Takeaway
Two short screening questions can uncover hidden food insecurity in patients. For those who screen positive, it is important to be ready with concrete resources available in your community.
Lifelong learning in clinical excellence | September 25, 2026 | 2 min read
By Ashli Greenwald, MS, RDN, LDN, Johns Hopkins Medicine
Older adults are a vulnerable population for food insecurity. Fixed incomes, rising food and housing costs, social isolation, transportation barriers, and/or physical or functional limitations can all increase their risk. These factors can lead to significant health consequences including poor diet quality, malnutrition, worsening chronic diseases, and increased risk of hospitalization. Screening patients during routine appointments can help identify at-risk patients who may benefit from additional resources and support.
How to screen patients for food insecurity
Screening should be brief, routine, and conducted in a nonjudgemental manner. The Hunger Vital Sign™ was developed in 2010 by Drs. Erin Hager and Anna Quigg with the Children’s HealthWatch research team, and is a validated two-question screening tool. In the U.S., it’s been incorporated into the Centers for Medicare & Medicaid Services (CMS) Health-Related Social Needs Screening Tool (HRSN). This tool can easily be incorporated into the patient assessment or intake process. Questions should be asked privately, routinely, and without judgment to let patients know this is a common issue and not a personal failure.
A template for screening for food insecurity
Tell patients, “We ask all our patients these questions because access to food can affect health. There are no right or wrong answers.” Then move to:
The Hunger Vital Sign™ Questions
1. “Within the past 12 months, have you worried that your food would run out before you had money to buy more?”
2. “Within the past 12 months, did the food you bought just not last, and you didn’t have money to get more?”
Response Options: Often True, Sometimes True, or Never True.
If the screen is positive:
A response of “Often True” or “Sometimes True” indicates a positive screen. Take a closer look at factors that may affect the patient’s ability to obtain, afford, store, or prepare food, such as:
1. Limited income or difficulty affording food
2. Transportation or access to grocery stores
3. Social isolation or lack of support
4. Physical or functional limitations
5. Difficulty shopping, cooking, or preparing meals
6. Cognitive or other barriers that may affect meal planning
Depending on individual needs, it’s important to connect to support.
A few resources in the U.S. include:
1. SNAP: Supplemental Nutrition Assistance Program (SNAP)
2. Senior meal programs, such as Meals on Wheels America
3. Local food pantries
4. Ride United USA and your state’s transportation assistance program
5. Social work or case management referrals
6. If you use the EHR EPIC program, click on Find Help Home and then narrow the search to Food and Meals to find meal assistance programs based on the patient’s zip code. Then place a referral.
Food insecurity may not always be obvious. A patient may not appear food insecure or may be hesitant to disclose difficulty affording food. A few simple respectful questions can help identify barriers to nutrition and create an opportunity to connect patients with the support they need.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.