Indirect Influences on Health in Older People

Older people who maintain social contact, whether it be with a spouse, with friends, or through outside interests, have fewer health problems. For example, older people who are married or who live with a roommate tend to be in better health than those who live alone. Older people who live with someone also have lower rates of hospitalization and nursing home admissions than those who live alone.

When older people live alone, lack social interaction, or both, new problems and symptoms may not be reported because no one notices. These older people may have no one to help them take their drugs as instructed. They may not prepare and eat balanced meals because physical impairments interfere, because they are lonely, or because they cannot drive or walk to a grocery store. Also, older people living alone are more likely to be lonely and depressed.

Occasionally, living with a relative or another person causes problems. Older people may conceal or minimize health problems because they do not want to impose on or inconvenience the relative. If any member of the household is not pleased with the living arrangement, older people may be neglected or mistreated (psychologically or even physically).

In people with higher levels of education, disorders tend to be detected earlier, and health outcomes tend to be better, even when a disorder is not detected early.

In the United States, poverty is more common among older people than among the general population, despite the financial help provided by Medicare, Social Security, and Medicaid. Medicare Part D (the prescription drug program), has made drug costs more manageable especially for older people with a low income. Yet, despite these programs, some older people still have significant out-of-pocket expenses, making it difficult to pay for health care. When paying for health care is difficult, otherwise treatable disorders often are undertreated or untreated or are treated at a late stage.

Older people may have difficulty coping with the many changes that occur with aging, such as retirement, loss of loved ones, and development of disorders. In response, older people may feel lonely, useless, powerless, or sad. They may lose their self-esteem. They may worry about becoming a burden to their family. They may become depressed, especially if they have a disorder that leads to temporary or permanent loss of independence or when they see their friends and loved ones die. These feelings may make older people less likely to see a health care practitioner, possibly delaying the diagnosis of a serious disorder. But research has shown that older people cope with these challenges better than younger adults.

Age-related changes and older people’s responses to them can make treating disorders in older people complicated. Thus, older people often benefit from interdisciplinary care—care provided by a team of health care practitioners working together. This team may consist of doctors, nurses, social workers, therapists, pharmacists, and psychologists. The care team evaluates the person’s needs and plans, coordinates, and implements care, including social services. Team members actively look for possible problems and take measures to correct or prevent them.