Thank you to Dr. Maurya D. Cockrell for contributing this guest post. Dr. Cockrell, a member of the VOYCE Board of Directors, is an established SDoH Solutionary from St. Louis, Missouri. She holds a BS in health management from Saint Louis University, with a minor in theological studies, an MA from Webster University in human resources management, and a doctorate in health professions education from Logan University. Dr. Cockrell founded YKNOT Consulting in 2015 and Leaves Speak Healthcare in 2017.

America’s population is aging at a rapid pace. Multiple data sources reveal that approximately 10,000 Americans turn 65 each day. Demographic research suggests human lifespan is increasing, not decreasing, bringing experts to the forefront collaborating on ways to meet the challenges of aging. We must design a society that builds multisector partnerships to support high-quality aging and long-term care. The foundation of these multisector partnerships is understanding the social determinants of health (SDoH). Lived experiences, societal norms, and policies contribute to the distribution of resources that often lead to health inequities. Healthcare can no longer operate in a silo. Cohesion is needed between individuals, providers, health systems, civic organizations, corporate partners, public health, and social partners.

Social Determinants of Health

Simply defined, the social determinants of health (SDoH) are non-medical factors that can positively or negatively impact health outcomes. The non-medical factors address how individuals live, learn, work, and play. The five domains of SDoH include:

  • Economic Stability: employment, food security, housing, and poverty
  • Education: literacy, high school graduation metrics, and access to higher education
  • Healthcare: understanding of one’s own health and wellbeing, access to care, health insurance, and health literacy
  • Neighborhood/Built Environment: quality of housing, transportation, and neighborhood crime/violence
  • Social/Community: spiritual community, civic duty, recreation, and incarceration

SDoH Interplay with Aging

As Boomers continue to age, the number of individuals needing help with basic care will likely increase. This care can take place in the home or a long-term care facility. The decision to where, how, when, and why care is provided is often based on SDoH. SDoH, cultural norms, policies, and procedures can influence health outcomes such as mortality and quality of life. Some feel aging should be considered as its own SDoH domain.

Aging and Economic Stability

Media outlets continue to report the fear of the US government running out of Social Security funds. Right now, it is more likely that Gen X, Millennials/Gen Y, and soon to be Gen Z will be the ones who work and pay taxes to support Social Security, Medicare, and other programs that aid aging Americans. There is a concern that employment fluctuations will reduce the number of Americans sharing the cost of Social Security beneficiaries.

AARP reports 40% of older adults are concerned about their ability to afford and maintain their homes. SDoH-related factors such as affordable housing can be a challenge for today’s older population. In addition, older adults express concerns about the cost of assisted living and long-term care facilities. According to the American Action Forum, come 2030, the cost of long-term care could reach $2.5 trillion. The SDoH domain, economic stability, looks at housing and poverty. Long-term care expenses primarily negatively impact middle-income older Americans who do not qualify for Medicaid but cannot afford to pay for quality long-term care out of pocket.

Aging and Education

A solid educational foundation is key to having a successful and healthy life. Not always, but aging can lead to decreased cognitive function. Individuals’ educational backgrounds often play a role in the quality of their healthcare (through literacy), social status, and economic status.

A new topic of discussion concerning aging and education is the design of Age-Friendly Universities and the promotion of lifelong learning. The increase in older adults returning to school indicates there should not be a deadline or expiration date on learning. Universities are beginning to see older adults returning to school to start a second career or achieve a lifelong dream. Instructors must now promote inclusion and belongingness in a multi-generational classroom. Learning strategies and communication preferences can differ between the generations.

Aging and Healthcare

Aging impacts healthcare just as much as healthcare impacts aging. The medical needs of older adults shape the structure of the US health system. It is also important to note that healthcare and health providers can positively or negatively impact aging depending on the style of communication. The use of elderspeak, a stereotype-based form of communication, can lower older adults’ self-esteem and make them feel less competent, leading to a lack of adherence to their care plans.

Aging and Neighborhood/Built Environment

The neighborhood/built environment is essential at all stages of life, but often safety is a primary concern for more vulnerable populations. As Americans age, the goal should be to live in an area where it is safe to walk and there is access to parks and places for exercise. As adults age in place, their transportation options may change due to physical limitations. Reliable transportation is a key SDoH domain.

Aging and Social/Community

Through 2020 and the pandemic, social isolation has been on the rise. Older adults and especially orphaned elders, need a solid social network for mental, emotional, behavioral, spiritual, and clinical support. For example, many older adults in the African American community find their social support through a church home. Before the pandemic, churches would often promote speaker series on health and tips for battling diseases such as cancer or diabetes. Traditionally, many older adults find healthcare providers based on recommendations from family, friends, and church members.

Next Step: Advocacy

  • Advocacy for Self
    • Use the resources below to review your health status with the lens of the five social determinants of health
    • Adopt a healthy lifestyle and develop a network of support to reduce social isolation
    • Discuss the social determinants of health with your care providers
  • Advocacy for Others
    • Once you understand the social determinants of health, help find resources for those who might lack access to nutritional food or carpool with a friend who does not have access to transportation
    • Work with your loved ones to plan for long-term care and end of life. Contact the VOYCEconnect Helpline for assistance navigating the process
  • Advocacy for Systemic Change
    • Support laws, policies, and/or organizational procedures that help reduce barriers to care and inequities. Join VOYCE’s advocacy efforts and receive updates on our advocacy work and how you can help
    • Promote global collaboration around health and wellness
    • Build multi-sectors partnerships to address SDoH

Resources

https://health.gov/healthypeople/objectives-and-data/social-determinants-health

https://www.cdc.gov/aging/agingdata/data-portal/clinical-preventive-services.html

https://health.gov/healthypeople/objectives-and-data/browse-objectives/respiratory-disease/reduce-hospitalizations-asthma-adults-aged-65-years-and-over-rd-d03

https://www.americanactionforum.org/research/the-ballooning-costs-of-long-term-care/

https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html

https://www.cdc.gov/aging/disparities/social-determinants-alzheimers.html

https://health.gov/healthypeople/objectives-and-data/browse-objectives/arthritis/reduce-proportion-adults-arthritis-whose-arthritis-limits-their-work-03

http://endseniorhunger.aarp.org/wp-content/uploads/2018/06/Issue-Brief_SDOHandAgingPopulation-v2-1.pdf

Comments

  1. 1
    JoAnn Lyles on June 2, 2021

    So informative!

  2. 2
    Mary Pratt Cooney on June 2, 2021

    SDOH. I got it. Excellent resources. Thanks

  3. 3
    Nageen on June 4, 2021

    Great considerations here on a topic that deserves much more focus!

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