Tuesday, Oct 11, 2022
Supporting older women facing increased health risks: Considerations for health leaders supporting senior women as they age
Amy Nguyen Howell, MD, MBA, FAAFPChief of the Office for Provider Advancement, Optum Health
The number of older adults in the United States is expected to surpass 80 million by 2040. Among them, elderly women are more likely to be widowed, live alone and experience higher medical costs, along with wage losses later in life. Hispanic and Black women are even more likely to face these challenges.1
Economically, many elderly women rely on what they have available in income and savings, but women, particularly those of color, experience deep disparities related to work, housing, the economy and health care systems throughout their lives. Taken together over a lifetime, these inequities limit their opportunities for economic security and often result in older women facing impossible choices between affording rent, groceries, medicine and other basic necessities.
Gender pay disparities and inequitable distribution of childcare responsibilities accumulate for women in the calculation of Social Security benefits, which are based on the individual’s highest earning years. While the average Social Security retirement and survivor benefit for men in 2019 (excluding disability benefits) was $1,612, women received only $1,283 — only 79 cents to the dollar as compared with men.2
On top of having a lower standard of living and fewer social supports, elderly women face increased health complications. Hypertension in women of color, for example, becomes more frequent in older age due to the long-term effects of microvascular inflammation and mental stress. Research shows that the prevalence of hypertension in this population of women is in part due to the impact of accumulated microaggressions, racism and anxiety—another example of the way that inequities add up to unjust health vulnerabilities.
Adding to that stress, women may have had the extra burden of serving as primary caretakers or of working multiple jobs.
Older women additionally face higher costs due to longer life expectancy and management of chronic conditions tied to older age and gender. Women are more likely than men to have a chronic condition and more likely to have more than one chronic condition.1 In general, medication usage among women increases with age. Seventy-two percent of women ages 50-64 take at least one medication regularly compared with only 42% of women ages 18-49.1
This greater risk of health issues, combined with lack of economic opportunity that forces women to pay out of pocket, pressures many aging women to forgo healthcare altogether. Or worse, to choose between paying for healthcare or utility bills.
So, what can health leaders do to address the increased health risks among the rising number of senior women in their populations?
One way is to educate care teams to be aware of the full set of challenges that aging women face. Raising such awareness removes blind spots, making way for screening and history-taking that can lead to the provision of supportive services. Collecting data on race, ethnicity, language, gender and other factors specific to this population that affect health equity can help, especially when it comes to chronic conditions that impact the fulfillment of the quintuple aim.
To earn their trust, health professionals must gain an understanding of what is important to elderly women and how they prefer to connect. For these women, bearing in mind the cornerstones of patient experience is essential. They want providers to get to know them, and they desire empathy, compassion, and a simple, warm and welcoming approach.
Increasing a health workforce’s competence for understanding each community and culture they care for can make a significant difference in outcomes for elderly women.
Involving elderly female patients through a patient advisory council is another method for gaining powerful ideas for improving patient experience and other measures of quality care. Doing so will aid in designing quality care programs that include cultural, social and caregiver support.
Care coordination is another key aspect of connecting the dots across the health system, so that older women don’t fall off the radar in terms of quality care. Care coordination can start with the primary care provider, a mental health specialist, subspecialists, and especially a hospital care team if an individual ends up in the hospital. Taking advantage of digital health tools may allow for facilitation and access to care for patients.
Providers, health plans and government leaders can invest in reducing social determinants of health and improving health equity as a true component of a clinical model of care excellence. Recognizing the impacts that economic insecurity, race and culture preferences have on outcomes for elderly women is vital.
Identifying ways to streamline access to social services and benefits is beneficial for elderly women. In addition, expanding access to Medicaid and the benefits of Medicare coverage can ensure that lower-income women who are not currently eligible for Medicaid can access care. This entails including coverage for oral health, vision and hearing, which help to eliminate high out-of-pocket medical expenses. Women — and particularly minorities — are more likely to be in the low-income bracket and unable to access these services.1
Advocating for expansion of other federal and state benefits — such as Social Security, Supplemental Security Income, the Supplemental Nutrition Assistance Program, refundable tax credits, and housing assistance programs for low-income, older adults — would also free up critical financial resources, providing some alleviation for ‘heat, treat or eat’ decision making.
Working with family or community organizations, such as churches or centers for aging, can also be supportive in addressing health needs. Helping older women make social connections to the community through friends, family and even pets are ways in which leaders may bring innovation to the existing clinical care model in support of health and wellbeing.
Healthcare Effectiveness Data and Information Set (HEDIS) measures and Medicare Star outcome metrics help in assessing the effectiveness of healthcare interventions in closing quality care gaps, covering the level of support the patient and member received related to medication adherence, cardiovascular care, diabetes and renal care, and 30-day readmission rates.
Sharpening a focus on the needs of older women — our mothers, aunts, grandmothers and neighbors — will help them access the high-quality care they need to thrive at every age.
- National Women’s Law Center. Supporting the Economic Security and Health of Older Women of Color. Sept. 29, 2021. Accessed August 2022. https://nwlc.org/resource/supporting-the-economic-security-and-health-of-older-women-of-color/.
- Social Security Administration Annual Statistical Supplement, 2020, accessed August 2022. https://www.ssa.gov/policy/docs/statcomps/supplement/2020/5a.html.
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