Framework for an Age-Friendly Public Health System
One in five people in the U.S. will be 65 or older by 2030. As the population of older adults in the United States grows, alongside an increasing recognition of the salience of social determinants of health, the value of a public health approach to supporting the well-being of older adults is clear. To explore potential public health roles in aging, TFAH convened stakeholders from public health, aging services, and healthcare and developed a framework that delineates the roles public health can play to promote older adult health and well-being.
The framework articulates five key public health roles:
- Connecting and convening multiple sectors and professions that provide the supports, services, and infrastructure to promote healthy aging.
- Coordinating existing supports and services to avoid duplication of efforts, identify gaps, and increase access to services and supports.
- Collecting data to assess community health status (including inequities) and aging population needs to inform the development of interventions.
- Conducting, communicating, and disseminating research findings and best practices to support healthy aging.
- Complementing and supplementing existing supports and services, particularly in terms of integrating clinical and population health approaches.
The vast majority, nearly 90 percent of Americans, prefer to “age in place” in their own homes for as long as possible. Aging in place is associated with better health outcomes, life satisfaction and self-esteem. However, health needs affect the feasibility of aging safely at home. The majority of older adults have one or more chronic health conditions that potentially impact their ability to perform activities of daily living. Functional limitations associated with declining health can create challenges for individuals to manage effectively in their homes, causing increased reliance on caregivers and health and social services. The inability to reside independently can precipitate costly nursing home care.
Suitable housing for older adults is critical for supporting health and preventing illness. The housing structure itself generally provides protection from weather events and temperature extremes. Due to existing health conditions, many older adults require additional services in the face of natural disasters and are at greater risk of experiencing hypothermia and hyperthermia as a result of decreased thermoregulation, certain medications, and illnesses. Indoor air pollutants may also further exacerbate respiratory illnesses prevalent among older adults such as chronic obstructive pulmonary disease (COPD). Other hazards include stairs and unsafe flooring which can increase the risk of injury and falls, the leading cause of preventable injury-related deaths among older adults. More than one out of four older adults fall annually, resulting in more than three million emergency-department visits, 800,000 hospitalizations and $50 billion in healthcare costs.
The broader community surrounding the home also contributes to the health of older adults. Active interactions within one’s “Life Radius,” a five-mile area surrounding the home, have been identified as a core component of social health and linked to longevity among the world’s longest-living persons. The majority of the nation’s older adults, particularly homeowners, live in suburbs, smaller towns, or rural areas which may be far from services or social activities. Moreover, access to healthcare providers can be unaffordable or unavailable in many locales. Older adults who are homebound are also at risk of social isolation: a precursor to physical and mental maladies including cardiovascular disease, depression, cognitive decline, and mortality.
This brief details the ways in which public health practitioners are well-positioned to support healthy-aging initiatives. Public health skill sets including population health assessment, policy development and championing, building and maintaining infrastructure, program evaluation, and working toward equity, are key to increasing healthy housing options for older adults.