Aging (and staying healthy) at home

As we age, our abilities inevitably decline. The activities of daily living (ADLs) capture those skills we need to remain living an independent life – primarily getting dressed, bathing and toileting, and eating meals. Bathing and hygiene are particularly crucial – simply put, if you cannot bathe and use the toilet where you are, you need to be somewhere else. Simple home modifications, a grab bar in the shower or tub, an elevated toilet seat, a shower seat all are inexpensive additions that reduce injury, enable independence, preserve dignity, and improve quality of life in older people with irreversible disability for complex multifactorial reasons.

Those simple modifications can reduce falls by 19 percent and increase independence by 30 percent, translating into considerable savings to the healthcare system over the cost.

It should come as no surprise that this is another area where we may have failed our seniors. Research reported in JAMA Internal Medicine utilized the National Health and Aging Trends Study (NHATS), which annually interviews a sample of Medicare beneficiaries over the age of 65. The data consists of information determined at both the 2015 and 2019 interviews. More specifically, in addition to the usual demographics, the researchers gathered information on the beneficiary’s ADLs and any subsequent help they might have received in the ensuing four years.

Of the 7,070 community-dwelling interviewees, 2,614 (37 percent) had sufficient disability to warrant home modification – a cost not covered by Medicare, which readily covers the cost of a walker in the presence of mobility impairment. Mean age was 80.5, two-thirds women, 25 percent Black, 7 percent Hispanic. The majority owned their home, and 80 percent lived in a metropolitan area; 40 percent were living with their spouse, and 40 percent had some college or more education.

Also, 42 percent had an unmet need for equipment for bathing or toileting. That unmet need is significant, especially when you consider that it really reflects unmet preventative care.

While the result appears to be “penny wise, pound foolish,” the reality is more likely that these needs were invisible. First, there is some unwarranted shame that prevents us from sharing our needs. When patients come to the attention of the healthcare system, we do act. Individuals with walkers, who were presumably seen and cared for after an injury or hospitalization, were more likely to have the other necessary assistive devices. Unfortunately, seeing a physician is no guarantee; 98 percent of these participants had seen their physician, but as the researchers write, “Few physicians are skilled at identifying incident disability in their older patients, asking screening questions about home environments, educating patients on available options, making recommendations, and routing patients to solutions.”


Dr. Charles Dinerstein, medical director at the American Council on Science and Health, wrote this article for its website (