● Two-thirds of the older adults said they regularly see, hear, or read insulting jokes about older people. According to new research, older adults in the U.S. are more likely to report racial and ethnic discrimination in the health system than their peers in 10 other high-income countries. (How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do, 2022). Other findings reveal that in the U.S., one in four Black and Latinx/Hispanic adults aged 60 and older reported that they have been mistreated or felt that their health concerns were not taken seriously by health professionals because of their racial or ethnic background. This data also shows that more than a quarter of U.S. older adults said they did not get the care or treatment they felt they needed because of discrimination. Finally, older adults who have experienced discrimination in a healthcare setting were more likely to have worse health status, face economic hardships, and be more dissatisfied with their care than those who did not experience discrimination. Evidence-Based Practice: Men are more likely to take their own lives, but less likely to seek professional help when they are depressed, especially as they age. Note : From “Age differences in public stigma, self-stigma, and attitudes toward seeking help: A moderated mediation model,” by Mackenzie, et al., 2019. Journal of Clinical Psychology, 75(12), 2259–2272. Social Isolation and Loneliness Among Older Adults Social isolation is a lack of quality contact with others. This is an objective measure; the number of contacts a person has is quantifiable. Loneliness, by contrast, is a subjective concept where a person feels isolated. A person may have many contacts but feel lonely, or few contacts and be content with no feelings of loneliness. Therefore, isolation and loneliness among older adults have been a growing concern. The COVID-19 pandemic impacted the social interaction of everyone in this country, but older adults seemed to have been dealt the most brutal blow. Studies show that isolation among older adults increased drastically during the pandemic. In June 2020, more than half of older adults (56%) reported feeling isolated from others (43% some of the time, 13% often) compared to 27% (22% some of the time, 5% often) in 2018. When comparing their feelings in June 2020 to those before the pandemic, about half of adults aged 50–80 (48%) felt more isolated, 8% felt less isolated, and 44% reported feeling the same. Nearly half of older adults (46%) in June 2020 reported infrequent social contact (once a week or less) with family, friends, or neighbors from outside the home, compared to 28% in 2018. (Loneliness Among Older Adults Before and During the COVID-19 Pandemic, 2020). Overall, this data suggests that the COVID-19 pandemic has substantially impacted feelings of loneliness (lack of companionship and isolation) and social connections among older adults. A more significant proportion of adults aged 50–80 felt a lack of companionship, felt socially isolated, and had infrequent contact with others from outside their homes during the early months of the pandemic than in 2018 when those numbers were already worrisomely high. Loxton (2021) reveals that social isolation and loneliness are precipitated by several factors, including living alone, health problems and disability, and sensory impairment, such as hearing loss. Older adults with chronic conditions often have physical limitations that make it difficult to leave their homes and socially interact. Impaired vision and hearing can make it difficult to interact with others. Sensory loss can result in the suspension of driving privileges and make public transportation challenging to navigate, reducing mobility
(National Academies of Science Engineering and Medicine, 2020). Social isolation and loneliness are more common in adults with anxiety or depression. Older adults with anxiety disorders are more likely to experience loneliness, even when their social networks include many quality contacts (National Academies of Science Engineering and Medicine, 2020). Family caregivers’ risk social isolation and loneliness, particularly when caring for a person with demanding mobility needs or cognitive impairment. Caregivers often give up other societal contacts, such as work or hobby groups, to meet the demands of their caregiving role. Caregivers are also at additional risk for social isolation and loneliness if the loved one they are caring for dies, particularly if their existing social network has disintegrated during their caregiving years (National Academies of Science, Engineering and Medicine, 2020). Numerous studies have shown that significant life events, such as a spouse's death, dramatically increase seniors’ vulnerability to emotional and social isolation. This is made worse if there is a drop in communication with family or friends at the same time or even a move to an unfamiliar neighborhood. The same is true if family members move for work or other personal reasons or aging siblings and friends die. Under these circumstances, an emphasis on senior independence increases physical isolation and social disengagement and triggers instability and insecurity. Research shows that older adults who experience social isolation and loneliness are at an increased risk of premature death (National Academies of Science Engineering and Medicine, 2020). Poor social connection is linked to dementia and cognitive impairment in older adults, with the risk of dementia increasing by as much as 50% in older adults experiencing high levels of loneliness (National Academies of Science Engineering and Medicine, 2020). Older adults experiencing social isolation and loneliness are at an increased risk of depression, anxiety, and suicidal ideation. This risk remains elevated irrespective of age, sex, socioeconomic status, or relationship status (National Academies of Science, Engineering and Medicine, 2020). Socially isolated older adults are at an increased risk of experiencing and being victims of elder violence and abuse. Elder abuse is linked to psychological distress, displacement, and at its extreme, threats to physical safety and death. The COVID-19 crisis has increased the risk of elder abuse in social isolation and loneliness (World Health Organization, 2021). Research from Alignment Healthcare USA (2022) revealed three major social determinants of health factors as barriers to care for America’s seniors. They identify these barriers as economic instability, loneliness, and food insecurity. Economic instability—challenges in paying medical bills— was a widespread issue for respondents. One out of six seniors shouldered medical debt, and one out of five reported that finances were their most significant barrier to care. For many seniors, financial barriers to care were tied to competing priorities. Over a third of individuals said financial responsibilities precede health within the upcoming year. Additionally, nearly a quarter of individuals said that challenges in covering medical bills, prescriptions, and medical supplies were a significant financial barrier to care in the next year. Other barriers included unresponsive providers, lack of in-home support, transportation access issues, lack of nutritious foods, and technology troubles. Sixteen percent of seniors said they had outstanding medical debt, of which more than half reported having medical debt amounting to one month of living expenses or more (Alignment Healthcare USA, 2022). These financial difficulties contribute to uncertainty around seniors’ ability to cover medical expenses in the next year. Loneliness, previously discussed here, is another predominant social
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