While the consequences of both Food Insecurity (FI) and Social Isolation (SI) are known to have negative impacts on the physiological and psychological health of older adults age ≥ 65 years, the intersection of FI and SI is largely an unresearched area. FI is a problematic term to define. It can be described as a condition characterized by limited access to nutritious food, uncertain availability of food, and lack of socially acceptable means to obtain food (1). It also contributes to malnutrition, a condition that arises when a person’s diet lacks sufficient nutrients or contains too much of certain nutrients, leading to health problems (2, 3). SI is an objectively observable condition that exacerbates the psychosocial difficulties individuals experience due to a lack of social proximity and engagement, even if they do not subjectively feel lonely (4). The rising rate of FI combined with a higher risk of SI associated with increasing age disproportionately affects the quality of life of older adults (1) and can be addressed through nutrition support programs. For older adults, age-related physical comorbidities, the death or loss of friends and family, and impairments in cognition and sensory systems limit the frequency of social interaction. This in turn, reduces access to resources (5) information about quality food (6) and awareness of food services available within the community (7).

SI and FI are interrelated social determinants of health that frequently co-occur and influence one another, particularly in older adult populations. This relationship can be understood through an ecological or social determinants framework (8), which emphasizes that health outcomes are shaped by a dynamic interaction across multiple levels: individual, interpersonal, community, and societal. At the individual level, factors such as age, gender, race/ethnicity, income, education, health status (including depression, BMI, and limitations in daily activities), and length of time in the U.S. can directly influence an older adult’s vulnerability to both SI and FI. Moving to the interpersonal level, the presence or absence of emotional and financial support networks, such as family, friends, or caregivers can either buffer against or exacerbate the risks of isolation and limited food access. At the institutional level, access-related challenges—such as lack of private insurance, limited routine healthcare, and long travel distances to grocery stores—can further restrict food availability and deepen social disconnection. Community-level influences also play a significant role. Factors like rural versus urban residence, regional geographic differences, and the availability of community-based resources (e.g., meal delivery programs or senior centers) can support or hinder both social engagement and nutritional well-being. Finally, at the policy and societal level, broader structural elements, especially access to food assistance programs like the Supplemental Nutrition Assistance Program (SNAP), are crucial in shaping outcomes and reducing disparities related to SI and FI.

When considering FI, approximately 6.9 to 8.3% of the United States’ older adult population are at risk due to economic decline (9, 10). In fact, FI and malnutrition have associations with many diseases which affect older adults. More precisely, older adults experiencing FI not only have low nutrient intake, but also suffer from poor health, depression, diabetes, obesity, and functional limitations (11–13). Studies also posit that cognitive function can be negatively affected by FI and malnutrition (14–18). Furthermore, there is evidence that cardiometabolic risk may be present in those exposed to FI (19).

A population-level intervention addressing FI and SI for older adults would involve a policy or program designed to improve access to food, through community-based initiatives that simultaneously foster social connection and reduce feelings of isolation. These include community gardens, community kitchens, congregate meal programs, or social support networks linked to food distribution programs (20). Key elements of such intervention involve connecting people to resources such as screening for FI, providing referrals to food assistance programs, like Supplemental Nutrition Assistance Program (SNAP) proving free or low-cost meals, and building skills and confidence through nutrition education. These programs aim to enhance community food security and social support by implementing “check-in” systems within food distribution programs to ensure regular contact with vulnerable individuals. For older adults, partnering with local community centers or senior centers for food accessibility alongside social activities are effective as individuals connect while assisting with food distribution and consumption based upon culturally appropriate and local needs.

Some key interventions that attempt to address FI and SI in older adults include eating together or commensality, a health-promoting activity that contributes to improved health outcomes (21) with enhanced social support supplemented by dietary intake in multiple ways (22). Community-organized activities, such as Food Classes for Older Adults (FCOA), can provide sustainable commensality for homebound older adults who are often unable to cook for themselves (22.7%), those who are unable to shop for themselves (31.4%), and those who (14.6%) report money as a concern (23). When such programs are supported by apps or technology, they are more effective, as technology-based interventions such as mHealth provide the opportunity to stay socially connected (24) thus mitigating SI, and reducing the adverse impacts of FI (25).

Internet Food Delivery Applications (IFDA) are one way to mitigate the psychological issues of loneliness or depression and redress SI in older adults. Connecting to older adults, the service providers of IFDA optimize and enhance the nutrition status and deepen their understanding of how the issues of SI can factor into the pathophysiology of older adults as well. While services of this kind are common in some places of the United States, some regions are still in dire need. For example, in central Texas, there is a significant population of underserved, poor, insecure, malnourished, and socially isolated older adults (26, 27). Given that these measures are important social determinants (28) of health, programs that address these issues are necessary. Texas is ranked 44th in the United States for those aged 65 and older in poverty with an overall state poverty rate of 10% (26). With 33% Hispanic population, nearly 19% of the population aged 60 and older report food insecurity (29). The average malnutrition crude death rate in Texas is 65.6 per 100,000 before the COVID-19 pandemic based on 2014–2018 American Community Survey data (30), which worsened during the pandemic as malnutrition is a risk factor for COVID-19 mortality (29, 31).

The purpose of this systematic review was to identify and analyze the efficacy of combined SI and FI interventions for older adults over the past 10 years and analyze the facilitators and barriers in the published literature. We also attempted to review studies that implemented technology-based interventions and collected insights about FI and SI that might lead future researchers to additional interventions.

The flow diagram of study selection procedure (Figure 1) shows that a total of 392 results were provided by the four research databases from our search string, of which 138 were duplicates. A total of 244 articles were screened. Screening removed 206 results, leaving 38 full-text studies to be analyzed. A Cohen kappa was calculated from this process (k = 0.95, high agreement) (35, 36). During the analysis phase, an additional 32 studies were removed (not caught in the abstract screening process). This left 6 articles for full analysis.

This systematic literature review examined six articles published over the past 10 years from five different countries, focusing on interventions addressing SI, FI, and malnutrition. The review reveals a significant gap in literature, as only six studies met the inclusion criteria. Notably, none of these studies employed a specific intervention model or utilized randomized controlled trials (RCTs), highlighting the limited evidence base in this area. The studies primarily relied on descriptive statistics and inferential analyses, including logistic regression and pre-test/post-test designs. The pre-post-test study consisted of a nutritional intervention to address blood pressure, FI, SI, and malnutrition using Dietary-Approach to-Stop-Hypertension (DASH) -based diet congregate meal program in community senior centers in New York City. The major objective of this intervention was to assess the effectiveness of DASH diet in lowering systolic blood pressure. The intervention was effective in lowering systolic blood pressure among DASH participants. Moreover, compared with individuals who did not experience FI, those who experienced FI reported higher systolic blood pressure (43).

Some validated instruments such as the Mini Nutritional Assessment survey was used to measure malnutrition levels, the Food Insecurity Experience Scale were used to assess FI, and Gijon’s social-familiar evaluation scale was used to measure social risk. These studies were conducted in different countries including Turkey (1 study) (38), Mexico (1 study) (39), Japan (1 study) (40), Portugal (1 study) (41), and the United States (2 studies) (42, 43). One of the articles from the U.S. was limited as it was a letter to the editor regarding an intervention to address FI among hospitalized patients during COVID-19 pandemic (42). The major findings from our review show that social factors and health status are the factors mostly associated with FI and malnutrition among older adults.

The social factors associated with FI consisted of being female, lack of money including pension and/or social security, lack of socialization, living alone loneliness, high level of social risk, low education level, and lack of access to community food programs (39, 41). The health-related factors associated with FI consisted of the presence of diabetes, depression, and physical impairment (41).

The social factors associated with malnutrition or the risk of malnutrition consisted of older age (≥ 70), being single, being a woman, being lonely and eating alone (not eating together with peers), poverty, and dealing with FI (38, 40, 41). The health status associated with malnutrition and/or risk of malnutrition consisted of poor health status and presence of chronic and acute diseases (depression, presence of orthopedic disability, acute myocardial infarction, and cerebrovascular accident) (38, 41).

None of the reviewed studies specifically targeted SI; however, by addressing FI and malnutrition, they implicitly engaged with aspects of SI. Although we anticipated identifying app-based food service interventions designed to address both FI and SI, none of the six studies employed mobile applications as a tool for meal delivery or social support. Most existing studies are cross-sectional and more appropriate for scoping reviews. Research on technology-based solutions for FI or SI is also limited, likely due to the complex challenges in public health, markets, and supply chains. An interdisciplinary approach combining public health, economics, and technology could help develop more effective, integrated interventions.

This systematic review has several limitations. First, although we queried four databases to reduce sampling bias, this approach yielded 138 duplicate articles, potentially reflecting overlapping coverage rather than expanding the diversity of sources. Second, the generalizability of the findings is limited. None of the studies were conducted across multiple countries, introducing selection bias and limiting global applicability. Furthermore, within-country generalizability is also constrained, as the study samples were not representative of the broader older adult populations in their respective nations. Third, five of the six studies exhibited sampling bias, with a predominance of female participants. Finally, methodological limitations, particularly the absence of randomized controlled trials (RCTs), mixed methods approach, and longitudinal data pose significant concerns regarding internal and external validity. These limitations restrict the extent to which the reviewed interventions can be confidently applied to the older adult populations.

Although our systematic review is based on six articles, it is a valuable review because it underscores the need for gold standards in research, randomized controlled trials (RCTs) using robust experiments to assess the effectiveness of interventions to address SI, FI, or malnutrition affecting the QoL of older adults. While RCTs focus on specific outcomes they may not capture the overall impact of an intervention, particularly where existing confounding variables like human behavior require holistic examination. Observational studies or non-randomized controlled trials in the form of cohort studies, case studies, or longitudinal research provide such insights into real-world applicability and scalability.

A notable gap in literature remains, as many technology-based interventions report only short-term impacts and are often tested on homogenous groups, limiting their relevance to diverse populations (47). Future research should employ longitudinal designs to evaluate the sustained effects of these interventions on FI and SI over time. Moreover, existing studies frequently neglect key behavioral and psychosocial indicators—such as social connectedness, mental health, and self-efficacy—that are closely tied to both challenges (48). Using validated scales for depression, loneliness, and perceived social support alongside food security measures would allow for a more comprehensive understanding of outcomes (49). Additionally, assessing technological barriers such as device availability, internet access, and user interface challenges is essential. Current evaluations often rely heavily on quantitative metrics like app usage or survey data, missing the nuanced, long-term behavioral shifts that digital interventions may produce (50). Comparative analysis of various approaches such as mobile apps, online forums, and telemedicine can further inform best practices and guide the integration of technology into public health strategies to more effectively and equitably address the intertwined issues of FI and SI.

Digital literacy also plays a vital role in addressing the overlapping challenges of SI and FI, in older adults, but significant barriers remain in the form of limited digital proficiency in older adults. Many lack the knowledge to navigate essential online platforms for food assistance programs like SNAP or WIC and cannot easily participate in telehealth services or virtual social activities (51). Cost is another major obstacle, as fixed incomes for older adults often make internet service, devices, and up-to-date technology unaffordable (52). Moreover, physical limitations, such as impaired vision or reduced mobility, and the absence of reliable broadband in rural or underserved areas further restrict digital access (53). To address these challenges, community-based initiatives have begun integrating food engagement with digital support. Programs such as virtual communal meals, online cooking classes, and recipe sharing platforms promote commensality, the shared experience of eating together, which enhances emotional and social well-being. Some holistic approaches that foster digital inclusion while meeting both nutritional and social needs include Commons Table, senior center tech workshops, library digital training, and device donation programs. However, large-scale technological solutions often fall short in addressing the specific needs of marginalized or underserved populations.

As the market for food production and distribution is often fragmented, with many players in the food supply chain with myriad interest; cost, accessibility, or infrastructure, particularly in low-resource settings, makes it difficult for developing advanced technology or food distribution innovations. Traditionally, public health research has focused on understanding the social, behavioral, and epidemiological aspects of FI and malnutrition, often relying on policy interventions or community-based solutions (54). Technologies that aim to address these issues may need to manage sensitive personal data, such as health and nutrition information. This raises concerns about privacy, consent, and ethical considerations, which could deter both research and technological development in this area.

FI, SI, and malnutrition are frequently associated with poorer outcomes in older adults and highlight the need for further research to clarify causal pathways and the extent of impact. Based on this systematic review, there has been a lack of interventions addressing these three issues simultaneously. Moreover, there is a need for conducting a scoping review that synthesizes information about the barriers and facilitators to improving food security and decreasing SI in older adults. A scoping review might suggest factors for consideration in developing potential interventions and by using a broader search criterion to capture all relevant information. Additionally, while technology could be leveraged to facilitate food delivery, to our knowledge, no app-based interventions have been published. We urge more technology-driven solutions to address these key challenges faced by older adults.