Aging in place, access to transportation and economic insecurity are the three biggest social barriers to aging well in America, according to a new survey.

Alignment Health’s 2024 Social Threats to Healthy Aging in America survey sought to identify the top social and environmental factors that prevent older adults from receiving the care and support they need to live healthy lives as they age. Alignment Health, a Medicare Advantage company, and Ipsos, a market research and polling company, surveyed 2,051 older adults online.

This year’s report examines eight key social determinants of health – aging in place, lack of transportation and access, economic challenges, lack of support, mental health issues, loneliness, cultural barriers and food insecurity. Last year, lack of support, lack of access to transportation and food insecurity were the top social barriers to health for older adults cited in the survey.

Sixty-nine percent of over 2,000 older adults surveyed said aging in place tops their list of social threats to aging well. Among those who reported experiencing stress and anxiety in the past year, 22% cited aging in place as the primary reason for these feelings, while 45% cited aging in place among their top three stressors.

A majority of survey respondents (67%) said they would use services that support senior living—including personal medical alerts, home visits from caregivers, and nonmedical companion care—if their health insurance offered them.

For 64% of respondents, lack of transportation/access to health care was second on the list of social threats to aging. Among those who forego health care, 64% cited lack of reliable transportation and access as the primary reason, and 50% said they may miss future doctor appointments due to unreliable transportation.

A majority (71%) of respondents said they would use transportation services, such as rides to medical appointments, if they were offered by their health insurance, while 18% said these services were most necessary or important.

Economic security was the top three social threats of aging for 56% of respondents. They face rising costs for housing, healthcare and everyday expenses. And 15% said economic uncertainty in the coming year was the reason for their decreased stress or anxiety.

Forty-four percent of those facing economic hurdles reported being burdened by medical debt, and 59% of respondents said they had at least one month’s worth of debt.

Lack of support (38%), mental health (33%) and loneliness (30%) were ranked as the next most important social and environmental factors that place a high burden on older adults. One in five older adults also cited cultural barriers (21%) and food insecurity (18%) as obstacles to their health and well-being.

“As an industry, we need to pay close attention to what our nation’s seniors tell us are the biggest barriers affecting their health so we can find solutions that help eliminate as many of those barriers as possible and ensure they are successful in their later years,” said Dr. John Kim, senior vice president of market management at Alignment Health and chief medical officer of Alignment Health Plan in California, in a statement. “Our research to date has shown that we need to accelerate innovative partnerships for our growing member base, such as those that address food insecurity or provide services that support home care.”

Respondents were also asked to predict what they think will hinder or continue to hinder their health trajectory in the future. The survey found that 29% of older adults nationwide ranked economic instability as their top concern for the future. Lack of transportation and access to care, as well as aging in place, came in second, with 25% of respondents each. Lack of support was ranked as the top concern for the future by 11% of survey respondents, coming in third among future obstacles.