The Vital Connection Between Technology and the Social Determinants of Health for Older Adults
By Helen Eddy
Personal health is a complex subject, and factors from genetics to diet to lifestyle all play a role. Yet the environment in which an individual lives, their access to care, and their social support network also affect health. In fact, such social determinants of health (SDoH) account for an estimated 75% of population health and at least 20% of premature deaths in the United States.
Broadly speaking, SDoH are the factors of the environment in which people live, learn, work, play, worship, and age, which all affect a wide range of health attributes and quality of life. These factors can be grouped into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
The impact of these SDoH represents a challenge to improving health. Because, while health care providers can address individual health concerns with clinic visits and diet recommendations, social determinants at the macro level are a different kind of obstacle. There’s no prescription for improving economic security or neighborhood quality, and no doctor’s order can improve a patient’s social support network.
This is especially true for older individuals, nearly 70% of whom will need long term care services at some point. Those individuals may lack the mobility to seek solutions and may be at greater risk of isolation and loneliness, which contributes to increased levels of dementia, stroke, anxiety, and premature death. Further, many older individuals struggle with the technical tools that have become critical for creating connections. One-third of adults aged 65 and older say they’ve never used the internet, and one-half don’t have internet access at home. Even when they have internet access, 40% of older adults lack basic digital literacy skills.
The health risks associated with such isolation make it essential that caregivers have a way to frequently check on older individuals to ensure they are doing well and that their environment is conducive to continued good health.
In some cases, monitoring the health of older loved ones involves frequent visits by friends, family, or professional caregivers. But such visits are not always practical, and the COVID-19 pandemic has made it clear that we need solutions for times when visits by family members or other caregivers are difficult or impossible due to distance or health concerns. Ensuring that health care access for these individuals is not just equal but equitable will require innovative thinking.
For many, telehealth has provided crucial connections. And while telehealth use has moderated since a spike early in the pandemic, it is still at levels 38 times higher than those prior to the pandemic. And, while remote care can’t address all aspects of SDoH, increased familiarity with telehealth has inspired innovation in the ways providers use remote care to address patients’ unique needs. Following are examples of how Programs of All-Inclusive Care for the Elderly (PACE) organizations have used a telehealth platform built for people older than 75 to address SDoH factors for those who have multiple health conditions and are considered low income.
Neighborhood and Built Environment
Providence PACE introduced a tablet-based solution as a way to conduct remote visits when COVID-19 made in-person care impossible. However, staff at the organization quickly realized that they could use the simplified video calls to conduct safety assessments of a participants’ surroundings and offer tips to make them more secure, all remotely.
Similarly, when PACE at Element Care transformed its fall-prevention curriculum for delivery via the same platform, they quickly realized they could also use video visits to assess fall risks in participants’ homes.
Just as video calls simplify the process of monitoring an individual’s living conditions, it also allows caregivers to assess food supplies and even offer instruction for preparing healthy meals. In many cases, this involves using video calls to quickly scan a participant’s food supply and offer suggestions for healthy meals. In the case of Midland Care, however, organizers took advantage of group video calling over Zoom to offer live cooking classes. Such support is critical because eating a healthy diet reduces the risk of arthritis, heart disease, diabetes, and other conditions.
Social and Community Context
Zoom gatherings became a crucial tool for many early in the pandemic. For older users, this has also become critical for combating loneliness and isolation. According to an industry survey conducted by GrandPad, 82% of older adults are unable to view photos on a smartphone, leaving them cut off from updates about their children and grandchildren.
Regular conversation can reduce isolation. In one instance, a participant at the Northeast Iowa Area Agency on Aging (NEI3A) who had previously been calling his center as many as 10 times a day just for conversation, was able to use simplified video calling to reconnect with an old military buddy. Expanding his social circle meant the man no longer needed to rely on the agency for companionship. In another instance, an NEI3A participant was able to hold a virtual birthday party with his family. He called the tablet provided to him by NEI3A “the best thing that had happened to him in years.”
Health Care Access and Quality
For all of its promise, telehealth is not accessible to everyone. For example, only about 20% of NEI3A participants have access to the internet or a computer at home. Meanwhile, only 53% of individuals 75 and older use a smartphone, only 58% have Wi-Fi at home, and only 11% of adults 65 and older say they have used a device to talk via video with a doctor or health care provider in the past two weeks. As telehealth becomes a more central element of health care, lack of access will leave older individuals at a disadvantage.
There are many reasons older adults are missing out on technology that could help them address SDoH, and while say they would need help to learn how to use a smartphone, many do not consider getting online worth the effort. In addition, with people older than 70 being hit hardest by financial scams, they, along with their families, also worry about navigating those risks.
Increasing access to telehealth in meaningful ways requires technology that’s accessible to users who are not familiar with smartphones, tablets, or computers. Such technology must be intuitive to use and accommodate older users’ physical and cognitive limitations. It should also offer cellular connectivity to eliminate the need for home Wi-Fi and protect users from scams.
When users have access to technology that connects them to care, they will be better able to access ongoing medical support. But those connections will have benefits that go beyond providing access to doctors. Creating reliable resources for conducting video visits will also make it easier to address SDoH, which will have a significant impact on overall health and well-being.
— Helen Eddy is director of strategic partnerships at GrandPad, where she works closely with health care providers and community organizations to improve quality of life and well-being for older adults through effective telehealth.