Factors associated with eating behaviors in older adults from a socioecological model perspective

(2023) 23:1726 Wang et al. BMC Public Health https://doi.org/10.1186/s12889-023-16651-2 BMC Public Health Open Access RESEARCH Factors associated with eating behaviors in older adults from a socioecological model perspective Xue Wang1† , Yibo Wu2† , Juanxia Miao1 , Keping Pu1 , Wai‑Kit Ming3   and Shuang Zang1*    Abstract Background The eating behaviors of older adults are associated with multiple factors. To promote older adults’ healthy diets, it is imperative to comprehensively study the factors associated with the eating behaviors of the aging population group. This study aimed to probe the associated factors of older adults’ eating behaviors from a socioeco‑ logical model (SEM) perspective. Methods In 2021, a cross-sectional survey was performed to recruit participants in China. The survey data were analyzed using a multivariate generalized linear model to identify the factors associated with eating behaviors in older adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using a multivariate generalized linear model. Results The survey contained 1147 valid older adult participants. Multivariate generalized linear model results showed that older adults with older age [aged 71–80 (β = -0.61), ≥ 81 (β = -1.12)], conscientiousness personality trait (β = -0.27), and higher family health levels (β = -0.23) were inclined to have better eating behaviors. The older adults with higher education levels [junior high school and high school (β = 1.03), junior college and above (β = 1.71)], higher general self-efficacy (β = 0.09), more severe depression symptoms (β = 0.24), and employment (β = 0.82) tended to have poorer eating behaviors. Conclusions This study identified factors that are specifically associated with older adults’ eating behaviors from an SEM perspective. The comprehensive multiple-angle perspective consideration may be a valuable idea for studying healthy eating behaviors in older adults. Keywords Eating behavior, Older adults, Socioecological model, China † Xue Wang and Yibo Wu share the first authorship on this work. *Correspondence: Shuang Zang 1 Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122, China 2 School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing 100191, China 3 Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, No.31 To Yuen Street, Hong Kong 999077, China Introduction Globally the population is aging at an unprecedented rate. By 2050, the global population aged 60 and older will double from 1.4 billion in 2015 to 2.1 billion [1]. The World Health Organization proposed that it is very important to promote the health of the older adult population in response to aging [2]. The trend of population aging has increased people’s interest in promoting the constituents of healthy aging. One of the fundamental aspects of healthy aging is healthy eating behaviors [3]. The findings of © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom‑ mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wang et al. BMC Public Health (2023) 23:1726 epidemiological studies have shown that maintaining healthy eating behaviors could reduce the incidence of morbidity, particularly associated with cognitive decline and metabolic disease, thus reducing the cost of healthcare [4, 5]. Additionally, some studies have also indicated that healthy eating behaviors are associated with better health and quality of life for older adults [6, 7]. However, older adults may eat unhealthily due to physical problems or decreased appetite [8], putting them at risk for malnutrition [9]. The effects of malnutrition can be severe on the health, well-being, and autonomy of older adults [10, 11]. Therefore, it is crucial to identify the associated factors of older adults’ eating behaviors, with the aim of developing specific health promotion strategies tailored to the needs of this targeted group. Several studies have examined the associated factors of older adults’ eating behaviors [12–14]. A study has revealed that older adults eating behaviors are associated with multiple factors, mainly at the individual level (e.g., income) [15]. Several other studies highlighted the role of social factors in older adults’ eating behaviors, such as social relationships and social support [16, 17]. In addition, older adults eating habits have also been demonstrated to be associated with family factors, for example, whether living alone [18, 19]. However, it should be recognized that most existing studies on factors associated with eating behavior in older adults tended to focus on only one or a few angles (e.g., individual level and social level), a holistic view of factors associated with older adults eating behavior is lacking, thus, a comprehensive framework should be established to sort out associated factors. Additionally, based on the bio-psycho-social medical model, the person is regarded as a whole and is affected by environmental, physiological, psychological, and social factors, it is very necessary to study the associated factors of eating behavior from a holistic point of view. Thus, this study introduced the socioecological model (SEM) to assist in an understanding of factors associated with older adults eating behaviors at multiple levels [20]. SEM is a useful tool for addressing health behaviors by the attribution of health outcomes to factors. SEM can provide a theoretical framework for understanding the interactions between individual and environmental factors that affect health outcomes and behaviors [21]. In this multilevel model, individual characteristics, individual behaviors, interpersonal networks, community, and policy levels are all considered factors that relate to health outcomes and behaviors and highlight the imp (...truncated)