Most U.S. adults (77%) age 50 and older in the United States rated their overall health as good, very good, or excellent in an online survey conducted by WebMD and Capital Caring Health (CCH), a nonprofit hospice/advanced illness care organization based in Virginia.
Among the respondents, 41% said their health was very good or excellent.
However, the ratings differed largely by race, employment status, and income (Table 1).
Table 1. Self-Reported Health Status by Race/Ethnicity*
|Health Status||% White||% Black||% Hispanic**|
Employment status was also associated with a significant difference in the way people viewed their health at the top tier and bottom tier.
The middle tier ("good" health) was reported similarly (from 33% to 37%) whether a person was employed, retired, or not employed. However, employed respondents were much more likely to report they had "excellent" or "very good" health (51% vs. 44% for retirees and 21% for the not employed).
Conversely, those who were not employed were far more likely to report "fair" or "poor" health (45%) than those who were employed (13%) or retired (20%).
Similarly, respondents with incomes of less than $50,000 were three times more likely to report their health as "fair" or "poor" than were those with incomes of more than $100,000 (36% vs 12%).
WebMD/CCH surveyed 3,464 U.S. residents ages 50 and older between Aug. 13 and Nov. 9, 2020. WebMD.com readers were randomly invited to take a 10-minute online survey.
Aging at Home a Priority
The survey also highlighted a strong preference for aging in place, says Steve Cone, chief of communications and philanthropy at CCH.
"More now than ever before, thanks to the COVID experience, baby boomers and their children really believe that's the holy grail," he says.
Cone notes that the quick spread of COVID-19 through some nursing homes early in the pandemic likely has strengthened people's resolve to live out their lives in their own homes.
The survey indicated that 85% of people aged 50+ who are living in their own home, a family member's home, or a loved one's home responded that it is "very important" or "important" to stay in their home as they age.
When asked what services they would need to continue their living situation, the most common responses were housekeeping, home repair services, and transportation (listed as needs by 35% to 45% of respondents). Regarding changes they would have to make to feel safe in their home as they age, installing grab bars and/or safety rails in the bath/shower was the most popular answer (50%).
Use of Telemedicine
Respondents were also asked about their acceptance of telemedicine, and 62% said they would be likely or very likely to engage in virtual visits with a doctor it in the future.
However, the likelihood varied by income level (Table 2). Specifically, respondents with incomes over $100,000 were significantly more likely to say they would use telemedicine in the future than were those with incomes below $50,000 (74% vs 60%). They were also more likely to already have used telemedicine.
Table 2. Percentage Who Have Used Telemedicine by Income
|Income Level||% Use|
|More than $100,000||64|
|Less than $50,000||47|
Although respondents generally embraced telemedicine, they are less confident about some types of monitoring, according to Cone.
Emergency response (64%) was the leading type of remote monitoring respondents ages 50 and older would allow. Only a minority of respondents would allow the other types of monitoring asked about in the survey.
Close to one-quarter of respondents would not allow any type of monitoring.
Fewer than one-third would allow tracking of medication compliance, refrigerator use, sleep habits, or bathroom use.
People see monitoring of some movements as "Orwellian," Cone says.
Knowledge of Hospice
The survey findings support the need for more widespread use of hospice so people can stay in their homes as they age, Cone says.
When illness gets severe, "There's no reason you have to get rushed to the emergency room or wind up in a hospital," Cone says.
He notes that hospice and palliative care can come to patients wherever they reside -- in their home, an assisted living center, a nursing home, or even a hospital room.
"That doesn't mean the physician isn't involved," he says. "But working as a team, we can keep them in their homes and their lifestyle intact."
Patients whose doctors attest that they are likely to live a maximum 6 months are eligible for hospice. But most families wait too long to long to start hospice or palliative care for a patient, Cone says, and may not be aware of what these services typically cover, including meal preparation and pet care.
In the survey, nearly one-third of respondents said they did not know that palliative care is something that "can be given at any stage of a serious illness" or "provides non-medical services (e.g., patient/family communication, help with insurance issues, scheduling appointments, arranging transportation)."
He notes palliative care and hospice are covered by Medicare and Medicaid and also by most private insurance plans or by individual companies providing the service.
However, health care providers may have to overcome a general reluctance to discuss hospice when sharing options for those severely ill.
The survey showed that while 51% of those 50 and older are at least "slightly interested" in learning more about hospice, a nearly equal number say they are "not at all interested" (49%).
Most Using Hospice Are White
More than 90% of those surveyed reported that aspects of hospice care, including "comfort and relief from pain at the end of patients' lives," providing a dedicated care team, and an alternative to other care settings, are "very important" or "important."
However, national hospice use rates are extremely low for minorities and the LGBTQ community, according to Cone. Among Medicare hospice recipients, 82% were white, 8.2% Black, 6.7% Hispanic, and 1.8% Asian or Pacific Islander, according to the National Hospice and Palliative Care Organization.
Those numbers signal a need for outreach to those communities with information on what services are available and how to access them, he says.
Health Costs Top Concern
The survey also asked about level of concern regarding matters including family, health, financials, and end-of-life directives and found adults aged 50 and older expressed the greatest amount of concern for health care costs that are not covered by insurance.
More than half (56%) said they were concerned or very concerned about those costs, which was higher than the percentage concerned about losing a spouse (49%).
Respondents were less concerned ("slightly concerned" or "not at all concerned") about their children living far away, planning end-of life-directives, and falling or having reduced mobility.
WebMD/Capital Caring Health survey.
Steve Cone, chief of communications and philanthropy, Capital Caring Health.