America’s Health System Isn’t Ready for the Surge of Seniors With Disabilities
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The number of older adults with disabilities — difficulty with walking, seeing, hearing, memory, cognition, or performing daily tasks such as bathing or using the bathroom — will soar in the decades ahead, as baby boomers enter their 70s, 80s, and 90s.
But the health care system isn’t ready to address their needs.
That became painfully obvious during the covid-19 pandemic, when older adults with disabilities had trouble getting treatments and hundreds of thousands died. Now, the Department of Health and Human Services and the National Institutes of Health are targeting some failures that led to those problems.
One initiative strengthens access to medical treatments, equipment, and web-based programs for people with disabilities. The other recognizes that people with disabilities, including older adults, are a separate population with special health concerns that need more research and attention.
Lisa Iezzoni, 69, a professor at Harvard Medical School who has lived with multiple sclerosis since her early 20s and is widely considered the godmother of research on disability, called the developments “an important attempt to make health care more equitable for people with disabilities.”
“For too long, medical providers have failed to address change in society, changes in technology, and changes in the kind of assistance that people need,” she said.
Among Iezzoni’s notable findings published in recent years:
Most doctors are biased. In survey results published in 2021, 82% of physicians admitted they believed people with significant disabilities have a worse quality of life than those without impairments. Only 57% said they welcomed disabled patients.
“It’s shocking that so many physicians say they don’t want to care for these patients,” said Eric Campbell, a co-author of the study and professor of medicine at the University of Colorado.
While the findings apply to disabled people of all ages, a larger proportion of older adults live with disabilities than younger age groups. About one-third of people 65 and older — nearly 19 million seniors — have a disability, according to the Institute on Disability at the University of New Hampshire.
Doctors don’t understand their responsibilities. In 2022, Iezzoni, Campbell, and colleagues reported that 36% of physicians had little to no knowledge of their responsibilities under the 1990 Americans With Disabilities Act, indicating a concerning lack of training. The ADA requires medical practices to provide equal access to people with disabilities and accommodate disability-related needs.
Among the practical consequences: Few clinics have height-adjustable tables or mechanical lifts that enable people who are frail or use wheelchairs to receive thorough medical examinations. Only a small number have scales to weigh patients in wheelchairs. And most diagnostic imaging equipment can’t be used by people with serious mobility limitations.
Iezzoni has experienced these issues directly. She relies on a wheelchair and can’t transfer to a fixed-height exam table. She told me she hasn’t been weighed in years.
Among the medical consequences: People with disabilities receive less preventive care and suffer from poorer health than other people, as well as more coexisting medical conditions. Physicians too often rely on incomplete information in making recommendations. There are more barriers to treatment and patients are less satisfied with the care they do get.
Egregiously, during the pandemic, when crisis standards of care were developed, people with disabilities and older adults were deemed low priorities. These standards were meant to ration care, when necessary, given shortages of respirators and other potentially lifesaving interventions.
There’s no starker example of the deleterious confluence of bias against seniors and people with disabilities. Unfortunately, older adults with disabilities routinely encounter these twinned types of discrimination when seeking medical care.
Such discrimination would be explicitly banned under a rule proposed by HHS in September. For the first time in 50 years, it would update Section 504 of the Rehabilitation Act of 1973, a landmark statute that helped establish civil rights for people with disabilities.
The new rule sets specific, enforceable standards for accessible equipment, including exam tables, scales, and diagnostic equipment. And it requires that electronic medical records, medical apps, and websites be made usable for people with various impairments and prohibits treatment policies based on stereotypes about people with disabilities, such as covid-era crisis standards of care.
“This will make a really big difference to disabled people of all ages, especially older adults,” said Alison Barkoff, who heads the HHS Administration for Community Living. She expects the rule to be finalized this year, with provisions related to medical equipment going into effect in 2026. Medical providers will bear extra costs associated with compliance.
Also in September, NIH designated people with disabilities as a population with health disparities that deserves further attention. This makes a new funding stream available and “should spur data collection that allows us to look with greater precision at the barriers and structural issues that have held people with disabilities back,” said Bonnielin Swenor, director of the Johns Hopkins University Disability Health Research Center.
One important barrier for older adults: Unlike younger adults with disabilities, many seniors with impairments don’t identify themselves as disabled.
“Before my mom died in October 2019, she became blind from macular degeneration and deaf from hereditary hearing loss. But she would never say she was disabled,” Iezzoni said.
Similarly, older adults who can’t walk after a stroke or because of severe osteoarthritis generally think of themselves as having a medical condition, not a disability.
Meanwhile, seniors haven’t been well integrated into the disability rights movement, which has been led by young and middle-aged adults. They typically don’t join disability-oriented communities that offer support from people with similar experiences. And they don’t ask for accommodations they might be entitled to under the ADA or the 1973 Rehabilitation Act.
Many seniors don’t even realize they have rights under these laws, Swenor said. “We need to think more inclusively about people with disabilities and ensure that older adults are fully included at this really important moment of change.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Is it OK to lie to someone with dementia?
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There was disagreement on social media recently after a story was published about an aged care provider creating “fake-away” burgers that mimicked those from a fast-food chain, to a resident living with dementia. The man had such strict food preferences he was refusing to eat anything at meals except a burger from the franchise. This dementia symptom risks malnutrition and social isolation.
But critics of the fake burger approach labelled it trickery and deception of a vulnerable person with cognitive impairment.
Dementia is an illness that progressively robs us of memories. Although it has many forms, it is typical for short-term recall – the memory of something that happened in recent hours or days – to be lost first. As the illness progresses, people may come to increasingly “live in the past”, as distant recall gradually becomes the only memories accessible to the person. So a person in the middle or later stages of the disease may relate to the world as it once was, not how it is today.
This can make ethical care very challenging.
Pikselstock/Shutterstock Is it wrong to lie?
Ethical approaches classically hold that specific actions are moral certainties, regardless of the consequences. In line with this moral absolutism, it is always wrong to lie.
But this ethical approach would require an elderly woman with dementia who continually approaches care staff looking for their long-deceased spouse to be informed their husband has passed – the objective truth.
Distress is the likely outcome, possibly accompanied by behavioural disturbance that could endanger the person or others. The person’s memory has regressed to a point earlier in their life, when their partner was still alive. To inform such a person of the death of their spouse, however gently, is to traumatise them.
And with the memory of what they have just been told likely to quickly fade, and the questioning may resume soon after. If the truth is offered again, the cycle of re-traumatisation continues.
People with dementia may lose short term memories and rely on the past for a sense of the world. Bonsales/Shutterstock A different approach
Most laws are examples of absolutist ethics. One must obey the law at all times. Driving above the speed limit is likely to result in punishment regardless of whether one is in a hurry to pick their child up from kindergarten or not.
Pragmatic ethics rejects the notion certain acts are always morally right or wrong. Instead, acts are evaluated in terms of their “usefulness” and social benefit, humanity, compassion or intent.
The Aged Care Act is a set of laws intended to guide the actions of aged care providers. It says, for example, psychotropic drugs (medications that affect mind and mood) should be the “last resort” in managing the behaviours and psychological symptoms of dementia.
Instead, “best practice” involves preventing behaviour before it occurs. If one can reasonably foresee a caregiver action is likely to result in behavioural disturbance, it flies in the face of best practice.
What to say when you can’t avoid a lie?
What then, becomes the best response when approached by the lady looking for her husband?
Gentle inquiries may help uncover an underlying emotional need, and point caregivers in the right direction to meet that need. Perhaps she is feeling lonely or anxious and has become focused on her husband’s whereabouts? A skilled caregiver might tailor their response, connect with her, perhaps reminisce, and providing a sense of comfort in the process.
This approach aligns with Dementia Australia guidance that carers or loved ones can use four prompts in such scenarios:
- acknowledge concern (“I can tell you’d like him to be here.”)
- suggest an alternative (“He can’t visit right now.”)
- provide reassurance (“I’m here and lots of people care about you.”)
- redirect focus (“Perhaps a walk outside or a cup of tea?”)
These things may or may not work. So, in the face of repeated questions and escalating distress, a mistruth, such as “Don’t worry, he’ll be back soon,” may be the most humane response in the circumstances.
Different realities
It is often said you can never win an argument with a person living with dementia. A lot of time, different realities are being discussed.
So, providing someone who has dementia with a “pretend” burger may well satisfy their preferences, bring joy, mitigate the risk of malnutrition, improve social engagement, and prevent a behavioural disturbance without the use of medication. This seems like the correct approach in ethical terms. On occasion, the end justifies the means.
Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Walk Like You’re 20 Years Younger Again
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How fit, healthy, strong, and mobile were you 20 years ago? For most people, the answer is “better than now”. Physiotherapist Dr. Doug Weiss has advice on turning back the clock:
The exercises
If you already have no problems walking, this one is probably not for you. However, if you’re not so able to comfortably walk as you used to be, then Dr. Weiss recommends:
- Pillow squat: putting pillow on a chair, crossing hands on chest, standing up and sitting down. Similar to the very important “getting up off the floor without using your hands” exercise, but easier.
- Wall leaning: standing against a wall with heels 4″ away from it, crossing arms over chest again, and pulling the body off the wall using the muscles in the front of the shin. Note, this means not cheating by using other muscles, leveraging the upper body, pushing off with the buttocks, or anything else like that.
- Stepping forward: well, this certainly is making good on the promise of walking like we did 20 years ago; there sure was a lot of stepping forward involved. More seriously, this is actually about stepping over some object, first with support, and then without.
- Heel raise: is what it sounds like, raising up on toes and back down again; first with support, then without.
- Side stepping: step sideways 2–3 steps in each direction. First with support, then without. Bonus: if your support is your partner, then congratulations, you are now dancing bachata.
For more details (and visual demonstration) of these exercises and more, enjoy:
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Want to learn more?
You might also like:
4 Tips To Stand Without Using Hands
Take care!
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What’s the difference between ‘man flu’ and flu? Hint: men may not be exaggerating
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What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.
The term “man flu” takes a humorous poke at men with minor respiratory infections, such as colds, who supposedly exaggerate their symptoms.
According to the stereotype, a man lies on the sofa with a box of tissues. Meanwhile his female partner, also with a snotty nose, carries on working from home, doing the chores and looking after him.
But is man flu real? Is there a valid biological reason behind men’s symptoms or are men just malingering? And how does man flu differ from flu?
baranq/Shutterstock What are the similarities?
Man flu could refer to a number of respiratory infections – a cold, flu, even a mild case of COVID. So it’s difficult to compare man flu with flu.
But for simplicity, let’s say man flu is actually a cold. If that’s the case, man flu and flu have some similar features.
Both are caused by viruses (but different ones). Both are improved with rest, fluids, and if needed painkillers, throat lozenges or decongestants to manage symptoms.
Both can share similar symptoms. Typically, more severe symptoms such as fever, body aches, violent shivering and headaches are more common in flu (but sometimes occur in colds). Meanwhile sore throats, runny noses, congestion and sneezing are more common in colds. A cough is common in both.
What are the differences?
Flu is a more serious and sometimes fatal respiratory infection caused by the influenza virus. Colds are caused by various viruses such as rhinoviruses, adenoviruses, and common cold coronaviruses, and are rarely serious.
Colds tend to start gradually while flu tends to start abruptly.Flu can be detected with laboratory or at-home tests. Man flu is not an official diagnosis.
Severe flu symptoms may be prevented with a vaccine, while cold symptoms cannot.
Serious flu infections may also be prevented or treated with antiviral drugs such as Tamiflu. There are no antivirals for colds.
OK, but is man flu real?
Again, let’s assume man flu is a cold. Do men really have worse colds than women? The picture is complicated.
One study, with the title “Man flu is not a thing”, did in fact show there were differences in men’s and women’s symptoms.
This study looked at symptoms of acute rhinosinusitis. That’s inflammation of the nasal passages and sinuses, which would explain a runny or stuffy nose, a sinus headache or face pain.
When researchers assessed participants at the start of the study, men and women had similar symptoms. But by days five and eight of the study, women had fewer or less-severe symptoms. In other words, women had recovered faster.
But when participants rated their own symptoms, we saw a somewhat different picture. Women rated their symptoms worse than how the researchers rated them at the start, but said they recovered more quickly.
All this suggests men were not exaggerating their symptoms and did indeed recover more slowly. It also suggests women feel their symptoms more strongly at the start.
Why is this happening?
It’s not straightforward to tease out what’s going on biologically.
There are differences in immune responses between men and women that provide a plausible reason for worse symptoms in men.
For instance, women generally produce antibodies more efficiently, so they respond more effectively to vaccination. Other aspects of women’s immune system also appear to work more strongly.
So why do women tend to have stronger immune responses overall? That’s probably partly because women have two X chromosomes while men have one. X chromosomes carry important immune function genes. This gives women the benefit of immune-related genes from two different chromosomes.
X chromosomes carry important immune function genes. Rost9/Shutterstock Oestrogen (the female sex hormone) also seems to strengthen the immune response, and as levels vary throughout the lifespan, so does the strength of women’s immune systems.
Men are certainly more likely to die from some infectious diseases, such as COVID. But the picture is less clear with other infections such as the flu, where the incidence and mortality between men and women varies widely between countries and particular flu subtypes and outbreaks.
Infection rates and outcomes in men and women can also depend on the way a virus is transmitted, the person’s age, and social and behavioural factors.
For instance, women seem to be more likely to practice protective behaviours such as washing their hands, wearing masks or avoiding crowded indoor spaces. Women are also more likely to seek medical care when ill.
So men aren’t faking it?
Some evidence suggests men are not over-reporting symptoms, and may take longer to clear an infection. So they may experience man flu more harshly than women with a cold.
So cut the men in your life some slack. If they are sick, gender stereotyping is unhelpful, and may discourage men from seeking medical advice.
Thea van de Mortel, Professor, Nursing, School of Nursing and Midwifery, Griffith University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Science Of New Year’s Pre-Resolutions
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The Science Of New Year’s Pre-Resolutions
There’s a military dictum that “prior preparation and planning prevents piss-poor performance”.
Would it surprise you to know that soldiers going on the attack are not focused on the goal? Rather, they are focused on the process.
With drills and mnemonics, everything that can be controlled for in advance is; every action, every reaction, everything that can go wrong, and all the “if x then y” decisions in between pre-battle PREWAR and PAWPERSO and post-battle PACESDO (all mnemonic acronyms; the content is not important here but the principle is).
In short: take Murphy’s Law into account now, and plan accordingly!
The same goes for making your plans the winning kind
If you want your resolutions to work, you may need to make pre-resolutions now, so that you’re properly prepared:
- Do you want to make an exercise habit? Make sure now that you have the right clothes/shoes/etc, make sure that they fit you correctly, make sure you have enough of them that you can exercise when one set’s in the wash, etc.
- What grace will you allow yourself if tired, unwell, busy? What’s your back-up plan so that you still do what you can at those times when “what you can” is legitimately a bit less?
- If it’s an outdoors plan, what’s your plan for when it’s rainy? Snowy? Dangerously hot?
- What are the parameters for what counts? Make it measurable. How many exercise sessions per week, what duration?
- Do you want to make a diet habit? Make sure that you have in the healthy foods that you want to eat; know where you can and will get things. We’re often creatures of habit when it comes to shopping, so planning will be critical here!
- Do you want to cut some food/drink/substance out? Make sure you have a plan to run down or otherwise dispose of your current stock first. And make sure you have alternatives set up, and if it was something you were leaning on as a coping strategy of some kind (e.g. alcohol, cannabis, comfort-eating, etc), make sure you have an alternative coping strategy, too!
See also: How To Reduce Or Quit Alcohol
We promised science, so here it comes
Approach-oriented resolutions work better than avoidance-oriented ones.
This means: positively-framed resolutions work better than negatively-framed ones.
On a simple level, this means that, for example, resolving to exercise three times per week is going to work better than resolving to not consume alcohol.
But what if you really want to quit something? Just frame it positively. There’s a reason that Alcoholics Anonymous (and similar Thing Anonymous groups) measure days sober, not relapses.
So it’s not “I will not consume alcohol” but “I will get through each day alcohol-free”.
Semantics? Maybe, but it’s also science:
Why January the 1st? It’s a fresh start
Resolutions started on the 1st of January enjoy a psychological boost of a feeling of a fresh start, a new page, a new chapter.
Similar benefits can be found from starting on the 1st of a month in general, or on a Monday, or on some date that is auspicious to the person in question (religious fasts tied to calendar dates are a fine example of this).
Again, this is borne-out by science:
The Fresh Start Effect: Temporal Landmarks Motivate Aspirational Behavior
Make it a habit
Here be science:
How do people adhere to goals when willpower is low? The profits (and pitfalls) of strong habits
As for how to do that?
How To Really Pick Up (And Keep!) Those Habits
Trim the middle
No, we’re not talking about your waistline. Rather, what Dr. Ayelet Fischbach refers to as “the middle problem”:
❝We’re highly motivated at the beginning. Over time, our motivation declines as we lose steam. To the extent that our goal has a clear end point, our motivation picks up again toward the end.
Therefore, people are more likely to adhere to their standards at the beginning and end of goal pursuit—and slack in the middle. We demonstrate this pattern of judgment and behavior in adherence to ethical standards (e.g., cheating), religious traditions (e.g., skipping religious rituals), and performance standards (e.g., “cutting corners” on a task).
We also show that the motivation to adhere to standards by using proper means is independent and follows a different pattern from the motivation to reach the end state of goal pursuit❞
Read: The end justifies the means, but only in the middle
How to fix this, then?
Give yourself consistent, recurring, short-term goals, with frequent review points. That way, it’s never “the middle” for long:
The fresh start effect: temporal landmarks motivate aspirational behavior
See also:
How do people protect their long-term goals from the influence of short-term motives or temptations?
Finally…
You might like this previous main feature of ours that was specifically about getting oneself through those “middle” parts:
How To Keep On Keeping On… Long Term!
Enjoy!
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- Do you want to make an exercise habit? Make sure now that you have the right clothes/shoes/etc, make sure that they fit you correctly, make sure you have enough of them that you can exercise when one set’s in the wash, etc.
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Night School – by Dr. Richard Wiseman
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Sleep is a largely neglected part of health for most people. Compared to factors like food and exercise, it’s something that experientially we’re mostly not present for! Little wonder then that we also often feel like it’s outside of our control.
While Dr. Wiseman does cover the usual advices with regard to getting good sleep, this book has a lot more than that.
Assuming that they go beyond the above, resources about sleep can usually be divided into one of two categories:
- Hard science: lots about brainwaves, sleep phases, circadian rhythms, melatonin production, etc… But nothing very inspiring!
- Fantastical whimsy: lots about dreams, spiritualism, and not a scientific source to be found… Nothing very concrete!
This book does better.
We get the science and the wonder. When it comes to lucid dreaming, sleep-learning, sleep hypnosis, or a miraculously reduced need for sleep, everything comes with copious scientific sources or not at all. Dr. Wiseman is well-known in his field for brining scientific skepticism to paranormal claims, by the way—so it’s nice to read how he can do this without losing his sense of wonder. Think of him as the Carl Sagan of sleep, perhaps.
Style-wise, the book is pop-science and easy-reading. Unsurprising, for a professional public educator and science-popularizer.
Structurally, the main part of the book is divided into lessons. Each of these come with background science and principles first, then a problem that we might want to solve, then exercises to do, to get the thing we want. It’s at once a textbook and an instruction manual.
Bottom line: this is a very inspiring book with a lot of science. Whether you’re looking to measurably boost your working memory or heal trauma through dreams, this book has everything.
Click here to check out Night School and learn what your brain can do!
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Ageless Athletes – by Dr. Jim Madden
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This is an approach to strength and fitness training specifically for the 50+ crowd, and/but even more specifically for the 50+ crowd who do not wish to settle for mediocrity. In short, it’s for those who not only wish to stay healthy and have good mobility, but also who wish to be and remain athletic.
It does not assume extant athleticism, but nor does it assume complete inexperience. It provides a fairly ground-upwards entry to a training program that then quickly proceeds to competitive levels of athleticism.
The author himself details his own journey from being in his 30s, overweight and unfit, to being in his 50s and very athletic, with before and after photos. Granted, those are 20 years in between, but all the same, it’s a good sign when someone gets stronger and fitter with age, rather than declining.
The style of the book is quite casual, and/but after the introductory background and pep talk, is quite pragmatic and drops the additional fluff. In particular, older readers may enjoy the “Old Workhorse” protocol, as a tailored measured progression system.
In terms of expected equipment by the way, some is bodyweight and some is with weights; kettlebells in particular feature strongly, since this is about functional strength and not bodybuilding.
In the category of criticism, he does refer to his other books and generally assumes the reader is reading all his work, so it may not be for everyone as a standalone book.
Bottom line: if you’re 50+ and are wondering how to gain/maintain a high level athleticism, this book can definitely help with that.
Click here to check out Ageless Athlete, and go from strength to strength!
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