Category Archives: Social Isolation

Changing American Demographics Make Hospital Operations Harder

Posted on by • Posted in Chronic Conditions, Consumer Segmentation, Culture, Demographics, Family, Medication Management, Mental Health, Public Health, Social Determinants of Health, Social Isolation, Social Support & Isolation, Solo Living • Leave a comment

https://www.kaufmanhall.com/insights/thoughts-ken-kaufman/changing-american-demographics-make-hospital-operations-harder

Regular readers know I’ve long been curious about the forces driving one essential question in healthcare today:

Why is it so hard to run a hospital now? One area worth exploring is the interplay between the healthcare system and our nation’s changing demographics.

Baby Boomers have been displaced as the largest generation of adults in America. Millennials now hold that position, and Gen Z will likely outnumber Baby Boomers in the workplace sometime this year. Our nation is rapidly diversifying, as more than two-fifths of Americans identify as people of color.

It’s not just a matter of who we are as a nation that’s changing; how we live is evolving, too. The number of 40-year-olds who’ve never been married reached record highs in 2022, according to the Pew Research Center, dovetailing with a steadily growing trend since 1970 toward single living.

The U.S. Census published a report earlier this year showing that nearly 29% of American households include only one person. Further, the U.S. fertility rate is at an all-time low — and, according to a Pew survey, may not recover, given that 47% of those under 50 said they were unlikely to have children. That’s an increase of 10 percentage points since 2018.

The effects of this are starting to shape our broader culture. Solo living has been cited as a contributing factor to the housing crisis, and we’re starting to hear more about how people are grappling with the practical implications of retiring while living alone. This column in The New York Times is just one example. 

As for the potential health effects of living alone, in 2023, U.S. Surgeon General Vivek Murthy raised an alarm with a report documenting the negative effects of social isolation on individual and public health. Murthy outlined a host of risks, including cardiovascular disease, hypertension, diabetes and increased susceptibility to infectious disease. Mental health is a major concern. A 2024 study published in National Health Statistics Reports found that people who live alone were more likely to be depressed, particularly if they lacked social or emotional support. 

All of this adds up to an increasing burden on the U.S. healthcare system.

As providers who care for the socially isolated already know, it’s impossible to operate as usual if a patient lacks family support. Hospitals and the traditional American family structure are fundamentally intertwined. When family support is not available for a medical emergency, then the entire hospital episode becomes more fragile. Patient discharge procedures assume someone is available at home to help with care, assist in transporting patients for follow-up visits, and engage with the business office around billing and insurance.

Without this family safety net, the potential for readmission rises, harming patient outcomes, increasing costs and putting quality ratings at risk. The rise in younger people living alone also raises further financial implications, given that about 45% of Americans access health insurance through employer-sponsored programs. If someone living alone becomes too sick to work, patients may be less able to pay for care when they need it most.

This is just another in a long list of challenging hospital operational dilemmas. How best to respond to such profound change in the American demographic landscape? The right strategy may be to re-think consumer segmentation.

Consumer segmentation has become very popular at the clinical product level, but perhaps the next level of service segmentation is not among disease types but based on demographic characteristics. 

As an increasing portion of the American population has less family support to navigate a hospital stay or chronic illness, it will become more important to identify these patients and determine which new and enhanced services need to be provided to them by the hospital. Social work programs will need to be more robust, and health systems should invest in community partnerships to help bridge the resource gap. But the wide-ranging nature of patients’ practical needs will likely require healthcare leaders to think creatively. 

Consider the scope:

  • Care coordinators: Particularly for patients with complex conditions, it may be beneficial to designate a care coordinator to oversee healthcare planning.
  • Home health care: Without family members to help with day-to-day care, more nurses and aides will be needed to provide healthcare at home as well as help with day-to-day living. For patients with less demanding healthcare needs, adult day care may be useful.
  • Medication management: Patients need to understand how to take their medications, watch for potential side effects and interactions, and develop a system to make sure they take them on time. Further, they may need help navigating the pharmacy, either in getting prescriptions filled or with financial assistance programs.
  • Meal delivery: Nutrition is vital to a patient’s recovery, and ensuring patients have access to healthy options can help to reduce the likelihood of readmission.
  • Personal emergency response systems: Patients may need devices to call for help during an emergency as well as medical bracelets or other methods for communicating important information to first responders.
  • Housekeeping assistance: Hospitals may need to help connect patients with resources to maintain clean, safe homes. 
  • Volunteer companions: While volunteer companions usually help elderly patients with social interaction and basic needs, it may be necessary to develop programs that target a wider range of ages.
  • Transportation services: Patients need help getting to and from follow-up visits.
  • Telehealth: Remote care will become increasingly important. Clinical services should consider whether care plans could be adjusted to reduce the number of in-person visits.

Beyond targeting resources, consumer segmentation also offers an opportunity to communicate with patients in a more effective and personalized way. This sort of engagement fosters trust and increases loyalty that’s particularly important, given the intimate nature of healthcare.

It’s long been true that the stronger the family system, the better off hospitals are. But as the concept of the American family shifts, and in this case, unwinds, healthcare leaders need to be attuned to new demands—and nimble enough to meet them. This requires making the most of the information you have today to plan for tomorrow.

On average, older adults spend over half their waking hours alone

Posted on by • Posted in Health Policy, Life Expectancy, Lifestyle Factors, Social Determinants of Health, Social Isolation • Leave a comment

https://www.pewresearch.org/fact-tank/2019/07/03/on-average-older-adults-spend-over-half-their-waking-hours-alone/?utm_source=Pew+Research+Center&utm_campaign=ddfdfc2c29-EMAIL_CAMPAIGN_2019_07_05_05_40&utm_medium=email&utm_term=0_3e953b9b70-ddfdfc2c29-400197657

Americans ages 60 and older are alone for more than half of their daily measured time – which includes all waking hours except those spent engaged in personal activities such as grooming. All told, this amounts to about seven hours a day; and among those who live by themselves, alone time rises to over 10 hours a day, according to a new Pew Research Center analysis of Bureau of Labor Statistics data.

In comparison, people in their 40s and 50s spend about 4 hours and 45 minutes alone, and those younger than 40 spend about three and a half hours a day alone, on average. Moreover, 14% of older Americans report spending all their daily measured time alone, compared with 8% of people younger than 60.

While time spent alone is not necessarily associated with adverse effects, it can be used as a measure of social isolation, which in turn is linked with negative health outcomes among older adults. Medical experts suspect that lifestyle factors may explain some of this association – for instance, someone who is socially isolated may have less cognitive stimulation and more difficulty staying active or taking their medications. In some cases, social isolation may mean there is no one on hand to help in case of a medical emergency.

People ages 60 and older currently account for 22% of the U.S. population – 73 million in all. It’s estimated this share will rise to 26% by 2030, fueled by the aging of the Baby Boom generation. The well-being of older adults has become a topic of much interest both in the United States and in other developed nations, particularly as it relates to social connection.

Not surprisingly, time alone is closely associated with living arrangements, for both younger and older Americans. About one-in-four adults ages 60 and older (23%) live alone today – 16.7 million in all. These older adults say they spend, on average, about 10 and a half hours alone each day – almost twice as much time as those who live with a spouse. More than a third (37%) of older adults who live alone report spending all their measured time alone. Among those who live with someone other than a spouse, the average amount of alone time a day is seven and a half hours. (The 3% of older adults who are living in institutionalized settings are not included in this analysis.)

There are significant variations by age, gender and education in time spent alone daily, driven in part by differences in marriage and living arrangements. For instance, people in their 60s report 6 hours and 32 minutes of alone time, compared with 7 hours and 28 minutes for people in their 70s and 7 hours and 47 minutes for people ages 80 and older. These age differences are due in part to the fact that that older people are far less likely to live with a spouse or cohabiting partner – 64% of those in their 60s do, compared with 59% of those in their 70s and 36% of those 80 and older.

Older women spend more time alone, on average, than their male counterparts, and this gap widens markedly at the oldest ages. This is largely due to the fact that women ages 60 and older are more likely than their male counterparts to live alone (28% vs. 18%) given their longer life expectancies and higher rates of widowhood – and this gap in living arrangements also widens with age.

While there aren’t significant gender differences in time spent alone for people in their 60s, for instance, women ages 80 and older spend about eight and a half hours a day alone, compared with 6 hours and 40 minutes for comparable men. When it comes to the share spending all measured time alone, there are no gender differences among all people ages 60 and older, but again a gap emerges at older ages – for people ages 80 and older, 20% of women report spending all measured time alone, compared with 13% of men.

This gender pattern in alone time reverses once gender differences in living arrangements are accounted for, suggesting other factors are also in play. While 43% of men 60 and older who live alone report spending all of their time alone, this share is lower for women who live alone (34%). And among those living with someone other than a spouse, 21% of men report spending all measured time alone, compared with 12% of women. The fact that older women are more likely than men to be involved in activities outside the home such as going to church or volunteering may partly explain this pattern.

Differences in time spent alone also emerge across educational levels. People ages 60 and older who have a high school diploma or less education spend, on average, 7 hours and 18 minutes a day alone – about 45 more minutes than their counterparts with a bachelor’s degree. These patterns reflect in part the fact that less educated people are less likely to be married and living with a spouse than their more educated counterparts. (This is true among younger adults as well.) About half (51%) of adults ages 60 and older with a high school diploma are living with a spouse, compared with 59% of those with some college education or an associate degree and 67% of those with a bachelor’s degree.