Study- Half of All States Approaching a ‘Caregiving Emergency.’

Home care worker shortages and rising care costs in America have pushed nearly half of states to the brink of a “of an unpaid family caregiving emergency,” according to a new study by Columbia University Mailman School of Public Health. “America’s Unseen Workforce: The State of Family Caregiving” is the latest installment in a caregiver research series sponsored by Otsuka America Pharmaceutical, Inc. (Otsuka). Unlike most studies that concern the availability of paid professional caregivers, the new study focuses on unpaid family caregiving.

The good news: Ohio and Missouri are among the list of 20 states categorized as "Safe for Now;" the others are Alaska, Colorado, Connecticut, Delaware, Illinois, Indiana, Kansas, Maine, Massachusetts, Montana, New Jersey, New York, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wyoming. The study warns, however, that active monitoring is necessary in these states to ensure that family caregivers remain in control; economic and demograghic pressures are stressing these family caregivers. More, even in states where critical shortages don't yet exist, and family caregivers are generally supported, caregiving is especially challenging in more rural communities.

The challenges are felt most acutely in Alabama, Arkansas, Florida, Georgia, Louisiana, Nevada, South Carolina and Tennessee. In these states, pervasive workforce shortages and large rural populations make it extremely hard for home-based care providers to deliver services, placing an outsized caregiving burden on seniors’ family and friends. Georgia, for example, has one of the largest home care aide shortages in the US and is designated as “critical” in the report.

Nationwide, unpaid caregivers contribute approximately $375 billion in labor each year, the report found. The report also highlighted the high and growing burden of dementia caregiving. Dementia is associated with approximately 40% of the total value of unpaid caregiving in the US, according to the report. This is equivalent to roughly $150 billion annually in unpaid dementia-related care costs.

Given these significant burdens — as well as the federal government’s focus on cost-cutting — the researchers called on state and local policymakers to implement solutions that benefit unpaid family caregivers. John McHugh, PhD, lead researcher for the report, said in a statement:

“At a local level, it is repeatedly the family caregiver who shoulders the immense pressures generated by healthcare shortages and rising dementia cases.Without strategic, state-level initiatives, the strain on our healthcare system and economy will only intensify. It is important for policymakers to recognize the value of family caregivers and consider the long-term savings that can be achieved by acting now.”

Debra Barrett, vice president, corporate affairs at Otsuka added:

“Although caregivers don’t have a choice but to continue their vital work, it is essential that policymakers understand the difficult choices being made by families across their state and assist in supporting the valuable contributions of unpaid caregivers. Progress is being made, but achieving comprehensive change requires strong support and collaboration from both federal and state governments. At Otsuka, our support of this study reflects our broader commitment to advocating for family caregivers everywhere. As we look ahead, we must commit to long-term solutions that uplift and sustain family caregivers, recognizing their critical impact across the country.”

The report findings underscore the need to advocate for more support and resources for unpaid family caregivers:

• In an era of reduced government spending, it’s crucial to establish a consistent and reliable standard of support for unpaid family caregivers at the state level.

• States must advocate for funding to support programs that provide financial assistance, training, and respite care for unpaid family caregivers to meet the growing demand and avoid putting more strain on their local healthcare systems.

• States with a higher rate of dementia care must urgently implement new solutions for unpaid family caregivers to bridge the workforce gap. 

• To get ahead of the rising demand for managing complex, chronic conditions like dementia — traditionally managed by healthcare professionals — training and certification programs for family caregivers are essential.

• States with higher rural populations must implement targeted strategies to support the unpaid caregiving workforce. 

• Where there is a shortage of healthcare workers, states can support family caregivers financially in recognition of their contribution to the healthcare system.Investing in the long-term care workforce at the federal level is crucial. This involves better training, higher wages, and finding long-term solutions for staffing challenges for both institutional and community-based care.

Just the fact that there is a focus on home health caregivers is important- these cargivers are vital in an aging in place plan. Tax, and regulatory reform could better incentivize and support family caregiving.

Otsuka is the lead, founding sponsor of Caregiving, a two-hour documentary for PBS portraying paid and unpaid caregivers navigating the challenges and joys of "this deeply meaningful work." Intertwining intimate personal stories with the untold history of caregiving, the documentary reveals the state and the stakes of care in America today. The project, created with executive producer Bradley Cooper, premieres June 24 on PBS and is available to stream on May 27 on PBS.org and the PBS App. It is the next feature film of the WETA award-winning Well Beings campaign, which addresses critical health needs in America. To learn more about Otsuka’s caregiver commitment visit: otsuka-us.com/caregiver.

“Fate Worse Than Death”: Long-Term Care’s Independence Crisis: Aging-in-Place Planning Offers Solutions

A recent study highlighted by NBC Right Now, titled “Fate worse than death: Many long-term care residents lose all independence, study says,” paints a grim picture of life in long-term care (LTC) facilities. The headline is attention-grabbing, and for seniors and families planning for the future, the subject study underscores the importance of aging in place strategies to preserve independence and autonomy.

THE STUDY

Published on April 23, 2025, "Cognitive and Functional Decline Among Long-Term Care Residents," is a retrospective cohort study (meaning an observational study that uses existing data to examine individuals by looking back in time to assess how past variables relate to specific outcomes) involving more than 120,000 Canadian residents followed for up to 5 years.  One aspect of the study was interviewing residents to determine their goals in seeking long-term care and their feelings about long-term care. The study provides a compelling glimpse into older adults’ fears of losing independence, and the trajectories of needs while in long-term care. 

Study Results: Some of the key findings of the study include: 

• Many people lose all independence soon after entering long-term care;

• About 20% lose the ability to make everyday decisions within five years of admission, and 13% become totally dependent for all personal care including bathing, toileting and eating;

• Residents living with dementia may be at risk of spending more time living in states of impairment than residents who have no cognitive impairment; the increased survival of residents with dementia may reflect the natural history of dementia as a progressive terminal disease with great variability in survival time, ranging from 3 to 15 years.

• Advance directives may play an important role in reducing time spent living with severe disability; residents with Do Not Resuscitate (DNR) or Do Not Hospitalize (DNH) orders experience shorter periods of institutionalization while suffering profound impairment associated with a loss of all independence.

• The standard care practice of providing longevity can leave residents in states that they consider "worse than death," contradicting the goals that residents view as most important.

• Despite advance care directives, 25% of long-term care residents have at least 1 transfer to the hospital every 6 months, and many die shortly after a hospital transfer. 

Indeed, in the introduction to the study, the authors write:

"Patients, including healthy outpatients and those with serious illness, consider states such as being “unable to get out of bed,” “unable to communicate,” or “unable to reason or remember” as worse than death, and yet these outcomes are rarely explicitly discussed. [citations omitted].  Pursuing longevity-focused care when a person is living in a state they consider worse than death is contrary to resident-centered principles for which LTC homes strive. However, pursuit of longevity against a patient’s wishes may occur because preferences change when death is imminent and because substitute decision-makers and clinicians are partial toward life-prolonging treatment when clinical outcomes or resident preferences are uncertain."

Researcher Assessments: The researchers released statements regarding their findings and assessments:

• Dr. Ramtin Hakimjavadi, lead researcher, a resident in internal medicine at the University of Ottawa in Canada, and one of more than fifteen medical professionals that authored the study, characterized the findings:

"In interviews, long-term care residents have expressed that loss of independence is more distressing to them than the thought of dying. [Residents aren’t receiving the best care] if we don’t talk about the possibility of severe disability and ask about the circumstances when life prolonging treatments would not be acceptable."

• Senior researcher, Dr. Daniel Kobewka, an investigator at Bruyère Health Research Institute and adjunct scientist at the Institute for Clinical Evaluative Services in Ottawa, advised that: 

“[r]esidents, their family members, and care teams should have open discussions about what quality of life means to the resident, considering the possibility of prolonged disability. Planning ahead can help ensure that future care aligns with personal values, including the choice to prioritize comfort and dignity over life-prolonging interventions.” 

Call to Action: The study represents a call to action. 

• The Health Care Industry:  Clinicians and health care professionals are called to consider critically  life-prolonging treatment, appropriate for the healthy and recovering, as being contrary to the wishes and consent of residents that "follow a frailty trajectory with no clear terminal phase...experienc[ing instead] a progressive decline in cognition and physical function after admission due [for example] to the accumulation of chronic conditions." Care for these residents must be guided by their wishes and goals, ensuring dignity and quality of life for residents and care partners. 

• Residents: Residents should make their wishes and goals explicit.  At a minimum that means executing Durable Powers of Attorney for Health Care, Advanced Directives in the form of a Living Will and Advanced Directives for Dementia, and a broad form HIPAA release in favor of trusted health care decision-makers. Residents and their families should consider a DNR, DNH, and where appropriate, Physician Orders for Life-Sustaining Treatment (POLST). Residents should also consider aggressive, comprehensive aging in place planning, and a robust estate plan to protect a resident's independence, decision-making, and dignity.   

Study Limitations: The authors acknowledge key limitations:  

• First, all studies that use administrative data have a risk of bias from misclassification or incomplete capture of variables, which the researchers addressed by using validated definitions when possible and maintaining consistency with previous research. 

• Second, the study did not stratify data by the type of dementia (e.g., Alzheimer, Lewy body, or frontotemporal dementia) given the available data. Although different dementia subtypes carry distinct trajectories and prognoses, the researchers concluded that their findings reflect residents living with Alzheimer dementia given its prevalence relative to other subtypes.

• Third, the length of stay observed in the study is subject to local admission and aging-in-place policies, which vary by jurisdiction.

• Fourth, while the study aimed to inform resident-centered decision-making in LTC through the identification of resident-important cognitive and functional impairments, resident and caregiver perspectives may differ from those of the patient partners who informed this study. The researcher believe that, nonetheless, their data provides a foundation for communication and future studies to consider functional and cognitive impairments as outcomes for prognostication. 

• Fifth, the  study has limitations in generalizability. The findings are generalizable to regions with a similar LTC population of mostly older adults with frailty and chronic conditions requiring continuous care. However, the  population studied may be older and have higher levels of frailty and health burdens at admission because of the prioritization of home care in Canada compared with regions with less emphasis on home care or with more flexible LTC eligibility criteria. Additionally, the publicly funded single-payer system in Canada may result in a more homogenous population compared with regions using a third-payer system, which may have a more diverse LTC population. This difference may limit the generalizability of our results to other regions.

The Study Is Worthy of Serious Considerations Despite the Limitations

There are number of reasons that this study deserves attention despite the acknowledged limitations.

1. Peer Review and Credibility: Published in JAMA Network Open, a peer-reviewed, open-access journal with a strong reputation the study benefits from rigorous editorial oversight. The authors are affiliated with reputable institutions  and have expertise in health policy and aging, enhancing credibility. No funding conflicts are disclosed, reducing bias concerns.
2. Methodology: A retrospective cohort study afforded the researchers an immense sample size, and a fairly long period over which to follow subjects. The weakness of these types of studies, data quality/bias, was addressed by using validated definitions when possible and maintaining consistency with previous research. 
3. Generizability: There are obvious differences between the Canadian health care model and the U.S. model.  Aging in place planning is public policy in Canada and is heavily subsidized.  The concern was that Canadian residents might be older and in worse health than, say, in the U.S.  Although U.S. commitment to aging in place in Medicare  may not be as robust, there is some semblance of public support, for example, in the adoption of alternatives available in Medicare Advantage Plans, the recent "Hospital at Home" initiative of Medicare, and Medicare/Medicaid's Program of All-Inclusive Care for the Elderly (PACE) program for adults 55+ who need nursing home-level care but can live safely in the community, which provides comprehensive services (medical, social, home care) through an interdisciplinary team, centered at an adult day health center, with in-home support.  More importantly, with the risk of asset loss from long-term care spend down, U.S. residents are much more likely to avail themselves of institutional care alternatives, meaning the populations of LTC residents may not differ dramatically.  Moreover, it appears to me that the quality of care in Canada is higher given that the rehospitalization rate described in the study was an average of every six months, while U.S, residents run an almost one-in-three risk of rehospitalization in the first 28 days of care from just medical "mistakes."
4. Is the Headline "Fair?": The headline, “Fate worse than death: Many long-term care residents lose all independence, study says,” is undeniably dramatic. The phrase “fate worse than death” is emotionally charged, invoking despair and finality. While it risks overgeneralizing, implying that all long-term care leads to catastrophic outcomes, the headline isn’t entirely unfair. Loss of independence is a profound fear for seniors, and the study’s emphasis on this issue aligns with documented concerns. For example, a 2023 New York Times article notes that many aging Americans struggle to stay independent due to a fragmented long-term care system, supporting the study’s premise. The hyperbolic tone serves a purpose: it grabs attention and sparks discussion about a critical issue.

Aging-in-Place Solutions to Preserve Independence

The study’s findings underscore why many seniors prefer to age in place—remaining in their homes or communities with support tailored to their needs. Aging in place planning, a cornerstone of this blog, empowers seniors to maintain independence, dignity, and control. Below are solutions commonly explored here, designed to address the risks highlighted by the study:

• Home Modifications for Safety and Accessibility: Modifying the home to accommodate mobility or health challenges is a proactive step. Common upgrades include installing grab bars, widening doorways, adding ramps, or creating single-level living spaces. These changes reduce reliance on institutional care by enabling seniors to navigate their homes safely. For example, a walk-in shower can preserve independence in bathing, directly countering the loss of control noted in the study. 

• Multigenerational Living: Multigenerational living is a powerful strategy for aging in place, offering financial savings, emotional support, and caregiving flexibility. By reducing reliance on institutional care, families can avoid spend-down and preserve assets, aligning with elder law goals. However, success requires planning. For more see the article: Aging in Place: Multigenerational Living as a Strategy to Avoid Institutional Care and Support Family Caregiving.

• Deploy Technology for Safety, Health, and Communication: Technology serves two purposes.  First, technology use supports cognitive health. Second, technology offers solutions to challenges faced when aging in place that otherwise might demand institutionalization. 

• Revocable Living Trusts for Asset Protection: A revocable living trust, as discussed in our recent article “The Dangers of Last-Minute Estate Planning.” ensures assets are managed and distributed per the senior’s wishes, even if they become incapacitated. Unlike wills, trusts are transparent in asset titling (e.g., on deeds or accounts), deterring manipulation and supporting financial independence. Trusts can also fund home care or modifications, avoiding the asset depletion that forces some into long-term care, and protect against guardianships, and abusive guardians.

• General Durable Powers of Attorney (GDPOA): A GDPOA appoints a trusted agent to handle financial and healthcare decisions if a senior becomes incapacitated. This prevents the need for court-ordered conservatorships, which can strip autonomy, as seen in the Autry case. By ensuring a trusted person manages their affairs, seniors maintain control indirectly, aligning with the study’s call for personalized care.  Structuring trusts to prevent third-party guardians access to trust assets disincentivizes guardians, and helps prevent control of assets being wrestled away from trusted advisors and agents.  

• Aging-in-Place Care Coordination:  In-home care, such as nonmedical caregivers or telehealth services, allows seniors to receive support without leaving home. Emerging technologies like tele-dentistry or remote monitoring, noted in LTC News, enhance access to care for mobility-challenged seniors. Coordinating care through family, agencies, or professionals ensures needs are met without the institutional routines criticized in the study.

• Guardianship Protections and Nominations: Nominating a guardian in a GDPOA or trust ensures that, if guardianship is needed, a trusted individual is appointed. Structuring trusts to limit guardian access to assets, as discussed in “The Dangers of Last-Minute Estate Planning,” preserves the senior’s plan. This protects against the loss of control highlighted by the study, as seniors retain influence over their legacy.   Structuring trusts to limit guardian access to assets, as discussed in “The Perils of Last-Minute Estate Planning,” preserves the senior’s plan. This protects against the loss of control highlighted by the study, as seniors retain influence over their legacy.

• Medicaid Planning for Long-Term Care Costs:  Strategic Medicaid planning, using trusts or asset transfers, can preserve resources for in-home care rather than nursing home costs. Unlike the hasty Medicaid attempts in the Autry case (Dangers of Last Minute Estate Planning), a well-crafted trust allows crisis planning without disrupting the estate plan, supporting aging in place. Consideration of and implementation of asset transfers permissible to qualified family members under Medicaid are more certain and less expensive and disruptive than either monolithic irrevocable transfers so common from trust mills, or crisis planning planning.

• Lifestyle Changes: Simple lifestyle changes can support, protect, and improve cognitive and physical health as well as  emotional and psychological well-being, and build a broader community and social safety net thereby removing barriers and creating opportunities for home and community based care. 

These strategies and solutions, regularly featured on this blog, empower seniors to avoid the institutional settings critiqued in the study. By planning proactively, families can create environments where independence thrives, reducing the risk of a “fate worse than death.” 

Aging in Place Planning: Groundbreaking Study- Take Charge of Your Cognitive Health with Simple Lifestyle Changes

As we age, the risk of stroke, dementia, and late-life depression threaten our independence, decision-making, and financial health. The consequences of these conditions threaten our families with burden, cost, and concern. These conditions change how we live, make decisions, and plan for the future. But here’s the good news: a groundbreaking new study from Mass General Brigham, widely covered by CNN, The New York Times, and Fox News, suggests that simple everyday steps can lower our risks.

By making small changes now, we can protect our brains, stay independent longer, and make life easier for ourselves and our loved ones. From the perspectives of estate planning, elder law, and aging in place planning, the findings offer critical insights into preventive health strategies that can enhance quality of life, reduce care giving burdens, and inform legal and financial preparations for aging. This article dives into what the study found, why it matters for planning your future, and how you can start today.

What the Study Says

The Mass General Brigham study, looked at tons of research to identify 17  modifiable risk factors shared by stroke, dementia, and late-life depression (LLD), things we can change to lower our chances of suffering from these conditions. These aren’t complicated medical fixes—they’re things like eating better, staying active, or even spending more time with friends. 

High blood pressure and kidney problems have the most profound impact, but staying active and keeping your brain engaged can make a significant difference in cutting your risk. The study found that improving just one of these areas—like going for regular walks—can help protect against all three conditions. They even created a tool called the Brain Care Score to help you track your progress. For example, boosting your score by 5 points could cut your risk by 27% over 13 years. That’s something to get excited about!

The reason that the study is groundbreaking is that these conditions, which contribute significantly to stroke, dementia and depression, share vascular and small vessel pathologies, making their overlapping risk factors critical. The 17 modifiable risk factors common to at least two of the three diseases are: blood pressure, kidney disease, fasting plasma glucose, total cholesterol, alcohol use, diet, hearing loss, pain, physical activity, purpose in life, sleep, smoking, social engagement, stress, body mass index (BMI), leisure time cognitive activity, and depressive symptoms. Among these, high blood pressure (hypertension ≥ 140/90 mm Hg) and severe kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m²) had the greatest impact on disease incidence and burden, while physical activity and cognitive leisure activities were associated with the most significant risk reduction. The interconnected nature of these risk factors means that improving one—such as increasing physical activity—can positively impact others, like blood pressure, sleep, and social engagement.

Why This Matters for You and Your Family- Aging in Place, Estate Planning and Elderlaw Implications

As we get older, we want to stay in control of our lives—living in our own homes, making our own choices, and not leaning too heavily on our kids or loved ones. Stroke, dementia, and depression can make that harder, affecting everything from your health to your finances. This study gives us a roadmap to fight back, and it’s especially important if you’re thinking about aging in place, planning your estate, or  protecting your future.

Staying in Your Home (Aging in Place): Most of us want to stay in our own homes as we age,  surrounded by our friends, family, memories, and comfort. This study says you can make that more likely by moving your body, sleeping well, and managing stress. Here’s how to make your home work for you:

• Make It Health-Friendly: Add a place for stretching, a blood pressure cuff, or even smart lights to help you sleep better. These little changes support the habits the study recommends.  

• Fix Hearing Loss Early: Your home should not be a prison. Untreated hearing loss can make you feel isolated and raise your dementia risk. It makes you less likely to leave your home, and more likely to isolate. Get a check-up—it’s a small step with big payoffs.

• Get Family/Friends Involved: Ask your kids or grandkids to join you for walks or game nights. Invite friends over for a sports event or movie. It's fun, keeps you social, and lowers your risk of depression.  

• Use Tech: Set up reminders on your phone for meds or try a sleep-tracking or exercise app to stick with healthy habits.  Schedule Zoom or Facetime calls with families and friends to talk. Consider my article regarding the use of technology to reduce dementia risk and age in place.

Planning for Your Future (Estate Planning): Nobody wants to think about losing the ability to make decisions, but stroke or dementia can make that a reality. By taking steps like managing your blood pressure or quitting smoking, you can keep your mind sharp longer, which means you’re more likely to stay in charge of your money, your home, and your care. Here’s how you can plan smarter:

• Set Up a Routine Healthcare Plan: Work with a doctor, physicians assistant, personal trainer, deploy an online health app, and/or work with family and friends to improve your health, increase activity, and spend more active and engaging time with family and friends.  Design these around things you already enjoy or like.  Set goals, and work towards them to create a routine. 

• Advance Directives: Engage a lawyer to create a healthcare proxy and living will that says what you want if you become sick. Avoid simple minimalist forms, and actually state your intentions regarding long-term care (e.g., "if I need care I want it to be in my home," or "I do not want to burden my children financially, but hope they will provide time and support when needed").  Mention your current routines and plans (e.g., "monitor my blood pressure a few time a day," or "continue my selected supplements as they have demonstrated success" or I might qualify for Aid and Attendance because your father was a wartime vet, talk to the VA if I need help at home"). 

• Pick Someone You Trust: Choose a family member or friend to handle your finances and/or health decisions if you can’t. Make sure they know your goals, like staying healthy to avoid nursing homes and direct them to take advantage of your existing plan (e.g., if my Medicare benefit runs out, use my MA plan's "hospital at home" benefit, or pay for home care using my long-term insurance policy/short- term disability policy).   

• Deploy Trusts: Consider establishing trusts to fund healthcare needs, including home modifications or caregiver support, to facilitate aging in place, and/or to protect assets from long-term care spend down in the worst case.

• Save for Care: Set up a trust or savings to cover things like home modifications (think grab bars, ramps, a hospital bed at home, or a simple blood pressure monitor) so you can live independently longer.

• Financial and Insurance Planning: Consider aging in place planning when making other financial, insurance, or investment decisions. Consider, for example a Medicare Advantage Plan with home health care benefits, or a life insurance policy that is convertible to lifetime long-term care benefits.

Protecting Your Rights (Elder Law):  Elder law is fundamentally about making sure you’re taken care of as you age, whether that’s qualifying for Medicaid or finding community support. This study shows that simple changes—like joining a book club or getting your hearing checked—can keep you healthier, which means less stress on your wallet and your family. Here’s what you can do:  

• Stay Social: Loneliness can lead to depression, so find a local senior center or volunteer opportunity to stay connected. It’s good for your brain and your mood.  More, it protects your decision-making by providing interactions with people who know you and can alert you or your family if there are changes and/or help you if a predator or scammer attempts to take advantage of you.

• Plan for Medicaid: If you’re worried about long-term care costs, talk to an elder law attorney about protecting your savings while staying healthy to delay those costs.  

• Guardianship Protection: Implement a plan to protect you and your assets from guardianship.  Even a simple revocable trust can, in many states, be crafted to remove or frustrate guardianship control of the trust assets.

Easy Steps to Start Today

The study calls these 17 factors a “menu of options,” meaning you don’t have to do everything—just pick what works for you. Here are some ideas to get going: 

1. Check Your Blood Pressure: Get a home monitor and aim for under 120/80. Cut back on salty snacks, eat more fruits, and talk to your doctor if you think you need meds.  
2. Move More: Walk around the block, try chair exercises, or join a local tai chi class. It helps your heart, brain, and even your mood.  
3. Quit Smoking: If you smoke, call a quitline or ask your doctor for help. It’s one of the best things you can do for your brain.  
4. Stay Connected: Call a friend, join a hobby group, or volunteer. Feeling connected keeps depression at bay, and keeps you active.  
5. Challenge Your Brain: Do crosswords, read a new book, or learn a skill like painting or a new technology or device. It’s fun and keeps your mind sharp. 
6. Sleep and De-Stress: Try a bedtime routine or a quick meditation app to relax. Good sleep and less stress are brain boosters.

The Brain Care Score is a great way to see how you’re doing—just answer questions about your habits, and it’ll show you where to focus. The study says they’re working on more ways to use this tool, so keep an eye out!

How They Did the Study (And Why It’s Solid)

The researchers looked at 182 big studies from 2000 to 2023, narrowing it down to 59 that really dug into what causes these conditions. They focused on things you can actually change, like how much you exercise or how you manage stress, and figured out which ones matter most. They then employed a statistical analysis to compare how much each factor affects your risk, so you know where to put your energy.

This approach is strong because it pulls together lots of research, not just one small study. But it’s not perfect—they might’ve missed some things specific to depression, for example, and they can’t say for sure that changing these habits causes less disease (it’s more like a strong hint). Still, it’s a reliable guide for making smart choices.

What Else We Learned (And Why People Are Talking)

This study’s a big deal because it shows you don’t need a magic pill to protect your brain—just small, doable changes. People are excited about it—CNN called it a “hopeful message,” and experts say it’s empowering to know we can take control. It’s also a wake-up call: with dementia cases expected to skyrocket and strokes hitting even younger folks, starting now is key. Plus, things like finding purpose or staying social remind us that aging well isn’t just about your body—it’s about your heart and soul too.

One cool takeaway? The study’s Brain Care Score is like a personal coach for your brain. It’s already helping people, and researchers want to test it more to make it even better. For now, it’s a simple way to see what you’re doing right and where you can improve.

Wrapping It Up

Growing older doesn’t have to mean losing your independence or worrying your family. The Mass General Brigham study shows that by making small changes you can lower your chances of stroke, dementia, and depression. That means more years in your own home, more control over your future, and less stress for everyone. Whether you’re planning your estate, talking to a lawyer, or just want to age on your terms, these steps are a powerful way to take charge and implement a plan. So grab a friend, take a walk, and start building a healthier, happier future today.

Hearing Loss Linked to Nearly One-third of Dementia Cases in Older Adults- What it Means

A recent article, "Hearing loss linked to nearly one-third of dementia cases in older adults" from McKnights, references a study published on April 17, 2025, in JAMA Otolaryngology-Head & Neck Surgery. Let’s break down the study’s claims, assess its implications, and explore actionable steps for seniors and their families.

Analysis of the Study

The study, conducted on 2,946 older adults with a mean age of 75, found that nearly one-third (32%) of dementia cases at a "population level" could be attributed to hearing loss, as measured through audiometric testing. This figure is derived from the population attributable fraction (PAF), a statistical measure estimating the proportion of a disease (dementia, in this case) that might be prevented if a specific risk factor (hearing loss) were eliminated. 

Notably, the study found no significant association between self-reported hearing loss and dementia risk—only audiometrically confirmed hearing loss showed this link. The association was stronger in women, those over 75, and white individuals.

Does Hearing Loss "Cause" Dementia, or Contribute to Faster Onset?

The study does not claim that hearing loss directly causes dementia. Instead, it highlights a correlation, suggesting that hearing loss may contribute to dementia risk at a population level. The article and related sources  emphasize that if the relationship is causal, addressing hearing loss could potentially delay or prevent up to 32% of dementia cases. However, causality is not proven here. Several mechanisms are proposed to explain the link:

• Cognitive Load Hypothesis: Hearing loss forces the brain to expend more energy on processing sounds, leaving fewer resources for memory and cognitive functions, potentially accelerating cognitive decline.

• Social Isolation: Hearing loss can lead to social withdrawal, which is a known risk factor for dementia due to reduced cognitive stimulation.

• Brain Atrophy: Some research suggests hearing loss may cause faster brain shrinkage in areas related to memory and cognition.

The study’s language—“could be attributed to”—indicates an association, not causation. It aligns with prior research, such as the 2020 Lancet Commission on Dementia, which identified hearing loss as one of 12 modifiable risk factors, estimating it contributes to about 8% of global dementia cases.  Similarly, isolation has been associated with a 28% higher risk of developing dementia over nine years, regardless of race or ethnicity, according to a study in the Journal of the American Geriatrics Society This new study’s higher estimate (32%) reflects a focus on older adults with clinically significant hearing loss, but it doesn’t confirm that hearing loss directly triggers dementia. Instead, it suggests hearing loss might accelerate the onset or progression of dementia symptoms in those already at risk.

Limitations and Critical Examination

• Correlation vs. Causation: The study relies on observational data, which cannot establish causality. Other factors, like shared underlying causes (e.g., vascular issues affecting both hearing and cognition), might explain the link.

• Self-Reported vs. Audiometric Data: The lack of association with self-reported hearing loss raises questions. It could mean many older adults are unaware of their hearing loss, or that self-reports are unreliable, potentially skewing the perceived impact.

• Demographic Bias: The stronger link in women, white individuals, and those over 75 might reflect demographic differences in the study population rather than universal truths. For example, women tend to live longer, increasing their dementia risk overall.

• Interventional Evidence: While the study suggests treating hearing loss might delay dementia, it doesn’t provide direct evidence. Related research, like the 2023 ACHIEVE study, found that hearing aids slowed cognitive decline by 48% in high-risk older adults over three years, but this also isn’t definitive proof of dementia prevention.

• Meaning of "Population Level" Relationship: When a study finds a correlation "at a population level," it means the relationship between two variables (e.g., hearing loss and dementia) is observed across a large group of people, typically representing a broad population. This correlation reflects a general trend or pattern in the data when averaged over the entire group, but it doesn’t necessarily apply to every individual within that population. For example, a study might find that higher coffee consumption is correlated with increased anxiety at a population level, meaning this trend holds true when looking at the group as a whole.

• Meaning of "Individual Level" Relationship: The alternative is finding a correlation "at an individual level," where the relationship between variables is examined for specific individuals rather than the group. This approach looks at how changes in one variable correspond to changes in another for each person. For instance, a study might track an individual’s coffee intake and anxiety levels over time to see if they rise and fall together for that person.

Comparison:

• Population-level correlations are generally more reliable for understanding broad trends because they are based on larger sample sizes, which reduce the impact of outliers and individual variability. They’re useful for making generalizations about a group, but they can mask individual differences. For example, a population-level correlation might show that smoking increases lung cancer risk, but some individuals who smoke might never develop cancer due to other factors like genetics.
• Individual-level correlations can be less reliable for generalizing because they’re based on fewer data points (just one person or a small group) and are more susceptible to noise, such as random fluctuations in the data or unaccounted variables. However, they’re more precise for understanding a specific person’s experience, which can be critical in personalized medicine or tailored interventions.
• Merits of Both:  In short, population-level correlations are more reliable for broad insights but less precise for individuals, while individual-level correlations are more specific but less generalizable. The choice depends on the study’s goal—general trends versus personalized understanding.

What the Study Actually Tells Us

The study tells us that hearing loss, when confirmed through objective testing, is strongly associated with dementia risk in older adults, particularly those over 75. It estimates that addressing hearing loss could theoretically reduce population-level dementia risk by 32%, but this is a hypothetical projection, not a guaranteed outcome. The findings underscore hearing loss as a significant, modifiable risk factor, but they don’t confirm it as a direct cause of dementia. Instead, hearing loss likely interacts with other risk factors, potentially hastening the appearance of dementia symptoms in vulnerable individuals.  In making individual health decisions, it is just one of several variable that may factor in health care decisions.

Actionable Steps for Seniors

Based on the study’s findings, seniors can take proactive steps to potentially reduce their dementia risk:

• Get Regular Hearing Tests: Since the study found a link only with audiometrically confirmed hearing loss, seniors should prioritize objective hearing assessments, especially if they’re over 60, as one-third of this age group experiences hearing loss. Regular testing can catch issues early.

• Use Hearing Aids if Needed: If hearing loss is detected, using hearing aids may help. The ACHIEVE study suggests hearing aids can slow cognitive decline in high-risk individuals. Even if they don’t prevent dementia, they can improve quality of life by enhancing communication and reducing social isolation.

• Stay Socially Engaged: Hearing loss can lead to isolation, a known dementia risk factor. Seniors should maintain social connections, whether through community activities, day centers, or family interactions, to keep their brains active.

• Monitor Overall Health: Hearing loss is one of many modifiable risk factors for dementia. Seniors should also address other risks, like high cholesterol, physical inactivity, and depression, as outlined in the 2024 Lancet Commission Report, which identifies 14 such factors (action items for all 14 risk factors are outlined at the end of this article).

• Advocate for Accessibility: Hearing aids can be expensive, and access varies. Seniors should explore subsidies or programs that make hearing aids more affordable, as equitable access is crucial for widespread impact.

How Family Members Can Help

Family members can play a critical role in supporting seniors to act on this information:

• Encourage Hearing Tests: Family members can gently encourage seniors to get their hearing checked, especially if they notice signs like difficulty following conversations or frequent misunderstandings. Offering to accompany them to appointments can make the process less daunting.

• Support Hearing Aid Adoption: If hearing aids are recommended, families can help seniors adjust to them. This might involve researching affordable options, assisting with fittings, or providing emotional support, as some seniors may resist using hearing aids due to stigma or discomfort.

• Facilitate Social Interaction: Families can help combat isolation by organizing regular visits, outings, or activities that keep seniors engaged. For example, involving them in family events or community programs can provide cognitive stimulation.

• Monitor for Cognitive Changes: Since hearing loss may accelerate dementia symptoms, families should watch for early signs of cognitive decline, like memory lapses or difficulty with tasks. If noticed, they can encourage cognitive screening, as suggested by related research on falls and dementia risk.

• Advocate for Holistic Care: Families can ensure seniors see healthcare providers who take a comprehensive approach, addressing hearing loss alongside other dementia risk factors like diet, exercise, and mental health.

Conclusion

While the study highlights an important link, it’s worth questioning the narrative that hearing loss is a primary driver of dementia. The 32% PAF figure is striking, but it’s a population-level estimate, not a personal risk prediction. Other factors, like genetics or socioeconomic barriers to healthcare, might play larger roles for some individuals. Additionally, the focus on hearing loss shouldn’t overshadow other modifiable risks—like vision loss, isolation, or smoking—which also appear to contribute to dementia rates. Seniors and families should view hearing loss as one piece of a larger puzzle, addressing it within a broader strategy for brain health.

In summary, the study suggests hearing loss is a significant risk factor that may hasten dementia onset, but it doesn’t prove causation. Seniors should prioritize hearing tests and interventions like hearing aids, while families can support them through encouragement, social engagement, and advocacy for comprehensive care. This approach can potentially delay cognitive decline, though it’s not a guaranteed shield against dementia.

The 14 Risk Factors identified by Lancet

1. Ensure good quality education is available for all and encourage cognitively stimulating activities in midlife to protect cognition.
2. Make hearing aids accessible for people with hearing loss and decrease harmful noise exposure to reduce hearing loss.
3. Treat depression effectively.
4. Encourage use of helmets and head protection in contact sports and on bicycles.
5. Encourage exercise because people who participate in sport and exercise are less likely to develop dementia.
6. Reduce cigarette smoking through education, price control, and preventing smoking in public places and make smoking cessation advice accessible.
7. Prevent or reduce hypertension and maintain systolic blood pressure of 130 mm Hg or less from age 40 years.
8. Detect and treat high LDL cholesterol from midlife.
9. Maintain a healthy weight and treat obesity as early as possible, which also helps to prevent diabetes.
10. Reduce high alcohol consumption through price control and increased awareness of levels and risks of overconsumption.
11. Prioritize age-friendly and supportive community environments and housing and reduce social isolation by facilitating participation in activities and living with others.
12. Make screening and treatment for vision loss accessible for all.
13. Reduce exposure to air pollution.
14. Considerations for People with  Dementia:

• Interventions after diagnosis help people to live well with dementia, including planning for the future. Multicomponent coping interventions for family carers and managing neuropsychiatric symptoms are important and should be person-centred.
• Neuropsychiatric symptoms should be treated, and clear evidence exists that care-coordinated multicomponent interventions are helpful. Activity interventions also reduce neuropsychiatric symptoms and are important to maintain enjoyment and purpose for people with dementia. There is no evidence for exercise as an intervention for neuropsychiatric symptoms.
• Cholinesterase inhibitors and memantine should be provided for people with Alzheimer's disease and Lewy body dementia. These drugs are cheap, with relatively few side-effects; attenuate cognitive deterioration to a modest extent, with good evidence of a long-term effect; and are available in most high-income countries, although less so in low-income and middle-income countries.
• There is progress in and hope for disease-modifying treatments for Alzheimer's disease, with some trials of amyloid-β-targeting antibodies showing modest efficacy in reducing deterioration after 18 months of treatment. However, effects are small and drugs have been trialled in people with mild disease and people with few other illnesses. These treatments have been licensed in some countries but have notable side-effects, with few data about long-term effects. The expense of these treatments and the precautions that must be taken, which have resource implications for staff, scanning, and specialist blood testing, could limit their use and be challenging for health systems. We recommend that full information is shared broadly about the unknown long-term effects, the absence of data about the effects in people with multimorbidity, and the scale of efficacy and side-effects, particularly for APOE ε4 genotype carriers. We recommend that people on amyloid-β-targeting antibodies are carefully monitored.
• Cerebrospinal fluid or blood biomarkers should be used clinically only in people with dementia or cognitive impairment to help to confirm or exclude a diagnosis of Alzheimer's disease. Biomarkers are only validated in largely White populations, limiting generalizability and raising health equity concerns.
• People with dementia who become acutely physically unwell and need to be admitted to hospital deteriorate faster cognitively than others with dementia. It is important to protect physical health and ensure that people have help if needed to ensure that they eat and drink enough and can take medication.
• COVID-19 exposed the vulnerability of people with dementia. We need to learn from this pandemic and also protect people with dementia as their lives and wellbeing, and that of their families, have been valued less than that of people without dementia.