Many older adults (age 60+) in the United States rely on fixed incomes, subsisting solely on Social Security benefits and Supplemental Security Income, which, on average, total less than $1,800 per month [1]. Economically insecure older adults who are faced with the challenge of trying to meet basic food, shelter, and medical needs may feel forced to make decisions with harmful health consequences, such as taking less of the medication than prescribed [2], forgoing treatment entirely, or buying less food. Poor nutrition among older adults can exacerbate medical conditions and debilitation, decrease immune system function, and lead to increased need for medical attention. Similarly, non-adherence with medication regimens is a serious concern. Patients who do not take their medications as prescribed may be putting themselves at additional risk for negative health consequences.

This article examines the health-related decisions of older adults with limited finances, including forgoing prescription medications and reducing or skipping meals, using data from the Community Health Data Base’s 2012 Southeastern Pennsylvania (SEPA) Household Health Survey, a telephone survey in more than 10,000 households in the SEPA region, including Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties.

Overview

As is common nationally, tens of thousands of older adults (60+) in our region are reducing the size of meals or skipping meals entirely because there is not enough money in their budgets for food. Similarly, thousands of medication prescriptions are left unfilled due to financial constraints.

In our region, approximately 112,500 older adults have either cut/skipped a meal, or left a prescription unfilled, due to budgetary constraints in the past year. Additionally, approximately 20,900 individuals report both cutting a meal and not filling a prescription because of a limited budget.

Poverty and Insurance Status

Not surprisingly, older adults (age 60+) living below 100% of the federal poverty level in our region are more likely to report forgoing a prescription (16.0%), or cutting a meal (21.5%), in the past year compared to those living at or above 100% of poverty guidelines (9.1% and 5.0%, respectively).

While the majority of older adults in SEPA currently have prescription medication coverage, 10.9%, or approximately 90,900 individuals, do not. Even those with health insurance report cutting a meal: 11.4% of those with Medicaid, 7.3% with TRICARE/CHAMPUS, 6.7% of those with Medicare B, and 6.5% of older adults with Medicare A.

Chronic Disease

Many older adults (60+) who have cut a meal due to a lack of money, and who have also not filled a prescription because of the cost, suffer from chronic diseases. This includes: 81.2% of those who have been diagnosed with arthritis, 66.8% diagnosed with high blood pressure, 49.9% diagnosed with diabetes, 30.5% diagnosed with asthma, and 9.8% diagnosed with cancer. Unhealthy diets and not maintaining a regular medication regime often exacerbate these conditions and result in a greater risk for poor health outcomes.

Nutrition and Food Consumption

Many older adults (60+) in SEPA face challenges in accessing and affording healthy foods. The cost of food and the availability of fresh foods in some neighborhoods in the region can be limiting.

According to HHS 2012 survey results, approximately 43,500 older adults (60+) in our region may not be getting adequate nutrition, consuming three or fewer servings of fruits and vegetables per day. Older adults who report cutting a meal due to lack of money are less likely to report meeting recommended guidelines for daily fruit and vegetable consumption than adults who do not report having cut a meal. For example, 86.7% of older adults who cut a meal ate three or fewer servings of fruits per day, compared to 75.9% of adults who did not cut a meal. Only 5.1% of those who cut a meal consumed the recommended five or more servings of fruits and vegetables per day, compared to 13.6% of those who did not cut a meal.

Among older adults who have cut a meal due to a lack of money and who have also not gotten a prescription filled because of the cost, only 7.2% consume the recommended five or more servings of fruits and vegetables per day (80% consume three or fewer servings per day).

Older adults who report cutting a meal due to lack of money are more likely to report the overall quality of groceries available in the stores in their neighborhood as “fair” or “poor’” (25.8%), compared to those who did not cut a meal (8.5%).

Among older adults who have cut a meal and not filled a prescription due to a lack of money, 17.4% rate the overall quality of groceries available in the stores in their neighborhood as “fair,” and 10.6% rate the quality of groceries available as “poor.”

Conclusion

Many lower-income older adults (60+) across the SEPA region are faced with making difficult decisions that could potentially have serious negative impacts on their health. Older adults reduce or skip meals, do not get the recommended daily servings of fruits and vegetables, and forgo filling prescription medications. Many older adults in the region may not be getting adequate nutrition, and only 10.7% are currently enrolled in the federal Supplemental Nutrition Assistance Program (SNAP). Approximately two in three (66.8%) older adults who report both cutting a meal and forgoing filling a prescription medication have been diagnosed with high blood pressure and one-half (49.9%) have been diagnosed with diabetes. These chronic conditions are often best managed by a combination of healthy eating and prescribed medications, and failing to adhere to this regimen may pose an increased risk for potentially lethal medical complications.

Improving prescription medication adherence can improve health and quality of life, lower rates of hospitalization, and reduce total medical costs. To improve prescription adherence, many older adults will require assistance in fully accessing all available public benefits (prescription insurance coverage, SSI, SNAP/food stamps, affordable housing) and personal finance management [3].

For more information about these findings, please contact Lisa Kleiner at lisa@phmc.org.

To download this article in as a PDF, click here.  To read more about our previous data, please click here.

[1] Social Security Administration, available at http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/

[2] The American Society on Aging and the American Society of Consultant Pharmacists Foundation. Overview of Medication Adherence: Where Are We Today? Available at http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html

[3] At least 3.8% of older adults in the SEPA region report needing at least some assistance handling money (from managing a checkbook or paying bills to requiring complete assistance in all money matters). It is likely that many more require assistance in navigating medical insurance and prescription coverage plans and payments.