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Wealth Matters in Health of Older Adults

65-and-older Medicaid patients face higher risk of developing physical and cognitive disabilities after ICU visit

close up of a woman's hand with an iv tube, she is laying in a hospital bed

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After being released from a hospital intensive care unit, low-income 65-and-older adults face a starkly higher risk of developing new physical and cognitive problems than other patients their age who are better off financially, according to a study appearing in the Annals of Internal Medicine.

The study, led by researchers at Yale University’s School of Medicine, found that in the six months after being discharged from the ICU, those poor enough to be eligible for both Medicaid and Medicare were nearly 10 times more likely to suffer serious cognitive decline than patients with higher incomes who qualified only for Medicare.

Study coauthor Lauren Ferrante, M.D., an assistant professor of medicine at the Yale School of Medicine, called the finding — based on an analysis of data gathered from older ICU patients from 2011 to 2017 — a “shocking effect” of income disparities.

“This is problematic in an older adult, because our cognitive function is so much of what helps someone remain independent in his or her daily life,” Ferrante said.


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The researchers also found low income was associated with a significantly higher risk of developing physical disabilities that interfered with seven everyday activities, including eating, dressing and getting around inside and outside their homes without assistance. The difference translated to “almost two more activities in which they’re not independent, out of the seven,” Ferrante said.

Although the study doesn’t answer why these disparities exist, lead author Snigdha Jain, M.D., a clinical fellow at the Yale School of Medicine, said the problem may have multiple causes “across the continuum of care.”

Hospital care​

One possible explanation might be differences in the treatment poorer patients receive while in the hospital, Jain said. “Are they being treated at hospitals or rehab facilities that are not performing so well?” she questioned. Helping patients recognize their surroundings, giving them the right medications and getting them moving again after days in bed all are crucial to preserving cognitive abilities and physical function.

Lack of support

​It may also be that low-income older patients aren’t getting the help they need after leaving the ICU, Jain said. Their families may be less able to provide caregiving support, and they may have more difficulty getting transportation to appointments with their doctors or to rehabilitation sessions at outpatient clinics.

Advocacy gap​

Additionally, low-income older patients with less education may have more difficulty interacting with the health care system and advocating for themselves to get the assistance they need, Jain said.

The researchers have obtained funding for a follow-up study, in which they’ll look at the extent to which poorer patients are getting access to rehabilitation services, such as physical therapy and occupational therapy, after leaving the hospital. That might point to ways to fix disparities in the system and ensure that all patients get the same care, Jain said.

Ferrante said finding ways to keep low-income older patients cognitively and physically healthier after they leave the ICU will also benefit the rest of society. Patients able to live independently and avoid going into nursing homes will help reduce costs to the health care system, she said.

Hospitals may be able to help lower-income patients stay in better health by tasking someone on staff to serve as a “navigator” to help them get the care they need to recover, Ferrante said.

“It’s basically someone who knows how to maneuver through the very complicated health care system and helps people make appointments, coordinate care for the transportation, medical appointments or rehabilitation appointments,” she said.

And something as simple as providing better access to available benefits, like the Supplemental Nutrition Assistance Program (SNAP), could make a significant difference in quality of life after a hospital stay. Participation in SNAP has been shown to increase older adults’ prescription adherence, as well as decreasing hospital and long-term care admissions. Learn more about the difference food security can make by visiting AARP Foundation

Patrick J. Kiger is a contributing writer for AARP. He has written for a wide variety of publications, including the Los Angeles Times Magazine, GQ and Mother Jones, as well as the websites of the Discovery Channel and National Geographic.​​​