In this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations; however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.
References
[1]
McGilton, K.S., et al. (2018) Identifying and Understanding the Health and Social Care Needs of Older Adults with Multiple Chronic Conditions and Their Caregivers: A Scoping Review. BMC Geriatrics, 18, Article No. 231.
[2]
Hood, C.M., Gennuso, K.P., Swain, G.R. and Catlin, B.B. (2016) County Health Rankings: Relationships between Determinant Factors and Health Outcomes. American Journal of Preventive Medicine, 50, 129-135. https://doi.org/10.1016/j.amepre.2015.08.024
[3]
McCartney, G., Hearty, W., Arnot, J., Popham, F., Cumbers, A. and McMaster, R. (2019) Impact of Political Economy on Population Health: A Systematic Review of Reviews. American Journal of Public Health, 109, e1-e12. https://doi.org/10.2105/AJPH.2019.305001
[4]
Gordon, N.P., Banegas, M.P. and Tucker-Seeley, R.D. (2020) Racial-Ethnic Differences in Prevalence of Social Determinants of Health and Social Risks among Middle-Aged and Older Adults in a Northern California Health Plan. PLOS ONE, 15, e0240822. https://doi.org/10.1371/journal.pone.0240822
[5]
Brown, T.H. (2018) Racial Stratification, Immigration, and Health Inequality: A Life Course-Intersectional Approach. Social Forces, 96, 1507-1540. https://doi.org/10.1093/sf/soy013
[6]
Boen, C.E. and Hummer, R.A. (2019) Longer—But Harder—Lives? The Hispanic Health Paradox and the Social Determinants of Racial, Ethnic, and Immigrant-Native Health Disparities from Midlife through Late Life. Journal of Health and Social Behavior, 60, 434-452. https://doi.org/10.1177/0022146519884538
[7]
Lucas, J.W., Freeman, G. and Adams, P.F. (2016) Health of Hispanic Adults: United States, 2010-2014. US Department of Health & Human Services, Centers for Disease Control and Prevention, Washington DC.
[8]
Cutler, D.M. and Lleras-Muney, A. (2006) Education and Health: Evaluating Theories and Evidence. National Bureau of Economic Research, Cambridge. https://doi.org/10.3386/w12352
[9]
Singh, G.K. and Lee, H. (2021) Marked Disparities in Life Expectancy by Education, Poverty Level, Occupation, and Housing Tenure in the United States, 1997-2014. International Journal of Maternal and Child Health and AIDS, 10, 7. https://doi.org/10.21106/ijma.402
[10]
Diaz, C.J. and Niño, M. (2019) Familism and the Hispanic Health Advantage: The Role of Immigrant Status. Journal of Health and Social Behavior, 60, 274-290. https://doi.org/10.1177/0022146519869027
[11]
Killoren, S.E., Wheeler, L.A., Updegraff, K.A., Rodríguez de Jésus, S.A. and McHale, S.M. (2015) Longitudinal Associations among Parental Acceptance, Familism Values, and Sibling Intimacy in Mexican-Origin Families. Family Process, 54, 217-231. https://doi.org/10.1111/famp.12126
[12]
Grotto, I., Huerta, M. and Sharabi, Y. (2008) Hypertension and Socioeconomic Status. Current Opinion in Cardiology, 23, 335-339. https://doi.org/10.1097/HCO.0b013e3283021c70
[13]
Braveman, P. and Gottlieb, L. (2014) The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Reports, 129, 19-31. https://doi.org/10.1177/00333549141291S206
[14]
Jemal, A., Thun, M.J., Ward, E.E., Henley, S.J., Cokkinides, V.E. and Murray, T.E. (2008) Mortality from Leading Causes by Education and Race in the United States, 2001. American Journal of Preventive Medicine, 34, 1-8.e7. https://doi.org/10.1016/j.amepre.2007.09.017
[15]
Brønnum-Hansen, H., Foverskov, E. and Andersen, I. (2020) Occupational Inequality in Health Expectancy in Denmark. Scandinavian Journal of Public Health, 48, 338-345. https://doi.org/10.1177/1403494819882138
[16]
Açci, R.C. and Samut, P.K. (2021) Wealthier Is Healthier? Healthier Is Wealthier? A Comprehensive Econometric Analysis of the European Countries. Acta Oeconomica, 71, 387-404. https://doi.org/10.1556/032.2021.00019
[17]
Närvänen, A.-L. (2018) Age, Ageing and the Life Course. In: Changing Worlds and the Ageing Subject, Routledge, London, 65-80. https://doi.org/10.4324/9781351161961-4
[18]
Grundy, E. and Holt, G. (2000) Adult Life Experiences and Health in Early Old Age in Great Britain. Social Science & Medicine, 51, 1061-1074. https://doi.org/10.1016/S0277-9536(00)00023-X
[19]
Pond, R., Stephens, C. and Alpass, F. (2010) How Health Affects Retirement Decisions: Three Pathways Taken by Middle-Older Aged New Zealanders. Ageing & Society, 30, 527-545. https://doi.org/10.1017/S0144686X09990523
[20]
Minkler, M. (1981) Research on the Health Effects of Retirement: An Uncertain Legacy. Journal of Health and Social Behavior, 22, 117-130. https://doi.org/10.2307/2136288
[21]
Coe, N.B. and Zamarro, G. (2011) Retirement Effects on Health in Europe. Journal of Health Economics, 30, 77-86. https://doi.org/10.1016/j.jhealeco.2010.11.002
[22]
Nyqvist, F., Näsman, M., Hemberg, J. and Nygård, M. (2021) Risk Factors for Loneliness among Older People in a Nordic Regional Context—A Longitudinal Study. Ageing & Society, 1-22. https://doi.org/10.1017/S0144686X21001707
[23]
Beam, C.R. and Kim, A.J. (2020) Psychological Sequelae of Social Isolation and Loneliness Might Be a Larger Problem in Young Adults than Older Adults. Psychological Trauma: Theory, Research, Practice, and Policy, 12, S58. https://doi.org/10.1037/tra0000774
[24]
Kotwal, A.A., et al. (2021) The Epidemiology of Social Isolation and Loneliness among Older Adults during the Last Years of Life. Journal of the American Geriatrics Society, 69, 3081-3091. https://doi.org/10.1111/jgs.17366
[25]
Berkman, L.F. and Syme, S.L. (1979) Social Networks, Host Resistance, and Mortality: A Nine-Year Follow-Up Study of Alameda County Residents. American Journal of Epidemiology, 109, 186-204. https://doi.org/10.1093/oxfordjournals.aje.a112674
[26]
House, J.S., Robbins, C. and Metzner, H.L. (1982) The Association of Social Relationships and Activities with Mortality: Prospective Evidence from the Tecumseh Community Health Study. American Journal of Epidemiology, 116, 123-140. https://doi.org/10.1093/oxfordjournals.aje.a113387
[27]
Cacioppo, J.T., et al. (2002) Loneliness and Health: Potential Mechanisms. Psychosomatic Medicine, 64, 407-417. https://doi.org/10.1097/00006842-200205000-00005
[28]
Wang, M. (2007) Profiling Retirees in the Retirement Transition and Adjustment Process: Examining the Longitudinal Change Patterns of Retirees’ Psychological Well-Being. Journal of Applied Psychology, 92, 455. https://doi.org/10.1037/0021-9010.92.2.455
[29]
Wang, M., Adams, G.A., Beehr, T.A. and Shultz, K.S. (2009) Career Issues at the End of One’s Career: Bridge Employment and Retirement. In: Baugh, S.G. and Sullivan, S.E., Eds., Maintaining Focus, Energy, and Options over the Life Span, Information Age Publishing, Charlotte, 135-162.
[30]
Wang, P.S., et al. (2005) Suboptimal Antidepressant Use in the Elderly. Journal of Clinical Psychopharmacology, 25, 118-126. https://doi.org/10.1097/01.jcp.0000155819.67209.e5
[31]
Tyndall, A.V., et al. (2018) Protective Effects of Exercise on Cognition and Brain Health in Older Adults. Exercise and Sport Sciences Reviews, 46, 215-223. https://doi.org/10.1249/JES.0000000000000161
[32]
Lee, I.-M. and Skerrett, P.J. (2001) Physical Activity and All-Cause Mortality: What Is the Dose-Response Relation? Medicine and Science in Sports and Exercise, 33, S459-S471. https://doi.org/10.1097/00005768-200106001-00016
[33]
Schoenborn, C.A. (2004) Marital Status and Health, United States 1999-2002 (No. 351). US Department of Health and Human Services, Centers for Disease Control and Prevention, Washington DC. https://doi.org/10.1037/e609172007-001
[34]
Mata, J., Frank, R. and Hertwig, R. (2015) Higher Body Mass Index, Less Exercise, but Healthier Eating in Married Adults: Nine Representative Surveys across Europe. Social Science & Medicine, 138, 119-127. https://doi.org/10.1016/j.socscimed.2015.06.001
[35]
McWilliams, J.M., Zaslavsky, A.M., Meara, E. and Ayanian, J.Z. (2004) Health Insurance Coverage and Mortality among the Near-Elderly. Health Affairs, 23, 223-233. https://doi.org/10.1377/hlthaff.23.4.223
[36]
Novoa, A.M., Bosch, J., Díaz, F., Malmusi, D., Darnell, M. and Trilla, C. (2014) Impact of the Crisis on the Relationship between Housing and Health. Policies for Good Practice to Reduce Inequalities in Health Related to Housing Conditions. Gaceta Sanitaria, 28, 44-50. https://doi.org/10.1016/j.gaceta.2014.02.018
[37]
Nguyen, A.W., Chatters, L.M., Taylor, R.J. and Mouzon, D.M. (2016) Social Support from Family and Friends and Subjective Well-Being of Older African Americans. Journal of Happiness Studies, 17, 959-979. https://doi.org/10.1007/s10902-015-9626-8
[38]
Visioli, F., Marangoni, F., Poli, A., Ghiselli, A. and Martini, D. (2022) Nutrition and Health or Nutrients and Health? International Journal of Food Sciences and Nutrition, 73, 141-148. https://doi.org/10.1080/09637486.2021.1937958
[39]
Ordovas, J.M., Ferguson, L.R., Tai, E.S. and Mathers, J.C. (2018) Personalised Nutrition and Health. BMJ Clinical Research, 361, k2173. https://doi.org/10.1136/bmj.k2173
[40]
Iott, B.E., Pantell, M.S., Adler-Milstein, J. and Gottlieb, L.M. (2022) Physician Awareness of Social Determinants of Health Documentation Capability in the Electronic Health Record. Journal of the American Medical Informatics Association, ocac154.
