Alignment Health revealed the results of its fourth annual survey that focuses on the social and environmental hurdles that keep older adults from living healthier, longer lives.
For the second consecutive year, seniors say the lack of support for aging in place is the main barrier to their overall health.
Indeed, aging in place impacts most seniors regardless of geography, income, or education, according to the survey of more than 2,200 Americans ages 65 and older.
While more seniors choose to live independently and longer in their homes, 64 percent indicated in the 2025 Social Threats to Aging Well in America survey that they would use benefits that cover safety rails, personal medical safety alerts, memory exercises, or care and assistance with an end-of-life plan.
The annual report, now in its fourth year, studies the social and environmental factors that affect U.S. senior health and is based on a nationwide survey conducted via an online poll of 2,266 Americans aged 65 and older between April 29 and May 22, 2025. Additional surveys were collected in Arizona, Nevada, and North Carolina to reach a minimum sample size of 100 per state.
The findings can help industry leaders, policymakers, and advocates create solutions for the growing aging population to age well.
“Our annual survey looks beyond the medical diagnosis and provides a full picture of seniors’ state of being, their desires in aging, and what support they need to reach their optimal level of aging as they wish,” said Ken Kim, M.D., chief medical officer at Alignment Health, in the survey announcement. “Where they live, how they get care, and the support systems around them can change their health trajectory—for better or worse. These insights not only shape how we specifically design our benefits, services, and partnerships, but we hope these insights provide direction for others working in senior health.”
This year, the survey distinguishes between transportation and access to medical care as separate challenges, expanding the total to nine social barriers. The vast majority (88 percent) of seniors experience at least one of these barriers, consistent with last year’s results (91 percent). This underscores the widespread nature of social threats to aging well, Alignment Health said.
In addition to aging in place, the other top barriers to senior health include:
Medical care access: From long waits for appointments to lack of telehealth technology, issues with access to medical care affect 60 percent of seniors. More than half (54 percent) of seniors who skipped care cite access issues as the reason. Of those who never skipped medical care, 45 percent fear they might in the future for the same reason.
Economic insecurity: For the second year running, economic insecurity is the third most pressing threat. This year’s survey revealed that 27 percent of respondents say money worries rank among their top three stressors, and 13 percent of seniors say it’s been their top cause of stress or anxiety over the past year.
Loneliness: Nearly 2 in 5 seniors who experience loneliness say it’s harming their health, including, but not limited to, symptoms such as depression, anxiety, decreased physical activity, and sleep disturbances.
Persistent medical debt: Of those who are impacted by economic insecurity, the survey found 44 percent carry medical debt—unchanged from 2024—but the debt burden is growing heavier for seniors. More than 1 in 4 (26 percent) are carrying medical debt so large it equals at least four months of living expenses, an eight-point jump from 2024.
Lack of support and transportation: Support needs rank as the fourth most limiting factor, affecting 34 percent of seniors. As seniors age, they require more hands-on help—from in-home care to simply understanding medical information. Transportation (31 percent) remains another roadblock and ranks fifth in this year’s survey. Without safe, reliable transportation, many seniors are forced to skip doctor visits, leave prescriptions unfilled, and struggle with everyday essentials such as grocery shopping.
Mental health and depression: Mental health concerns rank as the sixth highest social threat, with 1 in 5 seniors (20 percent) sometimes or often feeling depressed. Twenty-two percent feel more depressed now than they did a year ago.