Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies

State and territorial health agencies are well positioned to support healthy aging and health equity by addressing social determinants of health and promoting healthy behaviors across the life course from childhood to older adulthood. As the number of US older adults increases, health agencies also have an opportunity to achieve population health impacts and health care savings by supporting policies, programs, and services that address older adults' health care needs and social determinants of health. Improving health equity in later life requires joint attention to healthy aging by addressing both the early-life health and social factors that affect health across the life course and in older adulthood, and older adult health specifically by promoting equitable access to preventive health, long-term care, social supports, and healthy community environments for all older adults.

This article summarizes key public health interventions to address healthy aging and older adult health that health agencies are equipped to champion or support. We bundle these interventions into a “technical package,” or a set of recommendations to the field to guide healthy aging and older adult health-focused public health activities. Association of State and Territorial Health Officials (ASTHO) technical packages are based on evidence-based interventions, promising practices, and subject matter expert recommendations. They are not intended to be comprehensive; rather, they serve as tools to prioritize efforts toward what works to address a particular public health problem and establish a proactive approach to technical assistance. The ASTHO technical package to support healthy aging and older adult health comprises 5 categories: paid family and sick leave; healthy community design; fall prevention and mobility; telehealth access; and the health care, long-term care, and public health workforce. Recognizing healthy aging is a multifactorial process; other ASTHO technical packages also offer promising strategies to promote health across the life course. In the following text, we describe each category in depth and outline details in the Table.

TABLE - ASTHO Technical Package on Healthy Aging and Older Adult Health

Objective	Potential Indicators	Mechanisms	Levels of Influence
Expand paid family and sick leave	State policies Federal policy Workforce survey	State legislation Forthcoming ASTHO policy statement on family and sick leave Model policies for state and local government Employee benefit requirements for state and local contractors Tax and other incentives for employers to expand benefits	Federal policy makers State policy makers Employers Employer associations (eg, state restaurant association)
Support healthy community design	Public health participation in jurisdiction planning commissions Complete streets policies Affordable, accessible housing stock Transportation access and reliability	Promote investments and policies to increase housing and transportation accessibility Support community design that promotes connectedness and physical activity Consider equitable access to community resources, including nutritious food options and outdoor recreation infrastructure Support health equity zones	Local, state, and federal transportation agencies Local, state, and federal housing sector Private sector
Promote fall prevention and mobility	State programs funding medical alert technology, assistive devices, and home modifications Number of health care providers who have implemented the STEADI initiative into their practices Number of community-based fall prevention programs	Support health agency involvement in fall surveillance and clinical-community connections to increase mobility supports for those with high fall risk Support community-based programs to increase mobility and reduce fall risk in the built environment Support increased access to affordable assistive devices and home modifications to reduce fall risk	Community-based social supports organizations Health care providers Medicaid agencies Local planning/urban design departments Local, state, and federal housing sector Insurance providers/Medicaid agencies
Increase telehealth access	State Medicaid policies Telemedicine usage rates1 State broadband policies State, local, and privately led technology literacy programs for older adults	Support expansion of Medicaid reimbursement policies for in-home telehealth services Support clinical- and community-based programs to provide education around usage of telehealth for older adults Expand access to low-cost broadband options to support Internet connectivity	Health care providers Insurance providers/Medicaid agencies Hospital systems/clinics Internet providers
Strengthen the health care, LTC, and public health workforce	Health care, LTC, and public health workforce size and turnover State and local public health programs directly addressing healthy aging and/or older adult health Number of organizations with Age-Friendly Health Systems or Age-Friendly Public Health Systems designation	Address health care and LTC workforce shortages through Medicaid reimbursement rates Support standardized training and development on older adult health for health care, LTC, and public health workforce Support infection control in LTC facilities through ensuring adequate staff training and PPE	LTC sector Hospital systems/clinics High education institutions Medicaid agencies LTC and health care worker unions State legislators

Abbreviations: ASTHO, Association of State and Territorial Health Officials; LTC, long-term care; PPE, personal protective equipment; STEADI, Stopping Elderly Accidents, Deaths & Injuries.

Expand Paid Family and Sick Leave

Paid family leave and sick leave are benefits that address economic security and health for employed people, including family caregivers, as well as care recipients of all ages. Evidence suggests that paid family leave is beneficial to child and infant health, reduces older adults' risk of nursing home admission,² and improves parents' and family caregivers' economic security, a well-established social determinant of health.³ Jurisdictions can expand access to leave through several mechanisms. State and territorial health officials (S/THOs) can provide data and recommendations to inform paid leave policy decisions such as eligibility criteria, leave duration, benefit amount, and job protections included in legislation. S/THOs can also work with individual employers or employer associations to share information on the health benefits of paid family and sick leave and inform organizational decision-making around paid leave policies.

Support Healthy Community Design

Supporting healthy community design involves “planning and designing communities that make it easier for people to live healthy lives.”⁴ It includes planning for equitable access to community resources such as nutritious food, recreation and transportation infrastructure, and affordable housing. It also entails designing communities to promote physical activity and social connectedness, such as developing community gathering spaces and safe mobility options. Other benefits of healthy community design include improving air quality and lowering injury risk.⁴ These benefits serve people of all ages, promoting health over the life course and into older adulthood. Health officials can leverage their role as health strategists to influence community design policies by informing jurisdiction budget priorities and developers' investments to increase housing accessibility and affordability. S/THOs can use their authority to promote health department participation in local planning and provide guidance on healthy community design principles and benefits. Health agencies can also invest in health equity zone models to identify community-driven solutions for designing the built environment.⁵

Promote Fall Prevention and Mobility

Building capacity and infrastructure within health departments and organizations for fall prevention and mobility helps promote age-friendly environments. Fall prevention is focused on taking precautions to reduce the occurrence of fall-related injuries and accidents. Falls are the leading cause of death in adults 65 years and older,⁶ and the Centers for Disease Control and Prevention reports that nearly $50 billion is spent on medical costs related to nonfatal fall injuries.⁷ Increasing mobility, the ability to move freely and easily, is an important strategy for reducing risk of falling and offers health benefits for older adults. Losing muscle mass may decrease mobility and potentially limit independence and performing activities of daily living. Health agencies can conduct fall surveillance, support evidence-based clinical- and community-based fall prevention programs, and provide funding or other supports to increase the availability of community-based fall prevention resources. These community-based efforts may focus on increasing older adults' mobility or reducing fall risks in the home environment through assistive devices, improved lighting, and home modifications.

Increase Telehealth Access

Developing and expanding age-inclusive telehealth policies, as well as programs to support their adoption, are essential components of improving health care access, efficiency, and safety for older adults. The use of telehealth became widespread during the pandemic and has shown benefits in access not only for older adults but also for adults of all ages and abilities, including those who live in rural areas, are homebound, and/or have limited transportation access.⁸ S/THOs can use their influence to sustain Medicaid telehealth reimbursement policies that were expanded during the pandemic. In addition to coverage expansion, supporting clinical- and community-based programs to address the digital divide experienced by older adults is a necessary complement to ensuring that telehealth is utilized to its fullest capacity. To promote telehealth utilization, S/THOs can develop innovative public and private partnerships to ensure that infrastructural supports to expand broadband access for all are possible so that older adults and their caregivers can access these services.

Strengthen the Long-term Care, Health Care, and Public Health Workforce

A robust and skilled long-term care, health care, and public health workforce is essential to delivering equitable, efficient, and high-quality care that improves health and quality of life for older adults.³ Long-term care workforce shortages are a persistent challenge across settings, magnified by the COVID-19 pandemic, with implications for health, safety, and independence of older adults and people with disabilities who have long-term care needs.⁹ S/THOs can collaborate with Medicaid agencies, long-term care providers, and policy makers to identify feasible strategies, to strengthen infection control practices and quality of care in nursing homes, and to improve compensation, training, and job quality for workers across the long-term care continuum. To improve health care quality for older adults, S/THOs can partner with health care organizations and providers in their jurisdiction to enhance providers' competence with geriatric care principles and increase recruitment and retention of geriatric specialists.³ S/THOs can also build the public health workforce's capacity by strengthening investments in department activities that influence healthy aging and older adult health and by guiding programs to be inclusive of the older adult population.

Conclusion

Public health attention to healthy aging and the older adult population has increased in recent years, largely due to the COVID-19 pandemic's disproportionate impact on older adults.² S/THOs are well positioned to champion and support population-level actions that provide all people with the opportunity to age healthily and achieve equitable health and social outcomes through older adulthood. The 5 approaches in this ASTHO technical package highlight actionable and evidence-informed strategies that health agencies can implement in collaboration with partners to promote healthy aging and older adult health in their jurisdictions.