Older Adults Who Don’t Have Meaningful Relationships are Sicker—and Cost Medicare More

Older Adults Who Don’t Have Meaningful Relationships are Sicker—and Cost Medicare More

Elizabeth “Izzy” Barnett, 80, is a full-time caregiver for her husband, Bob, who has dementia. They have no children or family to help and Izzy has lost contact with friends because she is busy taking care of Bob. Izzy’s is not alone in this situation. Millions of older adults are socially isolated—in other words, they lack meaningful relationships with family and friends. Life circumstances—losing a spouse, friends, and loved ones, or retirement—put older adults at increased risk for isolation.


New AARP Public Policy Institute Report Links Social Isolation to Increased Medicare Spending

While we’ve known for a long time that isolation is associated with poorer health, no one had examined whether there is a link between social isolation and Medicare spending. Now, a  new report from the AARP Public Policy Institute finds that an estimated 14 percent of older adults enrolled in Traditional Medicare (or 4 million people) are socially isolated, costing the federal government almost $7 billion in additional spending every year. And this number would be much larger if you add in people enrolled in private Medicare plans (Medicare Advantage).

We’re not sure what causes the link between social isolation and greater Medicare spending, but one possibility could be that socially isolated individuals do not have the support they need to stay healthy in their homes and communities, and instead rely on more costly hospital or skilled nursing facility care. What’s more, people who are socially isolated may be sicker before finally going to see a health care provider, driving up the cost of care.


A Start to Fixing the Problem

Social isolation is increasingly being recognized as a significant health and public health issue. Despite this, clinicians do not have a way to reliably and efficiently screen socially isolated individuals. Nor do we have public health surveillance strategies to help us understand the problem at a population level.   What’s more, even if we could effectively screen individuals and collect good population-based data, we really don’t know what works in terms of alleviating isolation. Here are some strategies that federal, state, and local governments and the private sector can take to begin to address the problem:


  • Fund the development of a reliable and efficient tool to screen patients for isolation;



  • Establish public/private partnerships to identify and test interventions that can alleviate isolation; and,


  • Recognize social isolation as an important social determinant of health as well as a critical public health problem that should be addressed through the investment of federal, state, and local government resources.


The Public Policy Institute’s report puts numbers to the reality of Izzy’s story, as well as that of millions of other older adults. Social isolation can be a hidden problem, but new evidence of the cost should encourage greater attention to the issue and support for solutions to improve the lives of older Americans.




Lynda Flowers is a Senior Strategic Policy Adviser with the AARP Public Policy Institute, specializing in Medicaid issues, health disparities and public health.




Claire Noel-Miller is a Senior Strategic Policy Adviser for the AARP Public Policy Institute, where she provides expertise in quantitative research methods applied to a variety of health policy issues related to older adults. 






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Regulatory Reform Options for Implantable Devices

Regulatory Reform Options for Implantable Devices

In 2011, some widely used implantable heart defibrillators, designed to correct potentially fatal irregular heart rhythms, developed cracked insulation on their high-voltage electrical wires. The result was that in some cases they caused severe shocks, and even deaths.

Consumers with the defective implants had to decide whether to undergo dangerous surgery to replace the device or simply monitor it. Until the defective device is replaced, consumers run the risk that it will deliver an unnecessary high-voltage jolt of electricity—described as a feeling similar to being hit across the chest with a baseball bat—or simply fail, which could lead to cardiac arrest and death.

As the population has aged and technology has advanced, the range and number of implantable devices, like cardiac pacemakers and artificial hip replacements, have become ubiquitous. Experts estimate that 7.2 million Americans are living with joint implants alone. These devices can significantly improve the quality of life and, in some cases, save lives. However, while implantable devices can provide benefits, they also carry substantial risks to patients, including serious injury and even death if they fail. A number of serious implantable device failures have caught the public’s attention and raised questions about the need to improve the safety and effectiveness of implantable devices. The 2011 example above illustrates the issue.

A recently published AARP Public Policy Institute Insight on the Issues  explores areas of public concern surrounding these devices. The report, “Implantable Devices: Regulatory Framework and Reform Options,” discusses the FDA’s process for approval and oversight of these devices. The paper suggests policy options that could both strengthen and streamline the process to better protect public health and safety while also encouraging the development and marketing of devices that will benefit patients. Some of the options discussed in the publication include:

  • Strengthening and streamlining the pre-market approval and clearance processes for implantable devices.
  • Strengthening post-market oversight and reporting for implantable devices through the use of more post-market surveillance studies, innovative monitoring techniques, and additional funding for these activities.
  • Making better use of patient registries to track device performance and patient outcomes.
  • Expanding use of unique device identifiers so devices can be tracked and identified.
  • Improving communication with stakeholders.
  • Strengthening quality controls by giving the FDA authority to conduct pre-market inspection of all facilities that make implantable devices.
  • Strengthening FDA enforcement activities through more effective recalls and other actions.


Open dialogue on these issues and options can help inform needed policy action. In another blog post, I discuss a second Insight on the Issues that deals with the lack of price transparency and need for greater competition in the implantable device marketplace.



Keith Lind is a Senior Strategic Policy Adviser for the AARP Public Policy Institute, where he covers issues related to Medicare and medical devices. 





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