The care needs of 3 million older adults in the U.S. that require help with three or more activities of daily living are not being met and may lead to adverse consequences, according to a new report in the Millbank Quarterly. A detailed analysis finds that a disproportionate share of older people who require substantial assistance are poor, minorities or widowed. Additionally, nearly half of older adults, or about 18 million people, need help with or had trouble carrying out at least one ADL in the month prior to analysis.
Researchers examined a representative sample from the 2011 National Health and Aging Trends Study (NHATS). Of those requiring assistance in non-nursing home settings, one in five — about 6.6 million seniors — received help with the most basic self-care or mobility activities. This includes a wide range of assistance from family or paid caregivers such as bathing, dressing, eating, getting rides to medical appointments, or help with walking.
This figure is “substantially larger” than prior estimates, of 7 percent to 9 percent of older adults in the mid-2000s, researchers said. Changes in several measurements within the survey may account for some of the discrepancy, but the need is real, given the wave of baby boomers aging into the senior cohort.
Researchers looked at data for about 8,000 Medicare enrollees living in community, residential care or other non-nursing home settings. They looked at activities of daily living and instrumental activities of daily living, and interviewed participants or their proxies. Questions included whether someone else had helped carry out an activity with them or for them, whether they could perform an activity alone, and if so, how much difficulty there was in doing so. Limitations were ranked by assistance needed, potential and actual care networks such as family, friends or paid caregivers, supportive care environments, adverse consequences associated with unmet needs such as falls, inability to leave home, inability to dress, bathe or eat, and demographic characteristics.
Overall, researchers found:
- Out of the 18 million older adults with some late-life disability, 19.6 percent had difficulty and 28.7 percent received help from another person with self-care, mobility or household activities.
- Another 11.5 million adjusted for their limitations through assistive devices or reducing activity frequency.
- About 20 percent of those under age 85 and more than 75 percent of those age 90 or older received some type of additional help
- Women and widows made up a disproportionate share of those needing assistance, which is not unusual since women tend to outlive men. African-Americans and Hispanics were overrepresented in self-care and mobility assistance categories.
- Those in the lowest-income quartile had significantly higher needs across all levels of assistance, especially those requiring help with three or more ADLs or IADLs.
- Family caregivers continue to provide most of the assistance to older adults, particularly for those in lower income brackets.
- Fifteen percent of older adults reported adverse consequences related to unmet needs in the month before the analysis. Minorities, widows, or never-married, and those with the lowest income reported the greatest number of adverse consequences.
- For those living at home or supportive care environments, 32 percent reported at least one adverse consequence in the previous month.
This, say the authors, strongly indicates unmet need. Those receiving paid care and those with low incomes had especially high levels of unmet needs.
While some of these findings reiterate conclusions similar to the Federal Commission on Long Term Care and other organizations, they again reinforce the urgency of addressing formal and informal care networks, the risks associated with unmet care needs, as well as the need for substantive federal and state long term services and supports policies.
Reporters can use this latest report to take a look at long term care supports in their communities. Who is getting help? Who isn’t? What type of help — family caregiving, paid care, state, county, or federal programs? Are those who need the most help and care receiving appropriate services? What are the similarities or differences to the socioeconomics found in this analysis?