Tag Archives for Geriatricians

National survey says care for older adults needs urgent rethinking 

Published in RINewsToday on January 27, 2025

With President Trump’s administration beginning and a new Congress poised to rethink, among other issues, Social Security, Medicare and federal aging programs and services, it might be prudent for the president and lawmakers to take a quick glance at the findings of a recently released national survey, “Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads.”

This 52-page national report, was released on Sept. 17, 2024 by Emeryville, California-based Age Wave, a think tank that studies the social, financial, healthcare, and business impacts of aging and The John A. Hartford Foundation (JAHF), a New York based-foundation dedicated to improving care of older adults. The survey was conducted by The Harris Poll, a marking and analytic company tracking public opinion in existence for over sixty years ago.  

According to the U.S. Census Bureau, America’s population of adults over 65 is expected to skyrocket, from 56.1 million in 2020 to 82.1 million by 2050. The enormous  increase in the number of older adults is forcing states, Congress, and the private sector to rethink their approaches to health care, social services, housing and more, to help older adults live well as they age.

As millions of Baby Boomers (born 1946 to 1964) age, living longer than previous generations and seeking ways to maintain wellness and independence to age in place, this nationwide survey shows deep dissatisfaction among older Americans aged 65 and over with health care and services they receive that do not meet their specific needs and preferences. 

Finding Policy Solutions to Maximize “Golden Years”

The national survey reported that four in five older adults (82%) say the U.S. health care system is not prepared for the growing and changing needs of America’s aging population. Just one in 10 (11%) give the health care system an ‘A’ grade. Instead of the status quo, older adults say they want solutions that will maximize their golden years, like interventions that make care more affordable, innovations to reduce or prevent cognitive decline and health care providers who understand what matters most to them when assessing care options.

“Older adults are stuck in a health care system that is not responsive to their goals and preferences. Boomers want health care that maximizes their health and ability to function, and they want their providers to listen to them,” said Terry Fulmer, JAHF’s president, in a Sept. 17 statement announcing the release of the report. “It is not too late to pivot to age-friendly care, which prioritizes the needs and desires of older adults in their care plan. There are many innovative approaches to help older adults live every year to its fullest, not just increase the number of years they live,” she says.

International longevity and aging expert, Ken Dychtwald, founder and CEO of Age Wave, added: “The United States is on the brink of an age wave of unprecedented proportions, and American health care requires a radical and immediate rethink to match our health spans, or being able to live every year to its fullest, to our lifespans.”

Dychtward urged policy and business leaders to prepare for older adults making up a large and growing percentage of the U.S. population. “Everyone knows this day has been coming, but our survey shows that older adults do not like the choices or care currently offered to them. And the fact that although we spend more per capita on health care than any country in the world yet have worse lifespans and health spans is cause for alarm,” he said.

The age 65 and over survey respondents called for America’s health care system to offer “age-friendly care.” Most older adults (94%) say it is more important to maintain quality of life than it is to live as long as possible.

Only three in five older adults with a health care provider (58%) report that their providers currently ask about what matters to them. Though older adults fear Alzheimer’s and dementia more than any other health condition, for example, less than half (40%) say their health care providers routinely evaluate their cognitive health and brain functioning. Similarly, less than half of older adults (45%) say their health care providers evaluate their mental health, and although the ability to walk freely without pain is top of mind for older adults, just 55% say their medical care providers evaluate their mobility and physical fitness. 

The national survey findings indicated that the older respondents say that there are not enough qualified care providers. Nearly all older adults (94%) say that health care providers should be trained on the unique health issues of people 65 or older, but only 10% of medical schools require a rotation in geriatric care, compared to 96% that require a rotation in pediatric care. 

Between 2000 and 2022, the U.S. population of adults aged 65 and older rose 60%, but the number of geriatricians dropped by a whopping 28%. says the report. 

Not surprisingly, the survey findings indicate that health care costs are viewed as “unaffordable” and of a bigger concern to older adults than living expenses, inflation, tax increases and an economic downturn or recession. For instance, just 16% give an ‘A’ grade to satisfaction with their out-of-pocket costs. Older adults are especially concerned with the cost of long-term care, stressing that one of their greatest concerns is not being able to afford future health and long-term care needs (68%), and that the government should prioritize having Medicare cover long-term care (80%).

Differing Views of the Quality of Nursing Home Care

An estimated 36 million Americans have a family member or friend living in a nursing home or memory care facility today, according to the survey. Just 37% of those adults ages 18+ say their family member or friend living in a nursing home or memory care facility receives high-quality care. Only half (50%) say these facilities are the safest place for them.

There must be more coordination between primary care providers and other health care providers. While 52% of Medicare beneficiaries see more than three physicians per year, half of older adults from the survey say their primary care provider does not coordinate their treatment with their other health care providers. The report notes that this may be attributed to the increasing shortage of primary care providers, which makes it less likely for people to have a usual source of primary care or long-term relationship with a primary care provider.

As noted in Primary Care in Rhode Island, in 2024, from 200,000 to 400,000 Rhode Islanders lack access to a primary care provider, resulting in a shortage of 133 to 266 primary care physicians to treat them.

Finally, more than half of older adults (56%) say it is challenging and very stressful to navigate the current health care system, while nearly two in three (62%) say health insurance plans provide too many confusing choices. Research has shown that more than half (55%) mistakenly believe Medicare will cover a long-term stay in a nursing home, the report added.

As the new Congress begins its debate on aging policy, regardless of political party, the national survey reports that their older constituents want public policies enacted that support quality care.  The survey findings indicate that adding long-term care to what Medicare covers is supported by most Republicans (76%), Democrats (84%) and independents or people with other political affiliations (79%). Additionally, there is bipartisan support for improving quality at U.S. nursing homes also earns bipartisan support (Republicans 62% support, Democrats 68% support, independents or people with other political affiliations 65% support). 

“Better federal and state policies can encourage the development of age-friendly health systems, that focus on improving patients’ well-being and quality of life,” predicts JAHF’s Fulmer. “Policies could include new options for affording long-term care insurance and developing a federal strategy to ensure disadvantaged populations are prioritized in a national strategy for age-friendly care,” she says.

Report Offers 5 Key Suggestions to Improve Care to older Americans 

After reviewing all survey findings, JAHF identified five key recommendations to improve health care provided to older adults and to promote healthier, happier aging.

JAHF calls for promoting age-friendly care that can assist the nation’s older adults maintain their health, ability to function, thus maintaining their independence in the community. Pursuing scientific breakthroughs could bring the end to diseases like Alzheimer’s adds JAHF, calling for social isolation must be addressed. 

Assist family caregivers with skill-building tools, policies that allow flexibility in taking paid leave and ensuring care providers coordinate among multiple providers the health care system easier to navigate. 

Finally, JAHF calls for the creation of a ‘national master plan for aging’ that will be focused on meeting the needs of older adults. This plan would identify and address barriers that contribute to inequities, also creating a strategic plan that would provide a roadmap to reform the financing of long-term care, enhance the quality of nursing home care and to create systems to assist people to age in place at home rather than being admitted to acute and congregate settings. 

“We are at a unique crossroads. However, changing America’s health care system to meet older adults’ expectations is possible, practical and could lead to greater health at a far lower cost—and can benefit the government, private enterprise and consumers,” said Dychtwald. “Older adults deserve health care partners who understand what they are going through, have the skills to most effectively support their patients and act on what their customers want,” he says.

The Nuts and Bolts Behind the Study 

The study was conducted by Age Wave on behalf of The John A. Hartford Foundation and in partnership with The Harris Poll. After thorough review of secondary research and through qualitative research with older adults through online focus groups, a  nationally representative online survey was conducted from April 17 to May 9, 2024. Of 5,023 adult (age 18+) respondents, 2,516 were age 65 and older. Data were weighted where necessary to align them with their actual proportions in the population, including by age, gender, race/ethnicity, region, education, household income, size of household, marital status, and political party affiliation. 

Note:  The full report, Meeting the Growing . for Age-Friendly Care: Health Care at the Crossroads, can be found at https://www.johnahartford.org/images/uploads/resources/The_Growing_Demand_for_Age-Friendly_Care_Report_FINAL.pdf.

To watch the “Webinar: What Older Adults Want: Emerging Breakthroughs & Opportunities for Age-Friendly Care, go to https://www.youtube.com/watch?v=ZK6D4-G3KPw.

A close look on “Facts and Figures” about Alzheimer’s

Published in RINewsToday on April 3, 2023

For over five years, Janet Bryant, 65, has been a caregiver for her 67-year-old husband, Paul, who suffers from Alzheimer’s disease. Their daughter, Alison, and husband Ryan, living in the condo above her parents, step in to assist with caregiver duties when needed. 

“It’s often a long day when you’re caring for someone with dementia,” says Janet, who handles all financial, medical and household tasks. Even when Paul helps out with a few tasks he must be closely supervised, she says. And you must be watchful. “A few weeks ago, Paul was trying to make a cup of tea, and put the metal tea kettle in the microwave, causing the handle to burst into flames. I disabled the microwave and now I make him his tea. His wife of 47 years says he can’t be left alone, and gets lost in their small condo. 

Janet acknowledges that the long day often continues into night, as Paul has trouble finding the bathroom or tries to roam around. 

Janet’s experiences as a caregiver taking care of a loved one with Alzheimer’s disease is not uncommon. The newly released Alzheimer’s Disease Facts and Figures reports that 6.7 million people aged 65 and over, like Paul, are living with Alzheimer’s or other dementias in the United States — it’s one of the costliest conditions to society and is projected to reach $345 billion, a $24 billion increase from a year ago. By 2050 these costs could rise to nearly $1 trillion.

In 2022, like Janet, more than 11 million caregivers provided unpaid care for people with Alzheimer’s or other dementias, providing an estimated 18 billion hours of unpaid assistance — a contribution valued at $339.5 billion, noted Facts and Figures.

Taking a look at Facts and Figures

The Alzheimer’s Association’s 2023 Facts and Figures report (the first released in 2007) provides an in-depth look at the latest national and state-by-state statistics on Alzheimer’s disease prevalence, mortality, caregiving, dementia care workforce and costs of care. 

Alzheimer’s disease is not a normal part of aging; it’s a devastating cognitive disorder that will be the number 1 killer by 2050. This year’s Fact and Figures findings indicate that 1 in 3 seniors dies with Alzheimer’s or another dementia. This devastating disorder also kills more than breast cancer and prostate cancer, combined. Between 2000 and 2019, deaths from heart disease have decreased by 7.3% while deaths from Alzheimer’s disease have increased by 145%.  

Researchers found that while only 4 in 10 Americans talk to their physician right away when experiencing early memory or cognitive loss, 7 in 10 would want to know if they have Alzheimer’s disease if it could allow for earlier medical treatment. 

This year’s report also examines the capacity of the medical specialty workforce essential for diagnosis, treatment and ongoing care for people living with Alzheimer’s and all other types of dementia. The shortage of dementia care specialists could soon become a crisis for Alzheimer’s disease care, warn the researchers, especially with the recent FDA accelerated approval of new treatments targeting the underlying biology of Alzheimer’s disease, which is reframing the health care landscape for people with early-stage Alzheimer’s or MCI due to Alzheimer’s disease.

Caring for those living with Alzheimer’s or other dementias poses special challenges, the report noted. As dementia symptoms worsen, caregivers can experience increased emotional stress (59%), depression, anxiety, chronic stress, and new or exacerbated health problems. Additionally, caregivers often experience depleted income and finances due to disruptions in employment, and paying for health care or other services for both themselves and those with dementia.

While recent advancements in treatment of early-stage Alzheimer’s, including mild cognitive impairment (MCI) due to Alzheimer’s disease, are providing hope to millions living with memory loss and early cognitive decline, the latest Fact and Figures finds too often individuals with memory concerns, and their doctors, are not discussing the issue, missing a critical first step toward diagnosis and potential treatment.

“Providing the best possible care for Alzheimer’s disease requires conversations about memory at the earliest point of concern and a knowledgeable, accessible care team that includes physician specialists to diagnose, monitor disease progression, and treat when appropriate,” said Maria C. Carrillo, Ph.D., chief science officer of the Alzheimer’s Association, in a statement announcing the release of the 128-page report.

“For the first time in nearly two decades, there is a class of treatments emerging to treat early-stage Alzheimer’s disease. It’s more important than ever for individuals to act quickly if they have memory concerns or experience symptoms.”

An accompanying special report, The Patient Journey in an Era of New Treatments, offers new insights from patients and primary care physicians (PCPs) on current barriers that impede earlier discussion of cognitive concerns. Focus groups reveal many people with subjective cognitive decline (self-reported memory concerns) do not discuss cognitive symptoms with their health care providers. Previous special reports have indicated many people believe their experiences are related to normal aging, rather than a potential diagnosable medical condition.

Taking a close look at Rhode Island

The number of people aged 65 and over with Alzheimer’s and other dementia continues to increase in Rhode Island, from 24,000 in 2020, and expected to climb to 27,000 by 2025.  That’s an estimated 12.5% increase.  Fifty-two percent of Rhode Island caregivers report having one chronic condition, 41% say they are depressed and 11% rate their health as poor. 

Currently there are 36,000 unpaid caregivers in the Ocean State providing about 51 million total hours of uncompensated care (valued at over $1.29 million).  

The cost of health care continues to skyrocket to care for those with Alzheimer’s and other dementias.  The state’s Medicaid program spends over $470 million, with the projected cost to increase by 20.1% by 2025. 

Two years ago, there were 33 practicing Geriatricians in Rhode Island. By 2050, a 48.5% increase of this medical specialty will be needed to meet the patient care demands. Three years ago, there were 7,410 Health and Personal Care Aides providing care. By 2030, an increase of direct care workers by 27.5% will be needed to provide personal care. 

Implications for Rhode Island lawmakers, state officials

Donna McGowan Executive Director of the RI Chapter of the Alzheimer’s Association expects the release of the latest Alzheimer’s Disease Facts and Figures to educate state policy makers about the impact of Alzheimer’s on their own communities and districts, specifically the number of Rhode Islanders living with Alzheimer’s or related dementia, and the number of caregivers who provide for them. 

“Further, along with personal discussions, the report will help them to understand the reality that many of their constituents are hesitant to seek a medical diagnosis, or even support it. And the report will highlight for policy makers the crisis that is the shortage of workers in the Alzheimer’s and related dementia professional caregiving field,” notes McGowan.

As the 2023 Alzheimer’s Disease Facts and Figures indicates, a growing number of caregivers have approached the Rhode Island chapter to access programs and services, says McGowan. Last fiscal year, approximately 4,600 individuals contacted the Rhode Island chapter to access programs and services which equated to an “8% overall increase over the previous fiscal year,” she said.  

According to McGowan, this year they are tracking approximately a 16% increase in individuals contacting their helpline, totaling approximately 5,336 individuals accessing programs and services. 

“With the report showing we may not have sufficient specialist capacity to deal with the projected increase in Rhode Islanders with ADRD, there is a critical need to provide Rhode Island primary care practices with the training needed to care for persons with dementia and their caregivers,” says Maureen Maigret, Policy Advisor for Senior Agenda Coalition of RI (SACRI), who also serves on the state’s Advisory Council on Alzheimer’s Disease and Care and a member of The Care Transformation Collaborative (CTC).  Fortunately, the CTC, in partnership with the Rhode Island Department of Health, is offering such training now through the state’s Geriatric Education Center. 

“And with a projected need for close to a 30% increase in home health aides and personal care attendants, the workforce shortage will worsen dramatically if we fail to increase direct care staff wages and expand training staff to care for persons with ADRD,” warns Maigret, noting that this is why SACRI is advocating for funding to increase direct care staff wages to a minimum of $20 an hour. 

“As the prevalence of people living with dementia continues to increase in Rhode Island, the health system and long-term care continuum will be challenged by the findings highlighted in this report,” says Nancy Sutton, MS, RD, the Rhode Island Health Department’s (RIDOH) Chief, Center for Chronic Care and Disease Management. “RIDOH, the Rhode Island Alzheimer’s Disease and Related Disorders Advisory Council, and our many partners are committed to continuing efforts to educate the public on the importance of speaking to a healthcare provider about memory concerns, she said.

Sutton says, “with the support of federal funding, resources such as a Brain Health Toolkit are being developed to support health system partners in their engagement in conversation with patients and caregivers about the importance of early detection and navigating complex systems of care and community resources to support people living with dementia.”

“We know that age is a big risk factor for Alzheimer’s Disease and Related types of Dementia (ADRD),” said the RI Office of Healthy Aging (OHA) Director Maria Cimini. “As Rhode Islanders age if they or their caregivers are concerned about memory loss, we encourage them to talk to their physicians and get connected to resources through the Point, 401-462-4444 or through myoptionsri.gov to help navigate this journey.” 

At OHA, we have worked to build comfort and capacity among physicians through a recent Alzheimer’s Disease Programs Initiative (ADPI) grant with the focus of expanding the Dementia-Capable Home and Community Based Services which include outreach and education of primary care/direct service providers in identification, diagnosis, referral, and care planning process for ADRD and to provide services supportive of individuals living with dementia and their family caregivers within the statewide Aging and Disability Resource Center. OHA and its partners developed a provider resource tool to assist providers with referring patients with cognitive symptoms and family caregivers to services; and it also provides guidance to providers in conducting care planning, and billing for dementia-related services. That resource can be found here: https://oha.ri.gov/resources/oha-resource-center.

For a copy of the 2023 Alzheimer’s Disease Fact and Figures, go to: https://www.alz.org/alzheimers-dementia/facts-figures.

For a copy of the accompanying special report, The Patient Journey in an Era of New Treatments, to https://www.alz.org/media/Documents/alzheimers-facts-and-figures-special-report.pdf.

The Alzheimer’s Association’s  24/7 Helpline clinicians guide callers to financial assistance programs that may help pay for respite or a needed break. Caregivers will also find programs and services offered by this organization, too. For details, go to https://www.alz.org/ri.