HealthCommentary

Exploring Human Potential

The Class of ’65: Aging in Place.

Posted on | May 29, 2015 | No Comments

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Mike Magee

This weekend, I’ll be joining classmates for a 50th reunion of our high school. A half century ago, 1965, in the epicenter of a turbulent American decade, we graduated together. On the whole, our group has been pretty resilient, facing a range of challenges, including for many of my classmates, Vietnam. From the discussions in the lead-up to the event, it seems the group has aged well.

This reminded me of a quote by Donna Shalala, Commissioner of Health and Human Services at the turn of the 20th Century, who said: “We want life not only to be long, but good. This will be one of the central challenges of the 21st Century: to make dignity and comfort for the elderly as much a part of our national consciousness as education and safety are for our children.”(1)

Since then we have been in a scientific and social service race against the very real challenges of aging demographics. We’ve embraced a two-pronged strategy. The first arm has been prevention and health maintenance, intended to help elders maintain vitality and independence for as long as possible, by aggressively addressing those conditions that lead to disability and institutionalization. The second arm, which is complimentary to the first, has been the creation of new environments which actively manage the changes and disabilities that come with advanced age.

Long-term care is part of the natural fabric of life. It is fundamentally different than acute care in that it integrates health services and supports for daily living. The explosive growth of the long-term care industry simply reflects the numbers, with a projected doubling of the over-65s and tripling of the over-85s in the next 50 years.(2,3). During this period, the number requiring long-term care is projected to grow from under 10 million to 24 million.(4).

Of course, the big question is “independence”. What is it that causes individuals to require this support? The need for long-term care is measured by the limitation in capacity to perform certain basic functions or activities called “activities of daily living,” or ADLs. ADLs include bathing, dressing, getting in and out of bed, eating, toileting, and moving about. There are other activities, called “instrumental activities of daily living,” or IADLs, such as getting out, driving, preparing meals, shopping, maintaining a home, using a phone, managing finances and taking medications, which are critical and require help if absent, though not on the level of absent ADLs.

Early studies showed that 97 percent of nursing home patients had ADL limitations.(4). By age 85, the need for help was not at all unusual. Studies in the past have shown that some 35 percent needed assistance with walking, 31 percent with bathing, 22 percent with getting in and out of bed, 17 percent with dressing, 14 percent with toileting, and 4 percent with eating.

Most of those requiring long-term care prefer to “age in place,” in their own home and community, in familiar settings. And most do just that. They’re able to do that mostly because family and friends lend a hand.

The primary challenge for providing long-term care support for 4th and 5th generation Americans has fallen predominantly on 3rd generation female family members. As Jim Furman, president of the National Council on Aging has noted, “We mistakenly define long-term care problems as medical concerns rather than disability concerns. The care needs of most frail older people are primarily supportive: for example, help them move from here to there, help them eat and dress, and help them keep track of their medicine.”

The race against the aging juggernaut, then, is about science, about independence, and about “aging in place.” Long-term care is rapidly evolving with a primary focus on dignity, personal autonomy, support for caregivers, and personal resilience.

What are the major trends in long-term care? First, less institutionalized care. Nursing homes are being reserved for the most severely impaired. Second, more reliance on home care and community-based alternatives. Day care options, blended services, “assisted living,” and care for the caregiver programs all signal a shift in emphasis that presages a shift in finances. Third, these environments will feature more choices, greater use of supportive new life-assist technologies, a greater emphasis on prevention, and the opportunity for shared learning and community-based strategic planning.

For most of my classmates this weekend, I expect the challenges above will still seem far away. But time flies. A half century has passed in the wink of an eye.

For Health Commentary, I’m Mike Magee

References:

1.Shalala D. The United States Special Committee on Aging. Long Term Care for the 21st Century: A Common Sense Proposal to Support Family Caregivers. Testimony before the United States Special Committee on Aging: March 23, 1999.

2.The Long Term Care Workforce: Can the Crisis Be Fixed? Leading Age. http://www.leadingage.org/uploadedFiles/Content/About/Center_for_Applied_Research/Center_for_Applied_Research_Initiatives/LTC_Workforce_Commission_Report.pdf

3.The Growing Population of Persons Age 65 and Over: 1990 to 2050. Source: Cheeseman J. Population projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050. Current Population Reports. Washington DC: US Department of Commerce, Economics and Statistics Administration, US Bureau of the Census; February 1996. Publication No. P25-1130;12.

4. 1994 Green Book. Overview of Entitlement Programs. Committee on Ways and Means, US House of Representatives. Washington DC; July 15, 1994. [Appendix B: Health Status, Insurance, Expenditures of the Elderly, and Background].

 

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