Social determinants of health (SDOH) are the conditions in the environment where we are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. For older adults living in poverty, these determinants pose significant challenges, creating a double jeopardy that can significantly impact their health and well-being.

Here’s a breakdown of how various SDOH impact the health of older adults in poverty:

1. Economic Stability:

• Lower income: Older adults in poverty have limited financial resources to access adequate housing, nutritious food, healthcare, and other essential services. This can lead to food insecurity, housing instability, delayed or inadequate healthcare, and limited access to preventive care.
• Social security and pensions: Many older adults rely on social security and pensions for their income. However, these benefits are often insufficient to meet their basic needs, especially in areas with high living costs.
• Limited access to employment: Age discrimination and lack of suitable employment opportunities can make it difficult for older adults in poverty to supplement their income through work.

2. Social and Community Context:

• Social isolation and loneliness: Older adults in poverty are at increased risk of social isolation due to factors like limited transportation, mobility issues, lack of social connections, and loss of loved ones. Social isolation can have negative impacts on mental and physical health.
• Lack of social support: Older adults in poverty may lack strong social support networks, which can be crucial for emotional well-being, assistance with daily activities, and access to resources.
• Discrimination and stigma: Ageism and negative stereotypes about poverty can contribute to social isolation and discrimination, further jeopardizing the health and well-being of older adults in poverty.

3. Education Access and Quality:

• Limited education: Older adults in poverty may have had limited access to quality education, which can impact their health literacy, ability to navigate healthcare systems, and make informed decisions about their health.
• Lack of digital literacy: Limited access to technology and digital literacy skills can further disadvantage older adults in poverty, limiting their access to information, resources, and online services.

4. Health Care Access and Quality:

• Limited access to healthcare: Older adults in poverty may face barriers to accessing quality healthcare due to cost, lack of transportation, and limited availability of healthcare providers in their communities.
• Underutilization of preventive care: Due to cost and other barriers, older adults in poverty are less likely to utilize preventive care services, which can lead to early detection and management of chronic diseases.
• Fragmented care: Older adults in poverty may receive care from multiple providers, leading to fragmented care and poor communication between healthcare professionals.

5. Neighborhood and Built Environment:

• Unsafe neighborhoods: Older adults in poverty may live in unsafe neighborhoods with high crime rates, which can limit their physical activity and social interaction.
• Lack of affordable housing: Limited access to affordable housing can force older adults in poverty to live in substandard housing conditions, which can have negative impacts on their health.
• Limited access to transportation: Lack of reliable and affordable transportation can make it difficult for older adults in poverty to access essential services, including healthcare, grocery stores, and social activities.

Impact on Health:

These cumulative SDOH can have a significant impact on the health of older adults in poverty, leading to:

• Increased chronic diseases: Older adults in poverty are more likely to develop and experience complications from chronic diseases such as heart disease, diabetes, and cancer.
• Mental health issues: Poverty is a significant risk factor for depression, anxiety, and other mental health problems in older adults.
• Disability and functional limitations: SDOH can contribute to disability and functional limitations, impacting older adults’ independence and quality of life.
• Premature mortality: Older adults in poverty have a higher mortality rate than their wealthier counterparts.

Addressing the Challenge:

Addressing the double jeopardy faced by older adults in poverty requires a multi-pronged approach that tackles SDOH on various levels:

• Expanding access to affordable housing, nutritious food, and essential services.
• Improving healthcare access through expanded insurance coverage, reduced costs, and increased availability of healthcare providers.
• Strengthening social support networks through community programs, social activities, and volunteer opportunities.
• Combating ageism and discrimination through awareness campaigns and policy changes.
• Investments in education and digital literacy programs to empower older adults.
• Creating age-friendly communities with safe and accessible transportation, housing, and amenities.

By addressing these SDOH, we can create a more equitable and supportive environment for older adults in poverty, allowing them to age with dignity and enjoy a better quality of life.