#1 Booming 85+, Falls, MA and Home Health Access, Conversational AI

Landers StratAGEy Newsletter #1 5/22/2024

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85+ Population Growth: Pay Attention

There’s been a lot of talk about the “Silver Tsunami” and tons of references to the booming 65+ population. As a geriatric medicine physician or “geriatrician,” I must admit I’m not quite as worked up about the growth in the 65-74 age group. I like to think of people in their 60s and 70s as largely independent. My review of 2022 data from the United States Census Bureau shows that more than 75% of community-dwelling older people age 65-74 have no disabilities. I fully understand everyone in their late 60s and seventies isn’t jumping off pianos like Bruce Springsteen or looking like Cher, and there are sadly many exceptions to the trend, but there are lower rates of disability. This 65-74 population is where we have to remain focused on wellness, prevention, and preparation for the next stages of aging.

I think we (families, businesses, media, healthcare institutions, governments, etc) should be paying WAY more attention to the 85+ demographic, or the “oldest old.” This is where there is incredible projected population growth, and the opportunities for making an impact are enormous. It’s this booming 85+ group where currently ONLY 33% report no disabilities, and these data likely over-estimate the % of 85+ who are “disability free” because they only include community-dwelling elders and miss the nursing home population and much of the assisted living population. Here are the jaw dropping U.S. and global projections (from OECD Data Explorer) for the growth in the 85+ group:

At the same time, population growth for younger age groups is stagnant. It begs the question, who will be there to care for us if we need help? How should we prepare our homes, finances, and other aspects of our lives for aging in an aging world? These projections for such growth in the 85+ population should be motivating us to plan, innovate, problem solve. We are going to need empowered families, responsive age-friendly businesses, a strengthened caring workforce, and robust home and community-based solutions.

New Resource for Falls Prevention

Falls and falls prevention have to be front of mind for all of us---so much life and good living is lost because of preventable falls. This isn’t a new topic to people in the know, but I want to hype an important new clinical review on falls risk assessment and prevention, this JAMA review article should really help inform effective programming and services. The corresponding author is Dr. Cathleen Colón-Emeric at Duke University and the article is titled “Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review.” As someone with deep interests and experiences in home health, I was impressed in this review about the extensive potential actions / services that should be offered by home care, here are some examples: physical therapy and exercise programs, focus on assistive devices and sensory issues, occupational therapy, home-safety assessment and risk mitigation, medication reconciliation and considering deprescribing, assessing orthostatic blood pressures. I can see this article becoming important for guiding the planning and development of falls prevention programs in home and community-based care as well as independent living and outpatient settings.

Medicare Advantage and Home Health

Anyone who has been on the provider side of home healthcare and post-acute care lately has heard grumblings about whether or not the booming Medicare Advantage plans, in their efforts to promote efficient use of services, are sometimes restricting access in ways that could hurt vulnerable elders? Two recent research articles touch on this topic. A piece in the JAMA Health Forum looked at national data from 2019-2022 provided by BAYADA home care, the largest non-profit home health provider in the United States. The corresponding author is Dr. Rachel A. Prusynski, from the Department of Rehabilitation Medicine at University of Washington. In this article, the investigators conclude that Medicare Advantage enrollees are getting somewhat less home health visits and have slightly worse functional outcomes compared to Traditional Medicare enrollees with the same health status.

Another recent article on the topic of home health in Medicare Advantage was just published in Medical Care by a group led by Dr. Chenjuan Ma at the NYU Rory Myers College of Nursing. This study synthesized the results of 30 previous papers on the topic going back over more than 20 years using data ranging from 1996-2018. The authors didn’t identify any consistent themes about access from this review, they conclude “wild variation and conflicting findings.” Dr. Ma appears to be focusing her career on home health related research, so anyone interested in this topic should keep an eye out for her future endeavors.

These two recent articles add to the discussion about home health access and quality for Medicare Advantage enrollees, but they are not definitive. Given the growth and popularity of Medicare Advantage it will be important that there be more research on this topic.

Conversational AI / Voice Agents

Wow, oh my, I’m blown away by this conversational AI platform. I just spent an hour speaking with the demonstration “voice agent” recently shared by VAPI.AI. “We” talked about different resources for home automation and home monitoring that could be important or useful for aging in place, but I bet we could have discussed almost anything. Even more mind blowing is the vision Google has just unveiled with “Project Astra.” I’m still trying to pick my jaw up from the floor, but the implications for medical care and aging in place are tremendous. With the disclaimer that I’ve tended to be overly optimistic about the relevance of new tech to support aging in place, “virtual agents” and conversational AI are resonating with me. We have a desperate shortage of formal and informal caregivers and these types of tools might one day be useful for counseling, screening and risk stratification, scheduling, problem solving, and dare I say companionship and entertainment!?! My experience with the voice agent was smoother and more enjoyable than I expected, and I think there may be decent acceptability from elders if trained and used appropriately. Wow.

Inspiration

Gloria Donnelly is Professor and Dean Emerita at the Drexel University College of Nursing and Health Professions, has a massive legacy of innovation and inspiration in the field of nursing education, and is one of the coolest people you’ll ever meet. In her 2022 article “Self-care strategies for living artfully..” that seemed to be well timed for the COVID-burnt out workforce, she encourages caregivers to channel Epictetus (an ancient Greek Stoic philosopher). In honor of Gloria here are some Epictetus quotes:

“We cannot choose our external circumstances, but we can always choose how we respond to them.”

“No man is free who is not master of himself.”

“It is not what happens to you, but how you react to it that matters.”

“First say to yourself what you would be; and then do what you have to do.”

DISCLAIMER: Landers StratAGEy does not provide personal medical advice, please consult your physician if you have any medical issues or concerns