NEW YORK, Sept. 17, 2024 /PRNewswire/ -- A survey of older adults in the United States reveals wide-ranging dissatisfaction with health care and related services that don't reflect and respond to how people want to live as they age.
Age Wave and The John A. Hartford Foundation released findings of a national survey, "Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads," conducted by The Harris Poll. It underscores that America's 65+ population is skyrocketing, as opportunities go unmet to provide better care and tailored services to enhance a person's 'healthspan' versus 'lifespan'. Older adults who live in rural areas and/or are women, people of color, those who are economically disadvantaged or have limited functional health are especially dissatisfied.
U.S. Census Bureau data show the nationwide population over the age of 65 is expected to rise dramatically, from 56.1 million in 2020 to 82.1 million by 2040. The massive increase in the number of older adults is compelling governments and the private sector to rethink approaches to health care, social services, housing and more to help older adults live well as they age.
"Older adults are stuck in a health care system that is not responsive to their goals and preferences. Boomers want health care that maximizes their health and ability to function, and they want their providers to listen to them," said Terry Fulmer, president of The John A. Hartford Foundation. "It is not too late to pivot to age-friendly care, which prioritizes the needs and desires of older adults in their care plan. There are many innovative approaches to help older adults live every year to its fullest, not just increase the number of years they live."
Four in five older adults (82%) say the U.S. health care system is not prepared for the growing and changing needs of America's aging population. Just one in 10 (11%) give the health care system an 'A' grade. Instead of the status quo, older adults say they want solutions that will maximize their golden years, like interventions that make care more affordable, innovations to reduce or prevent cognitive decline and health care providers who understand what matters most to them when assessing care options.
"The United States is on the brink of an age wave of unprecedented proportions, and American health care requires a radical and immediate rethink to match our healthspans, or being able to live every year to its fullest, to our lifespans," said international longevity and aging expert Ken Dychtwald, founder and CEO of Age Wave. "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."
Today, America ranks 50th in terms of lifespan and 68th in the world in terms of healthspan, according to the Institute for Health Metrics.
Challenges Prevent America's Health Care System from Adequately Serving Older Adults
NEED FOR AGE-FRIENDLY CARE. Most older adults (94%) say it is more important to maintain quality of life than it is to live as long as possible. Only three in five older adults with a health care provider (58%) report that their providers currently ask about what matters to them. Though older adults fear Alzheimer's and dementia more than any other health condition, for example, less than half (40%) say their health care providers routinely evaluate their cognitive health and brain functioning. Similarly, less than half of older adults (45%) say their health care providers evaluate their mental health, and although the ability to walk freely without pain is top of mind for older adults, just 55% say their medical care providers evaluate their mobility and physical fitness.
NOT ENOUGH QUALIFIED CARE PROVIDERS. Experts say health care organizations have struggled to meet people's needs in part because of workforce and talent shortages. Nearly all older adults (94%) say that health care providers should be trained on the unique health issues of people 65 or older, but only 10% of medical schools require a rotation in geriatric care, compared to 96% that require a rotation in pediatric care. Between 2000 and 2022, the U.S. population of adults aged 65 and older rose 60%, while the number of geriatricians dropped 28%.
UNAFFORDABLE CARE. The poll shows health care costs are a bigger concern to older adults than living expenses, inflation, tax increases and an economic downturn or recession. Just 16%, for example, give an 'A' grade to satisfaction with their out-of-pocket costs. Older adults are especially concerned with the cost of long-term care, saying that one of their greatest concerns is not being able to afford future health and long-term care needs (68%), and that the government should prioritize having Medicare cover long-term care (80%).
LOW-QUALITY NURSING HOMES. An estimated 36 million Americans have a family member or friend living in a nursing home or memory care facility today, according to the survey. Just 37% of those adults ages 18+ say their family member or friend living in a nursing home or memory care facility receives high-quality care. Only half (50%) say these facilities are the safest place for them.
LACK OF COORDINATION. While 52% of Medicare beneficiaries see more than three physicians per year, half of older adults from the survey say their primary care provider does not coordinate their treatment with their other health care providers. This may be attributed to the increasing shortage of primary care providers, which makes it less likely for people to have a usual source of primary care or long-term relationship with a primary care provider.
CONFUSION OVER COVERAGE. More than half of older adults (56%) say it is difficult and stressful to navigate the current health care system, while nearly two in three (62%) say health insurance plans provide too many confusing choices. Research has shown that more than half (55%) mistakenly believe Medicare will cover a long-term stay in a nursing home.
Varying Satisfaction with U.S. Health Care Among Different Groups of Older Adults The survey shows that women, people who live in rural areas, people of color and the economically disadvantaged are far less satisfied with the U.S. health care system than other older adults. For example, women have greater worries about their longevity than men, which may explain why they engage in more healthy habits than men.
Older adults from rural areas are less satisfied with the health care system overall than older adults from urban areas (41% compared to 51% give it a grade of an A or B), which may be attributed to living in areas which now have few or no convenient health care providers.
Compared to white peers, Black older adults report lower physical health (31% rate it as fair or poor compared to 25%) and financial well-being (34% compared to 24%), and voice greater concern for being mistreated or disrespected if they live in a long-term care facility (66% compared to 49%). Hispanic older adults, compared to white peers, are less likely to report excellent to very good mental health (52% compared to 65%) and financial health (34% compared to 48%).
In every category assessed, economically disadvantaged older adults report that their health is worse than older adults who have more financial means—suggesting a wide gap between wealth and health.
Regardless of Political Party, Older Adults Want Public Policies that Support Quality Care At a time of deep political divisions in American life, nearly all older adults—regardless of ideology or political party—want access to quality care. Adding long-term care to what Medicare covers is supported by most Republicans (76%), Democrats (84%) and independents or people with other political affiliations (79%). Improving quality at U.S. nursing homes also earns bipartisan support (Republicans 62% support, Democrats 68% support, independents or people with other political affiliations 65% support).
"Better federal and state policies can encourage the development of age-friendly health systems, that focus on improving patients' well-being and quality of life," said Fulmer. "Policies could include new options for affording long-term care insurance and developing a federal strategy to ensure disadvantaged populations are prioritized in a national strategy for age-friendly care."
Care Improvements that Can Help Older Adults Age Well After reviewing all survey findings, The John A. Hartford Foundation and Age Wave identified five key recommendations to improve health care for older adults and promote healthier, happier aging, including:
Promote age-friendly care that helps older adults maintain their health, ability to function and independence—focusing on wellness and quality of life rather than treating diseases.
Pursue scientific breakthroughs that could bring an end to diseases like Alzheimer's.
Address social isolation in older adults by supporting tools for empathetic and respectful mental health care and support, tailored to individual needs.
Assist family caregivers with skill-building tools, flexibility in taking paid leave and ensuring care providers coordinate among multiple providers—making care easier to navigate.
Support a 'national master plan for aging' that is centered on the needs of older adults and identifies and addresses barriers that contribute to inequities—specifically a plan for financing long-term care and reform of nursing homes, including systems to provide health care in people's homes rather than in acute and congregate settings.
"We are at a unique crossroads. However, changing America's health care system to meet older adults' expectations is possible, practical and could lead to greater health at a far lower cost—and can benefit the government, private enterprise and consumers," said Dychtwald. "Older adults deserve health care partners who understand what they are going through, have the skills to most effectively support their patients and act on what their customers want."
The John A. Hartford Foundation and several partners lead a global drive toward health system adoption of the 4Ms Framework for age-friendly care—which designs care around what patients say matters to them, not necessarily their care providers, and addresses older adults' medications, mind, and mobility. The Centers for Medicare and Medicaid Services recently approved a quality measure requiring hospitals to report on their ability to provide age-friendly care, but only one in five older adults (19%) report that their providers routinely assess the essentials of age-friendly care.
Methodology The study was conducted by Age Wave on behalf of The John A. Hartford Foundation and in partnership with The Harris Poll. After thorough review of secondary research, we conducted qualitative research with older adults through online focus groups, and then conducted a nationally representative online survey. The survey was conducted April 17 to May 9, 2024. Of 5,023 adult (age 18+) respondents, 2,516 were age 65 and older. Data were weighted where necessary to align them with their actual proportions in the population, including by age, gender, race/ethnicity, region, education, household income, size of household, marital status, and political party affiliation.
Read the Report The full report, Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads, can be found at www.johnahartford.org/crossroads.
About The John A. Hartford Foundation The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. For more than three decades, the organization has been the leader in building a field of experts in aging and testing and replicating innovative approaches to care. The foundation has three priority areas: creating age-friendly health systems, supporting family caregivers and improving serious illness and end-of-life care. Working with its grantees, the foundation strives to change the status quo and create a society where older adults can continue their vital contributions. For more information, visit johnahartford.org.
About Age Wave Age Wave is the nation's foremost thought leader on issues relating to an aging population, with great expertise in the profound business, social, healthcare, financial, workforce and cultural implications. Age Wave has a unique understanding of the body, mind, hopes and demands of new generations of maturing consumers and workers and their expectations, attitudes, hopes, and fears regarding longevity, aging, and retirement. Since its inception in 1986, the firm has provided breakthrough research, compelling presentations, award-winning communications, education and training systems, and results-driven marketing and consulting initiatives to over half the Fortune 500.Learn more at agewave.com.
About the Harris Poll The Harris Poll is a global public opinion, analytics, and market research consultancy that strives to reveal society's authentic values to inspire leaders to create a better tomorrow. With a global research reach of more than 90 countries, Harris offers advisory services across sectors to world leaders, CEOs, and business decision-makers with state-of-the-art analytics, real-time software services, and practitioners in marketing, reputation, customer experience, trends, futures, and thought leadership/research-for-public release. The Harris Poll translates shifting social sentiment into a competitive marketplace advantage. Harris is a Stagwell (NASDAQ: STGW) company. For more information, please visit theharrispoll.com.
