Fall 2025
Aging Out of America
By Martha Nolan
Illustration by Chiara Vercesi
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Top public health issues impacting older adults today
Aging Out of America
We are on average living longer than ever before—30 years longer over the past century—thanks to public health advances and groundbreaking medical interventions. But longer lives bring new challenges. While our lifespans have grown, our healthspans—the portion of life spent in good health—have not kept pace.
“With the aging of the Baby Boomers, we have and will continue to have more older adults than we ever have,” says Regina Shih, PhD, professor of epidemiology. “At the same time, individuals are living longer. So, we all must be better prepared to meet the needs of this burgeoning group.”
Here is a look at some of the biggest issues facing older adults in the quest for increasing healthspan along with lifespan.
The Health Care Gap
Currently 93% of Americans age 65 and older live with at least one chronic disease and 80% live with two or more, according to the National Council on Aging. Navigating those health challenges can be confusing and even contradictory.
“Older adults may see two different specialists for two different conditions and get different, sometimes contradictory advice,” says Ted Johnson, MD, a geriatric physician and adjunct professor of epidemiology. “Your cardiologist, for example, may want for you to take a stronger diuretic (water pill) to improve your heart function while your nephrologist may advise you to take fewer diuretics to help protect your kidney function.”
What’s needed are specialists trained in managing the competing medical demands associated with aging: someone who can help manage, delay, and even prevent many age-related health issues. That specialist is a geriatrician. However, there is only one geriatrician for every 10,000 older adults, according to the National Institutes of Health. And the situation is getting worse. The number of board-certified geriatricians has fallen from about 10,000 in 2000 to about 7,400 in 2022. The situation in rural areas is even worse, since many such areas don’t have enough primary care physicians, much less a geriatrician.
Johnson and his colleagues are doing their part to help remedy the situation. Johnson is co-lead of Georgia Gear, a federally funded Geriatrics Workforce Enhancement Program. The program partners with other organizations and universities in the state to provide interprofessional geriatric training to health care workers, particularly in rural areas.
“We do a lot of work with physical therapists, pharmacists, nurses, and social workers,” says Johnson. “We work together to help everybody to raise their game to have Georgia health professionals provide better care for older adults in all settings.”
Paying for Care
Older adults in the U.S. face significant challenges when it comes to paying for health care, particularly as their needs become more complex with age. While Medicare provides essential coverage for many people over 65, it doesn’t cover everything—especially when it comes to long-term care, dental, or vision. As chronic conditions multiply with age, so do out-of-pocket costs for prescriptions, specialist visits, co-pays, and services not fully covered by insurance. For those on fixed incomes, these expenses can become overwhelming, forcing difficult choices between health care, housing, food, and other essentials.
The situation is even more precarious for older adults with lower incomes who rely on Medicaid to cover the gaps. However, cuts to Medicaid programs—the primary payer for long-term care, such as long-term nursing home stays—threaten access to vital care for the most vulnerable older adults. Kathleen Adams, PhD, professor of health policy and management, is particularly concerned about the threat Medicaid cuts pose for rural hospitals.
“These hospitals already operate on razor-thin margins, and they are heavily reliant on Medicaid and Medicare,” she says. “There has been an ongoing pattern of rural hospital closures, and these Medicaid cuts are only going to exacerbate that.”
Without a comprehensive system to finance long-term care, too many older Americans face financial instability just when they need stability and support the most. What’s to be done? “Educate yourself as much as you possibly can,” says Adams. “Try to prepare yourself as best you can for future medical and long-term care expenses. And vote.”
Caregiving: An Invisible Thread
In the U.S., more than 63 million family caregivers provide unpaid support to loved ones who are aging or have disabilities. These caregivers help with bathing, dressing, meal preparation, and more—often without formal training or compensation.
“Family caregivers are the backbone of our long-term care system,” says Shih. “Without them, many more older adults would have to go into assisted living or nursing homes.”
But the caregiver landscape is changing. Many older adults don’t have children, or their families live far away. Many are aging without partners. “We need to stop thinking of caregiving as something [that can] only be done by a spouse or child,” says Alexis Bender, PhD, a social gerontologist and associate professor of behavioral, social, and health education sciences. “Increasingly, we are seeing friends, neighbors, and church members stepping in, and many times they don’t even recognize what they are doing as caregiving.”
As an example, Bender points to a friend who began looking after her neighbor following his stroke. She delivers groceries, mows his lawn, walks his dog, and runs errands. But if you were to ask her if she is a caregiver, she would say no, according to Bender.
“Current studies may be underestimating the number of caregivers so we need to get a handle on it so we can demonstrate their importance in keeping the health care and long-term care systems from being overburdened,” says Bender. “Once we have a better idea, we can think about the types of supports that need to be made available for these caregivers.”
Currently support for caregivers is available through Area Agencies on Aging (AAA), which operate under different names and offer different services in each state. They act as a clearinghouse for information and referrals to services to support family caregivers, such as education, respite care, and support groups. Rollins is working with the National Alliance for Caregiving and other partners to identify how to best support AAAs to deliver evidence-based programs and track family caregiver outcomes.
The Housing Dilemma
Almost everyone wants to age in place, to remain in their family home and function independently. But a sudden fall, stroke, or diagnosis can transform a once-livable space into a danger zone.
Home modifications such as grab bars in the bathroom, wider doorways to accommodate wheelchairs, and stair lifts can be the answer for some, but Medicare does not pay for these alterations, and they can be pricey. “We definitely need more resources to be available for home modifications for people to be able to stay at home in a safe way,” says Bender.
Services such as Meals on Wheels, transportation services, and caregiver support can all help older adults remain in their homes. These types of services and more are funded by the Older Americans Act of 1965, which must be renewed by September, or it will disappear along with its funding. Even with this funding, the Older Americans Act falls short of what is needed, so grassroots organizations have sprung up to meet the need.
Village to Village Network is just one example. These villages are not places you live, they are organizations you belong to. They are organized and run primarily by volunteers to support older adults in their homes, offering health education, transportation, and social engagement, like museum trips. But with only about 250 villages across the U.S., the model is far from universal.
And sometimes staying in one’s home is simply not an option. Assisted living communities—which are a social, not medical model of care—could be a solution, but they are often expensive. Medicare does not cover assisted living communities. Medicaid does not pay for room and board in assisted living costs, however many states offer waiver programs that can help with the costs. Another option may be available in small, licensed personal care homes, which sometimes accept Medicaid through waiver programs. “These may be in someone’s house who has three extra bedrooms,” says Bender. “They provide some meal assistance and maybe some other services. It varies widely and they are regulated in various ways. Overall, I think we need more options for older adult housing and funding to support them.”
Climate Change: A Growing Threat
Older adults are disproportionately affected by extreme weather. During Hurricane Katrina, almost half of those who died were 75 and older. In the deadly Texas freeze of 2021, nearly 60% of fatalities were older adults.
Why? Many live alone, are socially isolated, or have medical needs that make evacuation difficult. Many older adults also live in disaster-prone areas and are unaware of or unable to access emergency services.
Shih has done work funded by the CDC to help public health departments, age-friendly communities, and villages think about how they can prepare older adults for climate-related events. When she first approached these organizations, she found a nearly universal dearth of planning related to older adults and extreme weather events. These organizations were either focused on meeting the day-to-day needs of older adults, or they didn’t tailor preparedness programs specifically for older adults.
“We worked with them to understand how climate-related events affect older adults and we developed a toolkit that helped them think about what they needed to be doing together,” she says. “By the time our project finished we started to see these entities thinking about the needs of older adults in climate related emergencies and how to meet them in a proactive instead of reactive way. It was really exciting to see, and they are continuing those efforts.”
Elder Abuse: A Hidden Crisis
It’s a sobering statistic. One in six older adults experience elder abuse or mistreatment every year. This abuse can take many forms, including neglect, physical abuse, or financial exploitation.
Preventing elder abuse requires a multi-pronged approach that prioritizes awareness, education, resources, and accountability, says Shih. First, we need to train health care workers, social service providers, financial institutions, and law enforcement to recognize the often subtle signs of abuse—whether physical, emotional, financial, or neglect—and to know how to respond appropriately. Public awareness campaigns can also empower communities and families to spot and report mistreatment. Stronger support for Adult Protective Services and Long-Term Care Ombudsman programs is essential, as these agencies are on the front lines but are often underfunded and understaffed. In addition, expanding legal protections and accessible reporting channels for victims is critical. Ultimately, preventing elder abuse means creating a culture that values and safeguards older adults, ensuring they are treated with dignity, respect, and care.
The Loneliness Epidemic
Of all the potentially problematic issues facing older adults, Vincent Marconi, MD, sees the greatest one as isolation. Older adults have always faced the tragedy of losing family members and friends as they aged. Many face decreased mobility, health problems, hearing loss—all factors that can make their support circle smaller and smaller. Today that loss is compounded with the rapid and total transformation wrought by digital technology.
“It’s so very easy to feel left behind,” says Marconi, professor of medicine and global health. “Today you need a QR code to park. It can be challenging to navigate your insurance plan without an advanced degree. These are people who used to know their mail carrier and would chat with them as they walked past their home. They knew their bank tellers and would catch up when they made a deposit. Now they may feel that everything is just racing by, and they feel less and less connected to the world around them.”
Loneliness and isolation increase the risk of depression, cognitive decline, and even premature death. Almost counterintuitively, Emory researchers have used technology as a way to try to address this depression and isolation. Marconi did a study involving exercise in small group settings in which the instruction was delivered by a remote person who could interact with the participants and give feedback.
“The camaraderie that developed between the participants in a short period of time took us by surprise,” says Marconi. “We did something similar with medication and saw the same type of results. These interventions were small and modest at best, but they were proof of principle that connectedness can be created.”
Robert Krafty, PhD, chair of the Department of Biostatistics and Bioinformatics, was involved in a study that enrolled older adults who had recently lost a spouse. Half of the participants received traditional care enhanced with some lifestyle coaching. The other half of the participants received a digital health intervention developed by Krafty and his colleagues that was designed to sync behavioral and activity patterns to promote healthy behaviors that strengthen the biological clock and circadian rhythm.
“We asked each of the people in the digital intervention to name things they would like to anchor them,” says Krafty. “For example, one person might say they want to make sure they get out of bed and get going each morning and another to have three meals at regular times per day. We then tracked and followed them using either cellphones or tablets to help make sure they achieved their two things.”
At the end of the two-year study, about 67% of the participants who received the digital intervention reported no depressive symptoms, which was a sizeable benefit compared to the control group.
Inequities in Aging
Every issue mentioned above impacts marginalized older adults by a much greater magnitude. Access to health care is already a huge hurdle faced by low income and/or rural older adults, so they may be entering older age in poorer health to begin with. “Structural and psychosocial stressors, such as stigma, discrimination, unsafe living conditions, trauma, leave our immune systems poised for threat 24/7,” says Marconi. “That ultimately puts us in a position of accelerating the aging process.”
Marginalized older adults also face larger hurdles related to caregiving, housing, climate change, and myriad other issues facing aging adults. In today’s political climate, that message does not resonate with everyone.
“We're a country that's built on an independence and self-reliance and strength, and that serves us well for good portions of our lives,” says Bender. “We're also a society that does not like to think about frailty and aging. Those two things come together to create a perfect storm for a small but sizable portion of older adults, and I see a lot of victim blaming—‘You should have planned better for retirement.’ In reality, there was never an option for the first 60 years of their life to do that, they were just barely getting by as it was. As a country, we need to support these people.”
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Rollins Magazine is published twice a year by the Rollins School of Public Health, a component of the Woodruff Health Sciences Center of Emory University, for alumni and friends of the school.