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Research from UnitedHealthcare and AARP Services, Inc. shows what can help older adults thrive through aging

Dr. Charlotte Yeh has seen the power of resiliency up close in her work as an emergency room physician. “I could have two women, 80 years old, both with a broken hip. I could look at one woman and say, ‘Oh boy, this could be the start of the end.’ And another woman…I could see her and say, ‘You know what, she is going to walk right out of the hospital.’

“What’s in the secret sauce? There’s always this sparkle … that you knew meant they were going to do well.”

That “secret sauce,” as Dr. Yeh, chief medical officer of AARP Services, Inc., puts it, is resilience.

Though sometimes overlooked, our health often is determined by far more than medicines, doctor visits, diet, and exercise. Personal circumstances beyond “traditional” health care can profoundly influence our health and happiness. Some of these factors, known as social determinants of health, are variables like food security, housing, air quality, and transportation.

Less understood, though increasingly studied, are personal factors that can also meaningfully impact wellbeing. For instance, resiliency — the ability to adapt or grow in the face of challenge — may have more to do with health outcomes than was ever thought possible.

Understanding resiliency and other personal determinants of health

Experts are interested in resiliency, especially as America ages. From 2020 to 2060, the number of Americans older than 65 is expected to grow by 69%, to more than 94 million. Serving 12.5 million seniors and others eligible for Medicare, UnitedHealthcare is increasingly seeking innovative ways to meet the needs of this population, said Annette Fellows, vice president of health products and services, who leads the Healthcare Transformation team helping to spearhead some of this innovation.

“To understand more about what helps people cope with adversity and thrive through aging, researchers with UnitedHealthcare and AARP Services, Inc. developed a framework called Personal Determinants of Health,” explained Fellows. “Understanding personal determinants, especially as a companion to social determinants, may not just help improve individual health outcomes but also help reduce the cost of care – both for individual people and across the entire health system.”

Dr. Yeh added, “This is a lever we’ve been underutilizing. We’ve got this health care delivery system that’s really awesome but hugely expensive and we’re sinking under the cost of care as everyone is aging.”

The UnitedHealthcare-AARP Services research outlines personal determinants of health and the three key factors that set the foundation for personal resilience. The first is purpose: having a life with meaning, goals, and a sense of direction. The second is possibility: having optimism about the future and a generally positive perception about aging. The third is people: having strong social connections.

But these are more than just “feel good” factors; early findings show that health care costs are higher in individuals who have low personal determinants. For example, costs are 24% higher in older adults who are less resilient; 20% higher in individuals who are severely lonely; and 12% higher for those with low purpose in life1.

Another recent piece of UnitedHealthcare-AARP Services research further examined five key “protective” factors that contributed to resilience among older adults: purpose, resilience, optimism, social connections and perception of a “locus of control” over one’s life. The more factors a patient had, the fewer health problems and functional limitations they had, and the less anxiety and depression. Every added factor led to a savings in health care costs of $1,356 per person year.

The importance of measuring and protecting personal resilience

There are tools available to help physicians measure the factors that influence a patient’s personal determinants of health. But Dr. Yeh would like to see these evolve to more wholly assess someone’s wellbeing.

“We are all familiar with the Health Risk Assessment, which asks about physical health – weight, blood pressure, cholesterol, etc.,” Yeh said. “But what if health care providers converted to a ‘Life Risk Assessment’ that is more holistic, engaging, personalized, and actionable? In better evaluating where someone is on the spectrum of personal skill sets, we can help our patients explore and address things like – what gets them up in the morning, how to build friendships with social support, and how to cultivate the benefits that come with aging. It starts with simply asking – a conversation starter showing you care.”

Beyond interactions with providers, health insurers are increasingly offering supplemental benefits through Medicare Advantage that can help beneficiaries get access to services that may strengthen their resilience – things like in-home care services and transportation. In addition, UnitedHealthcare pilot programs have shown success leveraging online digital tools, telephonic peer-to-peer conversations, and virtual and in-person events that can help members develop and leverage their own individual strengths related to purpose and social connections.

These programs, and other efforts, could help us stave off a pandemic-exacerbated epidemic of social isolation, especially among the older and most vulnerable populations.

“What concerns clinicians and experts most is the potential that this social isolation trend could worsen physical and mental health, leading to reduced longevity or poor quality of life,” said Fellows. “That lower quality of life is not just bad for individuals, it’s bad for the health care system.” 

A call for change

“We have the technology, we have the science, we understand what programs to offer in the community. But somewhere along the way, we’ve forgotten the person,” Dr. Yeh said.

Clearly, an opportunity exists to define personal determinants of health as a new psychosocial and behavioral concept that can help make a real impact on health outcomes and inform initiatives that improve the overall health and quality of life, especially for seniors, while reducing health care costs.

The other element toward potential success, Yeh said, is to reframe how we see aging and how we deal with it. “Our society often sees aging as a loss, but we should also focus on the strengths that come with age and experience. There is so much good in aging that should be shared, taught and fostered within all of us. And we know it can lead to better outcomes, greater life satisfaction and lower costs. What could be better?”

To learn more about personal determinants of health, click here.

1Findings when adjusted for age, gender, region, income, and health status.