The pandemic has exposed weaknesses in nursing homes, causing many families to rethink whether to keep an aging parent at home instead. Now a new study by UC San Francisco has found that many elderly Americans lack the basic self-care equipment that could enable them to live at home longer, postponing the need to move into residential care facilities.
In the study, researchers focused on three inexpensive, low-tech assistive devices: grab bars around the toilet and in the shower or tub area; a shower or tub seat; and a raised toilet or toilet seat. They identified approximately 2,600 seniors who were representative of Medicare recipients nationwide and were drawn from the National Health and Aging Trends study. These seniors lived at home but had mobility constraints, defined as substantial difficulty with bathing and toileting, keeping balanced and transferring from a seating to standing position.
The study found that 42 percent were found to have an “unmet need,” if they lacked both bathroom devices and/or both toilet devices. When transposed to the national population, this cohort amounted to 5 million Americans, representing “a missed opportunity to help [them] live independently and safely,” the researchers reported. The study publishes in JAMA Internal Medicine on March 22, 2021.
“In contrast with engineered T-cells and regenerative stem cell therapy, this equipment seems mundane,” said first author Kenneth Lam, MD, of the UCSF Division of Geriatrics, noting that each device costs around $50 and is not covered by Medicare. “Yet these low-tech interventions meaningfully reduce injury, enable independence, preserve dignity and improve quality of life in older people suffering from irreversible disability for complex multifactorial reasons.”
Culturally, we are drawn to the idea of reversing aging rather than adapting to it, Lam said. “We'd rather read a book that says we’ll never age than a book on how to cope with it. Yet many of us will get old and I believe, paradoxically, a fixed mindset that does not tolerate the adaptations that have to come with an aging body can make the experience of aging much worse.”
Self-Image May Trump Need in Younger Seniors
Younger age was found to be associated with not having the equipment participants needed: Among those ages 65 to 74, half had an unmet need, versus 29 percent for those who were 85 or older. Of note, participants who already had a walker were more likely to be better equipped.
“Many people find equipment stigmatizing,” said Lam. “Aesthetics are unappealing, and some may fear being perceived as old and vulnerable; older adults describe equipment as meant for ‘someone older,’ but not for themselves. This may explain why younger individuals were more likely to have unmet needs and why those who already owned a walker were the least likely, since they had already overcome stigma around assisted device use."
The researchers also found that nonwhites were more likely to lack equipment – 38 percent of whites had an unmet need, compared with 55 percent of other races – a finding that the authors say could be due to disparities in access or attributable to minority populations providing more caregiving in lieu of equipment.
The paucity of devices could also be explained by physicians’ failure to ask about patients’ home environments and recommend appropriate devices, Lam said. Many ER admissions of the elderly arise out of domestic incidents, such as tripping on the way to the bathroom, but asking about assistive devices “simply isn’t part of our training.”
Making Home Safer for Seniors with Memory Issues
Some 35 percent of the participants had probable or possible dementia. There are multiple home adaptations that could make it easier for this demographic, Lam stated, though he cautions that their usefulness has not been well studied. These include pill boxes that remind and assess whether medications were taken, electronic locks to monitor movement in and out of the home, and safety stoves that turn off if left unattended. Music, activity blankets and dolls may also soothe restless behaviors.
While these home modifications are inadequate to keep all seniors at home, Lam believes they may make caregiver burden more tolerable and delay the transition to nursing homes for some people.
Co-Authors: Senior author is Kenneth Covinsky, MD, MPH, of the UCSF Division of Geriatrics. Co-authors are Ying Shi, PhD, also of the UCSF Division of Geriatrics and John Boscardin, PhD, of the UCSF Division of Epidemiology and Biostatistics.
The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.