Food for Soul—Older Immigrants’ Food Habits and Meal Preferences After Immigration: A Systematic Literature Review

Global population migration has changed the demographics of many countries leading to culturally diverse societies [1]. In 2020, 281 million people resided in a country that was not their country of birth [2]. The world’s population is aging rapidly, and older adults compose a larger proportion of the world’s population [3]. Thus, the combination of migration and an ageing population are two major challenges that many countries face in the twenty-first century [4]. World Health Organization [3] defines older people as persons who are over 60 years of age. Older immigrants are defined as people aged 60 years or older, who have moved away from their place of usual residence to live temporarily or permanently in a foreign country [2]. Older people who receive healthcare services are facing challenges related to inadequate nutritional care and malnutrition [5]. Nutritional challenges is also a concern among older immigrants; therefore, to deal with the challenges related to nutrition, it is important that healthcare professionals understand the nutritional needs of the ageing population, as well as their preferences and perceptions related to food.

Because of the differences in cultural, religious, and socioeconomic backgrounds, immigrants may have food habits and meal preferences other than those of the host population. This is particularly pertinent for those who are in vulnerable conditions, such as illness and frailty, where immigrants need assistance with food and meals from healthcare services [6]. Results from a scoping review indicate that ethnic food consumption can have a positive impact on mental health among immigrants [7]. Food is not only important for health and in physical sustenance, but it is also linked to an individual’s personality, cultural identity, social practices, and religious beliefs, in addition to generating enjoyment and a supporting quality of life. Moreover, results from a previous study conducted among British Bangladeshis has shown that behaviors surrounding the preparation and consumption of ethnic foods are some of the most resilient aspects of a migrant culture [8].

After immigration and settlement in a new country, immigrants are exposed to the host country, resulting in physical, biological, political, economic, sociocultural and psychological changes [9]. The process through which immigrants and their children are exposed to the values, behavioural norms and attitudes of the host society is defined as acculturation [10] (p. 708). The acculturation process also includes food consumption [11], which is often called dietary acculturation. Dietary acculturation involves both the retention of certain dietary behaviours and incorporation of new foods and eating habits from the new country [12]. The results from a study conducted by a Romanian research team revealed that the longer Romanian immigrants resided in Andalucía, Spain, the more they perceived changes in their food consumption habits, thus demonstrating a gradual adoption of Spanish foods [13]. After acculturation has occurred, the most common feature is so-called ‘bicultural food habits’, indicating the consumption of traditional food or traditional meals while adding the host population’s food and meals [12].

Although immigrant groups tend to adopt the food habits of the host country [12], the opportunity to have access to traditional food and preserve familiar meal patterns is deemed important [14]. Food communicates history, memory, feelings, and social status [15]. Moreover, food is a source of comfort in life [16] and central to all the processes needed to adapt to a host country [17]. Meals are opportunities for socialisation and interaction, both of which are important for a person’s identity and integrity [18]. Although the meaning of meals and food has evolved across the stages of the life cycle, the eating habits of elderly individuals tend to be characterised by lifelong patterns of eating that have meaning and significance in their everyday lives [19].

During the ageing process, older immigrants may increasingly become more dependent on others to provide their meals. Traditionally, care for the elderly from minority groups was provided by family members [20]. However, because of the socioeconomic transformations in the host countries and societies at large, family caregiving attitudes have changed, and family caregiving is now somewhat weaking [21]. The responsibility of caring for older family members from immigrant groups, including the provision of nutritional care, has gradually been transferred to public healthcare services [21]. Therefore, healthcare workers providing nutritional care need to be aware of the food habits and meal preferences of elderly from minority groups [22]. Meals that are adequate from a nutritional perspective but fail to meet cultural, taste or religious preferences may be only partially eaten or not eaten at all, which again can have serious health consequences, particularly for vulnerable groups such as older immigrants. Although there are several studies exploring dietary changes after migration and settlement in a new country, there is a paucity of specific knowledge about food habits and meal preferences among older immigrants; therefore, more knowledge is needed. The aim of this systematic review is to identify and synthesise the research studies that address older immigrants’ food habits and meal preferences after immigration and settlement in the host country. The present systematic review will therefore answer the following research question: ‘What are the older immigrants’ food habits and meal preferences after immigration and settlement in the host country?’.

The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 27 September 2022 with registration number CRD42022358235.

A systematic review of the literature with qualitative and quantitative study designs was conducted following the recommendations of the Preferred Reporting Items Systematic Review and Meta-Analysis guidelines (PRISMA) [23] and the synthesis without meta-analyses items (SWiM) [24] (Supplementary Files S1&S2).

As a systematic review, the present study does not need ethical approval according to the Norwegian Research Ethics Act. The studies included in the review had ethical approval or clear ethical statements.

In the current literature review, we identified and synthesised 10 studies addressing older immigrants’ food habits and meal preferences after immigration and settlement in the host country. Our review has revealed that preparing and eating ethnic foods is an important part of everyday eating practices. For older immigrants, food and mealtimes were strongly linked to cultural and ethnic identities. Ethnic food was valued as an important bond connecting them to their country of origin. Moreover, preparing and eating ethnic foods created nostalgia for their country of origin, hence becoming part of remembering their past and acknowledging their heritage, thus providing a sense of belonging.

Maintaining cultural identity through the preparation and eating of ethnic food appeared to be more important to first-generation immigrants, which was especially true for women who had significant food-related roles in earlier life and was associated with providing food for their families as wives and mothers [33]. These feelings were echoed in a study on the meaning of food and food preparation for Goan women in Toronto, Canada, and the role of food in creating and maintaining distinctly gendered ethnic identities [39], revealing that among other things, the power of food and foodwork in transmitting ethnic identity and the opportunity to draw family and community together, thus maintaining collective solidarity and identity. As also pointed out in an early study [40], because of the strong connection between food and identity, immigrants tend to conserve their eating habits. For them, food is one of the remaining bonds with the country of origin and a strong and meaningful component of their identity, being a prominent feature for elderly Vietnamese [38] and Chinese [33] living overseas.

Our review also found that identity is preserved through food practices and sharing [32]. Chinese immigrants displayed their ethnic identities and reinforced their bonds to others who claimed the same heritage through the tangible medium of food. By sharing foods that they perceived to be traditional with other Chinese, they were reinforcing their common bond, even in a diaspora [33]. These findings were similar to the findings presented in a study conducted among Barbadian immigrants in Atlanta, US, showing that Barbadians consciously deployed conspicuously Barbadian foods to signify their ethnic and national identity, both in situations where they were demonstrating solidarity with the Barbadian community, as well as to distinguish themselves as distinctly Caribbean in mixed American settings [41].

For older immigrants living in a nursing home, when the institutional food did not meet the residents’ characteristics in terms of immigrant background and key elements of their cuisine, particularly seasoning and cooking techniques, family and friends chose to bring in home-cooked food that the resident appreciated and ate with gusto [29], thus honouring individual and family identity, which was special for those living with dementia [33]. Moreover, serving ‘recognisable’ dishes brought by family members has been shown to allow older immigrants living in nursing homes to maintain and reaffirm their ethnic identities, especially for those living with dementia. The idea that traditional food strengthens the feelings of belonging, identity and heritage, thus helping persons with dementia hold on to and reinforce their cultural identity, was also supported by the findings presented in a Norwegian study revealing that familiar tastes and smells awoke pleasant memories in people with dementia and boosted their sense of well-being, identity and belonging, even producing words in those who usually did not speak [42]. Moreover, food could bring back memories of childhood that reflected the usual practices and traditions that continue to influence current preferences.

The results from a recently conducted scoping review [18], showed that immigrants experienced that there was an overall abundance of food in the host country, with traditional foods being always available, not just seasonally as the immigrants were used to. The influx of ethnic minority corner shops and supermarkets in communities and larger cities, making available fruits, vegetables and spices, reinforced continuity of traditional food habits and meal preferences. This accessibility and affordability of traditional foods contributed to the continuity of the traditional food culture in older immigrants, which is in line with findings from our review [32, 35, 36]

The importance of spices as markers for the smell and flavour of food, thus influencing food choices, emerged in several qualitative studies [9, 29, 34, 35]. This idea was supported by findings from other studies [14, 43], suggesting that spicy food preparation was more valued and essential for older immigrants to preserve the original food culture after immigration and could not be replaced by commercially available food items. Our review has also shown that first-generation immigrants attempted to preserve food habits perceived as being of their country of origin, including spiciness in food [9, 34, 35]. This was the most visible in the studies with a quantitative design where food preferences and type of foods eaten before and after immigration were displayed and compared with the majority population from the host country [36, 38] or with the same ethnic group living in their country of origin, showing noticeable differences in food habits and meal preferences between older immigrants living in the host country and those living in their country of origin [37].

Sometimes, to preserve food habits and meal preferences, flexibility, and recipe modification were needed [34]. Moreover, unfamiliar ingredients were adapted to preserve known food taste by adding spices [9]. Flavours and distinct tastes are the strongest characteristics of traditional food [44]; therefore, our review indicates that, to preserve traditional familial food, older Chinese immigrants used mealtime as learning opportunities to teach younger generations cultural and traditional principles of food practices [33].

Although the significance of eating traditional food in maintaining older immigrants’ cultural identity was emphasised, similar to findings from another systematic review [45], our review has revealed a process of change in food habits and meal preferences among older immigrants [36]. Some of these changes occurred because of the older immigrants’ perceptions of the host country’s foods being healthier than their own traditional food [37]. Because of altered routines and lifestyles with a busy work schedule and lack of time to prepare traditional foods [9, 35], food changes were unavoidable. Other changes occurred involuntarily because of the process of ageism and altered sense of taste affecting their usual food habits, hence avoiding certain cultural spicy foods [30, 33]. For older immigrants living in nursing homes, the lack of culturally recognisable mealtimes contributed to altering their food habits [30]. Moreover, changes in their food habits consisted not only of adopting different foods from the host country or adapting to new food flavours, but also of changing the number of meals they consumed in the day, usually skipping breakfast and/or lunch [9, 34, 37]. However, eating traditional foods became a feature that occurred only on occasions such as family visits or feasts [35].

Accessibility and availability of ethnic food shops contributed to immigrants who migrated to the Western parts of the world in the last decade not perceiving challenges with maintaining their cultural food habits and meal preferences. In contrast, because of a lack of availability and accessibility to traditional foods, immigrants who migrated in the early 1970–1980s and grew old in the host country had to adopt certain foods [35] and dietary patterns [36, 37]. This contradicts the findings from a previous study [46], stating that, in the UK, the older generations of South Asians were less likely to change their food habits since they were more segregated from the majority population, thus continuing to eat traditional foods. This supports Kocktürk-Runefors’ [47] theory suggesting that staple foods are the last to change following the postimmigration period. In contrast, younger generations of South Asians were found to be more likely to change their food habits and meal preferences by including English foods in their daily meals [46]. These findings are in line with the findings from our review, where the younger generation accepted the host country’s foods easier than the older generation from the same family [9]. However, our review suggests that not only did the younger generation adopt the host country’s foods, but for several reasons, older immigrants living in the host country did as well [34‐37]. For example, Chinese immigrants have often adopted a bicultural eating pattern, appearing to be caught at the intersection of East and West food cultures [34] and, thus, preserving elements from their Chinese culture and adopting some elements from the host country. This contrasts the findings from a previous study reporting that Chinese immigrants minimally changed their food habits, even as time spent living in the UK increased [48].

An important factor influencing the adoption of new foods was the age of immigrants at the time of immigration [36]. Our review revealed that the older immigrants were at the time of immigration, the more difficult it was for them to change their food habits and be open to dietary acculturation. However, according to Cleveland et al. [49], acculturation is a complex process based on assimilation of the new culture (majority, the host) and the preservation and promotion of the culture of origin (minority), here further referring to Berry’s [11] four patterns of acculturation: integration, separation, assimilation and marginalisation, where integration is the most common applied pattern—adopting the new culture and, at the same time, cultivating their culture of origin. This supports the findings from our review.

The length of residence in the host country was found to influence the degree to which immigrants adopted the host country’s food habits. As our review suggested, the longer the stay, the easier it was for immigrants to adopt the host country’s food habits and meal preferences; these findings are supported by the results from a study conducted among Romanians living in Andalusia, Spain [13].

Finally, when people immigrate and settle dawn in a new country, in their ‘migrant suitcase’ they not only bring their food with them, but also their representations and ideals of good food [43]. Therefore, for older immigrants, eating ‘food from home’ can reconnect them with a sense of home, hence contributing to improving their quality of life in the host country.

To the best of our knowledge, this is the first review to present older immigrants’ experiences with food habits and meal preferences after immigration and settlement in the host country. We sought studies that included diverse groups of immigrants with different designs and methods of data collection. Several studies included Chinese immigrants in Australia, Canada, the UK, and the US – countries well-known for their increased level of immigration [50, 51], hence to some degree reducing the transferability of the findings.

The included studies revealed older immigrants’ experiences with food habits and meal preferences of both men and women from different ethnic groups belonging to several countries around the world, hence increasing the diversity with respect to ethnicity, gender and age. The participants in the included studies were home-dwelling older immigrants, but also those living in nursing homes. Because of the paucity of research focusing on older immigrants’ food habits and meal preferences, we also included studies presenting subgroups of results or specific statements from participants aged 65 years or older. In some studies, the sample was also comprised of family caregivers and/or healthcare personnel. To avoid bias during the data synthesis, only data generated from the participants defined as older immigrants were analysed and further synthesised. Statements from family caregivers or healthcare personnel were not included in the synthesis.

We are aware that, because of the search strategy, some relevant literature may have been missed, though we did not limit the period of published research to a certain period. Because of the aim of the review, we have not mentioned the problem of a relatively high prevalence of noncommunicable diseases, such as diabetes, heart diseases or obesity, among older immigrants. Major barriers to healthy eating among older immigrants included lack of nutrition knowledge, families’ preferences, cultural values, religious dietary proscriptions, financial constraints and low availability of food quality. These issues require further research.

The knowledge from the current review has several implications for health and social services that should be considered. An ageing immigrant population will gradually be challenged with difficulties in coping with their food and nutrition, besides potential other health challenges; therefore, one may wonder who will take care of these individuals when they face these challenges. With family ties becoming loser and attitudes towards family caregiving constantly changing [21], public health and social services play an important role in providing adequate cultural nutritional care to older immigrants. Healthcare personnel should be aware of the food and eating habits of older immigrants. It is important that healthcare personnel have competence and opportunities to meet the needs of culturally appropriate food habits of older immigrants. Not acknowledging older immigrants’ food habits and meal preferences could be a source of stress for this population when they are staying in a hospital or nursing home. Therefore, this issue should be carefully addressed by healthcare and social services and in future research.

Although there is a broad range of literature on food, immigrants and migration, this topic has not been fully investigated regarding older immigrants. There is a paucity of research focusing on older immigrants’ food habits and meal preferences in the postimmigration period and the role food plays in shaping a sense of belonging among this group. However, our review revealed that older immigrants, regardless of being newly arrived or belonging to those who aged in the host country, have different food habits and meal preferences compared with the majority population in the host country. Depending on several factors, such as availability and accessibility of ethnic food shops, the age immigrants came to the host country, the length of their stay in the host country and alterations of their lifestyle, different forms of dietary acculturation exist. Despite these differences, our review has revealed that older immigrants wish to maintain their traditional food habits and meal preferences. For them, although they adopted some culinary elements from the host country, eating traditional food contributed to maintaining their cultural identity and to the continuity of traditional food culture.

Healthcare personnel should make efforts to target food literacy skills in older immigrants and encourage them to try new foods and eat healthier. Finally, understanding older immigrants’ food habits and meal preferences helps health and social services ensure culturally appropriate nutritional care, thus optimising their health.