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Health tactics that pay off

Insurance doesn't yet cover some relatively inexpensive services, including periodic in-home assessments.

March 03, 2008|Shari Roan | Times Staff Writer

One piece of the puzzle is missing from the aging in place trend -- healthcare.

The nation's healthcare system is simply not designed to help seniors remain living independently, says Laura Gitlin, director of the Center for Applied Research on Aging and Health at Thomas Jefferson University in Philadelphia. "We know what helps people," she says. "What helps them age in place is not covered by insurers at this point."

Many seniors have chronic health conditions, such as dementia, diabetes or urinary incontinence, and must take multiple medications. But their medical care is often disjointed. Their primary care doctor doesn't have the time to coordinate that care, and nurses, home aides, geriatric care managers and technological devices are rarely covered by insurance.

"Growing old is challenging," Gitlin says. "Our whole approach to geriatric care must be multidisciplined and integrated and coordinated. Only when we have that approach will older people be able to age in place with a good quality of life."

Gitlin published a study in 2006 that tested a relatively inexpensive program to help seniors age in place. The study participants -- normal seniors who were not receiving home care -- received six visits from therapists who identified problems they were having functioning at home and offered coping skills, such as balance exercises or better ways to hold a book. The program provided inexpensive items including bathing devices and home improvements such as handrails.

"These were people who were beginning to experience small changes, such as having difficulty bending down to pick up the mail or reaching the dinner plates or getting in and out of the tub," Gitlin says. "But these very small difficulties compromise quality of life. It's highly associated with depressed symptoms that can lead to social isolation and promote further decline."

The study, published in the Journal of the American Geriatrics Society, found that after one year, 1% of people receiving the intervention had died compared with 10% in a control group. Among seniors who were hospitalized before the intervention (an indication of frailty), there were no deaths in the year after the intervention. The death rate in a control group, however, was 21%.

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