Tackling the Isolation Distressing Puerto Rico’s Elderly

The recent visits of first lady Jill Biden and U.S. Surgeon General Vivek H. Murthy to Puerto Rico have brought attention to the island’s severe loneliness epidemic, especially among its elderly population. This urgent issue requires immediate action and compassionate solutions as Puerto Rico experiences a significant demographic shift towards an older population. The impact of isolation on the physical and mental well-being of seniors has reached a critical point, and the discussions between the first lady and Puerto Rico’s Governor about the island’s most vulnerable population—the elderly—highlight the pressing need to address this crisis directly.

Puerto Rico is facing an unprecedented and concerning demographic transition that will have profound effects on its society if not addressed. The percentage of older adults has risen significantly over the last decade. In 1950, only 3.9 percent of the population in Puerto Rico was over 65 years old. By 2000, this proportion had increased rapidly to 10.8 percent. However, the estimates for 2020 show that Puerto Ricans over 65 make up the 10th highest share in the world—an alarming statistic for the territory. While the overall population has decreased due to economic factors driving young people to leave, the number of individuals over 65 continues to rise due to lower fertility rates and increased life expectancy. This results in more deaths than births, while seniors live longer without sufficient family support networks.

The exodus of 700,000 working-age adults in the past two decades has left behind an isolated, aging population lacking caregivers. This mass migration accelerated after Hurricane Maria in 2017 and worsened during the COVID-19 pandemic, exacerbating existing high unemployment rates. Nearly half of the elderly population had at least one child living outside Puerto Rico before the recent wave of departures. This dispersion of families weakens support systems and leaves many sick and elderly individuals without proper care. A significant portion of Puerto Ricans aged 65 and older, approximately 43.3 percent, live below the poverty line. This demographic often experiences geographic and emotional isolation, primarily due to managing chronic illnesses, which can worsen their health challenges and contribute to overall disparities.

Shortages of medical professionals further compound the situation. The high rate of outmigration includes many healthcare workers leaving Puerto Rico for better opportunities on the U.S. mainland, exacerbating the existing scarcity of medical providers and limiting access to healthcare for the elderly. With increasing medical needs due to isolation and declining health, the loss of doctors is particularly devastating for the elder population. Puerto Rico has lost over one-third of its physicians since recent hurricanes, severely limiting healthcare access and leaving many underserved.

In 2019, Puerto Rico had less than half the number of active doctors per capita compared to the overall U.S. population. Puerto Rican seniors, already typically in poorer health than mainland elderly Americans, struggle to find medical providers, leading to untreated conditions and worsening health outcomes. Approximately 60% of Puerto Ricans receive health services through Medicaid, CHIP, Medicare, or Veterans Affairs, but the lower reimbursement rates and stricter eligibility criteria in Puerto Rico compared to U.S. states drive more providers to leave the island, exacerbating the elder health crisis.

While efforts like the Incentives Law offering a 4% income tax rate aim to retain some medical professionals, more comprehensive solutions are needed to combat loneliness. The governor recently signed a new remote work law for private companies in January, allowing employees more flexibility to work from home. This could enable remote caregiving and companionship for elderly relatives through video calls and online interactions, fostering greater connections between geographically separated families to alleviate isolation.

Establishing multigenerational care centers across communities could provide integrated medical, social, and caregiver support services to isolated elders without nearby family. These centers could address physical and mental health needs, connect seniors with doctors, organize daily activities and social engagement opportunities, and assist with tasks like transportation, food access, and coordinating in-home health aides. Incentivizing doctor retention, maximizing insurance coverage, and creating senior care infrastructure are crucial steps to combat the elder health crisis in Puerto Rico.

With compassion and commitment from governmental leaders and local communities, we can create a society that allows our elders to age with dignity. Puerto Rico’s seniors deserve nothing less, and the time for decisive action is now.

Mariela Torres Cintrón is a Public Voices fellow of The OpEd Project and AcademyHealth and an assistant professor at the University of Puerto Rico, Medical Sciences Campus, School of Public Health.

The views expressed in this article are the writer’s own.