Older people don’t get enough help, study says

ABOUT 25 million Americans who are ageing in place rely on help from other people and devices such as canes, raised toilets or shower seats to perform essential daily activities, according to a new study documenting how older adults adapt to their changing physical abilities.

But a substantial number don’t get adequate assistance. Nearly 60 per cent of seniors with seriously compromised mobility reported staying inside their homes or apartments instead of getting out of the house. Twenty-five per cent said they often remained in bed. Of older adults who had significant difficulty putting on a shirt or pulling on undergarments or pants, 20 per cent went without getting dressed. Of those who required assistance with toileting issues, 27.9 per cent had an accident or soiled themselves.

The study, by researchers from Johns Hopkins University, focusses on how older adults respond to changes in physical function – a little-studied and poorly understood topic. It shows that about one-third of older adults who live in the community – nearly 13 million seniors – have a substantial need for assistance with daily activities such as bathing, eating, getting dressed, using the toilet, transferring in and out of bed or moving around their homes; about one-third have relatively few needs; and another third get along well on their own with no notable difficulty.

For older adults and their families, the report is a reminder of the need to plan ahead for changing capacities.

“The reality is that most of us, as we age, will require help at one point or another,” said Bruce Chernof, president of the Scan Foundation and chair of the 2013 federal Commission on Long-Term Care. Citing Medicare’s failure to cover long-term services and supports, which help seniors age in place, he said, “We need to lean in much harder if we want to help seniors thrive at home as long as possible.”

Previous reports have examined the need for paid or unpaid help in the older population and the extent to which those needs go unmet.

Notably, in 2017, some Johns Hopkins researchers found that 42 per cent of older adults with probable dementia or difficulty performing daily activities didn’t get assistance from family, friends or paid caregivers – an eye-opening figure. Of seniors with at least three chronic conditions and high needs, 21 per cent lacked any kind of assistance.

But personal care isn’t all that’s needed to help older adults remain at home when strength, flexibility, muscle coordination and other physical functions begin to deteriorate. Devices and home 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 specially designed clothes for people who have difficulty dressing; special utensils designed to make eating easier; and raised toilets or toilet seats, portable commodes and disposable pads or undergarments for individuals with toileting issues.

“What we haven’t known before is 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 comes from a 2015 survey conducted by the National Health and Aging Trends Study, a leading source of information about functioning and disability among adults 65 and older. More than 7,000 seniors filled out surveys in their homes and results were extrapolated to 38.8 million older Americans who live in the community. (Those who live in nursing homes, assisted-living centres, continuing care retirement communities and other institutions were excluded.)

Among key findings: 60 per cent of the seniors surveyed used at least one device, most commonly for bathing, toileting and moving around. (20 per cent used two or more devices and 13 per cent also received some kind of personal assistance.)

Five per cent had difficulty with daily tasks but didn’t have help and hadn’t made other adjustments yet. One percent received help only.

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

The problem, experts note, is that Medicare doesn’t pay for most of these non-medical services, with some exceptions.

As a result, many seniors, especially 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 in a companion report on financial strain experienced by older adults who require long-term services and supports. Slightly more than 10 per cent of seniors with high needs experienced at least one type of hardship, such as being unable to pay expenses like medical bills or prescriptions (5.9 per cent), utilities (4.8 per cent) or rent (3.4 per cent), or skipping meals (1.8 per cent). (Some people had multiple difficulties, reflected in these numbers.) – The Washington Post