Seniors Aging In position Turn To Devices And Helpers, But Unmet Needs Are typical


About 25 million Americans who are aging in place rely on help from other people and devices for example canes, raised toilets or shower seats to do essential day to day activities, based on a new study documenting how seniors adapt to their changing physical abilities.

But a considerable number do not get adequate assistance. Nearly 60 percent of seniors with seriously compromised mobility reported staying in their homes or apartments instead of getting out of the house. Twenty-five percent said they often remained in bed. Of older adults who had significant difficulty putting on a shirt or pulling on undergarments or pants, 20 % went without getting dressed. Of those that required help with toileting issues, 27.9 % had any sort of accident or soiled themselves.

The study, by researchers from Johns Hopkins University, focuses on how seniors react to changes in physical function – a little-studied and poorly understood topic. It implies that about one-third of older adults who live in the city – nearly 13 million seniors – have a substantial requirement for help with day to day activities for example bathing, eating, getting dressed, while using toilet, transferring in and out of bed or moving around their houses; about one-third have relatively few needs; and another third get along well by themselves without any notable difficulty.

For older adults as well as their families, the report is really a reminder of the have to plan in advance for changing capacities.

“The reality is that many people, as we age, will need help at one point or another,” said Dr. Bruce Chernof, president of the SCAN Foundation and chair from the 2021 federal Commission on Long-Term Care. Citing Medicare's failure to pay for so-called long-term services and supports, that really help seniors age in position, he said, “We have to lean in much harder if we want to help seniors thrive at home so long as possible.” (KHN's coverage of getting older and long-term care issues is supported partly through the SCAN Foundation.)

Previous reports have examined the need for paid or unpaid assist in the older population and the extent that those needs go unmet. Notably, in 2021, the same number of Johns Hopkins researchers found that 42 percent of seniors with probable dementia or difficulty performing day to day activities didn't get assistance from family, friends or paid caregivers – an eye-opening figure. Of seniors with a minimum of three chronic conditions and needs, 21 percent lacked any type of assistance.

But personal care isn't all that's required to help older adults stay at home when strength, flexibility, muscle coordination and other physical functions begin to deteriorate. Devices and residential modifications can also help people adjust.

Until this new study, it hasn't been clear how often older adults use “assistive devices”: canes, walkers, wheelchairs and scooters for people with difficulties walking; shower seats, tub seats and grab bars to help with bathing; button hooks, reachers, grabbers and engineered clothes for those who have difficulty dressing; special utensils made to make eating easier; and raised toilets or toilet seats, portable commodes and disposable pads or undergarments for people with toileting issues.

“What we haven't known before may be the extent of adjustments that older adults make to manage daily activities,” said Judith Kasper, a co-author of the study and professor at Johns Hopkins' Bloomberg School of Public Health.

The data develops from a 2021 survey conducted through the National Health insurance and Aging Trends Study, a number one supply of details about functioning and disability among adults 65 and older. A lot more than 7,000 seniors completed surveys within their homes and outcome was extrapolated to 38.8 million older Americans who live in the city. (People who reside in nursing homes, assisted living centers, continuing care retirement communities along with other institutions were excluded.)

Among key findings: Sixty percent of the seniors surveyed used at least one device, most commonly for bathing, toileting and moving around. (20 % used two or more devices and 13 percent also received some kind of personal assistance.) 5 % struggled with daily tasks but did not have help and hadn't made other adjustments yet. One percent received help only.

Needs multiplied as people grew older, with 63 percent of these 85 and older using multiple devices and getting personal assistance, compared with 23 percent of those between ages 65 and 74.

The problem, experts note, is that Medicare doesn't purchase many of these non-medical services, with a few exceptions. As a result, many seniors, particularly those at or near the bottom of the income ladder, go without needed assistance, even when they're enrolled in Medicaid. (Medicaid community-based services for low-income seniors vary by state and often fall short of actual needs.)

The precariousness of their lives is illustrated inside a companion set of financial strain experienced by seniors who require long-term services and supports. Slightly more than 10 % of seniors with high needs experienced a minumum of one type of hardship, such as being unable to pay expenses like hospital bills or prescriptions (5.9 percent), utilities (4.8 percent) or rent (3.4 %), or skipping meals (1.8 percent). (Many people had multiple difficulties, reflected during these numbers.)

These types of adverse events put older adults' health at risk, while adding to avoidable hospitalizations and nursing home placements. Given a growing population of seniors who'll need assistance, “I think there's a requirement for Medicare to rethink how to better support beneficiaries,” said Amber Willink, co-author of both studies as well as an assistant scientist at Johns Hopkins' Bloomberg School of Public Health.

That's begun to happen, using the passage last year of the CHRONIC Care Act, that allows Medicare Advantage intends to offer supplemental benefits such as wheelchair ramps, bathroom grab bars, transportation and personal care to chronically ill members. But it's unclear how robust these benefits is going to be going forward; this year, plans, which cover 21 million people, aren't offering much. Meanwhile, 39 million people signed up for traditional Medicare remain out altogether.

“We've had discussions with the [insurance] industry over the last month or two to explore what's going to happen and it's a big question mark,” said Susan Reinhard, director of AARP Public Policy Institute, which publishes a scorecard on the adequacy of state long-term services and supports with other organizations.

So far, she said, the response appears to be, “Let's wait and find out, and it is this likely to be affordable?”