Over the past decade, screening for health-related social needs (HRSNs), including housing instability, food insecurity, and lack of access to transportation, has been rapidly implemented in healthcare settings. Major medical and health societies have endorsed consideration of HRSNs in clinical decision-making, but most screening tools have not been developed or validated with older adults in mind. In a perspective for the New England Journal of Medicine, Dr. Mark Unruh, associate professor of population health sciences, and Dr. Joshua R. Vest, associate dean for research at the Indiana University Richard M. Fairbanks School of Public Health in Indianapolis, address the mismeasurement of HRSNs among older adults.
Current screening tools primarily use a one-size-fits-all approach, which may not account for variation in cognitive and physical functioning among older adults. Additionally, some screening questions may lack relevance for older populations or overlook residential settings such as nursing homes and other long-term care facilities. With the population of Americans aged 80 and older expected to double over the next twenty years, unmet needs in this population could be especially consequential.
Dr. Unruh and Dr. Vest offer several potential approaches to better integrate screening into care for older adults. Screening questionnaires could incorporate items that simultaneously consider age and variations in functional status, cognition, or need for proxy respondents. They could further be tailored to a patient’s care context and residential status, and should assess socioeconomic factors, such as health insurance coverage. Importantly, HRSN measures should be linked to interventions. Improved HRSN screening could also help identify gaps in service availability and inform efforts to better maximize service capacity. With these targeted, age-appropriate adjustments, HRSN measurement can allow for accurate needs identification, efficient use of resources, and opportunities to improve people’s health and well-being.
- Highlights