The Silver Tsunami & Seniors’ Social Determinants of Health

What is “The Silver Tsunami?” It almost sounds like a comic-book superhero or a rollercoaster at an amusement park. However, it’s the name experts have given to America’s rapidly expanding elderly population. Helping this population age healthily not only leads to happier patients, but lower national healthcare costs.

The World Health Organization defines healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age.” However, the social determinants of health are often left out of this conversation.

What does that have to do with the Silver Tsunami? A report found that 51 percent of older adults have at least one unmet social need.

Since social determinants of health govern 80 to 90 percent of health outcomes, it’s vital that providers are aware of what these forces are and how they affect patients. We’ll examine three key social determinants of health that can negatively affect this demographic and solutions providers can begin using immediately.

Transportation Difficulties & Immobility

Twelve percent of elderly patients occasionally or frequently miss appointments because of transportation challenges. And this number of individuals with mobility issues is increasing; experts estimate that by 2029 up to 60 percent of seniors will experience mobility limitations.

One way providers can overcome this obstacle is by partnering with a telehealth organization. Telehealth benefits several different patient demographics. However, there’s a widespread misconception that older adults won’t adapt to new technologies or always prefer an in-office visit. The mistaken belief that “you can’t teach an old dog a new trick” persists even in medicine.

However, this insidious bias couldn’t be less true. In fact, a quarter of seniors are currently using a mobile health app. While this group prefers to visit an emergency room for urgent care, 84 percent would use the telehealth for a prescription refill.

Using telehealth to refill prescriptions can help providers get a “foot in the door” and introduce reluctant seniors to the technology. Elaine Reale, MD, a pediatrician with Privia’s Marshak Medical Group in Rockville, Maryland, noted: “[Telehealth] does so much more with preventative healthcare and just making sure that things are staying on track, which will then serve us well as patients get older and move down the line because then they won’t potentially have as many health issues going on.”

Declining Health Literacy

Health literacy has been hailed as “the newest vital sign” as it is a strong predictor of health outcomes.

“Health literacy empowers patients to manage their health and well-being,” said Meredith Josephs, MD. “A patient who has the ability to understand their diagnoses and treatment options is then able to fully engage with the provider as a partner in making ongoing decisions about care.”

The opposite is also true. Patients who don’t understand their treatment may struggle to effectively manage their condition. Unfortunately, less than five percent of adults 65 years or older have “proficient” health literacy. In fact, only three percent of Medicare beneficiaries are “proficient.”

There are several ways providers can bolster patients’ health literacy:

• Practice the teach-back method. After reviewing a patient’s treatment, kindly ask them to repeat it using their own words. This simple question helps to ensure comprehension and gives providers a chance to identify and correct specific misunderstandings.
• Use everyday language. Guides such as “Everyday Words for Public Health Communication” exist to encourage providers to use language patients are more likely to understand. For instance, replace “abdominal pain” with “stomach ache” when appropriate.
• Consider telehealth. Patients may have questions that they don’t feel warrants an in-office visit, especially if they have aforementioned mobility issues. This barrier can deter patients from asking important health questions. However, adding a telehealth option removes this obstacle and helps patients stay connected and in-the-know.

Financial Instability

Simply stated, many seniors do not have the financial resources to afford all the healthcare they need, especially when you factor in the huge but overlooked role social determinants of health play.

• 11 percent of older adults were forced to choose between food and other necessities at some point in the past year.
• By 2029, the majority of middle-income seniors won’t be able to afford the necessary levels of healthcare and housing, according to Health Affairs.
• Approximately 25 percent of Medicare beneficiaries have less than $15,000 in total savings.

As the American Society on Aging notes, “Economic resources are considered a ‘fundamental’ cause of health because they are necessary to obtain all goods and services needed in a healthy life.” Said differently, poverty can compound other social determinants of health, such as food insecurity.

Providers can also offer resources that alleviate the effects of economic insecurity, such as Supplemental Nutrition Assistance Program (SNAP), which helps low-income individuals afford food. This program, according to AARP, is associated with “lower healthcare costs, decreased emergency department visits and hospitalizations, and reductions in cost-related medication nonadherence.” By preventing these costly health events, patients can become more financially stable and healthier.

Providers can also recommend CMS’ “What’s Covered” app to help patients find affordable care. This tool enables Medicare beneficiaries to “quickly see whether Medicare covers a specific medical item or service.”

While there are no quick fixes or miracle cures for social determinants of health, raising awareness and sharing simple, effective solutions go a long way. As a provider, you have the opportunity to meet “Silver Tsunami” patients where they are and take valuable initiative in their care.

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