Older adults are deeply dissatisfied with health care, report says

Older adults are disappointed with how health care and services are provided and want people 65 and older to rethink how the health care system addresses their needs and preferences, according to a recent report.

The study, released on September 17 by Age Wave and The John A. Hartford Foundation, and conducted by The Harris Poll, found that a majority of respondents think the U.S. is still unprepared for the changing needs of the aging population, including age-friendly health care, social services, housing, transportation, affordability and improving quality of life. (The John A. Hartford Foundation supports AHCJ's aging beat but had no input into this story).

Why this matters

Millions of Baby Boomers are now in their 60s and 70s, and are living longer than previous generations. The 65-plus population is expected to jump from 56 million to about 82 million by 2040, and will comprise about 23% of the U.S. population. Journalists can use this report to hold policymakers and stakeholders accountable when it comes to improving care, promoting healthier aging, and lowering cost of care.

Older adults consistently said that healthy aging means being able to do what they want - highlighting function over freedom from disease. That means care should focus on what matters to them, whether that's the ability to have lunch with friends, be free from pain, or do the crossword puzzle each day. The health system should keep out-of-pocket and prescription costs affordable, improve access to care, train more providers in the specific needs of older people, make long term care more accessible and less costly, and improve the quality of nursing home care.

But, not all clinicians use this approach when caring for older people. Many still treat only the disease, without accounting for the whole person, or even asking patients what matters most to them. Journalists can report on whether and how physicians or other health providers are using an age-friendly framework of care encompassing the 4Ms - medications, mind, mobility and what matters.

"Policy and business leaders must urgently 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 healthspans is cause for alarm," said aging expert Ken Dychtwald, founder and CEO of Age Wave.

Yet, only one in five older adults said that their providers regularly assess their priorities.

The report highlighted five key factors that put significant pressure on the health system to meet older adults' care needs:

• Aging and demographics: The health system is not keeping up with the care demands of older adults, who often use more care and cost the system more.
• Health span vs. life span: The last decade or so of life often encompasses greater care needs, due to a combination of loss of function and multiple diseases or conditions. Keeping older people healthy longer would narrow this gap.
• Fragmented, inequitable, and costly care: Structural barriers make it difficult to access quality care, or to afford care. And, many older people struggle to navigate a fragmented system that lacks coordination or puts the patient first.
• Workforce shortages" The lack of qualified direct care workers, nurses and physicians puts pressure on the system, including longer wait times and health care deserts. This situation will only get worse as care providers retire and recruitment efforts fall short. Many care professionals lack adequate training in caring for the unique needs of older adults.
• Science, AI, and health care delivery: While advances in science, use of AI in care delivery and disease treatment is progressing, unequal access and high cost prevent many older people from receiving cutting edge treatments.

"There are too few geriatricians in the U.S. and the need for our services are increasing every year. The small number of geriatrics fellows, 170, compared to more than 1,000 cardiology fellows who matched last year is notable," said Patrick Coll, M.D., medical director for senior health and ​​associate director for Clinical Geriatrics, UConn Center on Aging.

Efforts to improve geriatrics care in the U.S. have had only a modest impact, according to Coll. Most older adults, including those who are frail and have multiple comorbidities, receive care from providers who have had little or no geriatrics training, in hospitals and clinics, that are not staffed or equipped to meet their special needs. "As we enter this period of unprecedented demographic change, a more coordinated and concerted effort is necessary to meet the future medical needs of an increasingly complex population of older adults," he said.

Older adults want to make the most of their later years, which means focusing on efforts to make care more affordable, reduce or prevent cognitive decline and ensure health care providers understand what matters most to them when assessing care options, according to Terry Fulmer, president of the John A. Hartford Foundation.