By Geralyn Magan
Robyn Stone’s recent article in Generations describes how evidence-based programs for older adults are increasing well-being and decreasing costs by addressing the social dimensions of health.
Differing levels of spending on social services may be the key reason behind why some countries have significantly poorer health outcomes than others, according to an article by Dr. Robyn Stone in the supplement to the Winter 2019-20 Generations. Stone is co-director of the LeadingAge LTSS Center @UMass Boston.
The Generations supplement, entitled, “Older Adults and America’s Healthcare Cost Crisis,” features 13 articles exploring the pressing need to lower health care costs for older Americans, the medical perspective on cost containment approaches, and solutions that go beyond medical care. Stone’s article, “Investing in the Social Dimensions of Health” falls into the last category.
Stone begins her article by describing what has come to be known as “the American health-care paradox.” The United States spends more on health care than other countries, but its health outcomes are much poorer than many of those countries. The reason? Our spending on social services—including long-term services and supports (LTSS) – is relatively low compared to many of our peers around the globe.
SOCIAL DETERMINANTS OF HEALTH
Non-medical social determinants of health are key contributors to the overall health of individuals and populations, particularly those with chronic and serious illness, writes Stone. For these at-risk populations, health is often determined by access to:
- Adequate and affordable housing with supportive services.
- Nutritious meals and health eating regimens.
- Accessible transportation.
- A strong social network in a safe community.
“International and domestic research strongly underscores the need for more financial resources dedicated to the non-medical-social dimensions of health, disease prevention at older ages, and better integration between the medical care system, LTSS providers, and other community-based entities,” she writes.
PROMISING SOLUTIONS
Stone spends the bulk of her article describing a wide range of evidence-based health promotion programs and the research showing that these programs are having a positive effect on health outcomes and health care spending among older adults. Her examples include:
- Programs for the “well elderly,” including those supporting exercise and strength training to improve mobility, increase overall function, and prevent falls.
- Programs for older adults with chronic illness and disability, including those using housing as a platform for “patient-centered goal-setting, health oversight, and care coordination-integration.”
- Programs for people with advanced illness and significant disability, including those serving older adults who are dually eligible for Medicare and Medicaid.
A CALL FOR MORE INVESTMENT
Stone concludes her review by calling for more investment in:
- Developing a community-based infrastructure to expand affordable housing options, invest in home modification, and develop evidence-based prevention programs.
- Scaling of community-based programs in Fee-for-Service Medicare and through the new supplemental benefits available through Medicare Advantage.
- More longitudinal research to study whether and how community-based programs affect the heath and functional status, quality-of-life outcomes, and health and LTSS costs of older adults.
“The goal for the U.S. health care system should be to fund more upstream services and supports so that older adults may perhaps avoid the use of medical care to the extent possible, and to age successfully within their communities,” concludes Stone.