31. What the 2021 America’s Health Rankings Senior Report Discovered About Older Adults

Published August 11, 2021

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Show Notes

Sue Peschin, President and CEO of the Alliance for Aging Research, talks with Dr. Rhonda Randall, Chief Medical Officer for UnitedHealthcare Employer and Individual, about the UnitedHealth Foundation’s America’s Health Rankings Senior Report.

View the report here: https://www.unitedhealthgroup.com/newsroom/posts/2021/2021-5-18-report-challenges-older-americans-791889.html.

Episode Transcript

Sue Peschin:

Hi everyone, and welcome to the Alliance for Aging Research’s podcast, This is Growing Old. I’m your host, Sue Peschin, and I serve as President and CEO of the Alliance for Aging Research. Today, I’m fortunate to be speaking with Dr. Rhonda Randall, Chief Medical Officer for United Health Care Employer and Individual, about the United Healthcare Foundations America’s Health Ranking Senior report. Dr. Randall, thank you so much for joining us today.

Rhonda Randall:

Thank you for inviting us to have a conversation.

Sue Peschin:

Absolutely. So the United Health Foundation recently released a America’s Health Rankings Senior report, which we always find so insightful. Can you please explain the history and the purpose of the report?

Rhonda Randall:

Sure. Happy to do that. So for more than three decades, in fact, 31 years, the United Health Foundation has been publishing America’s Health Rankings. It’s the nation’s longest running population health report of its kind. And almost a decade ago, we really wanted to ask ourselves, as we saw the age wave, if a community could be healthy if its seniors were or were not. So we wanted to do a spotlight report on the health of seniors. And we’re now in our ninth edition. It gained so much interest. And the senior report in particular contains 49 different measures of our health, so it looks at our health very comprehensively from the community and environment where we live, from the behaviors we choose like smoking or being physically active, the clinical care you get when you go to the doctor, the hospital, and very importantly outcomes, things like premature death rates and rates of chronic diseases.

Rhonda Randall:

The data in this report comes from 22 different public health sources, and we put it together in a comprehensive way so that we can look at those trends over time, see where we’re making improvements at a national level and at a state level and more and more at a subpopulation level. So the report also allows us to drill down many of these measures by race and ethnicity, by gender, by geography, by level of education and much more.

Sue Peschin:

Excellent. It’s very rich and people need to check it out. But before they do that, tell everybody what were the main findings of this year’s report and what do you think they mean for older adults?

Rhonda Randall:

Well, it’s important to note that the data in this year’s report is pre-pandemic. So the majority of the measures in this report are 2019 and prior there are a few measures like the healthcare workforce measures that are 2020 data. But this report provides us an important baseline for those conversations around our personal health or the health of our communities and the public health of our states and our nations, particularly in regard to seniors. Everybody knows that seniors were significantly impacted by COVID-19 representing the population that had the highest rates of hospitalization, the highest rates of death from the recent pandemic. So we wanted to provide this baseline of data to spark that important conversation. A couple of things that we saw. Each year when we look at the report, we see some things that are trending positively and some things that concern us. Let’s start with the good news.

Rhonda Randall:

Geriatric professionals. So geriatricians, geriatric nurse practitioners, for example, up nationally 13%. So we’re seeing more individuals choosing careers in caring for the elderly, particularly frail seniors, and our report partner this year is the Gerontological Nurse Practitioners Association, a group who’s really dedicated their life and their professional career to caring for an aging population. So it’s nice to see that when we look at geriatricians like myself and geriatric nurse practitioners, that there is more people coming out of training with that specialty certification. The second thing that we saw going in the right directions was flu shots was up prior to the pandemic. So we’re happy to see that more seniors are getting their flu shots. Just under 64% of seniors got their flu shot in 2019. This compares to healthy people 20, 30. The goal there is to see us get to 70% vaccination rates. So we’re not quite there yet, but we’re making nice progress with regard to flu vaccinations.

Rhonda Randall:

Then when we look at those things where we could be doing better, some of the things that really concerned us prior to the pandemic is that impacts on our emotional wellbeing and behavioral health. We saw seniors experiencing higher rates of frequent mental distress. We saw seniors reporting higher rates of depression. We saw increases in drug deaths and increases in suicide rates prior to the 2019 pandemic. And there seems to also be a correlation between all of this and social isolation. Social isolation we define as… We follow the AARP foundation’s definition of social isolation. It’s the lack of meaningful social connectedness. So things like being never married, single, widowed, divorced, living alone, living in poverty, living with a disability. We know that that social connectedness is so important to our overall health. In fact, the states and communities that have the highest rates of social isolation also have a tendency to rank lowest on our America’s Health Rankings Senior report.

Rhonda Randall:

We saw an important correlation between high speed internet access and social isolation. So communities that had greater availability of high speed internet were also less likely to have high rates of social isolation. So all of that, you can see the correlations between a lot of these measures. And when the pandemic struck, I’m sure the Alliance for Aging Research, like geriatric professionals, we really wanted to stay away from language like social distancing and instead use language like physical distancing. Keeping that safe distance where those respiratory droplets could spread from one person to another, but not eliminate social connectedness that was so important.

Sue Peschin:

Yes, I think that’s a great point. And we always talked about stay socially close. Absolutely. So the report did highlight how the COVID-19 pandemic has impacted the health of older adults. And I just wanted to know from your perspective, what did we learn from the pandemic in terms of how we can improve healthcare for older adults?

Rhonda Randall:

Yeah, I think the baseline data is super important so that we understand where we were before the pandemic and the emerging data that we’re seeing real time come in, seniors with chronic conditions, for example, among the most vulnerable related to the pandemic, and before that as well. So managing those chronic conditions, avoiding them as we age, and what things we can do to age healthy. It’s never too late to quit smoking. It’s never too late to start getting some physical activity in our daily lives and things that we enjoy. Maybe this was a good time to restart gardening or taking a walk and getting out in the fresh air, for example. So all of those things super important.

Rhonda Randall:

The connectedness that we talked about just a moment ago with social isolation and social connections, we see how very important that is to our overall health, not just our emotional health and wellbeing, but our physical health as well. And then the pieces around mental health and behavioral health. Really concerning to see where those trends were going, that drug overdoses up in seniors, suicide rates up in seniors. So what are we doing at a community level? And we saw that each of those measures was not experienced equally among geographies, among races and ethnicities, among levels of education that seniors attain in their younger years and more.

Sue Peschin:

The next question, I think, is a good segue from what you just said. The report highlighted disparities that folks experience during the pandemic, especially among those who are older. So can you provide a bit of an overview of the disparities that you identified and how they could be addressed?

Rhonda Randall:

Sure. So just let me give you a concrete example. We looked at food insecurity. There was significant differences that we saw by geography, whether somebody lives in a metropolitan area or a rural area. We saw differences by educational attainment. We saw differences by race and ethnicity. So some of that early research in the pandemic’s effects indicate that it exacerbated some of these challenges. But there was also a lot of heroes and servants and organizations like the United Health Foundation and many others focused on the aging community that rallied around making sure that more and more services were available to seniors during the pandemic, taking steps to address that through partnerships. The piece around social isolation, we partnered with the AARP foundation and their campaign called Connect to Affect, really addressing social isolation. And people were asking the question, “How do I know if I am socially isolated or not?” So this was a tool where people could do an assessment and get some feedback, and then get connected to resources so that we could really address those ongoing needs in each of our communities.

Rhonda Randall:

Another thing that United Health Care did and United Health Group got involved in was an initiative called Stop COVID or where we’re seeing those differences between races and ethnicities, as far as how frequently they were more likely to contract COVID-19, how more likely they were to be hospitalized or die from the pandemic. So we really recognize that that needed to be local in nature, and we delivered a significant amount of free testing, health education, food, medical referrals, addressing those healthcare disparities in our local communities where we live, work, and serve.

Sue Peschin:

Oh, that’s amazing. You’ve done really great and important work, clearly. I think one thing a lot of folks don’t realize is that a lot of people who are volunteers are older themselves. So a lot of volunteerism was hurt during the pandemic, so for meal deliveries, some of the things that you mentioned, there was a need because folks needed to, if they were older and at higher risk, stay at home. And everything that you mentioned is terrific. We work with some corporate partners who had folks available to volunteer and the national area agencies on aging also. All of that really was remarkable how people came together. So now I’m pivoting, and I’m going to ask you a question that we ask all of our guests. When you were a kid, what did you imagine growing old would be like?

Rhonda Randall:

I think that’s a great question. I think probably we draw on the examples that we’re given. I guess the first question I have is when are we old, and as a geriatrician, I don’t have a good answer to that. I think it’s probably all relative. Geriatricians have a tendency to focus on the care of frail older adults, so people who need assistance with their activities of daily living, et cetera, not just the number of birthdays that we’ve had to celebrate. But I had the honor of being close to both of my great-grandmother’s when I was very young, and I think when I think about what my senior years look like, it’s family.

Rhonda Randall:

And the other thing is what you mentioned about service. In fact, it’s one of the measures that we include in this report is volunteerism. It’s a good proxy for maintaining purpose as we age, so something that’s so important to our health. When seniors weren’t able to volunteer as much during the pandemic, not only did that impact the communities where they were serving, but it also impacted their own health. There’s a lot of good that comes… Anybody who volunteers will tell you that they get more than they give. I guess I would say in the future, what I look to is more opportunities to serve my community and more opportunities to spend time with family.

Sue Peschin:

Oh, that’s awesome. Well, what do you enjoy most about growing older now?

Rhonda Randall:

I think just continuing to develop, to be a learner, to be a student, and to add to what our level of understanding is of our workplace, our home life, and what we’re doing in our community. So over the years you gain knowledge, but probably more importantly, you gain insight and wisdom.

Sue Peschin:

That’s great. It’s so true. I think what you’re doing, too, as a profession, on a day-to-day basis, you’re sort of reminded, so you’re kind of in it more than most people. Dr. Randall, thank you so much for joining us today. This was an absolute pleasure.

Rhonda Randall:

Thank you very much.

Sue Peschin:

Thank you to our listeners for listening to This is Growing Old. Our intro and outro music is City Sunshine by Kevin MacLeod. Please stay tuned for new episodes every other Wednesday. You can subscribe to us on Apple Podcasts, Google Podcasts, Spotify, or anywhere else you listen to podcasts. And please rate and review us if you’re enjoying the show. Thank you for listening to This is Growing Old and have a great day.