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Learning Objectives

  • Define social determinants of health, health disparities, and health equity.

  • Understand historical and contemporary contributing factors to health disparities in older adults within historically disenfranchised groups.

  • Apply a life course perspective to health equity and its role in older adult health.

  • Describe features of effective interventions to foster health equity.

Key Clinical Points

  1. Social determinants of health reflect the educational, economic, health care, neighborhood/environmental, and social and community context of everyday life. Social determinants of health play a key role in approaches to prevent and address adverse health outcomes.

  2. Health disparities are common among older adults and are often rooted in unfavorable exposure to social determinants, for example, disparate access to health opportunities and barriers.

  3. Multiple factors, including biological, health behavior–related, sociocultural, and environmental, interact and operate across the life course to influence later-life health outcomes.

  4. Individualized assessments are needed to understand opportunities and barriers to older adult health, and to avoid biased assumptions about individuals.

  5. Consideration of social determinants and their contribution to age-related health disparities requires increasing levels of collaboration among members of the care team, including geriatrics, mental health, and community-based supports and services (CBSS).


Scientific progress in aging and geriatrics has led to longer life expectancy, improved quality of life, and many advancements in geriatric medicine. Unfortunately, these benefits are not equally distributed across populations. Lower life expectancy, higher age-related disease incidence including Alzheimer disease, chronic disease burden, and worse health care quality and access disproportionately affect historically disenfranchised groups in the United States—which include but are not limited to racial and ethnic minorities, persons living in rural areas or who are socioeconomically disadvantaged, and sexual and gender minorities. Such health differences are broadly referred to as health disparities, and across the life course these negative health impacts are often compounded, exerting a cumulative influence on age-related health outcomes in older adults.

Getting to the root causes of health disparities requires a well-rounded understanding of the social/environmental, behavioral/psychological, and biological processes involved and how they interrelate. We often have a better understanding of geriatric conditions from a biological and sometimes behavioral vantage point, yet less often do we understand how unequal exposure to disadvantaged social and environmental contexts drives health disparities. Frailty risk, for example, is shaped by biological (female sex) and behavioral (physical activity level and cognitive status) factors along with social and environmental factors, such as access to safe spaces within which to exercise or financial resources to wear proper footwear for safe exercise. However, social and environmental factors are frequently overlooked in key clinical and research domains.

Social determinants of health are the conditions within which we live, grow, work, play, and age that impact health. They are particularly salient in the development and reinforcement of health disparities, playing a role in an estimated 80% of health outcomes. They include factors related to ...

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