KEY POINTS• Nearly half of Americans age 65 and older require help with routine daily activities such as bathing, meals or taking medications.• Substantial numbers of older adults living outside of nursing homes experience adverse consequences from unmet care needs.• There is a growing need for improved community-based services and support for older Americans and their caregivers.
Newswise — Nearly half of Americans age 65 and older, totaling about 18 million people, require help with routine daily activities like bathing, handling medications or cooking hot meals. A new study in Milbank Quarterly reveals a growing need for improved services and support for older Americans, their spouses, their children and other "informal caregivers."
While 51 percent of older Americans in the study reported no difficulty with routine tasks, "29 percent reported receiving help with taking care of themselves or getting around in the previous month," said co-author Vicki A. Freedman, Ph.D., a research professor with the Institute for Social Research at the University of Michigan. "Another 20 percent reported that they had difficulty carrying out these activities on their own."
The researchers examined 2011 data from the National Health and Aging Trends Study gathered during two-hour, in-person interviews with more than 7,500 Medicare recipients or a proxy, as well as information provided by staff members about nearly 500 nursing home residents.
For older adults who received help in a private home or in settings like assisted living, the average number of hours of care was 200 per month. Informal caregivers, mainly spouses and children, provided most of that help. About three in ten older adults who received assistance supplemented this informal care with paid help.
"About one in three people who reported help or difficulty with daily activities also reported having at least one adverse consequence related to having an unmet need for help in the month prior to the interview," noted co-author Brenda C. Spillman, Ph.D., a senior fellow with the Urban Institute's Health Policy Center. Adverse consequences included staying in bed, being unable to leave the house, not eating and misusing medications.
Models that effectively coordinate health and supportive services will become even more important as a rising number of older Americans with disabilities receive care in settings other than nursing homes. Spillman added, "The dominant role of informal caregivers, including their part in health care and navigating the health care system, highlights the value of current efforts to improve supports for them."
Jennifer Wolff, Ph.D., an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, stressed that the findings offer policymakers a "more comprehensive, nuanced profile" of how disabilities affect older people. The study illuminates how older adults perform daily activities, she said, and the ways in which they compensate for changing abilities with assistive devices, paid and unpaid help, and supportive services such as residential care.
Wolff observed that the large, rigorous, national survey analyzed for this study was a "unique data source," which provided a more detailed profile of the needs of U.S. seniors. The results, she said, "set the stage for a more comprehensive understanding of the potential implications of late-life disability for individuals and for society."
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Disability and Care Needs Among Older Americans. Vicki A. Freedman and Brenda C. Spillman. Milbank Quarterly DOI: 10.1111/1468-0009.12076
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