According to the U.S. Census Bureau, one in ten older adults in the U.S. — or 5.9 million individuals 65 or over — lives in poverty, although the percentage varies from state to state. In the District of Columbia, it is 22%. Today, poverty in our older population is growing faster than in any other age group.
These alarming statistics highlight a critical public health issue that, when combined with social determinants of health (SDOH) — such as access to healthcare, nutrition, reliable transportation, and safe housing — poses serious health risks, deepens socioeconomic disparities, and negatively impacts the quality of life among our older population.
How poverty and SDOH impact health outcomes
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The connection between poverty, SDOH, and outcomes is complex and varied. For example, poverty and rising healthcare costs have led to an epidemic of medication non-adherence in our older population. The Journal of the American Medical Association reported that 20% of older adults are choosing not to refill prescriptions and are skipping doses or cutting medications in half due to cost.
As individuals age, they will generally have more chronic illnesses and serious health conditions like hypertension, diabetes, and heart disease. As these conditions are chronic health issues, they are more expensive to treat and manage and usually require stringent medication protocols. When patients don’t take medications as prescribed, their conditions can worsen. This can result in deteriorating health, which can lead to emergency room visits, hospitalizations and potentially longer time spent in a rehab facility. Ultimately, this drives up costs for our health system and our seniors, creating a cycle of poverty-based health care risks.
In addition, seniors living at poverty levels may experience more significant social risks that impact their health. They may live in areas where they feel unsafe leaving their homes. They may lack reliable transportation to get to their medical appointments or treatment services. They are also more likely to live in food deserts where healthy food is not readily available. The complex issues of poverty and poor quality of life have a significant impact on the overall health and well-being of the individuals.
A substantial issue that affects the health of those who live in poverty is the compounding impact of depression. The National Council on Aging reports that up to 5% of older adults in the U.S. suffer from major depression. Health issues such as chronic pain, chronic conditions like cancer and arthritis, reduced mobility, and lack of physical activity play a prominent role in contributing to the unprecedented levels of depression. Other contributors include poor sleep and a lack of proper nutrition, unaddressed dental issues, the inability to afford healthy food, or a lack of education about the importance of eating healthily. They may also have lost the ability to drive or lack reliable transportation to the grocery store.
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Although access to good mental health is a challenge across all generations, it is especially so for seniors as they face higher levels of social isolation, which can deepen depression. This is related to the significant loss of loved ones and long-time friends. Treatment for depression may be inhibited by seniors not being aware of or recognizing the symptoms of depression, as well as acceptance of the stigma around talking about mental health or seeking help. These issues are why mental health conditions in seniors are vastly underdiagnosed.
Strategies for improvement
Addressing poverty and social risks in seniors requires a collaborative approach. Healthcare providers, social services, mental health associations, community organizations, and local, state, and federal agencies must work together to increase financial support and better address the social gaps that are prevalent within the senior population. This includes improving access to healthcare and healthy food, creating affordable housing in safe environments, and providing education about nutrition, medication compliance, mental health, and the importance of staying connected.
The time to act is now
Poverty significantly impacts the mental and physical health of older adults. Lack of access to care and unaddressed SDOH issues lead to poorly managed chronic conditions, delays in treatment, medication non-adherence, and lower utilization of preventive services. The result is higher healthcare costs, poor outcomes, and, ultimately, a poor quality of life and increased poverty for older adults.
We need to do a much better job of providing the right care at the right time and in the right place for our valuable senior population. We must all work together to ensure higher quality of life and better health outcomes.
Photo: delihayat, Getty Images
Jayme Ambrose, DNP, RN, CCM, is the visionary Founder and Chief Executive Officer of Adobe Population Health, an Arizona-based company offering an innovative, first-of-its-kind solution to the issue of health equity. Founded in 2018, Adobe employs a technology-driven model for interventional care management and takes a holistic approach to population health by closing care gaps, reducing costs, and caring for the whole person.
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