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

The current study examined the factors associated with eating behaviors in older adults based on SEM. The results showed that older age, higher educational level, conscientiousness personality trait, higher self-efficacy at the individual characteristics level; more severe depression symptoms at the individual behaviors level; higher family health at the interpersonal networks level; and employed career status at community level were associated with eating behaviors in older adults.

This study showed that SEM can help to better sort out and study the factors associated with older adults eating behaviors from a relatively comprehensive perspective. The results indicated that the factors associated with the eating behaviors of older adults are mainly concentrated in the SEM level of individual characteristics, and second, the level of individual behaviors, interpersonal networks, and community levels have also been found to have relevant factors. It is worth carrying out in-depth analysis and corresponding intervention guidance for improving older adults’ healthy eating behaviors from these perspectives in the future.

Our study revealed that older age was associated with healthy eating behaviors, which was in line with previous studies [35, 36]. The evidence suggested that aging was positively associated with healthy eating behaviors [37]. Older adults tend to maintain healthy eating behaviors, including consuming more fresh vegetables and fruits rather than high-fat foods [38]. With increasing age, older adults have gradually become aware of aging and the decline of digestive system functions [39], they may thus pay more attention to their health, such as health preservation, and diet. Additionally, in China, there is a high prevalence of digestive system illnesses in older adults, such as gastritis and colitis [40, 41], as well as a high prevalence of hypertension, diabetes, and hyperlipidemia [42, 43]. To comply with the need for treatment and care for digestive system diseases and other chronic diseases, many older adults tend to adopt healthy eating practices, such as eating soft food, low-salt and low-fat meals, having more meals a day but less food at each, etc. [6, 44]. Generally, older adults are likely to have more spare time after retirement, they thus have more time and energy to cook healthier foods, so they consume fewer unhealthy foods.

In this study, we found that the conscientiousness personality trait rated by BFI-10 was associated with more healthful eating behaviors, this finding was consistent with other studies among older adults [45, 46]. Individuals with high conscientiousness appear to maintain restrained regulatory eating and practice less counterregulatory emotional or external eating [47], and may be more capable of avoiding or controlling emotional stressors, resulting in decreased emotional eating and further decreased unhealthy eating [48]. Additionally, individuals with high conscientiousness may have more self-control resources to maintain their diet goals in tempting food situations and inhibit their eating enjoyment goals, thus adhering to a balanced and healthy diet [49]. As individuals generally pay more attention to their health in old age. Older adults should be encouraged to pay conscientious attention to diet. This highlights the need for personality traits that should be considered in the promotion of healthy eating among older adults.

The present study revealed an intriguing finding whereby a positive association was observed between a high education level and unhealthy eating behaviors among older adults. This finding contrasted with the expected trend observed in prior studies wherein individuals with higher education tend to exhibit healthier dietary habits [50, 51]. One potential explanation for this intriguing phenomenon lies in the possibility of overconfidence among individuals with elevated educational backgrounds when applying nutritional knowledge, resulting in suboptimal dietary choices. This phenomenon finds support in the research, which suggested that those with higher education levels might be more susceptible to specific nutritional information, potentially deviating from a comprehensive dietary approach [52]. Additionally, individuals with higher education may experience increased societal pressures, demanding a delicate balance between their professional, social, and familial responsibilities during their tenure [53]. These pressures could lead to decisions favoring expedient and convenient food choices, potentially at the expense of adhering to the principles of a wholesome diet [54]. This supposition resonates with the findings of Putri et al., which emphasized that individuals experiencing elevated stress levels tend to opt for high-calorie, low-nutrient foods [55]. These dietary habits tend to become ingrained from a young age and persist into later life, forming enduring patterns [56]. Furthermore, the interplay of social identity and cultural factors might wield influence over this observed association. Notably, individuals with advanced educational backgrounds may possess distinct social identities and cultural values that impact their dietary preferences [57]. Specific societal subgroups might exhibit a preference for traditional high-sugar, high-fat foods, thereby conflicting with the recommendations of a health-conscious diet [58]. The implications of this noteworthy revelation underscore the importance of addressing potential determinants contributing to unhealthy dietary behaviors among older adults with elevated educational status. Consequently, the development of targeted and effective public health interventions tailored to this specific demographic becomes imperative. Given the ongoing global aging phenomenon, promoting healthful dietary habits, and tackling the unique challenges faced by older adults with higher educational backgrounds emerge as essential endeavors for optimizing both their health and overall quality of life.

This study also confirmed that high self-efficacy was associated with worse eating behaviors among older adults. In contrast to prior research, which has suggested that older adults with high self-efficacy exhibit better coping abilities in challenging situations, display goal-oriented behaviors, and are more likely to adopt healthy eating habits due to the significance of overcoming failures and making persistent efforts to maintain healthy dietary patterns [59, 60]. The underlying reason for the observed association between high self-efficacy and worse eating behaviors among older adults could be attributed to the complexity of psychological factors associated with eating behaviors in this population. First, it is crucial to consider the impact of self-regulation abilities. Despite having high self-efficacy, individuals may face hindrances in regulating food intake due to factors like emotional eating tendencies or external food-related cues, resulting in self-efficacy not always translating into optimal eating behaviors [61, 62]. Second, the role of habit formation and automaticity in eating behaviors should not be overlooked. Prior research has highlighted that habits play a significant role in determining eating patterns, especially among older adults who may have established long-standing routines [63]. Consequently, even with high self-efficacy, individuals may experience overshadowed confidence in making consistently healthy choices if unhealthy eating habits have become ingrained over time [64]. Furthermore, the dietary decisions of older adults are frequently shaped by their social networks, familial interactions, and the accessibility of healthful food alternatives within their immediate surroundings [65]. As a result, even those individuals possessing elevated self-efficacy could yield to external influences or contextual limitations, potentially predisposing them towards favoring less nutritious dietary selections [66]. Therefore, while self-efficacy remains a crucial determinant, its association can be intricately interwoven with external factors, necessitating a comprehensive understanding of the multifaceted dynamics that underlie the dietary behaviors of older adults.

Our study discovered that higher family health levels were associated with healthy eating behaviors. It has been demonstrated that the family environment can have a significant impact on health behaviors [67]. Previous studies found that a positive family system can contribute to establishing and promoting beneficial health behaviors through the exemplary role, provision of healthy foods, and encouragement of healthy eating behaviors [68]. The Chinese government has also realized the necessity of improving the health of the whole population and proposed the Healthy China Plan in 2016, with the aim of promoting people’s health and then improving the level of national health literacy [69], which further improves the level of family health literacy to a certain extent. The family is the tiniest cell of society and plays a vital role in both individual life and society. This study found that the health of individuals cannot be separated from the health of the family, and it is very important to implement the guidance of the national health environment into specific family life. It is thus clear that policymakers who promote healthy eating behaviors should give full play to the positive role of family health resources in establishing and promoting good eating behaviors.

We also found that more severe depression symptoms were associated with worse eating behaviors, which was consistent with prior research [70, 71]. Individuals with depression symptoms are more likely to increase unhealthy food consumption [72] and have unhealthy eating habits [73]. Furthermore, depression affects eating motivations and drives food choices toward less healthy foods [74]. There was, however, approximately 40% of older adults aged 60 or older in China who reported having depression symptoms [75]. It is therefore necessary to focus on depressed older adults. While considering addressing the psychological problems of older adults, lifestyle problems such as diet should also be considered to promote the improvement of their overall health.

Moreover, our study revealed that the career status of employed was associated with unhealthy eating behaviors. Employed older adults may put in more physical and mental effort to complete the work, which is very challenging for physical strength, time, and energy [76]. Therefore, older adults in employment can crowd out some of the time that could be divided between food preparation, learning about dietary management, etc. Additionally, numerous studies have confirmed that work-related stress is associated with unhealthy eating behaviors [77, 78]. Compared to other working-age populations, older adults are at significantly higher risk of stress because of their diminished physical and mental abilities [79, 80]. Therefore, it is necessary to pay attention to the dietary problems of employed older adults.

Several potential limitations of this study should be acknowledged. First, due to the cross-sectional study design, we cannot infer causal implications. Second, there is the possibility that data may be to some extent biased since some information was self-reported. Third, we could not exclude participants who were on a weight-loss diet, so careful consideration should be given to the possibility of measurement bias, as well as continued evaluation of the EBS-SF. Fourth, although some variables (i.e., age, sex, and urban-rural distribution) had been quota, there may have been some uneven data distribution (e.g., education level, smoking, and drinking), which could have a certain effect on the outcomes. Fifth, the data collection in this study was during the COVID-19 epidemic and sometimes was subject to epidemic containment management, which may affect eating behaviors. Sixth, although we have considered multiple factors related to eating behaviors in older adults from a socioecological model perspective, this study lacks the inclusion of nutritional status and cognitive functioning as variables. Nutritional status is significantly associated with eating behaviors in older adults, while cognitive functioning also plays a crucial role in their dietary decision-making and habits. Therefore, the omission of these variables may have impacted a comprehensive understanding of eating behaviors in older adults. Future research should incorporate measures of nutritional status and cognitive functioning to gain a more comprehensive insight into the factors associated with eating behaviors among older adults.