Older Pennsylvanians: Uncovering Healthcare Disparities

Pennsylvania ranks 8th in the nation in the percentage of adults over 65, and in the next two decades there will be exponential growth in the aging population. There are profound health disparities for older adults in the commonwealth and the Covid-19 pandemic has compounded already existing barriers to healthcare and technology.

A new report, Disrupting Disparities in Pennsylvania: Retooling for Geographic, Racial and Ethnic Growth, by AARP Pennsylvania and Drexel University’s College of Nursing and Health Professions highlights how geographic, racial/ethnic and economic factors restrict access to healthcare services for many Pennsylvanians, leading to health disparities. Older adults are particularly vulnerable as the number of low income seniors increases and gaps in access to healthcare and internet access grows.

Health disparities are most acute for those in rural and low or under resourced areas of Pennsylvania and among underrepresented populations, particularly Black and Latinos in the commonwealth. Those who lack access to healthcare, experience a digital divide without regular access to the internet, have low digital literacy or health literacy skills, and those who live in areas that face healthcare shortages experience persistent disparities.

“Pharmacy deserts” are areas with low access to prescription drugs and an estimated 100 million Americans lack pharmacy access . According to Drug Topics Journal, nearly 70% of Americans take at least one prescription drug. As our population ages, that percentage will increase compounding the pharmacy access issue. Older patients are among the groups most likely to experience pharmacy access problems and for older adults enrolled in state pharmaceutical assistance programs in Pennsylvania, 39% of the commonwealth's census tracts are pharmacy deserts.

Covid-19 is making health disparities worse. Pharmacy deserts directly impact access to vaccines, including Covid vaccines, particularly in rural areas. With locations such as seniors centers and libraries, sources of internet access for many seniors, technology barriers are also exacerbated for older Pennsylvanians during the pandemic.

Geography impacts healthcare disparities. The new AARP PA/Drexel report found residents of rural portions of Pennsylvania to have fewer physicians and hospital beds per capita and to be more underserved than more populated parts of the state. In 2017, there was one rural primary care physician for every 1,387 residents. In urban counties, there was one primary care physician for every 775 residents. Pennsylvanian’s who are in medically underserved areas primarily live in rural areas or are of minority status. They are poorly educated, experience transportation barriers and live in poverty.

Access to care, lack of insurance and healthcare costs are barriers for Pennsylvanians. Pike, Monroe, Susquehanna and Wayne Counties face greater challenges with 13 percent of adults uninsured. Philadelphia County's uninsured rates is 10 percent.

As the report outlines, and OAK Street Initiative advocates, more focus should be placed on elder care in the commonwealth. We have previously advocated for dedicated geriatric emergency departments and specially trained non-medical staff like social workers who improve health outcomes for older adults. But Pennsylvania also needs more doctors, nurses and direct service providers who are prepared and trained to manage the needs to an aging population. Additional medical professionals, including dentists, occupational and physical therapists, pharmacists and dietitians trained to work with older adults are also in demand. Grant based or loan forgiveness programs designed attract and retain medical professionals to work in geriatrics would help to ease the workforce burden.

Additional access to care in underserved and under-resourced areas is critical as our geriatric population grows. Telehealth can help, particularly in rural areas, but lack of broadband in portions of the commonwealth must first be addressed.

Meeting the health needs of older adults of the next decades is multi-faceted, but it is an issue that must be addressed without haste in order begin to disrupt health disparities for older adults now and in the decades to come.