. 2012).
The relationships between the variables describing the use of financial assistance and the perception of food insecurity in households allowed identifying two groups of older people. One of them were people not using financial assistance and at the same time not experiencing food insecurity, and the other were people experiencing food insecurity, and among them both those using and not using financial assistance. Feeling insecure was therefore accompanied by various reactions, namely seeking financial assistance or giving up such activities. The passivity in a situation of financial problems can be caused by many reasons. One of them may be living in the countryside, as shown in the study sample, but also in other studies (Wedgeworth et al. 2016;Xing et al. 2018). According to Bauman (2012), poor people in an era of community building become more vulnerable, and thus powerless and unhappy. The awareness that they lack adequate resources for effective functioning in social life causes social resignation in people with financial problems, and may be the reason for their passivity (Nosal 2014). Moreover, this may be the result of a lack of determination both to overcome institutional barriers and to overcome one's own limitations. Asking for financial support from a public institution or one's family may involve the need to fight with oneself (to overcome shame and humiliation, the loss of privacy, and a feeling of being indebted to others) and with bureaucratic structures (using self-help or even obtaining help) (Kaźmierczak-Kałużna 2012). Thus, people using financial assistance, especially assistance from institutions and organizations (7.0% of the study sample) have to overcome resistance to disclosing information about their situation, but above all they need information about where such help can be obtained. In the study sample, as many as one fifth of the respondents did not use social assistance despite their financial problems. It was noted that there were more people living in villages and smaller cities, or lived alone. These people require special attention from institutions offering social assistance due to the high probability of not disclosing unmet needs, which causes poor quality of their life.
Adequate organization of financial assistance by institutions established for this purpose is particularly important, because poor older people may not know about the available forms of assistance, and may also have limited opportunities because of their mobility and problems with communication via the telephone or the Internet (Huang et al. 2012). Leaving these people without financial assistance may be linked to a lack of food security and deterioration in their quality of life. Previous studies showed that people receiving financial social assistance are at an increased risk of food insecurity (Tarasuk et al. 2014;Na et al. 2019). The study by Temple et al. (2019) showed that 80% of households in Australia that benefit from financial social assistance also experienced a lack of food security. Thus, iIncreasing financial social assistance may reduce severe effects associated with food insecurity in households. For example, in Newfoundland and Labrador in Canada, food insecurity dropped significantly in 2007-2011 because of social assistance reforms (Nelson et al. 2019). It has been shown that a one-off increase in social assistance benefits leads to a significant decrease in moderate and severe food insecurity (Li et al. 2016). Social support may contribute also to a reduction in food insecurity in populations vulnerable to poverty. Strategies to increase social relationships should be encouraged in this group, to enhance their perceived social support (Interlenghi and Salles-Costa 2014).
Food insecurity caused by financial constraints tends to decrease in old age in Australia (Temple 2008); however, it is not confirmed due to statistical data in Poland (GUS 2017a) and also in the study sample. Although the relationship between poverty and food insecurity is confirmed by research (Oldewage-Theron et al. 2006;Dowler and O'Connor 2012), most poor households do not report food insecurity (Alaimo et al. 1998;Heflin et al. 2007), which was also confirmed in our study. This finding should be reflected in the development of social assistance programs, focused on financial aid, but above all on effective methods of reaching people who need help. Elderly living in poverty have limited possibilities to obtain support because of the low efficiency of the relevant institutions and the lack of public funds (Szrfenberg 2011), but on the other hand, they do not even seek such help. It is critical, therefore, to develop a comprehensive information system about the financial, physical, and social situation of older people in a country which can serve as a crucial point of reference for assessing needs, drafting programs, and making rough cost estimates. In addition, it is equally important to develop a comprehensive information system on available financial, physical and social assistance for the elderly in the country, which will be used at the community level to qualify recipients of this assistance.
More people who had financial problems benefited from family help than from social assistance, which can primarily be culturally conditioned. In Poland, caring for older parents has always been an important element of socialization, and you can still observe this behaviour among children, but also among other relatives towards older people (Trafiałek 2014). A preference for family help was also found in other countries, for example rural elderly in China have less favourable opinions of institutional eldercare and prefer home care (Chou 2010). In the study sample more people benefited from financial assistance from the family than from social assistance, and this is particularly noticeable in the rural environment, which may result from less anonymity in this area. There is therefore greater difficulty in overcoming shame and humiliation, and a sense of indebtedness to others is more evident. In the countryside, more people also declared that they were concerned about food availability and noted more changes, especially in food availability (C_F) and in the frequency of consumption and the amount of food consumed during meals (C_M). A similar effect is observed in the group of people running their own households or living with a family but with no partner. Moreover, regional differences in obtaining social assistance were observed, namely more people from the Śląskie Voivodeship than Świętokrzyskie Voivodeship received social assistance to cope with financial problems. The latter is a less industrialized region, so a more traditional perception of the family and its obligation to provide assistance to the elderly, but also less anonymity in these communities may contribute to not applying for social assistance. As there can be a contextual diversity in a country (Hadley et al. 2007), as evidenced by the differences between the two voivodeships surveyed, further research must take into account food security and its perception in a specific and local context, including the community, city and provincial / state levels.
One of the limitations of our study is disregarding the frequency of feeling food insecurity and the severity of this feeling. In addition, family and social assistance was limited to financial assistance and only to confirm the use of such assistance. However, there is no information on the amount of financial assistance. Moreover, the perception of food insecurity and the declaration of the use of family or social financial assistance were not considered in the context of the amount of financial resources and / or the level of household poverty, but were limited to self-reported financial problems. In addition, the survey is a cross-sectional one, and the causal relationship between food insecurity and the use of family and social assistance cannot be determined. Moreover, this type of survey does not allow for noticing changes over time, hence it is difficult to assess to what extent they are derived from the state of the country's economy. Because of the lack of representativeness of the study group (only two regions), the results of the study cannot be applied to the entire Polish population.
In order to prevent the deterioration of the quality of life of older people, there is a need to identify their situation by referring to both objective and subjective indicators. The latter may largely determine the use of external help by the elderly in coping with experienced food insecurity. The study showed that experiencing food insecurity is not a sufficient incentive to seek financial aid. It is therefore necessary to develop strategies aimed at effectively reaching such people with help aimed at reducing food insecurity. The relationship demonstrated between food insecurity and a lack of financial social assistance, despite financial problems, suggests the need to implement family education and state aid strategies in the field of financial assistance for the elderly. Educating families on financial assistance may be a factor that reduces the risk of food insecurity, however further research in this area is recommended. In turn, strategies for institutional social assistance, including financial assistance, for the improvement of food security for the elderly are confirmed by many studies (Tarasuk 2017;Wang and Bishop 2019), although not by all (De Marco and Thorburn 2009;Anderson et al. 2014). Therefore, such activities need to be further strengthened to prevent the development of insecurity among older people. However, when considering state aid strategies and family education in the field of financial assistance that are aimed at reducing food insecurity in the households of the elderly, sociodemographic characteristics of people should be addressed. In addition to the financial situation, place of residence of an older person should be taken into account when developing social assistance strategy. Thus, the financial and food situation of the elderly living without partner requires systematic monitoring so as to be able to counteract the emergence of a feeling of food insecurity in this group at risk of food shortage. As in the literature so far, the external approach to food insecurity (income, health effects, aid programs, etc.) prevails, and there is little research involving subjective perspective of food insecurity and using financial assistance, including experiences and perceptions of older people, this study allows to fill this gap.

Declarations
Conflict of interest The authors declared that they have no conflict of interest.
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