Seniors say these are the top barriers to healthcare: Alignment survey

What elderly individuals consider to be threats to their health and well-being changed slightly from last year to this year, perhaps reflecting the receding of the COVID-19 pandemic, but the usual suspects still looked somewhat familiar.

That’s one of the conclusions that can be drawn from insurtech Alignment Health’s second annual "Social Threats to Aging Well in America" survey.

“In 2022, COVID-19 had the greatest negative impact on the mental health of seniors with a quarter of respondents nationwide rating it their top stressor,” according to the survey. “The 2023 survey reveals COVID-19 concerns persist but are fifth on the list, and nearly 1 in 8 seniors nationwide still rank it No. 1.”

Respondents said the top three social barriers to their health comprised economic instability, food insecurity and lack of support and transportation, all of which tied. In 2022, they said the top three top barriers comprised economic instability, loneliness and food insecurity.

Alignment hired Toluna, a company that specializes in conducting online surveys, which reached out to 2,601 individuals ages 65 or older from June 28 to July 10 in six states: Arizona, California, Florida, Nevada, North Carolina and Texas.

In terms of not being able to afford healthcare, 1 in 5 respondents said they skip getting adequate medical care when they need it, with 28.9% of those saying that they skip needed care. In addition, 14% of respondents said they have medical debt, and half of those said that debt equals at least one month’s worth of living expenses, while 89% don’t think they can pay all their medical bills in the next year.

Adam Wolk, M.D., Alignment Health’s regional chief medical officer, told Fierce Healthcare that “we’re seeing the impact of inflation on issues like food insecurity; you saw that move up a little bit. On transportation, you saw that move up a little bit.”

Wolk said he’s witnessed firsthand just how much of a burden these problems place on the elderly, who are often on on a fixed income, when he visits them. The dollar just isn’t going as far. “If you have to choose between a medication and your mortgage or rent payment, you’re going to choose to keep the roof over your head and forego medical care that might be really important for you to do,” Wolk said.

Adam Wolk of Alignment Health
Adam Wolk, M.D. (Alignment Health)

Food insecurity moved up into the second spot this year, replacing loneliness, though loneliness continues to be an obstacle to health for many seniors. One in 5 seniors said they’re concerned that lack of healthy food to eat will adversely affect their health, and 1 in 11 individuals said the struggle to provide food for themselves adds to their anxiety and depression.

“Inflationary grocery costs, combined with physical difficulties preparing meals, lack of reliable transportation to get groceries or food and more, are increasing the number of U.S. seniors struggling to access healthy meals,” according to the survey.

Insurance coverage that includes a grocery allowance ranked highest when individuals were asked what insurance benefit they would use the most, with 55% of elderly saying they would use it.

Wolk said federal agencies such as the Centers for Medicare & Medicaid Services “have come a long way in recognizing the importance of tackling those issues. You’ll see them allow health plans to include nontraditional benefits along the lines of a food benefit or companionship benefit. Transportation is a good example.”

Access to transportation moved up from No. 4 last year to the three spot this year as what seniors consider to be the main social barriers to health. It was tied with (and tied in with) lack of support. “Among the 1 in 5 seniors who skipped needed medical care in the past year, nearly one-third say they skipped because they did not have a ride or a companion at their appointments,” according to the survey. Nearly 11% of seniors who skipped needed medical care in the last year said they did so because of lack of support.

Despite loneliness not making the top three concerns this year, the survey states that seniors’ struggles with loneliness keeps rising. The amount of time they spend with friends, family or other companions in this year’s survey “is consistent” with 2022, and 1 in 5  say they’re lonelier now than they were a year ago.

“Nearly 1 in 3 seniors say they frequently go two weeks or more without spending time with others—if ever,” the survey states.

One possible positive byproduct of the pandemic—with its lockdowns and isolation—might be that non-seniors will appreciate just how much of a burden loneliness can be. Wolk said that was certainly his experience when he couldn’t spend a week with his children because of COVID.

“I just want people to remember as they’re thinking about their neighbors and friends that the social isolation of seniors and economic hardship and other social determinants of may be hidden,” said Wolk. “I really want people to think about that and to reach out to friends and family.”

In addition, addressing the social determinants of health often affects health equity, he said. “You’re going to see potentially access to more resources for folks who are at risk for poor social determinants,” said Wolk.