Over the past decade, social determinants of health (SDOH) and their impact on health and quality of life have been the subject of a plethora of research, articles, discussion, and debate. However, the recent COVID-19 crisis has brought to the forefront many disturbing and unrecognized SDOH disparities in our communities and county. The pandemic has illuminated, perhaps more than ever before, that our senior population is among the most vulnerable because of SDOH disparities. Alarmingly, SDOH disparities are estimated to increase health care spending and lost productivity costs by $93 billion and $42 billion annually. Our society is not only confronted with a moral issue but also an economic crisis and call to action.
The World Health Organization defines social determinants of health as “the non-medical factors that influence health outcomes. They are conditions in which people are born, grow, live, and age, and the wider set of forces shaping the conditions of daily life.” SDOH variables such as economic security, social-connectedness, food security and nutrition, education, health care, and environment, if not addressed, can have consequential impacts on San Diego County’s 484,057 seniors who are 65 years of age or older – 14.5% of our local population.
By 2030, it is predicted that 20% of the nation’s population will be 65 years or older, and SDOH risks will increase. The call to action is indisputable – we must improve SDOH factors to protect seniors’ health, lower medical costs, and improve quality of life for vulnerable older people. Social determinants of health are interrelated, with each variable impacting or affecting others. SDOH-related risk factors can affect up to 80 percent of an individuals’ overall health and well-being.
Well-being for seniors is inexorably linked with their financial health. Economic security is essential to covering health care costs (e.g., pharmaceuticals, medical bills), housing expenses, transportation access, and monthly living expenses. National studies have found that 22.8% of low-income adults 65 and older find it very difficult to pay their monthly living expenses. The United Ways of California reported 23% of the San Diego senior population (ages 65+) do not have enough income to meet the basic needs of daily living.
In 2020, secondary to the COVID-19 pandemic, 42 million Americans battled food insecurity and hunger. An AARP Foundation report reveals 51% of low-income 50–59-year-olds and 22.9% of low-income adults aged 65 or above experience food insecurity. In San Diego County, one in 10 seniors are food insecure. Access to nutritious, affordable food is essential for seniors to live healthy lives. All too often, seniors are confronted with consequential choices. Do they purchase food, pay the rent, or purchase medications?
Access to affordable, timely, high-quality health care is vital to seniors, and the demand for senior health care is great. According to the CDC, 85% of older adults suffer from at least one chronic condition, and 60% of seniors have two chronic conditions. Seniors are frequently challenged with navigating health system complexities, understanding and adhering to complex treatment plans (inadequate health care literacy), paying for and accessing care (e.g., limited availability of services and lack of transportation).
Older people are more likely to live alone and be socially disconnected in the United States than elsewhere in the world. Today, 27% percent of individuals in the U.S. who are 60 years of age live alone. Living alone often results in isolation, loneliness, and cognitive decline. Additionally, social isolation and loneliness can worsen chronic conditions and increase the risk of death.
Social participation and integration have a profound positive effect on individuals. Studies have also shown greater social integration for the elderly lessens memory decline. Ageism and discrimination also impact the isolation and loneliness of seniors. This is especially true for those experiencing cognitive impairment.
Seniors’ ability to thrive is influenced greatly by home and community, yet seniors’ surroundings are often inadequate. Aging in place requires an environment that is safe, secure, and ideally walkable. A community that fosters a connected lifestyle and is proximal to support services, healthy food, pharmacies, doctor offices, and public transportation is essential. Support services are also needed to ensure a safe and secure home environment. Examples include home repair and maintenance, transportation, food preparation, and a single-level dwelling.
Living alone increases as seniors age and more women live alone than men. Affordable housing is paramount for seniors. Studies have revealed that 40% of older adults express concerns about being able to afford and maintain their homes as they age.
Educational level is a SDOH that is sometimes not “top of mind” but definitely is a factor that influences health status and outcomes. The American Public Health Association states that people who graduate college live at least five years longer than those who don’t graduate high school. Health literacy and outcomes are also impacted by level of education. Older women in many societies and communities may be at greater risk for poorer health outcomes secondary to lack of access to higher levels of education.
Successful, meaningful mitigation of SDOH disparities for our seniors will require national, state, and local action. This change must be seen as a moral, economic, social, and health mandate. At a minimum, it will require new bold health policies, economic investment in new senior programs and services, provision of safe and affordable housing programs, comprehensive transportation services, and implementation of new wholistic care delivery models.
The interrelatedness of many social determinants will necessitate integrated approaches from multiple agencies to address. If these types of actions are taken, our seniors will thrive, health care costs will decline, and we will become a more humane society. Senior mortality and morbidity will decline, seniors will live more independently and age in place, their basic needs will be met, and they will experience an improved quality of life.