How our social world shapes healthy aging

80 percent of our health is actually determined by social factors — including access to healthy food, our lived environment, financial security and social networks.

On this episode of Aging Forward, Dr. Amit Shah breaks down how community ties are crucial to our wellbeing, and shares many of the lesser known benefits – from legal resources to transportation aid to respite care – available to older adults.

Listen to How our social world shapes healthy aging

Read the Transcript:

Dr. Chen: This is “Aging Forward,” a podcast from Mayo Clinic about the science behind healthy aging and longevity. Each episode, we explore new ways to take care of our long term health, the health of our loved ones, and our community, so we can all live longer and better.

I’m Dr. Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota. And this episode, we’re talking about how our environment and support system impacts how we can successfully age well.

Our guest today is Dr. Amit Shah, a geriatrician and internist based at Mayo Clinic in Scottsdale, Arizona. He is an assistant professor of internal medicine, course director of the senior stages geriatrics curriculum and recognized nationally for his educational talents as well as mentorship. We are so happy to have you on this podcast today, Dr. Shah Welcome.

Dr. Shah: Thanks for having me. It’s great to be here.

Dr. Chen: You are the perfect person to have this conversation because as a geriatrician, you have taken care of older adults in the community. You have seen them in their home setting, and you’re very connected to all the resources and educational expertise to navigate some of the toughest situations that a lot of us are not aware of.

Dr. Shah: It’s one of my favorite topics. Whenever I teach medical students about how to take a history on patients, it’s always one of my pet peeves when they don’t go deep into the social history.

Dr. Chen: Right.

Dr. Shah: We should ask people about what’s most important in their lives, which is not often their blood pressure or their cholesterol level. It’s who’s in their lives.

Dr. Chen: Agreed. Our social influences, we often don’t think about that like you mentioned as a primary contributor to our health outcomes, but they do have tremendous impact. Let’s start from the basics here. What are social determinants of health?

Dr. Shah: This concept of “social determinants of health,” people argue about the terminology. I don’t love “social determinants.” It seems very fatalistic and like it’s set in stone and you can’t do anything about it, which is not true. I prefer the term that some people are moving towards, which is “social drivers” of health.

In other words, there are aspects of the world around us that do a lot for determining our health. And though medicine, regular old medicine, allopathic medicine and the advances of modern medicine are very important, we know that it’s actually been the advances in the rest of our lives that have really driven health outcomes, for example, clean water and good living conditions and all of that sort of thing.

Some estimates are that 80 percent of our health is actually determined by these other factors: things like, our access to good, healthy food, and our lived environment, financial security, our social networks — all of those sorts of things really, we know impact our health outcomes. And, to a greater degree than what our cholesterol is or our blood pressure is, though those things are important too, of course.

Dr. Chen: I like that word change. “Determinants” seems like there’s almost no way of changing things, but drivers, there’s ways to intervene and have impact downstream. You mentioned a few of these examples earlier, but as we break them down more and we talk about access to healthcare, income, education, can you give a little bit more detail behind how this affects the wellbeing of older adults in particular?

Dr. Shah: These sorts of things affect everybody, you know, it doesn’t matter what age you are. But as you get older, these sorts of things become even more important because you become more vulnerable when there are gaps or holes, or things can become really tight, for example, finances, right?

You know, when you’re earning an income, when you’re able to hold on to a job, et cetera, things can be okay, even if they’re tight, or at least you may have the ability to get additional income or take on a job. But let’s say you’re 100 years old, you have severe arthritis, and you’re not able to take on the job.

Dr. Shah: You become very dependent on, let’s say, a Social Security check or charity care or other things like that. These things become even more important and then inflation hits. Then everything gets more expensive and your Social Security check doesn’t go up as quickly. Now you start experiencing enormous financial hardships.

As you age, everything from income, lifetime income, how much you were able to save up for a time when you could no longer be making any more income becomes very, very important. Housing and losing your house, or not being able to afford even just the property tax. Your house could be paid off, but you can’t afford the property taxes anymore, for example. Or, you have used up all of your assets and your only asset left is your house and you start taking out a 2nd mortgage to dip into that, but then outlive your assets as life expectancy goes up. This is one of these hard things. Prior educational level and health literacy become a big part of social determinants of health. This is especially true in immigrant populations that we see, or people who are non primary English speakers, and as they try to navigate the healthcare system, which is not always the most friendly to people who are not primary English speakers.

Access can be important. For example, if you live in a rural area you may not have the best access to care, or not know how to navigate the system. Let’s say if you’re a veteran and if you’re not sure how to access your VA benefits — all of these things, impact, as you can imagine, the older individual disproportionately.

Dr. Chen: Right. I feel like access to health care is already hard enough for the average adult. Everything that you mentioned now, like the income background and education, housing, creates even more barriers for the older adult. You mentioned earlier about the environment. How does the environment and the space that they’re living in impact the aging experience? What exactly are we talking about there?

Dr. Shah: For the environment, it could be as simple as your environment within your home. I used to do house calls, and so it’s amazing what you see when you go into people’s homes, from the cord going across the floor or the tripping hazards, a beautiful rug that just isn’t tacked down. There’s a slipping hazard or poor lighting on a staircase or a loose railing.

Those sorts of things might seem like minor things, but if you’re reliant upon those things, or if you slip and you were to fall, fall risks become really huge. There’s a small environment of your own home. There’s the environment around you like safe neighborhoods. Can you walk places? Are you reliant upon having to drive? What happens if you’re no longer able to drive? Many of our communities don’t have good public transportation.

Certainly where I live here in Phoenix is like that. There’s no great subway systems or trains or buses that are convenient for an older person to use, especially when it’s 115 degrees outside.

How do you maintain your independence if you don’t have transportation? How do you feel safe going out if you think that you’re going to have someone steal your purse as you’re walking the street? Then, of course, there’s environmental changes that we’re seeing in our world with climate change and increasing frequency of floods and hurricanes. If you watch the news, you always see it’s always an older person who couldn’t get out of their home, who is stuck, who now needs to be rescued or who unfortunately perishes. The death rate in natural disasters is higher in older individuals. Environment affects us both locally and globally.

Dr. Chen: When we’re thinking more about the environment, I think the first thing we think about is the environment where they live, like you mentioned, which interestingly can be a very hazardous and unsafe place to be. But also it’s where people feel the most safe. Even though they feel safe, it may not be the appropriate environment for them, especially if they’re feeling isolated and lonely and just not supported from that aspect.

As we’re kind of moving into the mental health sphere, how does loneliness and lack of community and socialization affect that health experience?

Dr. Shah: In the United States, we tend to be a little bit more nuclear family, or I’m going to be independent. There’s less people that live in intergenerational households than in some other countries where that’s the norm. Because of that, the older person can very quickly become isolated, if they can’t get out anymore, or they can’t drive, or they lose a spouse or a partner, and next thing you know, they’re just by themselves at home.

This is what you would see. A lot of times people end up, nobody even knows, they’re self neglecting themselves. No one is checking in on them. People don’t recognize how much a decline has happened. And so you see some of these really challenging situations sometimes. We know a lot of times that people get socially isolated.

Social isolation is a little bit different than loneliness. Social isolation is something you can measure, like, how many times are they seeing somebody on a weekly basis, for example. People can be seeing somebody regularly and have people coming in and out, maybe even live in an extended family, but they could still feel lonely.

Lonely is a subjective feeling, this feeling of “I’m connected to somebody and connected to somebody who cares for me.” But both of those things have risks in terms of health risks, health outcomes, and other things like that. You could be socially isolated and not feel lonely. For health outcomes, for example, let’s say you need to go get a colonoscopy or some other medical procedure where you need someone to drive you back from it because you’re going to have had anesthesia. I’ve had patients who have delayed getting their colonoscopies because they didn’t have anybody, and they had to wait to try to figure out who was going to take them. They were happy to be an alone person, a socially isolated person, but it still was affecting their health outcomes.

Loneliness can affect things in terms of feeling chronic stress, depression, or a lack of feeling like there’s any meaning left in life — those sorts of things that are really important and wear on people’s immune systems, their cardiovascular systems, and their mood.

Dr. Chen: Thank you for making that distinction because sometimes, even for me, I’m okay being isolated. As someone who’s more, I guess more of an introvert, I wouldn’t mind being with myself for a while, but I think by nature humans are social creatures, and even the most introverted of introverts needs someone to communicate with and connect with. That is an important aspect to healthy aging as well.

Health disparities. Let’s touch on that a little bit. There’s different types of health disparities, and it may sound like the atmosphere where people are born into or raised into sort of determines your health outcomes from the very beginning. Sometimes we wonder, is that true? Can we change that? Are there steps that we can sort of mitigate some of these negative impacts on our lives as we age?

Dr. Shah: Yeah, there’s this concept of intersectionality, so let’s say being older is one risk factor. Being old and Black, or being older and Hispanic is another risk factor. Intersectionality. Let’s say being older, Black, and of the LGBTQ older population is another thing. It’s not additive, it’s almost multiplicative.

Relations where there’s this intersectionality, you see the most health disparities and it’s really quite a challenge. It’s something that we have to be aware of, certainly as physicians, but we should also be aware of it as people in our communities — reaching out and helping communities in need and recognizing that there are structural issues why these health inequities exist.

I grew up in Chicago and if you go to the south side of Chicago, in some neighborhoods in some areas, good luck finding a head of lettuce to buy. They call it food deserts. You go to the north side of Chicago, and you’ll find a Whole Foods over here and this over there and seven grocery stores within a five mile radius. This affects things like when you are telling people to eat more healthily. Well, how can I even get to a grocery store that will give me ingredients to make a salad?

We have to be very aware that things are not easy in these communities and are doubly hard, especially when someone has multiple factors for health inequities. There are lots of social resources that are out there that we can talk about. There are community resources. Oftentimes in my experience, all these wonderful things, but nobody knows how to access them. A lot of times patients are looking at their doctors to help them.

Your doctor may not be the right person. In geriatrics, we believe in interdisciplinary care and having a team that helps. In the best teams I’ve always been on, it’s been the social workers who have taught me these things about how to address social drivers of health, how to get people resources.

Dr. Chen: It’s empowering the patient to understand that there are ways we can mitigate some of these challenges and that they are not doing this on their own. The atmosphere they lived in for the past 20 or 30 years may not be what they need to live down the line. There are proactive ways we can help you live better in whatever deficit or whatever area that you’re lacking resources.

When we talk about finding healthy support for older adults, what does that look like? It’s probably a little bit different for each person, but, overall, what does healthy support for an aging older adult look like?

Dr. Shah: It’s bi-directional. I encourage my patients “Hey, you need to get out of your shell and reach out.” It’s really important. This is important for your health. There are lots of studies on this. For example, people who regularly attend religious services or belong to a church or temple or synagogue or a mosque, et cetera, their health outcomes are actually better. Now I’m not going to write a prescription plan, you know, go to church three times a week.

That would be silly. But why is that, right? Well, it turns out that that socially isolated person who couldn’t get to their colonoscopy has somebody from their church, et cetera, that’s willing to take them to and from. They have something to do. They have a reason to get up on the weekends to go and visit with people at their house of worship. Religious communities are very important.

We find that with aging, religion and spirituality sometimes becomes even more important for people. I encourage that and we have studies that show that people live longer who have a regular community that they belong to. For many people that’s a religious community, but it can be another community. I have a gentleman who loves building model railroads. That’s been his social network, his community, his reason to get up in the morning. I have another gentleman who restores old World War II planes and this is his thing. The pandemic really showed us how much of a loss it was when people lost these communities or could no longer do it. But then people innovated and started doing things on zoom. Some community is really, really, important. For those of us who are not in that older group category, for us to engage intergenerationally is really important.

We know how much value there is. One of my favorite ones is the walking school bus. Have you ever heard of the bus?

Dr. Chen: I have not. Enlighten me.

Dr. Shah: Getting your kids to school is always a struggle for everybody. How do you get them to school safely? There’s a shortage of school bus drivers, but oftentimes the school is just a mile or less down the road and you see people getting into the car, waiting in those long lines. Well, what if we did a “walking school bus” with an older person?

Dr. Chen: Oh!

Dr. Shah: They get their physical activity in, and they pick up the kids along the way and walk them to school.

Dr. Chen: I love that.

Dr. Shah: It gives them an intergenerational connection and wonderful exercise in the morning. They have the ability to do it because it’s nine o’clock in the morning when school starts and it’s okay because they’re free to do it, even though the parents have gone off to work.

These sorts of things can be really cool. There are some really neat intergenerational programs that communities can create. There are things where people go and read to the kids in the school. That has shown benefit, not just to the children’s literacy, but also to the older individuals, because of all of the physical activity involved in getting up, getting out, getting to the school, getting back and the socialization amongst those volunteers.

There’s lots of opportunities. You just have to get out of your shell and recognize that it’s important to do something and find your passion, what do you really love, what’s your hobby, whatever it might be.

Dr. Chen: I’m getting so many just great nuggets of ideas here. What it sounds like you’re summarizing is, number one, figure out what’s important to each person, what gives them purpose, what gets them out of bed in the morning. Even though they’re retired, they’re not doing the same thing that they did for the past 40, 50 years. Really explore again, what will help give you meaning over the next few days or weeks, or just start small and then go big. Also get creative about, “How do we help you get to those goals?”

As a healthcare provider, you’ve done a lot of home visits and you’ve probably seen a lot of situations that most other providers have not. Can you share some of your experiences? What are some situations that you’ve seen on the job during your home visits and what has that been like for you?

Dr. Shah: I’ve been interested in this topic for a very long time. I would have to say probably even before medical school when I was visiting veterans in a long term care facility at the VA, and spinal cord injury patients, that really got me interested in medicine to begin with. It was hearing their life story, what they had done. I love the story, and I think that as a clinician, I’m sure you’re the same way,

I always tell my students, because you can get very jaded and burned out in medicine if you don’t pay attention to the story, the social parts of the person. That’s where the connection happens. I had that inkling in the beginning. Then when I went to medical school, I had one amazing mentor. I call her Mother Teresa Incarnate. She really was. She did the hardest geriatrics — these patients who the world had forgotten who were really in dire straits because of some of their social drivers and determinants of health: lived in poverty, soiled environments, and other issues.

I got the opportunity to go out with her, and more importantly to go out with adult protective services workers, with social workers who allowed me to tag along with them. It was the most eye opening experience. First of all, I was appalled. I couldn’t believe that in today’s day and age in one of the most affluent countries in the world that our seniors were living in such conditions.

I also learned that it wasn’t about the stuff you hear about in the news where somebody is abusing grandma or stealing her money. That stuff still happens, and that’s very important to understand and to address, but most of it, 75 percent of all neglected elder abuse, is actually self neglect. Those home visits were eye opening to me about how important, first of all, social workers are, but also how much we need to address these things.

Then later on when I did house calls, I also saw how well people live at home, how much families care for it, how much work goes into it. I also learned how embarrassed sometimes people are to ask for help.

I remember a 98-year-old couple, they were 98 and 100, that I went to go and see in house calls. They were a very, very independent, fiercely independent couple. that had lived through a lot of things. They had a loving family that checked in on them and everything else, but they were too embarrassed to talk about it but they were losing weight. We’re doing this whole big cancer workup at the outpatient setting, and people didn’t think to ask, “Do you have food?”

When I went out to do house calls on this family, I asked to just poke around as I often do. I always like to look in the refrigerator and see, because sometimes people lose their sense of smell. There was spoiled food in the refrigerator, the freezer was bare, and the source of their weight loss was really just lack of access to food. They would just occasionally have family that dropped off meals and they would stretch those meals out because they were too ashamed to say that they were not able to do [go grocery shopping]. They were so afraid of someone taking them out of their home.

Dr. Chen: I see.

Dr. Shah: We got them Meals on Wheels. It’s amazing when you do home visits, how eye opening it is. I carry those with me to the office, to ask those very same questions. Sometimes my patients have trouble remembering to take their medicines. How often does this happen to you? Or getting to the grocery store or sequencing a meal or leaving the stove on and forgetting about it? Then address them, with whatever the underlying cause might be.

Dr. Chen: I really like that summary of everything that you learned from home visits. Those can take hours to do, but then you’re compressing that in a way when you can do it a little bit quicker and easier in the clinical setting, assessing the patient’s social situation.

Caregivers as well, they often see their loved ones struggling in their environments with self-neglect and experiencing limitations. They usually feel helpless because it’s like, “I want to help,” but they don’t know what to do. How do you help caregivers advocate for better support for their older adults in their care?

Dr. Shah: Eighty percent of all care that is done in the United States is still done by family and loved ones. It’s not paid caregivers or facilities that are doing it. This is challenging. People oftentimes in that sandwich generation, they’re raising children. They’re also taking care of their aging parents.

The stressors on people are tremendous and it affects their own health. They don’t get their mammograms as often if it’s a woman, or they’re not taking care of themselves or experiencing chronic sleep deprivation, all these sorts of things. A lot of times, the first thing I do with caregivers is say “Thank you” to them and try to make sure that they’re taking care of themselves, because a impaired caregiver or caregiver who becomes ill themselves is of no use to their loved one. I have to encourage them to take care of themselves so that they can take care of their loved one, which is their goal.

Caregivers sometimes do too much. They promise too much. “I promised my mom I’d never put her in a nursing home,” for instance. But things are just becoming too much. I try to give them permission. I say, “I get it, you tried, you’ve done a wonderful job, but now is the time for you to be a daughter and not the bed cleaner, diaper changer.” You just have to do that. Sometimes it’s a physician, you can provide them some help with creating some boundaries around what they’re able to do.

A lot of times they haven’t gotten the resources, so we can be, “Hey, you’re breaking your back, taking your mom out of the bed. How about we get the physical therapist to do a home safety evaluation to assess her for a Hoyer lift?” With that, we can give you this little thing where you just pull this lever with a little sling and now you’re not injuring yourself helping your mom to get in and out of the bed, or to change the sheets or other things like that.

I’m always surprised by how such simple fixes can completely change a caregiver’s lives. We don’t get taught this stuff in medical school often, and that’s using other people to help you, or just to think about it, and to connect people to these community resources, is really, really important.

Dr. Chen: Let’s just take a moment to thank all of the caregivers listening to this today. Just thank you for being the backbone of care, for just being the angels and the heroes. You are not recognized enough and nearly paid enough for this. In fact, you’re not being paid at all.

You mentioned some care resources, including home health, but what are some top resources that people can go to, whether it’s online or within the community, to address these gaps in care, perhaps to help their older adult loved ones maintain and build social connections — some things that perhaps they’re not aware of.

Dr. Shah: There are some amazing resources. The pandemic has actually done a wonderful job of making things so much more accessible and online. If someone is taking care of somebody with dementia, my absolute favorite resource for years has been the Alzheimer’s Association and their local chapters. There’s online resources, there’s so much information about how to deal with the long, slow goodbye, (unfortunately) that is often dementia, and the years and years of caregiving that people are giving, and how to deal with things as they come along.

I also love the oldie but goodie, The 36-Hour Day. That aptly titled book has been around and revised many times.

Dr. Chen: Love that book.

Dr. Shah: By Nancy L. Mace and Peter V. Rabins. I have given that book out many times to folks. That’s for dementia and Alzheimer’s care. Every state and every region has these things called the Area Agency on Aging, and they’re called different things in different areas, but they are usually funded by the state. It tells you exactly what is available locally for you. Phenomenal, tremendous resources, everything from legal resources to Meals on Wheels, transportation to this, to that, to the names of places, or “I need respite care,” or anything like that. It’s really wonderful.

There’s a newer resource that is out there from the National Council on Aging. Go to their website or you can go directly to benefitscheckup.org. This is one that I had not played around with previously and it’s phenomenal. You put your zip code in and you can find local and national programs that you might be eligible for.

For example, with certain electricity providers in Arizona and the heat, you want to make sure that your air conditioning doesn’t get turned off, even if you’re unable to afford to pay the bill. There are state laws around this, there are programs, there’s grants, but how would you know that this exists? This website, benefitscheckup.org will actually tell you all the things in all these different domains that you are eligible for.

They’ll even do a consultation with you about your income, your situation, these sorts of things, completely free, and will help to connect you to these organizations. It’s way better than anything I had seen exist before, because a lot of times it’s just overwhelming. You go to these websites and there are just so many things.

The AARP is really good.

Dr. Chen: Yes. Right.

Dr. Shah: On the Medicare and Medicaid websites, the government has things like nursing home comparisons. They’re also oftentimes programs available for people who are experiencing challenges or difficulties in assisted living, nursing homes, those sorts of things. It also has local things likebenefits, which vary state by state, but the SNAP program can be really helpful. Their website can walk people through.

Sometimes people don’t realize they’re eligible for hundreds of dollars in food assistance when they’re trying to live on a fixed income, and mistakenly think that since they’re getting a Social Security check, they’re exempt from SNAP, which is not always the case. There are lots of great resources that are out there, but they can be overwhelming.

Dr. Chen: Yeah, thank you for that summary. That’s amazing. I learned something new there too. We’ll try to summarize all the resources that you offered today, including websites at the end of our podcast for all of you to access as well.

I feel like when we talk about geriatric medicine and aging, the common theme is thatthings are always going to get harder and worse for you, but that’s not necessarily true. Despite our circumstances and backgrounds, how can we still strive to live well? How do we cultivate better living habits or resources moving forward?

Dr. Shah: First of all, it’s not just “struggle in silence.” So many times you find out that someone’s been dealing with something for such a long time because they are too prideful to ask for help. They think it’s a weakness. They worry that someone’s going to take them out of their home. They’re going to lose their independence, all these other things.

Usually, the people who are set up to help with these resources, their goal is not to ruin someone’s life or to take away their independence. It’s actually to try to maximize their independence. That’s the number one thing that I’m sure you’ve heard with your patients. “I wish I had told you earlier.”

Dr. Chen: Yeah.

Dr. Shah: It’s not “suffering in silence.” Recognize that this stuff is really common. You’re not the only one who has struggled with how to make ends meet, to struggle with how am I going to figure this out, to struggle with driving or transportation, or feeling isolated.

You really have to have areason to get up in the morning. That reason, whatever it might be, gives you meaning in life, and we know that’s very important. It’s hard when doors close. There’s a lot of loss in aging. You lose a partner or you no longer can do certain things. I have lots of patients who love a certain physical activity, like let’s say running — and their knees give out and now they can no longer run. They can get really depressed .

The people who do best, they pivot, oftentimes using their social networks or just putting themselves out there again. That is harder and harder to do sometimes, but the alternative is becoming lonely and isolated.

Dr. Chen: Right.

Dr. Shah: Your health really takes a decline. It’s pushing people a little bit to not stare at the door that’s closed. Look down the hallway and see all the other ones that are open and do those things. Even with significant loss of function, people can still have very meaningful and wonderful lives.

I’m a big Olympics and Paralympics fan. You’re just so inspired by people who have faced tremendous loss and look at what they’ve done with it.

Dr. Chen: Right.

Dr. Shah: Some say, “This terrible thing that happened to me gave my life so much more focus and meaning.” If that can happen to younger people that we see, that we put up on pedestals, that win gold medals — that can happen to us regular everyday people when we experience a loss, small or big, in our lives. How do we show our resilience? How do we bounce back? That’s a big part of aging. The people that I see, it’s not a lack of loss that accounts for why they’ve aged successfully. It’s their ability to bounce back.

Dr. Chen: I love that. That’s very inspirational. Obviously, you’ve done a lot of home visits. You’ve seen a lot of extreme social situations, both in the community and in your clinic and that can be really difficult but also as you’ve mentioned, really rewarding. Tell us a bit about the fun parts of the job. What makes it most rewarding for you? What do you love about it?

Dr. Shah: It’s been really fun for me just having these conversations. Sometimes we’re reluctant because we think it’s not part of doctoring, but I think the evidence tells us it is. If I told you there’s an intervention that might make your patient’s life seven years longer, you’d be like, “Give me that medicine. Let me learn about that medicine,” but that intervention is connection and socialization. There was some study that tried to equate loneliness and social isolation. It is equivalent to smoking 15 cigarettes a day. That got a lot of press, of course, but we know that these things actually make a difference.

Dr. Chen: Yeah.

Dr. Shah: Probably the most fun has been the light bulb moments that I’ve gotten from patients when I start talking about these things. It can be anything from doing pre-retirement counseling, where I say “Hey, we should start talking about these things. You need to have something figured out because playing golf is going to get really boring.” Especially our oldest old patients, when they’re in their nineties and hundreds, they experience so much loss. I remember one patient I have, who is on his third group of golf buddies because he’s outlived two groups of golf friends.

Dr. Chen: Oh, gosh.

Dr. Shah: It gets harder and harder each time. It’s going there with the patients and connecting it all to their overall health, which I think has been my absolute most fun thing. That’s why I say, “You have to get out of your shell.” It’s amazing how one little thing can make things a lot better.

My dad lives with us. My mom passed away, and so he’s with us. It took a long time, even with my in-laws living here in town, to introduce him to people. For him, it was this group of other widowers that he hangs out with. They love to play ping pong. That’s been their thing.

They’re all older Indian men, all immigrants, and they call themselves a “singles group.” On Friday nights, they go out. That was the thing that finally got him out of this kind of constant spiraling of being thrown out of his element and moving across the country from Georgia to here.

You can see that over time now, he’s just a much easier person to be around and isn’t so grumpy. Then because of that, now you’re going on a trip, you’re getting out of the house, you’re exercising, you’re getting up on time. It doesn’t have to be something dramatic. There’s this cascade of things that happen to people as they get out of their shell.

Dr. Chen: Very true. My last question for you, Dr. Shah, what does “aging forward” mean to you, and how do you personally try to age well? What are things you like to do to stay on task?

Dr. Shah: I mean, I love what I do. It gives me a lot of meaning in life and certainly makes me feel very fulfilled. I am definitely a workaholic. You can sometimes do too much of one thing, so I have learned from my patients the importance of embracing change or putting some boundaries around things. It’s always a work in progress, but I think that’s very important.

Getting involved in things is something else I try to do. I love reading, so being involved in a book club. I’m trying to do better with my physical activity and getting to the gy. Making that a priority is something that’s a constant struggle for me. I’ve learned, maybe I should pay a little bit more attention to that. But I think the importance of family, friends, community connections,paying more attention to that, because when we get busy, we sometimes let those things go on the wayside.

Dr. Chen: Well, Dr. Shah, this has been such a moving conversation. The realization that our ability to live well, within our means, with access to health care is critical. I hope that we all have learned there’s always something that can be done. Thank you so much for having this dialogue today.

Dr. Shah: Thanks for having me. It’s been a pleasure to talk about my favorite topic.

Dr. Chen: That’s all for this episode. Hopefully you’re feeling a little more informed, inspired, and empowered. If you have a topic suggestion for a future episode, you can leave us a voicemail at 507-538-6272. We might even feature your voice on the show!

For more “Aging Forward” episodes and resources, head to mayoclinic.org/agingforward. If you found this show helpful, please subscribe, and make sure to rate and review us on your podcast app. It really helps others find our show.

Thanks for listening, and until next time, stay curious and stay active.

LIST OF RESOURCES

1. Local Resources

Local resources are often the most direct and accessible support for older adults. These programs typically focus on community-based services and social support.

Area Agencies on Aging (AAAs)

●    What They Offer: AAAs provide a wide range of services to older adults, including meal programs, transportation, caregiver support, home modification assistance, and case management. They are a central hub for information on local services.

●    How to Access: Find your local AAA through the Eldercare Locator.

Senior Centers

●    What They Offer: Senior centers provide social, recreational, and educational activities, such as fitness classes, arts and crafts, health screenings, and social gatherings.

●    How to Access: Search for local senior centers through your AAA or local government website.

Meals on Wheels

●    What They Offer: Delivers nutritious meals to older adults who are unable to prepare food themselves. This service helps combat food insecurity and ensures seniors receive regular, balanced meals.

●    How to Access: Visit Meals on Wheels America to find a program in your area.

Community Health Centers

●    What They Offer: Community health centers provide affordable healthcare services, including medical, dental, mental health, and preventive care, often on a sliding fee scale based on income.

●    How to Access: Use the Health Resources and Services Administration (HRSA) Health Center Locator to find a nearby clinic.

Local Housing Authorities

●    What They Offer: Local housing authorities often provide affordable housing options for seniors, including subsidized housing programs like Section 8 and Section 202 Supportive Housing for the Elderly.

●    How to Access: Contact your local housing authority or visit your city’s housing department website for information on available programs.

Transportation Services for Seniors

●    What They Offer: Many communities offer transportation services specifically for older adults, such as senior shuttles or ride programs to medical appointments and social activities.

●    How to Access: Contact your local AAA, senior center, or city’s transportation office for details.

2. National Resources

National organizations and programs provide valuable services and support for older adults across the United States. These organizations often offer assistance with healthcare, housing, financial support, and caregiver resources.

Medicare and Medicaid

●    What They Offer: Medicare provides health insurance for individuals 65 and older, while Medicaid offers healthcare coverage for low-income seniors. Both programs cover a range of medical services, including doctor visits, hospital stays, and prescription drugs.

●    How to Access: Visit Medicare.gov for Medicare services or your state’s Medicaid website through Medicaid.gov.

Social Security Administration (SSA)

●    What They Offer: SSA provides retirement benefits, survivor benefits, and Supplemental Security Income (SSI) for low-income older adults. They also offer information on Medicare enrollment and disability benefits.

●    How to Access: Visit SSA.gov or call 1-800-772-1213 for assistance.

Supplemental Nutrition Assistance Program (SNAP)

●    What They Offer: SNAP provides food assistance benefits for low-income individuals, including older adults. Benefits can be used to purchase groceries at participating stores.

●    How to Access: Visit SNAP’s website or contact your local social services office to apply.

AARP

●    What They Offer: AARP is a national organization that advocates for older adults and provides a wide range of resources, including financial planning, healthcare information, discounts on services, and educational materials.

●    How to Access: Visit AARP.org or call 1-888-687-2277.

National Council on Aging (NCOA)

●    What They Offer: NCOA provides resources to help older adults find benefits programs, manage chronic diseases, and age well. They also run the BenefitsCheckUp tool to help older adults identify benefits they may be eligible for.

●    How to Access: Visit NCOA.org or use BenefitsCheckUp.org to find local and national programs.

Veterans Affairs (VA)

●    What They Offer: The VA offers healthcare, pensions, home loans, and other benefits to older veterans. The VA also provides long-term care services, including nursing homes and assisted living for eligible veterans.

●    How to Access: Visit VA.gov or call 1-800-827-1000 for information on veterans’ benefits.

Alzheimer’s Association

●    What They Offer: The Alzheimer’s Association provides support and resources for individuals living with dementia and their caregivers. Services include a 24/7 helpline, support groups, and educational materials.

●    How to Access: Visit Alz.org or call the helpline at 1-800-272-3900.

Elder Justice and Ombudsman Programs

●    What They Offer: Elder Justice programs and Ombudsman services advocate for the rights of older adults, particularly those in nursing homes and long-term care facilities. They investigate complaints and work to resolve issues of neglect, abuse, or mistreatment.

●    How to Access: Visit the National Long-Term Care Ombudsman Resource Center to find your local program.

3. Online Resources

The internet provides a wealth of online resources for older adults and their caregivers, including education, financial planning tools, and virtual social platforms.

BenefitsCheckUp

●    What It Offers: An online tool from the National Council on Aging that helps older adults find federal, state, and local benefit programs they may qualify for, such as food assistance, housing help, and healthcare subsidies.

●    How to Access: Visit BenefitsCheckUp.org.

Stitch

●    What It Offers: Stitch is a social platform specifically for older adults to make friends, join social groups, participate in activities, and engage in online discussions.

●    How to Access: Visit Stitch.net.

Senior Planet

●    What It Offers: Senior Planet provides technology training and support for older adults, helping them navigate the digital world and use the internet for socialization, health management, and more.

●    How to Access: Visit SeniorPlanet.org.

Family Caregiver Alliance

●    What It Offers: The Family Caregiver Alliance provides resources, support, and education for caregivers. They offer online tools, caregiver support groups, and information on long-term care and financial planning.

●    How to Access: Visit Caregiver.org.

Coursera and edX

●    What They Offer: These platforms offer free and low-cost online courses on a variety of topics, including health, technology, arts, and more. Older adults can use these platforms to continue learning and stay mentally active.

●    How to Access: Visit Coursera.org or edX.org.

4. Nonprofit Organizations

Nonprofit organizations often provide essential services and advocacy for older adults, caregivers, and families.

Habitat for Humanity

●    What They Offer: Habitat for Humanity offers home repair services, including modifications to make homes more accessible for older adults, such as installing ramps or grab bars.

●    How to Access: Visit Habitat.org to find your local chapter.

SAGE (Advocacy and Services for LGBTQ+ Elders)

●    What They Offer: SAGE provides advocacy and services for LGBTQ+ older adults, including social programs, health services, and caregiver support.

●    How to Access: Visit SAGEusa.org.

Relevant reading

Mayo Clinic on Osteoporosis

Around 54 million Americans live with osteoporosis or low bone mass, but many don’t recognize the symptoms until it is too late. Before a bad fall or fracture renders you immobile, learn how to reduce your risk of developing osteoporosis, manage your day-to-day symptoms, and even treat the disease with the tools provided in Mayo Clinic on Osteoporosis.