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The U.S. population age 80 and older is projected to double over the next two decades, yet few of the tools health systems use to screen for food insecurity, transportation barriers and other social needs have been validated in older adults.

In a perspective published in The New England Journal of Medicine, Regenstrief Institute research scientist Joshua R. Vest, Ph.D., MPH, and co-author Mark A. Unruh, Ph.D., of Weill Cornell Medicine, argue that screening should reflect how older adults live and receive care. The authors outline changes that could help care teams identify patients' needs more accurately and match them with appropriate services.

One widely used brief food insecurity screen, for example, was initially validated in families with young children. A question about affording groceries may be informative for someone who shops for their own food and less relevant for a nursing home resident whose meals are provided.

The authors cite research linking food insecurity with malnutrition, falls, cognitive decline and forgoing medications. They also note that social isolation is associated with frailty, poorer mental health and higher medical spending. Older adults with multiple social needs tend to have less access to preventive care and are more likely to visit an emergency department or be hospitalized.

Unmet needs can make chronic conditions harder to manage and reduce an older adult's ability to remain at home.

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