Help people age in place. Most older adults want to age in place, but many need assistance over time, surveys show. Will they be able to climb the stairs? Cook for themselves? Do the laundry? Take a shower?
Simple solutions can help, including relatively inexpensive home renovations (installing handrails on staircases, grab bars in bathrooms and better lighting, for example) and assistive devices such as raised toilet seats, shower stools or scooters. But Medicare doesn’t pay for renovations or certain helpful devices.
Covinsky of UCSF would make a program known as CAPABLE (Community Aging In Place — Advancing Better Living for Elders) a Medicare benefit, available to all 61 million members. That program combines at-home visits from an occupational therapist and a registered nurse, usually conducted over 10 weeks, with up to $1,300 in services from a handyman.
Evidence shows it has a significant positive impact, helping seniors perform daily activities and stay out of nursing homes. The total cost: $3,000 per person. “For less than one infusion of aducanumab, you can greatly improve someone’s quality of life and well-being,” Covinsky said.
Find out what older adults need. Sarah Szanton, director of the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing, developed CAPABLE. She would use $56 billion to assess every older adult annually to “figure out what they need to be able to live comfortably and independently. From that, I would generate a list of tailored interventions” — specific action items that might include CAPABLE or other programs, she told me.
Initiatives that could use extra funding might focus on managing depression, preventing falls or structuring activities for people with dementia, Szanton said.
Focus on prevention. A growing body of evidence suggests that dementia could be prevented — perhaps up to 40% of the time — if people didn’t drink excessive amounts of alcohol, controlled blood pressure and obesity, managed depression, used hearing aids, stopped smoking, and regularly engaged in exercise, social interactions and cognitively stimulating activities, among other strategies.
“If I had $56 billion to spend, I’d focus on prevention,” said Laura Gitlin, a dementia expert and dean of Drexel University’s College of Nursing and Health Professions.
“There is more evidence for these strategies than there is for Aduhelm at the moment,” said Dr. David Reuben, chief of UCLA’s geriatrics department and director of its Alzheimer’s and dementia care program.
Invest in social determinants of health. The health of older adults is shaped by the environments in which they live, their interactions with other people and how easy it is to fulfill basic needs.
Recognizing this, Dr. Anthony Joseph Viera, a professor of family medicine and community health at Duke University School of Medicine, said he would invest in “transportation for the elderly. Safe housing. Food. Programs that reduce social isolation. Those would end up helping a lot more people.”
Subscribe to KHN's free Morning Briefing.
Pages: 1 · 2
More Articles
- National Institutes of Health: Common Misconceptions About Vitamins and Minerals
- A Yale Medicine Doctor Explains How Naloxone, a Medication That Reverses an Opioid Overdose, Works
- Kaiser Health News Research Roundup: Pan-Coronavirus Vaccine; Long Covid; Supplemental Vitamin D; Cell Movement
- How They Did It: Tampa Bay Times Reporters Expose High Airborne Lead Levels at Florida Recycling Factory
- Indoor and Vertical Farming May Be Part of the Solution to Rising Demands for Food and Limited Natural Resources
- A Scout Report Selection: Science-Based Medicine
- Journalist's Resource: Religious Exemptions and Required Vaccines; Examining the Research
- Government of Canada Renews Investment in Largest Canadian Study on Aging
- Kaiser Family Foundation: FDA’s Approval of Biogen’s New Alzheimer’s Drug Has Huge Cost Implications for Medicare and Beneficiaries
- Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic