When asked what the top social barriers to accessing healthcare are, seniors put economic instability at the top of the list, a new survey found. Food insecurity came in second and lack of support and transportation access tied for third.

The report was published Thursday by Alignment Health, a Medicare Advantage company. The online survey was conducted between June 28 and July 10 and included responses from 2,601 U.S. seniors.

In the next year, nearly 42% of respondents said they anticipate not having enough money for medical expenses, about 19% said they expect not having enough healthy food to eat, 18% said they won’t have someone to help them and 18% said they anticipate having no reliable rides to medical care.

“It’s no surprise to see food insecurity and transportation access among seniors’ top concerns, given record inflation at the grocery checkout line, gas pumps and vehicle repair shops, as well as in the housing sector and elsewhere. Many people must choose between a roof over their head and a car to drive, food or medical care,” said Dr. Adam Wolk, regional chief medical officer of Alignment Health, in a news release.

Another 26% cited mental health concerns and 19% cited not wanting to leave home as barriers to care in the next year, but Alignment Health did not include these in its ranking.

“While survey respondents frequently cited mental health concerns and not wanting to leave home as obstacles to their health, the U.S. Department of Health and Human Services defines social determinants of health as the environmental conditions that affect an individual’s health and well-being,” the report stated. “Therefore, we did not include these two factors in our official rankings of the top ‘social’ threats to aging well in America.”

The top barriers listed in this year’s survey are slightly different from last year’s, which found that economic instability, loneliness and food insecurity were the top three barriers to care for seniors.

Alignment Health also found that one in five seniors reported skipping medical care, mostly because of financial troubles and a lack of transportation. In addition, one in five seniors said they are more depressed now than they were a year ago.

Additional findings from the report include:

• One in nine seniors aren’t able to cover medical bills in the next year and 14% have medical debt. Half of the seniors with medical debt have debt that is the same amount as at least one month of living expenses. About a quarter of respondents said paying for living expenses is a leading cause of depression and anxiety.
• More than one in 11 seniors said struggling to eat healthy leads to depression and anxiety. About 55% of respondents said help with paying for groceries is a benefit they would be most likely to use if their health plan offered it.
• About 11% of those who skipped medical care in the last year cited a lack of support as the reason. About one in five said they would use non-medical companionship if their health plan offered it.
• About 44% of seniors said they’d use fuel assistance for medical appointments if their health plan provided it.
• A third of seniors say they often go two or more weeks without spending time with other people. One in five respondents said loneliness has caused depression or anxiety.

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