A new survey from Alignment Healthcare offers a look at how social determinants of health are impacting seniors.
The Medicare Advantage insurer polled 2,266 people ages 65 and over in the spring and found three major barriers to their health: an inability to age in place, economic insecurity and limited access to care. This finding echoes last year's survey, where these were also the top three challenges cited by seniors.
Close to two-thirds, 64%, said they faced barriers to aging in place, while 60% said they have access challenges and 51% cited economic insecurity.
The study found that 27% would rank their financial situation among their top three stressors overall, while 13% of seniors said their finances were the largest source of stress and anxiety for them over the past year.
Close to half, or 44%, said they carry medical debt, and 26% said they are carrying medical debt that's equal to at least four months of their living expenses.
Ken Kim, M.D., chief medical officer for Alignment, told Fierce Healthcare that the number of people with severe medical debt showed a notable increase year over year. The survey showed an eight-percentage-point jump in the number of people with high debt loads compared to 2024.
"What stood out to me was, of those patients that had financial difficulties, what I saw was a significant increase in members that had a large debt," Kim said. "That's a lot of debt for seniors."
In addition, the study highlighted a preference for aging in place—for example, remaining in their homes rather than moving into a skilled nursing facility—but that there are barriers to key supports that held across geographies. Many of those surveyed (64%) said they would use benefits that support aging in place, such as coverage for safety rails, personal medical safety alerts, memory care or assistance with end-of-life planning.
Kim said for healthcare organizations to support members in this arena, they have to take both a local approach and as well as institutionally embrace the idea that social and behavioral health factors play a role in medical care. It also requires a combination of in-person, personalized interactions with technology and tools.
For example, the insurer is currently piloting a program with multiple sensors in the home, including movement trackers and fall sensors, that monitor a patient following discharge to avert readmissions. A model like this could enable seniors to age in place according to their preferences, he said.
"You have to take a multidisciplinary approach to helping these patients," he said. "It can't just be a doctor, it can't just be a social worker, you can't just be a case manager, you can't just be a care coordinator. It has to be the entire team addressing one patient at a time."
The study also found that 29% of respondents were struggling with loneliness, which can have a cascading effect on other medical challenges. Two in 5 of those who reported dealing with loneliness said it caused harmful symptoms like depression, anxiety, sleep disturbances or a decrease in physical activity.
Kim said that isolation and loneliness can also lead to worsening medical conditions. For example, a patient who lives with someone else may receive encouragement to seek care for more manageable symptoms, preventing more severe complications.
He also emphasized that while the survey ranks different social factors based on how often seniors reported them, these challenges are generally interrelated. A patient living alone may ignore symptoms for longer in part because they lack transportation to a visit, and their behavioral health may worsen alongside their physical health.
"If you think about the top five, six items—even though that the items are separated out—they're all related," Kim said. "You know, aging in place is related to access, which is related to economics and lack of support, loneliness and transportation."
"It's not just separate issues," he said. "One leads to another. One impacts the other."