On June 21, in collaboration with the MIT AgeLab, the Jefferson College of Population Health, and Health eVillages, Tivity Health hosted a conference on rural aging in Portsmouth, New Hampshire. The 2017 Connectivity Summit included presentations by: Donato Tramuto, CEO of Tivity Health; David Nash, Dean of the Jefferson College of Population Health, and Joseph Coughlin, Founder and Director of the MIT AgeLab, who also served as discussion moderator. The event featured more than 80 experts from academia, business, government, non-profit and community organizations and healthcare.
Donato Tramuto’s opening remarks framed the event as the kick-off of a movement toward improving the quality of life of rural older Americans. He identified the overarching problem facing rural seniors as one of isolation--from services, amenities, resources, and other people. Joe Coughlin reflected on the significance of health as an instrumental goal rather than an end goal, citing Sarah Knoss, a rural Pennsylvanian who lived to be 119 years old, who credited her enjoyment of life in older age to the following factors: “I have my health, and I can do things.”
The summit featured three roundtable discussions facilitated by experts in the field of aging and an idea generation session. The roundtables illuminated several key problems and possible innovations for rural living in older age.
The first roundtable underscored the importance of social determinants of health. In short, good health should not just be measured by lifespan, but also by well-being. Social services are as important to the well-being of older people as health care services. The built environment, including home layout and neighborhood design, plays a major role in the health and functioning of older people. Further, many problems that the rural elderly contend with, such as drug abuse, access to affordable housing, unemployment, and malnutrition, are not frequently observed or addressed by actors in the policy sphere.
The potential of technology to improve the lives of rural older people was examined in the second roundtable. Large companies are entering into the aging and technology spheres in ways that might have been surprising five years before. For example, Comcast is leveraging its hardware distribution network for a connected health initiative enabling health and wellness options in the home. But technology may have limits in helping the disadvantaged. To begin with, many older adults in rural areas do not have access to broadband. Questions of accessibility aside, while technology is a useful tool, it is not always the answer. Building out networks to unserved areas could provide residents with a new suite of resources, but tech can also become “a solution in search of a problem,” addressing issues that it is not well-suited for, or only partially addressing them. Ideally, technology should be paired with community tools and interventions. For example, an online service called Benefits Checkup helps people learn what government benefits they are eligible for but may not be receiving. In this case, technology connects older people with resources that already exist, but are not utilized.
Questions of healthcare accessibility dominated the discussion in the third roundtable. On whether rural areas are underserved by doctors, David Nash noted that “We do not have a physician shortage. We have a physician maldistribution.” Five percent of all American medical students are located in the Philadelphia area. They are brought up within and filtered out into urban areas instead of rural ones. Additionally, the ratio of specialists to primary care physicians in the United States is 3 to 1. In European countries, that ratio is reversed. Expanding the ranks of primary care physicians would reduce costs and help supply underserved rural areas with basic health care services. Federal health care policies also have significant impacts on older adults in rural areas. For example, Medicaid currently provides substantial subsidies to rural patients and rural hospitals. The current versions of the American Health Care Act in Congress (H.R. 1628) will severely reduce Medicaid funding. The effects of this on older people in rural areas may not be fully examined.
The latter part of the summit featured an idea generation session around aiding rural older adults. The group presented and considered various ideas to try to draw attention to the challenges of aging in rural America as well as to expand rural older people’s access to information, resources and services.