Food insecurity and its associated characteristics of the elderly in Seoul: analysis of the data from the Seoul Food Survey 2023

Hyunjeong Park; Youngmin Nam; Linxi Huang; Youngmi Lee; Jihyun Yoon

doi:10.4162/nrp.2025.19.1.117

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Park, Nam, Huang, Lee, and Yoon: Food insecurity and its associated characteristics of the elderly in Seoul: analysis of the data from the Seoul Food Survey 2023

Original Research

Nutrition Research and Practice 2025; 19(1): 117-130.

Published online: 31 January 2025

DOI: https://doi.org/10.4162/nrp.2025.19.1.117

Food insecurity and its associated characteristics of the elderly in Seoul: analysis of the data from the Seoul Food Survey 2023

Hyunjeong Park¹

, Youngmin Nam¹

, Linxi Huang¹

, Youngmi Lee²

, Jihyun Yoon^1,^3,⁴

¹Department of Food and Nutrition, Seoul National University, Seoul 08826, Korea.

²Department of Food and Nutrition, Myongji University, Yongin 17058, Korea.

³Research Institute of Human Ecology, Seoul National University, Seoul 08826, Korea.

⁴Institute on Aging, Seoul National University, Seoul 08826, Korea.

Corresponding Author: Jihyun Yoon. Department of Food and Nutrition, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea. Tel. +82-2-880-5706, Fax. +82-2-880-8750, hoonyoon@snu.ac.kr

Received 15 July 2024 Revised 14 January 2025 Accepted 17 January 2025

The Korean Nutrition Society and the Korean Society of Community Nutrition

https://creativecommons.org/licenses/by-nc/4.0/

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND/OBJECTIVES

This study examined the socio-demographic and dietary characteristics of the elderly in Seoul according to their food insecurity status and analyzed the characteristics associated with food insecurity.

SUBJECTS/METHODS

The data from 513 elderly individuals aged 65 or older were analyzed using the raw data from the Seoul Food Survey 2023. The subjects were classified into food-secure or food-insecure groups. The socio-demographic and dietary characteristics of each group were analyzed. Logistic regression analysis was conducted to identify the characteristics associated with food insecurity among the elderly in Seoul.

RESULTS

The proportion of the food-insecure group was 56.9% among the total elderly in Seoul. The main reasons for experiencing food insecurity were environmental (38.0%), followed by physical (37.5%) and financial (24.5%). The food-insecure group had a higher frequency of skipping breakfast and eating alone than the food-secure group while having lower dietary literacy and food environment satisfaction. Logistic regression analysis showed that the elderly living alone were approximately four times (odds ratio [OR], 3.59; 95% confidence interval [CI], 1.52–8.51) more likely to suffer food insecurity than those living with others. Higher digital food literacy (OR, 0.63; 95% CI, 0.41–0.97) and food environment satisfaction (OR, 0.38; 95% CI, 0.20–0.74) were associated with a lower likelihood of food insecurity.

CONCLUSION

These results suggest that policies aimed at improving food security for the elderly in Seoul should prioritize those living alone. Educational programs designed to enhance the ability to purchase online food, use self-service kiosks in restaurants, and use food delivery apps would effectively decrease food insecurity among the elderly in Seoul. Furthermore, policies aimed at improving the food environment may also help reduce food insecurity among this population.

Keywords: Food security, Seoul, aged, logistic models

INTRODUCTION

The aging population in Korea is rapidly increasing as the baby boomer generation enters old age. According to Statistics Korea, the population aged 65 or older exceeded nine million as of 2024, accounting for 19.2% of the population. By 2025, it is expected to surpass 20%, classifying Korea as a super-aged society [1]. Among Korea's 17 metropolitan local governments, Seoul has the second-largest elderly population, after Gyeonggi Province [2]. As of 2024, the population aged 65 or older in Seoul was approximately 1.76 million, representing an increase of approximately half a million compared to 2014.

The elderly are more vulnerable to poor dietary habits than other age groups because of physiological decline and the cessation of economic activity, resulting in lower food security. According to the Food and Agriculture Organization of the United Nations definition [3], “Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life.” Food insecurity, the opposite of food security, refers to the lack of access to adequate food. Previous studies reported that deteriorating health status, low income levels, and social isolation among the elderly are associated with food insecurity [4].

Studies have shown that the elderly experiencing food insecurity have poor health and inadequate nutrient intake [5 6]. In addition, they experience higher levels of stress and depression [7 8]. These findings suggest that food insecurity is associated with the physical and mental health of the elderly. Policy support to ensure food security for food-insecure elderly individuals or those at high risk of food insecurity is necessary because food insecurity is ultimately related to a decline in the quality of life of the elderly.

Regional factors must be considered when assessing food security for the elderly because the dietary habits among this population vary according to the residential area [9 10]. The Survey on the Welfare and Living Conditions of the Elderly in Seoul 2022 revealed a high proportion of dietary deficiencies among individuals aged 65 or older, suggesting that the elderly in Seoul are more vulnerable regarding dietary habits than other aspects of life [11]. Therefore, continuous attention and policy support are required to ensure food security for the elderly in Seoul.

Identifying the characteristics of those at high risk of food insecurity is essential to developing effective policies to ensure food security for the elderly. Food insecurity among the elderly is associated with socio-demographic characteristics such as gender, age, household type, and income level [12 13]. Dietary habits (e.g., the number of meals per day, frequency of eating alone [14 15], and the food environment [16]) are related to food insecurity. Moreover, with the advances in digital technology, there is increasing interest in whether digital tools, such as food delivery apps, are related to food insecurity among the elderly [17].

Although many studies have been conducted on food insecurity among the elderly, research explicitly focusing on the elderly in Seoul is limited. Therefore, this study examined the socio-demographic and dietary characteristics of the elderly in Seoul according to their food insecurity status and analyzed the characteristics associated with food insecurity.

SUBJECTS AND METHODS

Data source

This study analyzed the raw data from the Seoul Food Survey 2023 (Statistics Korea National Approved Statistics No. 201017, 2023 Korean National Institute for Bioethics Policy 2023 Approval No. P01-202309-01-004). The Seoul Food Survey has been conducted annually since 2020 to assess the dietary habits and related perceptions of Seoul residents aged 18 and above. The survey was conducted by a survey company between 8 September and 13 October 2023. Five hundred and thirty-three elderly individuals aged 65 or older were analyzed among 3,594 respondents. Fifteen elderly individuals who answered that their food situation was insufficient in quantity or quality in the past year for reasons such as ‘being on a diet’ or ‘other’ in the food security questionnaire were excluded. In addition, this study excluded five more people who answered ‘no purchase experience’ in the food environment satisfaction questionnaire, resulting in a final sample of 513 elderly individuals for analysis.

Measures

Food insecurity

The Seoul Food Survey 2023 measures food security with a similar question to the single-item food security assessment used in the Korea National Health and Nutrition Examination Survey (KNHANES). The question, “Which of the following statements best describes your dietary situation over the past year?” offered four response options: “1) Enough and various kinds of food,” “2) Enough but not always various kinds of food,” “3) Sometimes not enough to eat,” and “4) Often not enough to eat.” Individuals who reported “Enough and various kinds of food” were classified as the food-secure group. Individuals who reported “Enough but not always with various kinds of food,” “Sometimes not enough to eat,” or “Often not enough to eat” were all classified as the food-insecure group.

Reasons for experiencing food insecurity

The reasons for experiencing food insecurity were categorized into financial, environmental, and physical factors. The financial reasons included “insufficient money to purchase food.” The constraints on the resources related to food purchasing and preparation were classified as environmental factors, while the factors related to diseases, health issues, or individual capabilities were classified as physical factors [18]. Environmental reasons encompassed “insufficient time to purchase or prepare food,” “desired types of food are not available nearby,” and “long distances to grocery stores or inconvenient transportation.” The physical reasons included “dietary management for illnesses,” “lack of cooking skills,” “inability to cook due to health reasons,” and “limited mobility to go to grocery stores.”

Socio-demographic and dietary characteristics

The socio-demographic characteristics included gender, age group, region, household type, educational level, occupation, and monthly household income. The dietary characteristics included the frequency of breakfasts, frequency of eating alone, dietary literacy, digital food literacy, and food environment satisfaction. The frequency of breakfasts was assessed with the question, “How many times did you have breakfast in the past week?” The responses were categorized into 0–2 times/week, 3–4 times/week, and 5–7 times/week, and the average number of breakfasts per week was calculated. The frequency of eating alone was assessed with the question, “How many times did you eat breakfast, lunch, and dinner alone in the past week?” The total number of times eating alone for each meal was summed to calculate the average weekly frequency of eating alone. The average weekly frequency of eating alone was categorized as not eating alone, 1–7 times/week, 8–14 times/week, and 15–21 times/week. In logistic regression analysis, the frequency of breakfasts and eating alone were classified based on the average number of times per week. The participants were then divided into high-frequency and low-frequency groups for the analysis.

Dietary literacy included health (14 items), enjoyment (8 items), and value (11 items) components. The health literacy measured the following: knowledge and skills related to nutrition and food safety; enjoyment literacy assessed relationships related to food culture and cuisine; and value literacy evaluated knowledge, attitudes, perceptions, and practices related to the social and ecological values associated with food. Each literacy score was standardized to a maximum score of 100. The overall dietary literacy was calculated by averaging these three standardized scores. The digital food literacy was calculated as the average value of the scores of three items measured on a five-point Likert scale: competence in online food purchases, use of self-service kiosks in restaurants, and use of food delivery apps. This measurement tool showed construct validity through factor analysis, and its reliability was confirmed as appropriate, with a Cronbach’s α of 0.88. Food environment satisfaction was calculated as the mean of five items measured on a five-point Likert scale: availability, accessibility, affordability, convenience, and acceptability of the local food environment.

Data analysis

The Seoul Food Survey 2023 was conducted using the stratified cluster sampling method. Hence, a complex sample analysis was performed, reflecting the weights, stratification variables, and cluster variables. Rao–Scott χ² analysis was used to test the significance of differences in the distributions of categorical variables and compare the socio-demographic and dietary characteristics according to food insecurity. The general linear model was used to test the significance of the mean differences for continuous variables.

Logistic regression analysis was conducted to identify the characteristics associated with food insecurity. The dependent variable was food insecurity status, with the food-secure group assigned to zero and the food-insecure group assigned to one. Five socio-demographic characteristics (gender, age group, household type, occupation, and monthly household income) and five dietary characteristics (frequency of breakfasts, frequency of eating alone, dietary literacy, digital food literacy, and food environment satisfaction) were included as the independent variables.

The weighted percentage and SE were presented for the categorical variables, while the weighted mean and SE were presented for the continuous variables. The logistic regression analysis results are presented with odds ratios (ORs) and 95% confidence intervals (CIs). Data analysis was conducted using SPSS 25.0 (Statistical Package for Social Sciences, SPSS Inc., Armonk, NY, USA), and all significance tests were performed at the α = 0.05 level.

RESULTS

General characteristics of the subjects

Table 1 lists the general characteristics of the subjects. The proportions of men and women were 42.9% and 57.1%, respectively, indicating a slightly higher percentage of women. More than 87% of the subjects were aged between 65 and 74 yrs old. Approximately one-third of the subjects lived in the Southwest area (32.2%), followed by the Northeast (30.6%) and Southeast areas (21.2%). Those living with others (72.0%) were more than 2.5 times more common than those living alone (28.0%). More than 50% of the elderly in Seoul had an education level of middle school graduation or less. More than half (53.6%) of the elderly subjects were employed.

Table 1

General characteristics of the subjects

Characteristics		Subjects (n = 513)	Elderly in Seoul¹⁾
Gender
	Men	42.9 (4.0)	44.3
	Women	57.1 (4.0)	55.7
Age group (yrs)
	65–74	87.7 (2.5)	59.2
	≥ 75	12.3 (2.5)	40.8
Region²⁾
	Downtown area	4.4 (0.9)	5.4
	Northeast area	30.6 (3.5)	32.7
	Northwest area	11.7 (1.9)	12.0
	Southwest area	32.2 (4.4)	30.1
	Southeast area	21.2 (3.3)	19.8
Household type
	Living alone	28.0 (3.7)	25.3
	Living with others	72.0 (3.7)	74.7
Education level
	Middle school graduation or less	54.8 (4.3)
	High school graduation	36.8 (3.6)
	College graduation or higher	8.4 (1.3)
Occupation
	Employed	53.6 (4.4)
	Others (housewife, unemployed, etc.)	46.4 (4.4)
Monthly household income (10,000 KRW)
	< 200	35.8 (4.0)
	200 to < 350	34.5 (3.6)
	350 to < 500	13.5 (2.2)
	≥ 500	16.3 (3.3)

Values are presented as weighted % (SE) or %. All weighted models accounted for the complex sampling design of the Seoul Food Survey 2023.

¹⁾The following percentages are presented in order to facilitate comparison of the similarity of the socio-demographic characteristics of the subjects of this study with the national statistics. The proportions for gender, age, and region were calculated in relation to the total population aged 65 yrs or older in Seoul, based on the Seoul Resident Registration Population Statistics of Seoul Metropolitan City as of 2023 (Seoul Metropolitan City, 2023a). For household types, the proportions were calculated in relation to the total population aged 65 yrs or older in Seoul, based on the statistics of the status of elderly living alone in Seoul as of 2023 (Seoul Metropolitan City, 2024).

²⁾Downtown area: Jongno-gu, Jung-gu, Yongsan-gu; Northeast area: Seongdong-gu, Gwangjin-gu, Dongdaemun-gu, Jungnang-gu, Seongbuk-gu, Gangbuk-gu, Dobong-gu, Nowon-gu; Northwest area: Eunpyeong-gu, Seodaemun-gu, Mapo-gu; Southwest area: Gangseo-gu, Yangcheon-gu, Yeongdeungpo-gu, Guro-gu, Geumcheon-gu, Gwanak-gu, Dongjak-gu; Southeast area: Seocho-gu, Gangnam-gu, Songpa-gu, Gangdong-gu.

A comparison with the socio-demographic statistics of Seoul residents aged 65 or older based on the Seoul Resident Registration Population Statistics 2023 [19] revealed similar gender and region proportions. On the other hand, the proportion of individuals aged 75 and older in the survey (12.3%) was more than three times lower than the proportion in the Seoul population (40.8%), indicating some disparity in the age group distribution. The proportion of households living alone in this study (28.0%) was comparable to the figure documented in the 2023 Statistics of the Elderly Living Alone in Seoul (25.3%) [20].

Food insecurity

Table 2 lists the status of food insecurity among the elderly in Seoul. The proportion of the food-secure group who responded that they had “Enough and various kinds of food” to the single-item food security evaluation question was 43.1%. The proportion of those who answered “Enough but not always various kinds of food” was 37.3%, while 16.3% responded with “Sometimes not enough to eat,” and 3.3% indicated “Often not enough to eat.” The food-insecure group accounted for 56.9%.

Table 2

Food insecurity among the elderly in Seoul

Items		Total (n = 513)
Food secure¹⁾		43.1 (4.1)
	Enough and various kinds of food	43.1 (4.1)
Food insecure²⁾		56.9 (4.1)
	Enough but not always various kinds of food	37.3 (4.6)
	Sometimes not enough to eat	16.3 (3.1)
	Often not enough to eat	3.3 (1.3)

Values are presented as weighted % (SE). All weighted models accounted for the complex sampling design of the Seoul Food Survey 2023.

Question: Which of the following statements best describes your dietary situation over the past year?

¹⁾The group that responded that they could eat enough and various kinds of food.

²⁾The group that responded that they could eat enough but not always various kinds of food, and those who responded that they sometimes or often did not have enough food to eat.

Reasons for experiencing food insecurity

Table 3 presents the reasons for experiencing food insecurity among the elderly in Seoul. The most common reason for food insecurity among the entire elderly population of Seoul was “Insufficient money to purchase food,” reported by 24.5% of subjects. This was followed by “Insufficient time to purchase or prepare food” at 21.6% and “Desired types of food are not available nearby” at 14.9%. In addition, more than 10% of subjects each cited “Dietary management for illnesses” and “Lack of cooking skills” as the reasons for food insecurity. These findings indicate that various factors contributed to food insecurity among the elderly in Seoul. The reasons for food insecurity were categorized into financial, environmental, and physical factors. Similar proportions of subjects experienced food insecurity for environmental (38.0%) and physical (37.5%) reasons, while financial reasons accounted for a slightly lower proportion (24.5%).

Table 3

Main reasons for food insecurity among the elderly in Seoul

Items		Total (n = 247)¹⁾	Food-insecure group ① (enough but not various) (n = 149)²⁾	Food-insecure group ② (not enough to eat) (n = 98)³⁾	P-value⁴⁾
Financial reason
	Insufficient money to purchase food	24.5 (5.1)	17.1 (5.7)	38.5 (9.2)
Environmental reason
	Insufficient time to purchase or prepare food	21.6 (4.2)	28.7 (6.3)	8.1 (3.0)
	Desired types of food are not available nearby	14.9 (4.9)	15.5 (6.7)	13.7 (6.0)
	Long distances to grocery stores or inconvenient transportation	1.5 (0.5)	1.3 (0.6)	1.7 (0.8)
Physical reason
	Dietary management for illnesses	12.2 (2.7)	12.3 (3.4)	12.0 (4.3)
	Lack of cooking skills	10.5 (4.6)	15.4 (6.6)	1.3 (0.8)
	Inability to cook due to health reasons	9.7 (3.3)	7.7 (3.3)	13.6 (7.4)
	Limited mobility to go to grocery stores	5.1 (2.2)	2.0 (0.9)	11.0 (6.0)
Financial reason		24.5 (5.1)	17.1 (5.7)	38.5 (9.2)	< 0.001
Environmental reason		38.0 (5.4)	45.5 (7.2)	23.6 (6.3)
Physical reason		37.5 (5.1)	37.4 (6.4)	37.9 (8.7)

Values are presented as weighted % (SE). All weighted models accounted for the complex sampling design of the Seoul Food Survey 2023.

¹⁾Subjects who reported that they could eat enough but not always various kinds of food, as well as those who reported that they sometimes or often did not have enough food to eat.

²⁾Subjects who reported that they could eat enough but not always various kinds of food.

³⁾Subjects who reported that they sometimes or often did not have enough food to eat.

⁴⁾By Rao-Scott χ² test.

The reasons for experiencing food insecurity were examined by dividing the food-insecure group into two subgroups. The food-insecure group ① comprised individuals who reported they could eat enough but not always various kinds of food. The food-insecure group ② consisted of individuals who reported that they sometimes or often did not have enough food. The results showed that environmental reasons accounted for the highest proportion (45.5%) in the food-insecure group ①. On the other hand, financial reasons were the most common in the food-insecure group ②, accounting for 38.5%. Based on these results, financial support should be prioritized for elderly individuals experiencing quantitative food insecurity.

Socio-demographic and dietary characteristics according to food insecurity

Table 4 lists the socio-demographic characteristics of the elderly in Seoul, divided into food-secure or food-insecure groups. Significant differences were observed in the distribution of age (P = 0.033), region (P = 0.002), household type (P < 0.001), educational level (P = 0.001), and monthly household income (P = 0.003) between the two groups. The proportion of individuals aged 75 and older was more than twice as high in the food-insecure group (16.1%) compared to the food-secure group (7.4%). The residents in the food-secure group included 20.9% from the Northwest area, while only 4.7% of the food-insecure group lived there. Elderly individuals living alone were more than 2.5 times more common in the food-insecure group (38.0%) than the food-secure group (14.8%). Approximately 65% of individuals in the food-insecure group had an education level of middle school graduation or less compared to 42.1% in the food-secure group. Households with a monthly income of less than two million KRW comprised approximately half (48.2%) of the food-insecure group but only approximately 20% of the food-secure group. Hence, the food-insecure group had a higher proportion of low-income households.

Table 4

Socio-demographic characteristics of food-secure and food-insecure groups among the elderly in Seoul

Characteristics		Total (n = 513)	Food-secure group¹⁾ (n = 266)	Food-insecure group²⁾ (n = 247)	P-value³⁾
Gender					0.666
	Men	42.9 (4.0)	45.0 (5.1)	41.4 (6.3)
	Women	57.1 (4.0)	55.0 (5.1)	58.6 (6.3)
Age group (yrs)					0.033
	65–74	87.7 (2.5)	92.6 (2.1)	83.9 (3.9)
	≥ 75	12.3 (2.5)	7.4 (2.1)	16.1 (3.9)
Region⁴⁾					0.002
	Downtown area	4.4 (0.9)	4.0 (1.5)	4.6 (1.0)
	Northeast area	30.6 (3.5)	21.3 (2.8)	37.7 (6.0)
	Northwest area	11.7 (1.9)	20.9 (3.9)	4.7 (1.7)
	Southwest area	32.2 (4.4)	28.3 (4.5)	35.2 (6.8)
	Southeast area	21.2 (3.3)	25.5 (5.9)	17.9 (3.7)
Household type					< 0.001
	Living alone	28.0 (3.7)	14.8 (3.1)	38.0 (5.8)
	Living with others	72.0 (3.7)	85.2 (3.1)	62.0 (5.8)
Education level					0.001
	Middle school graduation or less	54.8 (4.3)	42.1 (6.3)	64.4 (5.0)
	High school graduation	36.8 (3.6)	50.2 (5.7)	26.7 (4.1)
	College graduation or higher	8.4 (1.3)	7.8 (1.7)	8.9 (1.9)
Occupation					0.107
	Employed	53.6 (4.4)	61.1 (5.6)	48.0 (6.2)
	Others (housewife, unemployed, etc.)	46.4 (4.4)	38.9 (5.6)	52.0 (6.2)
Monthly household income (10,000 KRW)					0.003
	< 200	35.8 (4.0)	19.4 (4.5)	48.2 (6.0)
	200 to < 350	34.5 (3.6)	39.9 (5.6)	30.4 (4.8)
	350 to < 500	13.5 (2.2)	19.1 (3.8)	9.2 (2.4)
	≥ 500	16.3 (3.3)	21.6 (4.4)	12.2 (4.7)

Values are presented as weighted % (SE). All weighted models accounted for the complex sampling design of the Seoul Food Survey 2023.

¹⁾Subjects who reported that they could eat enough and various kinds of food.

²⁾Subjects who reported that they could eat enough but not always various kinds of food, as well as those who reported that they sometimes or often did not have enough food to eat.

³⁾By Rao-Scott χ² test.

⁴⁾Downtown area: Jongno-gu, Jung-gu, Yongsan-gu; Northeast area: Seongdong-gu, Gwangjin-gu, Dongdaemun-gu, Jungnang-gu, Seongbuk-gu, Gangbuk-gu, Dobong-gu, Nowon-gu; Northwest area: Eunpyeong-gu, Seodaemun-gu, Mapo-gu; Southwest area: Gangseo-gu, Yangcheon-gu, Yeongdeungpo-gu, Guro-gu, Geumcheon-gu, Gwanak-gu, Dongjak-gu; Southeast area: Seocho-gu, Gangnam-gu, Songpa-gu, Gangdong-gu.

Table 5 compares the dietary characteristics of the elderly in Seoul according to food insecurity. A significant difference was observed when the breakfast frequency was categorized as 0–2 times, 3–4 times, and 5–7 times per week (P = 0.031). Subjects who had breakfast 5–7 times per week were slightly more common in the food-insecure group (74.7%) than in the food-secure group (66.8%). Those who had breakfast 0–2 times per week were also more prevalent in the food-insecure group (13.7%) than in the food-secure group (8.0%).

Table 5

Dietary characteristics of food-secure and food-insecure groups among the elderly in Seoul

Items		Total (n = 513)	Food-secure group¹⁾ (n = 266)	Food-insecure group²⁾ (n = 247)	P-value³⁾
Frequency of breakfasts
	0–2 times/wk	11.2 (2.2)	8.0 (2.8)	13.7 (3.3)	0.031
	3–4 times/wk	17.5 (3.1)	25.2 (5.8)	11.6 (2.7)
	5–7 times/wk	71.3 (3.5)	66.8 (5.9)	74.7 (4.0)
	Average	5.48 ± 0.2	5.47 ± 0.2	5.50 ± 0.2	0.925
Frequency of eating alone
	Not eat alone	30.0 (4.6)	31.1 (5.1)	29.1 (6.9)	0.001
	1–7 times/wk	36.4 (3.8)	42.0 (5.3)	32.2 (5.2)
	8–14 times/wk	19.4 (3.2)	24.8 (5.9)	15.4 (3.2)
	15–21 times/wk	14.2 (2.9)	2.2 (0.9)	23.3 (4.8)
	Average	6.10 ± 0.6	4.99 ± 0.6	7.21 ± 1.0	0.041
Dietary literacy⁴⁾		59.93 ± 0.8	61.07 ± 1.0	58.79 ± 1.1	0.126
	Health	61.02 ± 1.0	62.23 ± 1.2	59.81 ± 1.6	0.218
	Enjoyment	57.28 ± 1.0	57.81 ± 1.1	56.74 ± 1.3	0.513
	Value	61.49 ± 0.8	63.18 ± 1.1	59.81 ± 0.9	0.018
Digital food literacy⁵⁾		2.47 ± 0.1	2.71 ± 0.1	2.22 ± 0.1	0.002
	Online food purchase	2.41 ± 0.1	2.68 ± 0.1	2.15 ± 0.1	0.003
	Use of self-service kiosks in restaurants	2.73 ± 0.1	2.93 ± 0.1	2.52 ± 0.1	0.015
	Use of food delivery apps	2.26 ± 0.1	2.52 ± 0.1	2.00 ± 0.1	0.002
Food environment satisfaction⁵⁾		3.74 ± 0.0	3.85 ± 0.0	3.63 ± 0.1	0.004
	Availability	3.77 ± 0.1	3.88 ± 0.1	3.66 ± 0.1	0.078
	Accessibility	3.74 ± 0.1	3.85 ± 0.1	3.63 ± 0.1	0.051
	Affordability	3.59 ± 0.1	3.74 ± 0.1	3.44 ± 0.1	0.005
	Convenience	3.74 ± 0.0	3.83 ± 0.1	3.66 ± 0.1	0.090
	Acceptability	3.87 ± 0.0	3.96 ± 0.0	3.77 ± 0.1	0.027

Values are presented as weighted % (SE) or weighted mean ± SE. All weighted models accounted for the complex sampling design of the Seoul Food Survey 2023.

¹⁾Subjects who reported that they could eat enough and various kinds of food.

²⁾Subjects who reported that they could eat enough but not always various kinds of food, as well as those who reported that they sometimes or often did not have enough food to eat.

³⁾By Rao-Scott χ² test or general linear model.

⁴⁾Out of 100 points.

⁵⁾Out of five points using a five-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = neither agree nor disagree; 4 = agree; 5 = strongly agree).

A comparison of the average frequency of eating alone per week showed that the food-insecure group had a significantly higher average (7.21 times) than the food-secure group (4.99 times) (P = 0.041). In addition, the distribution of the frequency of eating alone per week, categorized as 1–7 times, 8–14 times, and 15–21 times, also showed a significant difference between the two groups (P = 0.001). The proportion of those who ate alone 15–21 times per week was more than ten times higher in the food-insecure group (23.3%) than in the food-secure group (2.2%).

A significant difference in the value component of dietary literacy was observed between the two groups (P = 0.018). The food-secure group scored 63.18 points, while the food-insecure group scored 59.81 points. This suggests that the knowledge, attitudes, perceptions, and practices related to the social and ecological values of food were higher in the food-secure group. No significant differences in overall dietary literacy and the health and enjoyment part of dietary literacy were observed between the two groups.

Digital food literacy was significantly lower in the food-insecure group (2.22 points) than in the food-secure group (2.71 points) (P = 0.002). All three components of digital food literacy—online food purchase ability (P = 0.003), use of self-service kiosks in restaurants (P = 0.015), and use of food delivery apps (P = 0.002)—were significantly lower in the food-insecure group than in the food -secure group. Among these, the ability to use food delivery apps scored the lowest (2.00 points) in the food-insecure group.

Food environment satisfaction also significantly differed between the food-secure and food-insecure groups (P = 0.004). The food environment satisfaction was lower in the food-insecure group (3.63 points) than in the food-secure group (3.85 points). Among the five components of food environment satisfaction, affordability (P = 0.005) and acceptability (P = 0.027) were lower in the food-insecure group than in the food-secure group. The satisfaction score for affordability was the lowest (3.44 points) among the five components in the food-insecure group and showed the largest difference between the two groups. For acceptability, the food-insecure group scored 3.77 points, which was the highest among the five components but still significantly lower than the food-secure group (3.96 points).

Characteristics associated with food insecurity

Table 6 presents the results of logistic regression analysis. The household type was strongly associated with food insecurity among the elderly in Seoul based on the socio-demographic characteristics. Digital food literacy and food environment satisfaction were associated with food insecurity among the dietary characteristics. Specifically, elderly individuals living alone were four times (OR, 3.59; 95% CI, 1.52–8.51) more likely to have food insecurity than those living with others. In terms of dietary characteristics, higher digital food literacy (OR, 0.63; 95% CI, 0.41–0.97) or higher food environment satisfaction (OR, 0.38; 95% CI, 0.20–0.74) were associated with a lower likelihood of food insecurity among the elderly in Seoul.

Table 6

Socio-demographic and dietary characteristics associated with food insecurity among the elderly in Seoul

Characteristics		n	OR (95% CI)¹⁾	P-value
Gender				0.342
	Women (ref.)	273	1
	Men	240	1.50 (0.65–3.43)
Age group (yrs)				0.729
	65–74 (ref.)	464	1
	≥ 75	49	1.16 (0.49–2.75)
Household type				0.004
	Living with others (ref.)	388	1
	Living alone	125	3.59 (1.52–8.51)
Occupation				0.513
	Employed (ref.)	303	1
	Others (housewife, unemployed, etc.)	210	1.27 (0.62–2.58)
Monthly household income (10,000 KRW)
	< 200	110	1.48 (0.59–3.73)	0.292
	200 to < 350 (ref.)	211	1
	350 to < 500	87	0.82 (0.33–1.99)	0.673
	≥ 500	105	0.80 (0.29–2.22)	0.980
Frequency of breakfasts per week²⁾				0.466
	High-frequency group	296	1
	Low-frequency group	194	0.77 (0.38–1.55)
Frequency of eating alone per week²⁾				0.647
	Low-frequency group	319	1
	High-frequency group	194	0.83 (0.38–1.84)
Dietary literacy³⁾		513	1.00 (0.96–1.05)	0.946
Digital food literacy⁴⁾		513	0.63 (0.41–0.97)	0.034
Food environment satisfaction⁵⁾		513	0.38 (0.20–0.74)	0.004

Model statistics: Nagelkerke R² = 0.244, Wald F = 4.059 (P < 0.001).

OR, odds ratio; CI, confidence interval.

¹⁾Logistic regression analysis was conducted with food security status (food secure = 0, food insecure = 1) as the dependent variable. The independent variables included gender, age group, household type, occupation, monthly household income, frequency of breakfasts per week, frequency of eating alone per week, dietary literacy, digital food literacy, and food environment satisfaction.

²⁾Participants below the average frequency were classified as the low-frequency group, and those at or above the average frequency were classified as the high-frequency group.

³⁾Calculated as the average score of the three dietary literacy items: health, enjoyment, and value (out of 100 points).

⁴⁾Calculated as the average score of the three digital food literacy items: online food purchasing, use of self-service kiosk, and use of food delivery apps (out of five points using a five-point Likert scale).

⁵⁾Calculated as the average score of the five food environment satisfaction items: availability, accessibility, affordability, convenience, and acceptability (out of five points using a five-point Likert scale).

DISCUSSION

This study examined the socio-demographic and dietary characteristics associated with food insecurity among 513 elderly individuals aged 65 or older from the Seoul Food Survey 2023. Individuals who reported they had enough food but insufficient variety and those who reported sometimes or often not having enough food were all classified as the food-insecure group. According to this criterion, 56.9% of the elderly in Seoul were classified as the food-insecure group. As of May 2024, the elderly population in Seoul was approximately 1.77 million [2], indicating that approximately 1 million were food insecure.

A previous study analyzed the food security of older adults aged 65 or older in South Korea using a single-item food security assessment from the KNHNES 2016–2018 [14]. The proportion of the food-insecure group was 49.1% for men and 53.6% for women. Nevertheless, some differences existed in how food insecurity is defined between KNHANES and this study. KNHANES examines food insecurity at the household level by asking the question to only one person in the household who is mainly responsible for purchasing food [21]. In contrast, the Seoul Food Survey 2023 examines food insecurity at the individual level. Another difference is that KNHANES measures food insecurity for financial reasons [21]. The Seoul Food Survey measures it for various reasons and includes an additional question to investigate the reasons for experiencing food insecurity. Households were classified as food secure if they had enough food and sufficient variety or had access to enough food but not always the required variety [22]. In the present study, however, only individuals who reported having enough food and sufficient variety were classified as the food-secure group.

According to the in-depth analysis report of the Seoul Food Survey 2023 [18], the proportion of Seoul citizens with enough food and diverse diets has decreased steadily over the past three years. This trend was attributed to the significant increase in the proportion of individuals who had enough food in quantity but insufficient diversity. These findings suggest that dietary diversity should be emphasized among Seoul citizens. In addition, this study classified individuals who did not eat various kinds of food as the food-insecure group because a lack of food diversity contributes to nutritional deficiencies and poor health [23 24]. Although the definition and method used in that study differ from the National research, it underscores that food insecurity was relatively common. Therefore, addressing food insecurity and reducing the concerns of those affected remains a critical and challenging task in South Korea.

Logistic regression analysis showed that the household type (living alone/living with others), digital food literacy, and food environment satisfaction were associated with food insecurity among the elderly in Seoul. The elderly living alone were more likely to be food-insecure than those living with others. Several studies reported a higher proportion of food insecurity among the elderly living alone than those living with others [12 13 25 26]. The overall poor nutrient intake, lower diet quality, and lower income levels among the elderly living alone were likely associated with food insecurity [27].

The KNHANES 2017–2021 data showed that the elderly living alone had a 19% lower proportion of practicing healthy dietary habits than those living with others [28]. The Consumer Behavior Survey for Food 2016–2021 found that the elderly living alone had more irregular meal patterns and were twice as likely to skip breakfast than those living with others [29]. In addition, social isolation has been reported to be associated with food insecurity [4]. Hence, an isolated environment may be a major factor in exacerbating food insecurity among the elderly living alone.

Among the dietary characteristics, higher digital food literacy was associated with a lower likelihood of being in the food-insecure group among the elderly in Seoul. Digital food literacy reflects the ability to order or purchase necessary food items or meals using digital technology. Digital food literacy is particularly low among the elderly compared to other age groups [18]. In this study, the digital food literacy of the elderly in Seoul was 2.47 out of five points, with the food-insecure group scoring significantly lower at 2.22. These results suggest that the elderly in Seoul have difficulties with online food purchases, the use of self-service kiosks in restaurants, and food delivery apps.

According to Table 4, a higher proportion of individuals aged 75 or older and those with an education level of middle school or less were found in the food-insecure group compared to the food-secure group. This suggests that this may have impacted their digital food literacy. In addition, the food-insecure group had a higher proportion of elderly individuals living alone. Although most people receive assistance from family members when facing difficulties with digital devices or services [30], elderly individuals living alone are socially isolated, limiting their ability to receive such help. They are also more vulnerable to accessing information about government support, such as digital education programs. Accordingly, digital food literacy may be associated with food insecurity among elderly individuals living alone.

The Survey on Digital Competence of Seoul Citizens 2021 reported that the ability to order delivery food among the elderly aged 55 and older was 37.6 out of 100, more than twice as low as adults aged 19–54 yrs (77.4) [31]. Furthermore, the reported experience and ability to use kiosks were lower among the elderly aged 65 yrs or older in Seoul [31]. The most common reason for not using kiosks among the elderly was “not knowing how to use them or finding them difficult” [31]. The same study found that approximately 70% of the elderly were willing to use kiosks if they received education on using them or if the devices and interfaces were easier and faster to use. The use of food delivery apps and kiosks can help improve the food consumption of the elderly. Therefore, providing digital food literacy education and developing elderly-friendly digital food environments is necessary in a rapidly changing digital society.

Food environment satisfaction is associated with food insecurity among the elderly in Seoul. Specifically, these results suggest that higher satisfaction with the food environment was associated with a lower likelihood of experiencing food insecurity. Previous research has highlighted the importance of access to grocery stores in ensuring food availability and the nutritional needs of older adults [32]. A survey-based study of single elderly individuals aged 65 and older in rural areas of South Korea showed that inadequate community food environments and limited household food resources are significant risk factors for food insecurity. These results show that those facing challenges in food accessibility were approximately 14 times more likely to experience food insecurity [33]. Another study also reported that among the elderly, a negative perception of the food store environment within their community can affect food insecurity among urban seniors [34 35]. A previous study showed that the food consumption environment, which can affect food accessibility, also influences food insecurity [16]. This indicates that the community food environment that can affect food consumption may play an important role in the food insecurity of the elderly. Hence, efforts are needed to improve the food environment for the elderly in regions of Seoul.

The proportion of the food-insecure group was highest in the Northeast area in this study. The Northeast area has the highest elderly population in Seoul. This area also has the highest proportion of elderly living alone and with a low income among the five regions [20]. A previous study [36] reported that accessibility to grocery stores was relatively low in areas densely populated with low-income elderly people. The districts of Gangbuk-gu, Nowon-gu, and Seongbuk-gu, which belong to the Northeast area, were evaluated as potential food desert risk areas. The dense elderly population, who are low-income and generally vulnerable in the food environment in the Northeast area, likely affected the food insecurity. This study found that food environment satisfaction in the Northeast area was lower than in the Northwest and Southeast areas, where food insecurity is less prevalent. Hence, the food environment in the Northeast area may be more vulnerable. Future research should closely examine the dietary environment of the Northeast.

This study is significant because it provides an in-depth understanding of the characteristics associated with food insecurity among the elderly in Seoul at a time of increasing aging. In addition, it offers a multi-faceted analysis of the food insecurity experienced by the elderly by investigating food insecurity arising from environmental, physical, and financial reasons. This study examined the relevance of various aspects of food insecurity, including dietary literacy, food digital literacy, and food environment satisfaction. On the other hand, the subjects’ specific nutrient and food intakes were not measured, so this study could not determine the actual differences in nutrient intake among the elderly based on food insecurity.

In summary, the proportion of food insecurity among the elderly in Seoul was more than half. They experienced food insecurity for various environmental, physical, and financial reasons. The elderly living alone were more likely to be food insecure, and lower digital food literacy or food environment satisfaction was associated with a higher likelihood of being food insecure. Based on these results, the elderly living alone should be prioritized as key targets for support measures to ensure food security among the elderly in Seoul. Education to strengthen their digital food literacy and establish an elderly-friendly digital food environment is also necessary. Further research is needed to identify and improve the vulnerabilities in the food environments of regions with high proportions of food-insecure groups. These study results provide foundational data for establishing dietary policies for the elderly in Seoul and are important references for addressing food insecurity issues in an aging society.

Notes

Conflict of Interest: The authors declare no potential conflicts of interests.

Author Contributions:

Conceptualization: Park H, Yoon J.
Formal analysis: Park H.
Investigation: Park H.
Supervision: Yoon J.
Writing - original draft: Park H.
Writing - review & editing: Park H, Nam Y, Huang L, Lee Y, Yoon J.

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