Association Between Loneliness, Stress, and Access to Healthcare in Older Adults: The Mediating Role of Social Determinants of Health

Loneliness and stress are increasingly prevalent among aged 65 years and older and have been linked to poor health outcomes and limited access to care. These psychological factors often intersect with social determinants of health (SDH), yet little is known about how SDH mediate their effects on healthcare utilization. This study used 2023 Behavioral Risk Factor Surveillance System (BRFSS) data to examine the relationships between loneliness, stress, and healthcare access among U.S. adults aged 65 and older (N = 62,878). Key outcomes included having a personal healthcare provider and attending a routine checkup. Ten SDH indicators, including income, education, emotional support, and transportation stability, were examined as mediators using logistic regression and path analysis. Older adults without loneliness or stress were significantly more likely to report better healthcare access. However, higher income, education, and lack of food assistance exhibited suppressor effects, weakening the positive relationship between emotional well-being and provider access. In contrast, transportation stability enhanced this association. Emotional support and life satisfaction fully mediated the relationship between loneliness, stress, and routine checkups. These findings highlight the complex role of SDH in healthcare access, suggesting that both emotional and structural supports are needed to reduce disparities among aging populations.