During procedures, he seemed “hesitant, not sure of how to go on to the next step without being prompted” by assistants, said Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore.

The chief of surgery, concerned about the doctor’s cognition, “would not sign off on his credentials to practice surgery unless he went through an evaluation,” Katlic said.

Since 2015, when Sinai inaugurated a screening program for surgeons 75 and older, about 30 from around the country have undergone its comprehensive two-day physical and cognitive assessment. This surgeon “did not come of his own accord,” Katlic recalled.

But he came. The tests revealed mild cognitive impairment, often but not necessarily a precursor to dementia. The neuropsychologist’s report advised that the surgeon’s difficulties were “likely to impact his ability to practice medicine as he is doing presently, e.g. conducting complex surgical procedures.”

That didn’t mean the surgeon had to retire; a variety of accommodations would allow him to continue in other roles. “He retained a lifetime of knowledge that had not been impacted by cognitive changes,” Katlic said. The hospital “took him out of the OR, but he continued to see patients in the clinic.”

Such incidents are likely to become more common as America’s physician workforce ages rapidly. In 2005, more than 11% of doctors who were seeing patients were 65 or older, the American Medical Association said. Last year, the proportion reached 22.4%, with nearly 203,000 older practitioners.

Given physician shortages, especially in rural areas and key specialties like primary care, nobody wants to drive out veteran doctors with skills and experience.

Yet researchers have documented “a gradual decline in physicians’ cognitive abilities starting in their mid-60s,” said Thomas Gallagher, an internist and bioethicist at the University of Washington who has studied late-career trajectories.

At older ages, reaction times slow; knowledge can become outdated. Cognitive scores vary greatly, however. “Some practitioners continue to do as well as they did in their 40s and 50s, and others really start to struggle,” Gallagher said.

A few health organizations have responded by establishing late-career practitioner programs mandating that older doctors be screened for cognitive and physical deficits.

UVA Health at the University of Virginia began its program in 2011 and has screened about 200 older practitioners. Only in four cases did the results significantly change a doctor’s practice or privileges.

Stanford Health Care launched its late-career program the following year. Penn Medicine at the University of Pennsylvania also put in place a testing program.

Nobody has tracked how many exist; Gallagher guesstimated as many as 200. But given that the United States has more than 6,000 hospitals, those with late-career programs constitute “a vast minority,” he said.

The number may actually have shrunk. A federal lawsuit, along with the profession’s lingering reluctance, appears to have put the effort to regularly assess older doctors’ abilities in limbo.

Late-career programs typically require those 70 and older to be evaluated before their privileges and credentials are renewed, with confirmatory testing for those whose initial results indicate problems. Thereafter, older doctors undergo regular rescreening, usually every year or two.

It’s fair to say such efforts proved unpopular among their intended targets. Doctors frequently insist that “‘I’ll know when it’s time to stand down,’” said Rocco Orlando, senior strategic adviser to Hartford HealthCare, which operates eight Connecticut hospitals and began its late-career practitioner program in 2018. “It turns out not to be true.”

When Hartford HealthCare published data from the first two years of its late-career program, it reported that of the 160 practitioners 70 and older who were screened, 14.4% showed some degree of cognitive impairment.

That mirrored results from Yale New Haven Hospital, which instituted mandatory cognitive screening for medical staff members starting at age 70. Among the first 141 Yale clinicians who underwent testing, 12.7% “demonstrated cognitive deficits that were likely to impair their ability to practice medicine independently,” a study reported.

Proponents of late-career screening argued that such programs could prevent harm to patients while steering impaired doctors to less demanding assignments or, in some cases, toward retirement.

“I thought as we got the word out nationally, this would be something we could encourage across the country,” Orlando said, noting that Hartford’s program cost only $50,000 to $60,000 a year.

Instead, he has seen “zero progress” in recent years. “Probably we’ve gone backward,” he said.

A key reason: In 2020, the federal Equal Employment Opportunity Commission sued Yale New Haven over its testing efforts, charging age and disability discrimination. The legal action continues (the EEOC declined to comment on its status), as does the hospital’s late-career program.

But the suit led several other organizations to pause or shut down their programs, including those at Hartford HealthCare and at Driscoll Children’s Hospital in Corpus Christi, Texas, while few new ones have emerged.

“It made lots of organizations uncomfortable about sticking their necks out,” Gallagher said.

Instituting later-career programs has always been an uphill effort. “Doctors don’t like to be regulated,” Katlic acknowledged. Late-career programs have “in some cases been very controversial, and they’ve been blocked by influential physicians,” he said.

As health systems wait to see what happens in federal court, most national medical organizations have recommended only voluntary screening and peer reporting.

“Neither works very well at all,” Gallagher said. “Physicians are hesitant to share their concerns about their colleagues,” which can involve “challenging power dynamics.”

As for voluntary evaluation, since cognitive decline can affect doctors’ (or anyone’s) self-awareness, “they’re the last to know that they’re not themselves,” he added.

In a recent commentary in The New England Journal of Medicine, Gallagher and his co-authors recommended procedural policies to promote fairness in late-career screening, based on an analysis of such programs and interviews with their leaders.

“How can we design these programs in a way that’s fair and that therefore physicians are more apt to participate in?” he said. The authors emphasized the need for confidentiality and safeguards, such as an appeals process.

“There are all sorts of accommodations” for doctors whose assessments indicate the need for different roles, Gallagher noted. They could adopt less onerous schedules or handle routine procedures while leaving complex six-hour surgeries to their colleagues. They might transition to teaching, mentoring, and consulting.

Yet a substantial number of older doctors head for the exits and retire rather than face a mandated evaluation, he said.

The future, therefore, might involve programs that regularly screen every practitioner. That would be inefficient (few doctors in their 40s will flunk a cognitive test) and, with current tests, time-consuming and consequently expensive. But it would avoid charges of age discrimination.

Faster reliable cognitive tests, reportedly in the research pipeline, may be one way to proceed. In the meantime, Orlando said, changing the culture of health care organizations requires encouraging peer reporting and commending “the people who have the courage to speak up.”

“If you see something, say something,” he continued, referring to health care professionals who witness doctors (of any age) faltering. “We are overly protective of our own. We need to step back and say, ‘No, we’re about protecting our patients.’”

The New Old Age is produced through a partnership with The New York Times.

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Finally, after decades of advocacy, the Biden administration in 2023 tackled the problem of perennial understaffing of long-term care facilities. Officials backed a Medicare regulation that would mandate at least 3.48 hours of care from nurses and aides per resident, per day, and would require a registered nurse on-site 24 hours a day, seven days a week.

The mandated hours were lower than supporters hoped for, said Hunter, who directs Washington state’s long-term care ombudsman program. But “I’m a pragmatic person, so I thought, this is a good start,” she said. “It would be helpful, for enforcement, to have a federal law.”

In 2024, when the Centers for Medicare & Medicaid Services adopted the standards, advocates celebrated. But industry lawsuits soon blocked most of the rule, with two federal district courts finding that Medicare had exceeded its regulatory authority.

And after the 2024 elections, Hunter said, “I was concerned about the changing of the guard.” Her concerns proved well founded.

In July, as part of Republicans’ One Big Beautiful Bill Act, Congress prohibited Medicare from implementing the staffing standards before 2034. Last month, CMS repealed the standards altogether. They never took effect.

“It was devastating,” Hunter said.

As with environmental law and consumer protections, the Trump administration’s enthusiasm for deregulation has undone long-sought rules to improve care for the aged. And it has introduced a Medicare experiment for prior authorizations, now getting underway in six states, that has alarmed advocates, congressional Democrats, and a good number of older Americans.

Taken together, the moves will affect many of the facilities and workers providing care and introduce complications in health coverage in several states.

On the nursing home front, “it’s clear CMS has no interest in ensuring adequate staffing,” said Sam Brooks, the director of public policy for the National Consumer Voice for Quality Long-Term Care.

“They’re repealing a regulation that could have saved 13,000 lives a year,” he added, citing an analysis by University of Pennsylvania researchers.

Industry groups argued that nursing homes, with high rates of staff turnover, were already struggling to fill vacancies.

The staffing mandate “was requiring nursing homes to hire an additional 100,000 caregivers that simply don’t exist,” said Holly Harmon, a senior vice president at the American Health Care Association.

The organization had brought one of the suits that largely vacated the rule. “Facilities would have been forced to limit admissions or downsize to comply with the requirements, or close altogether,” Harmon said.

For supporters, the action is now likely to shift to updating requirements in 35 states, along with the District of Columbia, that have already established some nursing home staff standards, and to developing them in those that haven’t.

Rules for Home Help

A second rescinded regulation, this one more unexpected, brought about upheaval in July, when the Labor Department announced a return to a policy excluding home care workers from the federal Fair Labor Standards Act.

Some history: Dating back to the New Deal, the FLSA mandated that workers receive the federal minimum wage (currently $7.25 an hour) and overtime pay. It exempted most “domestic service workers” until 1975, when a new Labor Department regulation included them — with the exception of home care workers.

“There was a misinterpretation of home care work as being casual, nonprofessional, non-skilled,” the equivalent of teenage babysitting, said Kezia Scales, a vice president at PHI, a national research and advocacy organization. “Just someone popping into your mother’s house now and then and keeping her company.”

For almost 40 years, workers and their supporters lobbied to change the rule, seeing it as a contributor to the low wages and meager benefits of a swiftly growing workforce, one made up primarily of women and minority groups, with many immigrants.

In 2013, the Labor Department responded with a rule that brought home care workers under the labor act, entitled to minimum wage, time and a half for overtime work, and payment for travel time between clients.

After industry lawsuits failed to overturn it, “everything settled down,” Scales said. “It was in place successfully for a decade.”

Home care workers brought hundreds of compliance complaints annually. In 87% of them, the Labor Department found violations of the labor act, according to a 2020 Government Accountability Office report.

Since 2013, home care agencies have paid about $158 million in back wages, PHI has calculated.

Then in July, the Labor Department abruptly announced that it would return to the 1975 regulations and stop enforcing the 2013 rule, which it said “had negative effects on the ground” and hindered consumer access to care.

The agencies employing most home care workers, primarily funded through Medicaid, would agree. “Many workers never got any benefit from this,” said Damon Terzaghi, a vice president at the National Alliance for Care at Home.

“States made a lot of moves to essentially absolve themselves of any responsibility,” he said. A 2020 federal report, for example, found that 16 states had capped Medicaid-covered home care hours at 40, thus averting overtime payment.

The alliance, which estimates that the number of impacted agencies and businesses has declined by 30% since 2013, supported the rescission. Scales, who hopes for congressional action, called it “a shocking step backward.”

Where they concur is that the United States has never really committed to sufficiently funding long-term care at home. With the July legislation setting the stage for a $914 billion cut to Medicaid over the coming decade, that seems unlikely to change anytime soon.

Medicare’s AI Referee

Beyond rolling back policies for care of the aged, the Trump administration has established a pilot program to introduce one to traditional Medicare: prior authorization, using artificial intelligence and machine learning technologies.

Touting it as a boon to taxpayers, Medicare calls it WISeR — Wasteful and Inappropriate Service Reduction.

Prior authorization, in which private insurers review proposed treatments before agreeing to pay for them, is widely used in Medicare Advantage plans despite its unpopularity with patients, doctors, and health care organizations. It has rarely been used in traditional Medicare.

This month, however, WISeR debuts in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington) in a six-year trial to determine whether review by tech companies can reduce costs and improve efficiency, while maintaining or improving quality of care.

Initially, WISeR targets 17 items and services that CMS said “historically have had a higher risk of waste, fraud and abuse.” The list includes knee arthroscopy for arthritis, electrical nerve stimulation devices for several conditions, and treatment for impotence.

The pilot program excludes emergency services and inpatient hospital care, or care where delay poses “a substantial risk.” Algorithmic denials will trigger review by “an appropriately licensed human clinician.” The tech companies get “a share of averted expenditures.”

“It injects some of the worst of Medicare Advantage into traditional Medicare,” said David Lipschutz, co-director of the Center for Medicare Advocacy. The six vendors that approve or reject treatments “have a financial stake in the outcomes,” he said, and therefore “an incentive to deny care.”

Moreover, the CMS Innovation Center overseeing the pilot could theoretically bypass Congress and expand prior authorization to include more medical services in more states.

The agency did not respond to questions about what kind of human clinicians would review denials, except to say that they would have “relevant experience” and that tech companies would be “financially penalized for inappropriate denials, high appeal rates or poor performance.”

It plans an “independent, federally funded evaluation” and will release public reports annually.

Democrats in Congress have introduced bills in both houses to repeal WISeR. “We should be reducing red tape in Medicare, not creating new hurdles that second-guess health care providers,” said Rep. Suzan DelBene of Washington, one of the bill’s sponsors.

For now, though, WISeR has opened for business, receiving prior authorization requests through its electronic portals.

“The New Old Age” is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Finalmente, después de décadas de lucha y presión, en 2023 la administración Biden abordó el problema crónico de la falta de personal en los centros de cuidado a largo plazo.

Las autoridades respaldaron una norma de Medicare que exigía que cada residente recibiera al menos 3,48 horas diarias de atención, brindada por enfermeras y asistentes. Además, establecía que debía haber una enfermera calificada en el lugar durante las 24 horas del día, los siete días de la semana.

Sin embargo, las horas obligatorias de cuidado resultaron ser menos de lo que esperaban quienes apoyaron la medida, dijo Hunter, directora del programa de defensoría de cuidados a largo plazo del estado de Washington. Pero explicó: “Soy una persona pragmática, así que pensé que era un buen comienzo. Y que tener una ley federal ayudaría a hacer cumplir la norma”.

En 2024, cuando los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés) adoptaron estos estándares, los defensores celebraron. Sin embargo, luego, demandas de la industria bloquearon la mayor parte de la ley: dos cortes federales dictaminaron que Medicare se había excedido en sus atribuciones regulatorias.

Tras las elecciones de 2024, “me preocupaba el cambio de mando”, dijo Hunter. Sus preocupaciones estaban justificadas.

En julio, como parte de la ley republicana conocida como One Big Beautiful Bill Act, el Congreso prohibió que Medicare implementara los estándares de personal antes de 2034. En diciembre, los CMS revocaron los estándares por completo. Nunca llegaron a entrar en vigencia.

“Fue devastador”, lamentó Hunter.

Como ocurrió con la legislación medioambiental y la protección de los consumidores, el entusiasmo de la administración Trump por la desregulación ha deshecho normas para mejorar la atención a las personas mayores que se estaban esperando hacía tiempo.

Además, introdujo un programa experimental de Medicare con autorizaciones previas, que ya se está llevando a cabo en seis estados y ha generado alarma entre defensores, legisladores demócratas del Congreso y muchas personas mayores.

En conjunto, estas decisiones afectarán a muchos centros de cuidado y a trabajadores que prestan servicios de salud, y complicarán la cobertura médica en varios estados.

En lo que respecta a los hogares de adultos mayores, “está claro que los CMS no tienen interés en garantizar una dotación adecuada de personal”, dijo Sam Brooks, director de políticas públicas de National Consumer Voice for Quality Long-Term Care.

“Están derogando una regulación que podría haber salvado 13.000 vidas al año”, agregó Brooks, citando un análisis de investigadores de la Universidad de Pennsylvania.

Los grupos de la industria argumentaron que los hogares de adultos mayores, que tienen altas tasas de rotación de personal, ya se veían en dificultades para cubrir las vacantes.

El mandato exigía “que los hogares de adultos mayores contrataran a 100.000 cuidadores adicionales que simplemente no existen”, sostuvo Holly Harmon, vicepresidenta sénior de la American Health Care Association.

Esa organización fue una de las que presentaron las demandas que, en gran medida, terminaron anulando la norma. “Para cumplir con los requisitos, los centros se habrían visto obligados a limitar las admisiones, reducir su tamaño o incluso cerrar por completo”, agregó Harmon.

Para quienes apoyan la regulación, ahora la atención se centrará en actualizar los requisitos sobre el personal de estos hogares en los 35 estados, más el Distrito de Columbia, que ya tienen ciertos estándares. Y, también, en desarrollarlos en aquellos estados que aún no los tienen.

Reglas para ayuda en el hogar

En julio, la inesperada anulación de una segunda norma provocó una fuerte conmoción. El Departamento de Trabajo anunció el regreso a una política que excluye a los trabajadores que brindan cuidados en el hogar de la Ley federal de Normas Justas de Trabajo (Fair Labor Standards Act, FLSA).

Un poco de contexto: en la época del New Deal, la FLSA estableció que los trabajadores debían recibir el salario mínimo federal (actualmente 7,25 dólares por hora) y cobrar por las horas extra. Pero la ley excluyó a la mayoría de los llamados “trabajadores de servicios domésticos”.  Recién en 1975 una norma del Departamento de Trabajo los incorporó, aunque dejó afuera a quienes se dedicaban al cuidado a domicilio.

“Hubo una mala interpretación del trabajo de cuidado en el hogar, como si fuera algo informal, no profesional, y sin calificación”, dijo Kezia Scales, vicepresidenta de PHI, una organización nacional de investigación y defensa. “Algo equivalente a una adolescente que cuida ocasionalmente niños. Alguien que pasa por la casa de tu mamá de vez en cuando y le hace compañía”.

Durante casi 40 años, los trabajadores y sus defensores lucharon por cambiar esa norma, ya que contribuía a los bajos salarios y escasos beneficios de una fuerza laboral en rápido crecimiento, compuesta en su mayoría por mujeres y personas de grupos minoritarios, con una gran presencia de inmigrantes.

En 2013, el Departamento de Trabajo respondió con una norma que incorporó a las trabajadoras de cuidado en el hogar a la ley laboral, dándoles derecho al salario mínimo, al pago de hora y media por las horas extra, y a que se les pagara el tiempo de traslado entre un cliente y otro.

Después de que las demandas de la industria no lograran revertir la medida en los tribunales, “todo se estabilizó y estuvo en vigor sin problemas durante una década”, explicó Scales.

Sin embargo, cada año trabajadoras de cuidado en el hogar presentaban cientos de denuncias por incumplimiento. En el 87% de los casos, el Departamento de Trabajo encontró violaciones a la ley laboral, según un informe de 2020 de la Oficina de Responsabilidad del Gobierno.

Desde 2013, las agencias que emplean personal de atención en el hogar debieron pagar unos $158 millones en salarios atrasados, según cálculos de PHI.

Repentinamente, en julio de 2025, el Departamento de Trabajo anunció que volvería a las regulaciones de 1975 y anularía la norma de 2013, argumentando que había tenido “efectos negativos en la práctica” y dificultado el acceso al cuidado para las personas.

Las agencias que emplean a la mayoría de las trabajadoras, financiadas principalmente a través de Medicaid, coincidieron en esa postura. “Muchas nunca obtuvieron ningún beneficio con esto”, señaló Damon Terzaghi, vicepresidente de la National Alliance for Care at Home.

“Los estados hicieron muchos cambios para, básicamente, desligarse de toda responsabilidad”, comentó. Un informe federal de 2020, por ejemplo, comprobó que 16 estados habían puesto un tope de 40 horas semanales a la atención en el hogar cubierta por Medicaid, para evitar así tener que pagar horas extra.

La alianza, que calcula que el número de agencias y empresas afectadas se redujo en un 30% desde 2013, respaldó la anulación de la norma.

Por el contrario, Scales, que espera que el Congreso actúe, calificó la medida como “un retroceso impactante”.

En lo que sí hay consenso es en que Estados Unidos nunca se ha comprometido realmente a financiar de manera adecuada el cuidado a largo plazo en el hogar. Con la legislación aprobada en julio —que abre la puerta a un recorte de $914.000 millones a Medicaid durante la próxima década—, resulta poco probable que esa situación cambie en el corto plazo.

El “arbitraje” de IA en Medicare

Además de eliminar políticas relacionadas con el cuidado de las personas mayores, la administración Trump ha establecido un programa piloto que introduce un elemento nuevo en Medicare tradicional: la autorización previa, utilizando inteligencia artificial.

Presentado como una medida a favor del contribuyente, Medicare lo llama WISeR, por sus siglas en inglés: Wasteful and Inappropriate Service Reduction (Reducción de Servicios Innecesarios e Inapropiados).

La autorización previa, mediante la cual las aseguradoras privadas revisan los tratamientos propuestos antes de aprobar su pago, es común en los planes de Medicare Advantage, a pesar de las objeciones de pacientes, médicos y organizaciones de salud. En cambio, casi no se ha aplicado en el Medicare tradicional.

Así y todo WISeR está comenzando a implementarse en seis estados (Arizona, New Jersey, Ohio, Oklahoma, Texas y Washington) como parte de un programa piloto de seis años, para evaluar si la revisión a cargo de empresas tecnológicas puede reducir costos y mejorar la eficiencia, sin afectar —y hasta tal vez mejorar— la calidad de la atención.

Inicialmente, WISeR se enfocará en 17 productos y servicios que, según los CMS, “históricamente han tenido mayor riesgo de desperdicio, fraude y abuso”. La lista incluye artroscopía de rodilla para artritis, dispositivos de estimulación nerviosa para varias afecciones y tratamientos para la disfunción eréctil.

El programa piloto excluye los servicios de emergencia, la atención hospitalaria o tratamientos cuyo retraso represente “un riesgo considerable”. Los rechazos basados en algoritmos deberán ser revisados por “un profesional clínico humano con la licencia correspondiente”.

Las empresas tecnológicas recibirán “una parte de los gastos que se eviten”. “Esto introduce lo peor de Medicare Advantage en Medicare tradicional”, dijo David Lipschutz, codirector del Center for Medicare Advocacy.

Las seis empresas que aprueban o rechazan tratamientos “tienen un interés financiero en los resultados”, dijo, y por lo tanto “un incentivo para negar los cuidados”.

Además, el Centro de Innovación de CMS, que supervisa el programa piloto, podría, en teoría, eludir el Congreso y extender la autorización previa a más servicios médicos en más estados.

La agencia no respondió preguntas sobre qué tipo de profesionales humanos revisarían las respuestas negativas, salvo que tendrían “experiencia relevante” y que las empresas tecnológicas serían “sancionadas financieramente por rechazos inapropiados, altas tasas de apelación o bajo desempeño”.

El programa prevé una “evaluación independiente, financiada con fondos federales” y la publicación de informes públicos anuales.

Legisladores demócratas presentaron proyectos de ley en ambas cámaras del Congreso para revocar WISeR. “Deberíamos reducir la burocracia en Medicare, no crear nuevos obstáculos que pongan en duda el criterio de los profesionales de la salud”, dijo la representante Suzan DelBene, del estado de Washington, una de las impulsoras de la iniciativa.

Por ahora, sin embargo, WISeR ya está en marcha y recibe solicitudes de autorización previa a través de sus portales electrónicos.

“The New Old Age” es una producción realizada en colaboración con The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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El motivo más importante para que las personas mayores se vacunen contra el virus respiratorio sincitial (VRS) es que su riesgo de ser hospitalizadas por esta infección respiratoria disminuye casi un 70% durante el año en que reciben la vacuna, y cerca de un 60% en los dos años posteriores.

Y la principal razón para recibir la vacuna anual contra la gripe es que, si bien no siempre evita el contagio, reduce de forma confiable la gravedad de la enfermedad, aunque su eficacia varía según qué tan bien hayan anticipado los científicos cuál será la cepa de influenza predominante ese año.

Pero también están surgiendo razones para que las personas mayores se vacunen. En el lenguaje médico, se conocen como “beneficios indirectos”: efectos positivos que van más allá de prevenir la enfermedad para la que esas vacunas fueron diseñadas.

La lista de estos beneficios indirectos sigue creciendo porque “las investigaciones se han ido acumulando y se han acelerado en los últimos 10 años”, explicó el doctor William Schaffner, especialista en enfermedades infecciosas en el Centro Médico de la Universidad de Vanderbilt.

Algunos de estos efectos protectores están respaldados por décadas de datos; otros provienen de estudios más recientes y sus beneficios aún no están del todo claros. La vacuna contra el VRS, por ejemplo, estuvo disponible recién en 2023.

Aun así, los hallazgos “son realmente muy consistentes”, señaló la doctora Stefania Maggi, geriatra e investigadora senior del Instituto de Neurociencias del Consejo Nacional de Investigación en Padua, Italia.

Maggi es la autora principal de un reciente análisis de múltiples estudios publicado en la revista británica Age and Ageing, que encontró una reducción en el riesgo de demencia después de la vacunación contra diversas enfermedades. Dado ese tipo de “efectos secundarios en cadena, las vacunas son herramientas clave para promover un envejecimiento saludable y prevenir el deterioro físico y cognitivo”, expresó Maggi.

Sin embargo, demasiados adultos mayores no se han vacunado, pese a que su sistema inmune está debilitado y la alta prevalencia de afecciones crónicas aumenta el riesgo de contraer enfermedades infecciosas.

A mediados de diciembre, los Centros para el Control y la Prevención de Enfermedades (CDC) informaron que aproximadamente el 37% de las personas mayores todavía no se había vacunado contra la gripe. Solo el 42% se ha vacunado alguna vez contra el VRS, y menos de un tercio recibió la vacuna más reciente contra covid.

Los CDC recomiendan una sola dosis de la vacuna antineumocócica para adultos de 50 años o más. Sin embargo, un análisis publicado en American Journal of Preventive Medicine estimó que, desde 2022 —cuando se actualizaron las recomendaciones— hasta 2024, solo el 12% de las personas de entre 67 y 74 años las recibieron, y apenas el 8% de quienes tienen más de 75.

La evidencia más sólida de los beneficios indirectos, que se remonta a 25 años, muestra una reducción del riesgo cardiovascular tras la administración de vacunas contra la gripe.

Los adultos mayores sanos que se vacunan contra la gripe tienen un riesgo considerablemente menor de ser hospitalizados por insuficiencia cardíaca, así como por neumonía y otras infecciones respiratorias. La vacunación contra la gripe también se ha asociado con un menor riesgo de ataque cardíaco y accidente cerebrovascular.

Además, muchos de esos estudios se realizaron antes de que estuvieran disponibles las vacunas contra la gripe más potentes, que se recomiendan actualmente para adultos mayores.

¿Podría la vacuna contra el VRS —que protege contra otra enfermedad respiratoria— ofrecer beneficios cardiovasculares similares?

Un estudio reciente con adultos mayores, realizado en Dinamarca a gran escala, encontró que las hospitalizaciones cardiorrespiratorias (que involucran al corazón y a los pulmones) habían disminuido casi el 10% entre las personas vacunadas, en comparación con un grupo de control. Una reducción significativa.

Sin embargo, la baja de las tasas de hospitalización por enfermedades cardiovasculares y accidentes cerebrovasculares no fue estadísticamente importante. Esto podría deberse a que el período de seguimiento fue demasiado corto o a que  las pruebas diagnósticas resultaron inadecuadas, advirtió la doctora Helen Chu, especialista en enfermedades infecciosas de la Universidad de Washington y coautora de un editorial que acompañó el estudio en JAMA.

“No creo que el VRS se comporte de forma muy distinta a la gripe”, dijo Chu. “Aún es demasiado pronto para tener toda la información sobre el VRS, pero creo que va a mostrar el mismo efecto, tal vez incluso mayor”.

Vacunarse contra otra enfermedad respiratoria peligrosa —covid-19— también se ha asociado con un menor riesgo de desarrollar covid prolongado, cuyos efectos dañan tanto la salud física como la mental.

Tal vez los hallazgos más provocadores tengan que ver con la vacuna contra la culebrilla. Los investigadores fueron noticia el año pasado, cuando mostraron que existía una asociación entre esta vacuna y menores tasas de demencia, incluso con la versión anterior y menos eficaz de la vacuna, que ya fue reemplazada por Shingrix, aprobada en 2017.

Casi todos los estudios sobre beneficios indirectos se basan en la observación, ya que los científicos no pueden, por razones éticas, negar una vacuna segura y eficaz a un grupo de control que podría terminar desarrollando la enfermedad.

Esto implica que los resultados podrían estar afectados por el “sesgo del voluntario saludable”, ya que las personas vacunadas tienden a tener otros hábitos saludables que las diferencian de quienes no lo hacen.

Aunque los investigadores intentan ajustar los datos considerando edad, sexo, salud y nivel educativo, “solo podemos afirmar que existe una asociación sólida entre la vacuna y la baja de la demencia, pero no una relación causal”, explicó Maggi.

Investigadores de Stanford aprovecharon un experimento natural ocurrido en Gales en 2013, cuando la primera vacuna contra la culebrilla, Zostavax, se ofreció a personas mayores que aún no habían cumplido los 80 años. Quienes ya tenían 80 o más no fueron elegibles.

Durante siete años, las tasas de demencia en quienes sí habían sido elegibles para la vacuna se redujeron un 20% —aunque solo la mitad de ellos efectivamente se vacunó— en comparación con quienes quedaron fuera por pocos días.

“No hay motivos para pensar que las personas nacidas una semana antes fueran distintas de las nacidas unos días después”, dijo Maggi.

Estudios en Australia y Estados Unidos también han detectado que vacunarse contra la culebrilla reduce las probabilidades de desarrollar demencia.

De hecho, en la revisión de estudios que Maggi y su equipo publicaron, varias vacunas infantiles y para adultos parecen tener efectos similares. “Ahora sabemos que muchas infecciones están asociadas al desarrollo de demencia, ya sea tipo Alzheimer o vascular”, explicó.

En 21 estudios que incluyeron a más de 104 millones de participantes en Europa, Asia y América del Norte, vacunarse contra la culebrilla se asoció a una reducción del 24% en el riesgo de desarrollar demencia. En el caso de la vacuna contra la gripe, la reducción fue del 13%. Para quienes recibieron la vacuna contra la infección neumocócica, el riesgo de enfermedad de Alzheimer fue un 36% menor.

La vacuna Tdap contra el tétanos, la difteria y la tos ferina (pertussis) se asoció con una disminución de un tercio en el riesgo de demencia. En los adultos se recomienda aplicarla cada 10 años. Muchos deciden vacunarse cuando nace un nieto, ya que los recién nacidos no pueden recibir la vacuna completa en sus primeros meses.

Otros investigadores están explorando si la vacuna contra la culebrilla también reduce el riesgo de sufrir ataques cardíacos y accidentes cerebrovasculares, y si la vacuna contra el covid mejora la supervivencia de pacientes con cáncer.

¿Qué causa estos beneficios adicionales de las vacunas?

La mayoría de las hipótesis se centran en la inflamación que se produce cuando el sistema inmunológico se activa para combatir una infección. “Se genera daño en el entorno que rodea a las células del cuerpo, y eso tarda un tiempo en volver a la normalidad”, explicó Chu.

Los efectos de la inflamación pueden durar mucho más que la enfermedad inicial. Esto puede facilitar que otras infecciones se desarrollen, o provocar ataques cardíacos y derrames cerebrales cuando se forman coágulos en vasos sanguíneos estrechos. “Si prevenís la infección, también prevenís ese otro daño”, añadió Chu.

La hospitalización, durante la cual los pacientes mayores pueden perder fuerza y movilidad o desarrollar delirio, es en sí misma un factor de riesgo para la demencia y otros problemas de salud. Por eso, las vacunas que ayudan a evitarlas podrían retrasar o incluso prevenir el deterioro cognitivo.

Funcionarios de salud de la administración Trump han cuestionado más las vacunas infantiles que las de adultos, pero su oposición abierta puede haber contribuido  a que muchos adultos mayores no se vacunen.

Muchos no solo se perderán los beneficios indirectos que se están descubriendo, sino que seguirán siendo vulnerables a las enfermedades que las vacunas previenen o atenúan.

“La política nacional actual sobre vacunación es, en el mejor de los casos, ambigua, y en algunos aspectos parece antivacunas”, dijo Schaffner, ex integrante del Comité Asesor sobre Prácticas de Inmunización de los CDC. “Todos los que trabajamos en salud pública estamos realmente muy preocupados”.

The New Old Age se produce en colaboración con The New York Times.

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The most important reason for older adults to be vaccinated against the respiratory infection RSV is that their risk of being hospitalized with it declines by almost 70% in the year they get the shot, and by nearly 60% over two years.

And the main reason to roll up a sleeve for an annual flu shot is that when people do get infected, it also reliably reduces the severity of illness, though its effectiveness varies by how well scientists have predicted which strain of influenza shows up.

But other reasons for older people to be vaccinated are emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.

The list of off-target benefits is lengthening as “the research has accumulated and accelerated over the last 10 years,” said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Some of these protections have been established by years of data; others are the subjects of more recent research, and the payoff is not yet as clear. The first RSV vaccines, for example, became available only in 2023.

Still, the findings “are really very consistent,” said Stefania Maggi, a geriatrician and senior fellow at the Institute of Neuroscience at the National Research Council in Padua, Italy.

She is the lead author of a recent meta-analysis, published in the British journal Age and Ageing, that found reduced risks of dementia after vaccination for an array of diseases. Given those “downstream effects,” she said, vaccines “are key tools to promote healthy aging and prevent physical and cognitive decline.”

Yet too many older adults, whose weakening immune systems and high rates of chronic illness put them at higher risk of infectious diseases, have not taken advantage of vaccination.

The Centers for Disease Control and Prevention reported last week that about 31% of older adults had not yet received a flu shot. Only about 41% of adults 75 and older had ever been vaccinated against RSV, or respiratory syncytial virus, and about a third of seniors had received the most recent covid-19 vaccine.

The CDC recommends the one-and-done pneumococcal vaccine for adults 50 and older. An analysis in the American Journal of Preventive Medicine, however, estimated that from 2022, when new guidelines were issued, through 2024, only about 12% of those 67 to 74 received it, and about 8% of those 75 and older.

The strongest evidence for off-target benefits, dating back 25 years, shows reduced cardiovascular risk following flu shots.

Healthy older adults vaccinated against flu have substantially lower risks of hospitalization for heart failure, as well as for pneumonia and other respiratory infections. Vaccination against influenza has also been associated with lower risks of heart attack and stroke.

Moreover, many of these studies predate the more potent flu vaccines now recommended for older adults.

Could the RSV vaccine, protective against another respiratory illness, have similar cardiovascular effects? A recent large Danish study of older adults found a nearly 10% decline in cardiorespiratory hospitalizations — involving the heart and lungs — among the vaccinated versus a control group, a significant decrease.

Lowered rates of cardiovascular hospitalizations and stroke did not reach statistical significance, however. That may reflect a short follow-up period or inadequate diagnostic testing, cautioned Helen Chu, an infectious disease specialist at the University of Washington and co-author of an accompanying editorial in JAMA.

“I don’t think RSV behaves differently from flu,” Chu said. “It’s just too early to have the information for RSV, but I think it will show the same effect, maybe even more so.”

Vaccination against still another dangerous respiratory disease, covid, has been linked to a lower risk of developing long covid, with its damaging effects on physical and mental health.

Probably the most provocative findings concern vaccination against shingles, aka herpes zoster. Researchers made headlines last year when they documented an association between shingles vaccination and lower rates of dementia — even with the less effective vaccine that has since been replaced by Shingrix, approved in 2017.

Nearly all studies of off-target benefits are observational, because scientists cannot ethically withhold a safe, effective vaccine from a control group whose members could then become infected with the disease.

That means such studies are subject to “healthy volunteer bias,” because vaccinated patients may also practice other healthy habits, differentiating them from those not vaccinated.

Although researchers try to control for a variety of potentially confounding differences, from age and sex to health and education, “we can only say there’s a strong association, not a cause and effect,” Maggi said.

But Stanford researchers seized on a natural experiment in Wales in 2013, when the first shingles vaccine, Zostavax, became available to older people who had not yet turned 80. Anyone who had was ineligible.

Over seven years, dementia rates in participants who had been eligible for vaccination declined by 20% — even though only half had actually received the vaccine — compared with those who narrowly missed the cutoff.

“There are no reasons people born one week before were different from those born a few days later,” Maggi said. Studies in Australia and the United States have also found reductions in the odds of dementia following shingles shots.

In fact, in the meta-analysis Maggi and her team published, several other childhood and adult vaccinations appeared to have such effects. “We now know that many infections are associated with the onset of dementia, both Alzheimer’s and vascular,” she said.

In 21 studies involving more than 104 million participants in Europe, Asia, and North America, vaccination against shingles was associated with a 24% reduction in the risk of developing dementia. Flu vaccination was linked to a 13% reduction. Those vaccinated against pneumococcal disease had a 36% reduction in Alzheimer’s risk.

The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for months. It was associated with a one-third decline in dementia.

Other researchers are investigating the effects of shingles vaccination on heart attacks and stroke and of covid vaccination on cancer survival.

What causes such vaccine bonuses? Most hypotheses focus on the inflammation that arises when the immune system mobilizes to fight off an infection. “You have damage to the surrounding environment” in the body, “and that takes time to calm down,” Chu said.

The effects of inflammation can far outlast the initial illness. It may allow other infections to take hold, or cause heart attacks and strokes when clots form in narrowed blood vessels. “If you prevent the infection, you prevent this other damage,” Chu said.

Hospitalization itself, during which older patients can become deconditioned or develop delirium, is a risk factor for dementia, among other health problems. Vaccines that reduce hospitalization might therefore delay or ward off cognitive decline.

Health officials in the Trump administration have assailed childhood vaccines more than adult ones, but their vocal opposition may be contributing to inadequate vaccination among older Americans, too.

Many will not only miss out on the emerging off-target benefits but will remain vulnerable to the diseases the vaccines prevent or diminish.

“The current national policy on vaccination is at best uncertain, and in instances appears anti-vaccine,” said Schaffner, a former member of the CDC’s Advisory Committee on Immunization Practices. “All of us in public health are very, very distressed.”

“The New Old Age” is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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O bien ya terminaste un par de semanas de rehabilitación. ¿Podrás manejar una rutina complicada de medicamentos, además de hacer las compras y cocinar?

Tal vez te caíste en la ducha y ahora tu familia quiere que consigas ayuda para bañarte y vestirte.

Por supuesto, hay centros que brindan ese tipo de asistencia, pero la mayoría de las personas mayores no quiere irse a vivir a esos lugares. Quieren quedarse en casa.

Y ahí está el problema.

Cuando las personas mayores comienzan a tener dificultades con las actividades diarias, ya sea porque se han vuelto más frágiles, por el avance de enfermedades crónicas o por la pérdida de una pareja o acompañante, la mayoría no quiere mudarse.

Desde hace décadas, las encuestas muestran que prefieren permanecer en sus hogares el mayor tiempo posible.

Eso significa que necesitan cuidado en casa, ya sea proporcionado por familiares, amigos, cuidadores pagos o por una combinación de ellos. Pero el cuidado remunerado en casa es una parte especialmente afectada del sistema de atención a largo plazo, que está atravesando una escasez de personal cada vez más grave, justo cuando la población envejecida impulsa una demanda creciente.

“Es una crisis”, definió la doctora Madeline Sterling, médica de atención primaria en Weill Cornell Medicine y directora de la Iniciativa sobre el Trabajo de Cuidados en el Hogar (Initiative on Home Care Work) de la Universidad de Cornell. “No funciona bien para quienes forman parte del sistema”, ya sean pacientes (que también pueden ser personas jóvenes con discapacidades), familiares o cuidadores en el hogar.

“No se trata de algo que vaya a pasar en una década”, señaló Steven Landers, director ejecutivo de la Alianza Nacional para la Atención en el Hogar (National Alliance for Care at Home), una organización del sector. “Haz una búsqueda en Indeed.com en cualquier ciudad de Estados Unidos para encontrar asistentes de atención en el hogar, y verás tantas vacantes que te vas a quedar con la boca abierta”.

Pero aun en ese panorama desalentador, hay algunas alternativas que muestran resultados prometedores al mejorar tanto las condiciones laborales en el sector como la atención a los pacientes. Y están creciendo.

Un poco de contexto. Desde hace años, investigadores y administradores del sistema de atención a personas mayores vienen advirtiendo sobre esta crisis inminente. El cuidado en el hogar ya es una de las ocupaciones de más rápido crecimiento en el país: el año pasado había 3,2 millones de asistentes de salud en el hogar y de cuidado personal, frente a 1,4 millones una década atrás, según datos de PHI, una organización de investigación y defensa del sector.

Así y todo, según la Oficina de Estadísticas Laborales, el país necesitará unos 740.000 trabajadores adicionales de cuidado en el hogar en los próximos diez años, y reclutarlos no será tarea fácil. El costo para los consumidores es alto: en promedio, $34 por hora por uno de estos asistentes el año pasado, según la encuesta anual de Genworth/CareScout, con grandes diferencias según la región.

Pero los trabajadores reciben, en promedio, menos de $17 por hora.

Siguen siendo empleos inestables y mal remunerados. De una fuerza laboral compuesta en su mayoría por mujeres, aproximadamente un tercio inmigrantes, el 40% vive en hogares de bajos ingresos y la mayoría recibe algún tipo de asistencia pública.

Incluso cuando las agencias que los contratan ofrecen seguro médico y los trabajadores reúnen los requisitos para tenerlo, muchos no pueden pagar las primas.

No es sorprendente que el índice de rotación de personal alcance el 80% anual, según una encuesta de The ICA Group, una organización sin fines de lucro que promueve cooperativas.

Pero no en todos lados. Una innovación que aún es pequeña pero está en expansión son las cooperativas de cuidado en el hogar que pertenecen a los propios trabajadores. La primera y más grande, Cooperative Home Care Associates en el Bronx, comenzó en 1985 y actualmente emplea a unos 1.600 cuidadores. The ICA Group contabiliza ahora 26 negocios de cuidado en el hogar propiedad de trabajadores en todo el país.

“Estas cooperativas están logrando resultados excepcionales”, dijo el doctor Geoffrey Gusoff, médico de familia e investigador en servicios de salud en la Universidad de California en Los Ángeles. “Tienen la mitad de la rotación que las agencias tradicionales, mantienen a los clientes el doble de tiempo y pagan $2 más por hora” a sus copropietarios.

Cuando Gusoff y sus colegas entrevistaron a miembros de cooperativas para un estudio cualitativo publicado en JAMA Network Open, “esperábamos escuchar más sobre la compensación”, comentó. “Pero la respuesta más común fue: ‘tengo más voz’” en cuanto a las condiciones laborales, la atención a los pacientes y la gestión de la cooperativa.

“Los trabajadores dicen que se sienten más respetados”, señaló Gusoff.

A través de una iniciativa que ofrece financiamiento, asesoramiento empresarial y asistencia técnica, The ICA Group planea aumentar el número de cooperativas a 50 en los próximos cinco años, y a 100 para 2040.

Otra alternativa que está ganando terreno son los registros que permiten que trabajadores de cuidado en el hogar y personas que necesitan asistencia se conecten directamente, a menudo sin involucrar a agencias que supervisan y hacen verificación de antecedentes, pero que también se quedan con aproximadamente la mitad del pago que hacen los consumidores.

Uno de los registros más grandes, Carina, conecta a trabajadores y clientes en Oregon y Washington. Establecido a través de acuerdos con el Service Employees International Union, el sindicato de salud más grande del país, Carina atiende a 40.000 proveedores y 25.000 clientes. (Según PHI, solo alrededor del 10% de los trabajadores de cuidado en el hogar están sindicalizados).

Carina funciona como una especie de “bolsa de trabajo digital” gratuita, explicó Nidhi Mirani, su directora ejecutiva. Salvo en el área de Seattle, solo atiende a personas que reciben cuidado a través de Medicaid, el principal financiador de atención en el hogar. Las agencias estatales se encargan del papeleo y de supervisar las verificaciones de antecedentes.

Las tarifas por hora que se pagan a proveedores independientes encontrados a través de Carina, establecidas por contratos sindicales, suelen ser más bajas que las que cobran las agencias. Pero los trabajadores ganan desde $20 por hora, además de recibir seguro médico, días de licencia paga y, en algunos casos, beneficios de jubilación.

Otros registros pueden ser gestionados por los estados, como ocurre en Massachusetts y Wisconsin, o por plataformas como Direct Care Careers, que está disponible en cuatro estados. “La gente busca tener afinidad con la persona que entra a su casa”, dijo Mirani. “Y los proveedores individuales también pueden elegir a sus clientes. Funciona en ambas direcciones”.

Por último, estudios recientes indican que una mejor capacitación para los trabajadores de atención en el hogar puede tener un impacto positivo.

“Estos pacientes tienen afecciones complejas”, dijo la doctora Sterling. Los trabajadores, al tomar la presión arterial, preparar alimentos y ayudar a que sus clientes se mantengan activos, pueden detectar síntomas preocupantes apenas surgen.

Su equipo llevó a cabo un ensayo clínico con asistentes de salud en el hogar que cuidaban a pacientes con insuficiencia cardíaca —“la principal causa de hospitalización entre los beneficiarios de Medicare”, señaló— en el que se midieron los efectos de un módulo virtual de capacitación de 90 minutos sobre los síntomas y el manejo de esta enfermedad.

“Hinchazón en las piernas. Falta de aire. Son las primeras señales de que la enfermedad no está bajo control”, explicó Sterling.

En el estudio, que incluyó a 102 trabajadores de VNS Health, una gran organización sin fines de lucro en Nueva York, la capacitación demostró mejorar tanto el conocimiento como la confianza del personal para atender a pacientes con insuficiencia cardíaca.

Además, cuando los asistentes recibieron una aplicación móvil para comunicarse con sus supervisores, hicieron menos llamadas al 911 y los pacientes tuvieron menos visitas a salas de emergencia.

Iniciativas a pequeña escala como los registros, cooperativas y programas de capacitación no resuelven el principal problema del cuidado en el hogar: el costo.

Medicaid cubre los cuidados en el hogar para adultos mayores de bajos ingresos con escasos recursos, aunque el nuevo presupuesto del gobierno de Trump recortará el programa en más de $900.000 millones durante la próxima década. En teoría, las personas con más recursos pueden pagar de su bolsillo.

Pero “las familias jubiladas de clase media terminan usando todos sus recursos y básicamente se empobrecen para poder calificar para Medicaid, o simplemente no reciben cuidados”, dijo el doctor Landers. Opciones como la residencia asistida o las residencias de mayores son aún más costosas.

Estados Unidos nunca ha asumido el compromiso de financiar el cuidado a largo plazo para las personas de clase media, y parece poco probable que lo haga esta administración.

Aun así, los ahorros derivados de estas innovaciones podrían reducir costos y ayudar a ampliar el acceso a esta atención a través de programas federales o estatales. Hay varias pruebas y programas piloto en curso.

Los trabajadores de cuidado en el hogar “tienen una comprensión muy profunda de las afecciones de los pacientes”, expresó la doctora Sterling. “Capacitarlos y darles herramientas tecnológicas demuestra que, si queremos que los pacientes se queden en casa, esta es una forma de lograrlo con la fuerza laboral que ya tenemos”.

The New Old Age se produce en colaboración con The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Or, you’ve completed a couple of weeks in rehab. Can you handle your complicated medication regimen, along with shopping and cooking?

Perhaps you fell in the shower, and now your family wants you to arrange help with bathing and getting dressed.

There are facilities that provide such help, of course, but most older people don’t want to go there. They want to stay at home; that’s the problem.

When older people struggle with daily activities because they have grown frail, because their chronic illnesses have mounted, or because they have lost a spouse or companion, most don’t want to move. For decades, surveys have shown that they prefer to remain in their homes for as long as possible.

That means they need home care, either from family and friends, paid caregivers, or both. But paid home care represents an especially strained sector of the long-term care system, which is experiencing an intensifying labor shortage even as an aging population creates surging demand.

“It’s a crisis,” said Madeline Sterling, a primary care doctor at Weill Cornell Medicine and the director of Cornell University’s Initiative on Home Care Work. “It’s not really working for the people involved,” whether they are patients (who can also be younger people with disabilities), family members, or home care workers.

“This is not about what’s going to happen a decade from now,” said Steven Landers, chief executive of the National Alliance for Care at Home, an industry organization. “Do an Indeed.com search in Anytown, USA, for home care aides, and you’ll see so many listings for aides that your eyes will pop out.”

Against this grim backdrop, however, some alternatives show promise in upgrading home care jobs and in improving patient care. And they’re growing.

Some background: Researchers and elder care administrators have warned about this approaching calamity for years. Home care is already among the nation’s fastest-growing occupations, with 3.2 million home health aides and personal care aides on the job in 2024, up from 1.4 million a decade earlier, according to PHI, a research and advocacy group.

But the nation will need about 740,000 additional home care workers over the next decade, according to the Bureau of Labor Statistics, and recruiting them won’t be easy. Costs to consumers are high — the median hourly rate for a home health aide in 2024 was $34, the annual Genworth/CareScout survey shows, with big geographic variations. But an aide’s median hourly wage was less than $17.

These remain unstable, low-paying jobs. Of the largely female workforce, about a third of whom are immigrants, 40% live in low-income households and most receive some sort of public assistance.

Even if the agencies that employ them offer health insurance and they work enough hours to qualify, many cannot afford their premium payments.

Unsurprisingly, the turnover rate approaches 80% annually, according to a survey by the ICA Group, a nonprofit organization that promotes co-ops.

But not everywhere. One innovation, still small but expanding: home care cooperatives owned by the workers themselves. The first and largest, Cooperative Home Care Associates in the Bronx borough of New York City, began in 1985 and now employs about 1,600 home care aides. The ICA Group now counts 26 such worker-owned home care businesses nationwide.

“These co-ops are getting exceptional results,” said Geoffrey Gusoff, a family medicine doctor and health services researcher at UCLA. “They have half the turnover of traditional agencies, they hold onto clients twice as long, and they’re paying $2 more an hour” to their owner-employees.

When Gusoff and his co-authors interviewed co-op members for a qualitative study in JAMA Network Open, “we were expecting to hear more about compensation,” he said. “But the biggest single response was, ‘I have more say’” over working conditions, patient care, and the administration of the co-op itself.

“Workers say they feel more respected,” Gusoff said.

Through an initiative to provide financing, business coaching, and technical assistance, the ICA Group intends to boost the national total to 50 co-ops within five years and to 100 by 2040.

Another approach gaining ground: registries that allow home care workers and clients who need care to connect directly, often without involving agencies that provide supervision and background checks but also absorb roughly half the fee consumers pay.

One of the largest registries, Carina, serves workers and clients in Oregon and Washington. Established through agreements with the Service Employees International Union, the nation’s largest health care union, it serves 40,000 providers and 25,000 clients. (About 10% of home care workers are unionized, according to PHI’s analysis.)

Carina functions as a free, “digital hiring hall,” said Nidhi Mirani, its chief executive. Except in the Seattle area, it serves only clients who receive care through Medicaid, the largest funder of care at home. State agencies handle the paperwork and oversee background checks.

Hourly rates paid to independent providers found on Carina, which are set by union contracts, are usually lower than what agencies charge, while workers’ wages start at $20, and they receive health insurance, paid time off, and, in some cases, retirement benefits.

Other registries may be operated by states, as in Massachusetts and Wisconsin, or by platforms like Direct Care Careers, available in four states. “People are seeking a fit in who’s coming into their homes,” Mirani said. “And individual providers can choose their clients. It’s a two-way street.”

Finally, recent studies indicate ways that additional training for home care workers can pay off.

“These patients have complex conditions,” Sterling said of the aides. Home care workers, who take blood pressure readings, prepare meals, and help clients stay mobile, can spot troubling symptoms as they emerge.

Her team’s recent clinical trial of home health aides caring for patients with heart failure — “the No. 1 cause of hospitalization among Medicare beneficiaries,” Sterling pointed out — measured the effects of a 90-minute virtual training module about its symptoms and management.

“Leg swelling. Shortness of breath. They’re the first signs that the disease is not being controlled,” Sterling said.

In the study, involving 102 aides working for VNS Health, a large nonprofit agency in New York, the training was shown to enhance their knowledge and confidence in caring for clients with heart failure.

Moreover, when aides were given a mobile health app that allowed them to message their supervisors, they made fewer 911 calls and their patients made fewer emergency room visits.

Small-scale efforts like registries, co-ops, and training programs do not directly address home care’s most central problem: cost.

Medicaid underwrites home care for low-income older adults who have few assets, though the Trump administration’s new budget will slash Medicaid by more than $900 billion over the next decade. The well-off theoretically can pay out-of-pocket.

But “middle-class retired families either spend all their resources and essentially bankrupt themselves to become eligible for Medicaid, or they go without,” Landers said. Options like assisted living and nursing homes are even more expensive.

The United States has never committed to paying for long-term care for the middle class, and it seems unlikely to do so under this administration. Still, savings from innovations like these can reduce costs and might help expand home care through federal or state programs. Several tests and pilots are underway.

Home care workers “have a lot of insight into patients’ conditions,” Sterling said. “Training them and giving them technological tools shows that if we’re trying to keep patients at home, here’s a way to do that with the workforce that’s already there.”

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But 5 pounds would come off and then invariably reappear, said Bucklew, 75, a public transit retiree in Ocean View, Delaware. Nothing seemed to make much difference — until 2023, when her body mass index slightly exceeded 40, the threshold for severe obesity.

“There’s this new drug I’d like you to try, if your insurance will pay for it,” the nurse practitioner advised. She was talking about Ozempic.

Medicare covered it for treating Type 2 diabetes but not for weight loss, and it cost more than $1,000 a month out-of-pocket. But to Bucklew’s surprise, her Medicare Advantage plan covered it even though she wasn’t diabetic, charging just a $25 monthly copay.

Pizza, pasta, and red wine suddenly became unappealing. The drug “changed what I wanted to eat,” she said. As 25 pounds slid away over six months, she felt less tired and found herself walking and biking more.

Then her Medicare plan notified her that it would no longer cover the drug. Calls and letters from her health care team, arguing that Ozempic was necessary for her health, had no effect.

With coverage denied, Bucklew became part of an unsettlingly large group: older adults who begin taking GLP-1s and related drugs — highly effective for diabetes, obesity, and several other serious health problems — and then stop taking them within months.

That usually means regaining weight and losing the associated health benefits, including lower blood pressure, cholesterol, and A1c, a measure of blood sugar levels over time.

Widely portrayed as wonder drugs, semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Zepbound, Mounjaro), and related medications have transformed the treatment of diabetes and obesity.

The FDA has approved several GLP-1s for additional uses, too — including to treat kidney disease and sleep apnea, and prevent heart attacks and strokes.

“They’re being studied for every purpose you can conceive of,” said Timothy Anderson, a health services researcher at the University of Pittsburgh and author of a recent JAMA Internal Medicine editorial about anti-obesity medications.

(Drug trials have found no impact on dementia, however.)

People 65 and older represent prime targets for such medications. “The prevalence of obesity hovers around 40%” in older adults, as measured by body mass index, said John Batsis, a geriatrician and obesity specialist at the University of North Carolina School of Medicine.

The proportion of people with Type 2 diabetes rises with age, too, to nearly 30% at age 65 and older. Yet a recent JAMA Cardiology study found that among Americans 65 and up with diabetes, about 60% discontinued semaglutide within a year.

Another study of 125,474 people with obesity or who are overweight found that almost 47% of those with Type 2 diabetes and nearly 65% of those without diabetes stopped taking GLP-1s within a year — a high rate, said Ezekiel Emanuel, a health services researcher at the University of Pennsylvania and senior author of the study.

Patients 65 and older were 20% to 30% more likely than younger ones to discontinue the drugs and less likely to return to them.

What explains this pattern? As many as 20% of patients may experience gastrointestinal problems. “Nausea, sometimes vomiting, bloating, diarrhea,” Anderson said, ticking off the most common side effects.

Linda Burghardt, a researcher in Great Neck, New York, started taking Wegovy because her doctor thought it might reduce arthritis pain in her knees and hips. “It was an experiment,” said Burghardt, 79, who couldn’t walk far and had stopped playing pickleball.

Within a month, she suffered several bouts of stomach upset that “went on for hours,” she said. “I was crying on the bathroom floor.” She stopped the drug.

Some patients find that medication-induced weight loss lessens rather than improves fitness, because another side effect is muscle loss. Several trials have reported that 35% to 45% of GLP-1 weight loss is not fat, but “lean mass” including muscle and bone.

Bill Colbert’s cherished hobby for 50 years, reenacting medieval combat, involves “putting on 90 pounds of steel-plate armor and fighting with broadswords.” A retired computer systems analyst in Churchill, Pennsylvania, he started on Mounjaro, successfully lowered his blood glucose, and lost 18 pounds in two months.

But “you could almost see the muscles melting away,” he recalled. Feeling too weak to fight well at age 78, he also discontinued the drug and now relies on other diabetes medications.

“During the aging process, we begin to lose muscle,” typically half a percent to 1% of muscle weight per year, said Zhenqi Liu, an endocrinologist at the University of Virginia who studies the effects of weight loss drugs. “For people on these medications, the process is much more accelerated.”

Losing muscle can lead to frailty, falls, and fractures, so doctors advise GLP-1 users to exercise, including strength training, and to eat enough protein.

The high rate of GLP-1 discontinuation may also reflect shortages; from 2022 to 2024, these drugs temporarily became hard to find. Further, patients may not grasp that they will most likely need the medications indefinitely, even after they meet their blood glucose or weight goals.

Re-initiating treatment involves its own hazards, Batsis cautioned. “If weight goes up and down, up and down, metabolically it sets people up for functional decline down the road.”

Of course, in considering why patients discontinue, “a large part of it is money,” Emanuel said. “Expensive drugs, not necessarily covered” by insurers. Indeed, in a Cleveland Clinic study of patients who discontinued semaglutide or tirzepatide, nearly half cited cost or insurance issues as the reason.

Some moderation in price has already occurred. The Biden administration capped out-of-pocket payments for all prescriptions that a Medicare beneficiary receives ($2,100 is the 2026 limit), and authorized annual price negotiations with manufacturers.

The reductions include Ozempic, Wegovy, and Rybelsus, though not until 2027. Medicare Part D drug plans will then pay $274, and since most beneficiaries pay 25% in coinsurance, their out-of-pocket monthly cost will sink to $68.50.

Perhaps even lower, if agreements announced in November between the Trump administration and drugmakers Eli Lilly and Novo Nordisk pan out.

The bigger question is whether Medicare will amend its original 2003 regulations, which prohibit Part D coverage for weight loss drugs. “An archaic policy,” said Stacie Dusetzina, a health policy researcher at the Vanderbilt University School of Medicine.

The Trump administration’s November announcement would expand Medicare eligibility for GLP-1s and related medications to include obesity, perhaps as early as spring. But key details remain unclear, Dusetzina said.

Medicare should cover anti-obesity drugs, many doctors argue. Americans still tend to think that “diabetes is a disease and obesity is a personal problem,” Emanuel said. “Wrong. Obesity is a disease, and it reduces life span and compromises health.”

But given the expense to insurers, Dusetzina warned, “if you expand the indications and extent of coverage, you’ll see premiums go up.”

For older patients, often underrepresented in clinical trials, questions about GLP-1s remain. Might a lower maintenance dose stabilize their weight? Can doses be spaced out? Could nutritional counseling and physical therapy offset muscle loss?

Bucklew, whose coverage was denied, would still like to resume Ozempic. But because of a recent sleep apnea diagnosis, she now qualifies for Zepbound with a $50 monthly copay.

She has seen no weight loss after three months. But as the dose increases, she said, “I’ll stay the course and give it a shot.”

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Barbara, 82, has chronic obstructive pulmonary disease, so a portable oxygen tank accompanies her everywhere. Spinal stenosis limits her mobility, necessitating the walkers and wheelchairs and considerable help from her husband, Dennis, who serves as her primary caregiver.

“I know I need hearing aids,” Barbara added. “My hearing is horrible.” She acquired a pair a few years ago but rarely uses them.

Dennis Meade, 86, is more mobile, despite arthritis pain in one knee, but contends with his own hearing problems. Similarly dissatisfied with the hearing aids he once bought, he said, “I just got to the point where I say, ‘Talk louder.’”

But if you ask either of them a question included on a recent University of Michigan survey — “Do you identify as having a disability?” — the Meades answer promptly: No, they don’t.

Disability “means you can’t do things,” Dennis said. “As long as you can work with it and it’s not affecting your life that much, you don’t consider yourself disabled.”

Their daughter Michelle Meade, a rehabilitation psychologist and the director of the Center for Disability Health and Wellness at the university, accompanies her parents to medical appointments and tends to roll her eyes at their reluctance to acknowledge needing support.

Working with other researchers on the recent national poll has shown her how often older adults feel that they are not disabled despite ample evidence to the contrary.

The survey looked at nearly 3,000 Americans aged 50 and older and found that only a minority — fewer than 18% of participants over 65 — saw themselves as having a disability.

Yet their responses to the six questions that the Census Bureau’s American Community Survey uses to track disability rates told a different story.

The survey asks whether respondents have difficulty seeing or hearing, limitations in walking or climbing stairs, difficulty concentrating or remembering, trouble dressing or bathing, difficulty working, or problems leaving the home.

In the university’s survey, about a third of those aged 65 to 74 reported difficulty with one or more of those functions. Among those over 75, the figure was more than 44%.

Moreover, when respondents were asked about several additional health conditions that would require accommodations under the Americans with Disabilities Act, including respiratory problems or speech disorders, the proportion climbed even higher. Half the 65-to-74 group reported disabilities, as did about two-thirds of those over 75.

Yet only a sliver — fewer than 1 in 5 — of older adults had ever received an accommodation from their health care providers to which they are legally entitled under the ADA.

Even among the small minority who identified as disabled, only a quarter had asked for an accommodation (though a third received one, whether they asked or not).

“It’s a familiar story,” said Megan Morris, a rehabilitation researcher at NYU Langone Health and director of the Disability Equity Collaborative. When it comes to the way people describe themselves, “many people still feel like ‘disability’ is a dirty word,” she said.

It’s almost an American value to decline to seek help, even when the law requires that it be available, Michelle Meade added. Faced with a disability, she said, “we’re supposed to toughen up and battle through it.”

That may be particularly true among older Americans whose attitudes formed before the landmark ADA became law in 1990, or even before the 50-year-old Individuals With Disabilities Education Act, which guaranteed access to public education.

“It’s going to be hard for that older generation,” Morris said. “Disability was something that was locked away. Younger folks are more open to seeing disability as being part of a community.”

In the University of Michigan survey, for instance, among people over 65 who had two or more disabilities, about half identified as a person with a disability. In the younger cohort, aged 50 to 64, it was 68%.

Why does that matter? “It greatly assists in health care settings if you disclose a disability and know to request an accommodation and support,” said Anjali Forber-Pratt, the research director at the American Association of Health and Disability.

Such accommodations “can make a stressful situation easier,” she added. They include mammography and X-ray machines that allow patients to remain seated, scales that wheelchair users can roll onto, examination tables that rise and lower so that patients don’t have to step onto a footstool and swivel around.

Health care providers may also offer amplification devices for people with hearing loss, as well as magnifiers and large print materials for the visually impaired. Buildings themselves must be accessible. Practices can send a staff member with a wheelchair to help patients traverse long distances.

Even with a disability parking placard, “you hike in, you wait for the elevator, you hike to the office,” said Emmie Poling, 75, a retired teacher in Menlo Park, California.

Because of arthritis and spinal stenosis, “I can’t walk with an upright posture for more than a few minutes” without pain, she said. “I basically live on Tylenol.” Yet when she makes an appointment and the scheduler asks if she will need assistance, Poling replies that she won’t.

“My personal voice says, ‘Come on, you can do it,’” she said.

Identifying as a person with a disability provides other benefits, advocates say. It can mean avoiding isolation and “being part of a community of people who are good problem-solvers, who figure things out and work in partnership to do things better,” Meade said.

Government programs and private organizations like the National Disability Rights Network, the Americans with Disabilities Act National Network, and the National Association of Councils on Developmental Disabilities help connect people with services and supports in their communities.

Several studies have found, too, that patients who identify as disabled have less depression and anxiety, higher self-esteem, and a greater sense of “self-efficacy” than disabled people who don’t.

For years, despite a lifetime of surgeries for congenitally dislocated hips, as well as joint replacements and cancer treatment, Glenna Mills, an artist in Oakland, California, told herself that she was not disabled.

“I suffered a lot by denying that I couldn’t walk very far,” she recalled. Although walking caused pain in her knees, hips, and shoulders, “I didn’t want people to see me as someone who couldn’t keep up,” she added.

But about 10 years ago, “I stopped worrying about that,” said Mills, 82. “I was more willing to say, ‘I can’t do that activity. I can’t walk that far.’” She bought a scooter that allowed her to take walks with her husband and dog, and to spend time in museums. “I’m happier now,” she said.

More often, older Americans resist a label that could help improve their care. Even those who do request accommodations may find that enforcement of the ADA remains spotty, in part because patients don’t always report violations.

The Meades, after years of pleading from their children, have made appointments to see an audiologist about new hearing aids.

But Poling intends to struggle on without seeking or accepting assistance. “I know that point will come,” she said. “I’ll attempt to surrender as gracefully as possible, given my personality.”

Until then, she said, “the mental picture that’s acceptable to me is not wanting to look like I’m disabled.”

The New Old Age is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Ambos pacientes, un hombre y una mujer, habían aceptado donar sus cerebros a la investigación. “Un regalo increíble”, dijo el doctor Edward Lee, neuropatólogo y director del banco de cerebros de la Escuela de Medicina Perelman de la universidad. “Ambos estaban muy comprometidos con ayudarnos a entender la enfermedad de Alzheimer”.

El hombre, que murió a los 83 años con demencia, vivía con cuidadores contratados en el vecindario de Center City, en Philadelphia. La autopsia mostró grandes cantidades de placas de amiloide y ovillos de tau —las proteínas asociadas con el Alzheimer— que se habían extendido por su cerebro.

Los investigadores también hallaron infartos, pequeños puntos de tejido dañado, lo que indicó que había sufrido varios derrames cerebrales.

En contraste, la mujer, que murió a los 84 años a causa de un cáncer cerebral, “casi no tenía signos de Alzheimer”, dijo Lee. “Le hicimos pruebas año tras año y nunca presentó problemas cognitivos”.

El hombre vivía a unas pocas cuadras de la autopista interestatal 676, que atraviesa el centro de Philadelphia. La mujer, a varias millas, en el suburbio de Gladwyne, rodeada de bosques y un club de campo.

La cantidad de contaminación del aire a la que ella estuvo expuesta —específicamente, el nivel de partículas finas conocido como PM2.5— fue menos de la mitad de la que recibió el hombre. ¿Fue coincidencia que él desarrollara Alzheimer severo y ella mantuviera una cognición normal?

Probablemente no, considerando la creciente evidencia de que la exposición crónica a PM2.5 —un neurotóxico— no solo daña pulmones y corazones, sino que también está relacionado con la demencia.

“La calidad del aire donde vives afecta tu cognición”, dijo Lee, autor principal de un artículo reciente publicado en JAMA Neurology, uno de varios estudios de gran escala publicados en los últimos meses que muestran una asociación entre el PM2.5 y la demencia.

Los científicos han estado analizando esta conexión por al menos una década. En 2020, la influyente Comisión Lancet (Lancet Commission) incluyó la contaminación del aire en su lista de factores de riesgo modificables para la demencia, junto con problemas comunes como la pérdida de audición, la diabetes, el tabaquismo y la presión arterial alta.

Estos hallazgos están surgiendo justo cuando el gobierno federal está desmantelando medidas adoptadas por administraciones anteriores para reducir la contaminación del aire mediante la transición de combustibles fósiles a fuentes de energía renovables.

“‘Perforar, bebé, perforar’ es completamente el enfoque equivocado”, dijo el doctor John Balmes, vocero de la American Lung Association e investigador de los efectos de la contaminación del aire en la salud en la Universidad de California en San Francisco.

“Todas estas decisiones van a reducir la calidad del aire y aumentar la mortalidad y las enfermedades. La demencia es una de esas consecuencias”, agregó Balmes, en referencia a las recientes medidas ambientales adoptadas por la Casa Blanca.

Por supuesto, hay muchos factores que contribuyen a la demencia. Pero el papel de las partículas —sólidas o gotitas microscópicas presentes en el aire— está recibiendo cada vez más atención.

Estas partículas provienen de muchas fuentes: emisiones de plantas eléctricas y calefacción residencial, gases industriales, escapes de vehículos y, cada vez más, humo de incendios forestales.

De los distintos tamaños de partículas, el PM2.5 “parece ser el más perjudicial para la salud humana”, dijo Lee, porque es de los más pequeños. Se inhala con facilidad, entra al torrente sanguíneo y circula por todo el cuerpo; también puede viajar directamente de la nariz al cerebro.

La investigación de la Universidad de Pennsylvania, el estudio de autopsias más grande hasta la fecha en personas con demencia, incluyó más de 600 cerebros donados a lo largo de dos décadas.

Investigaciones anteriores sobre la relación entre contaminación y demencia se habían basado principalmente en estudios epidemiológicos. Ahora, “estamos conectando lo que realmente vemos en el cerebro con la exposición a contaminantes”, explicó Lee. “Estamos profundizando más”.

Los participantes del estudio se habían sometido a años de pruebas cognitivas en el Centro de Memoria Penn. Gracias a una base de datos del medio ambiente, los investigadores pudieron calcular su exposición a PM2.5 según las direcciones de sus viviendas.

Los científicos también desarrollaron una matriz para medir la gravedad del daño cerebral causado por el Alzheimer y otras demencias.

El equipo de Lee concluyó que “cuanto mayor la exposición a PM2.5, mayor el grado de enfermedad de Alzheimer”, dijo. Las probabilidades de encontrar un Alzheimer más severo en la autopsia fueron casi 20% mayores entre quienes vivían en zonas con altos niveles de PM2.5.

Otro equipo de investigación reportó recientemente una conexión entre la exposición al PM2.5 y la demencia con cuerpos de Lewy, que incluye la demencia relacionada con la enfermedad de Parkinson. Generalmente considerada como el segundo tipo más común después del Alzheimer, la demencia con cuerpos de Lewy representa un estimado de 5% a 15% de los casos.

En el que se considera el estudio epidemiológico más grande hasta ahora sobre contaminación y demencia, los investigadores analizaron los registros de más de 56 millones de personas beneficiarias del programa tradicional de Medicare entre los años 2000 y 2014, comparando sus primeras hospitalizaciones por enfermedades neurodegenerativas con los niveles de PM2.5, según los códigos postales.

“La exposición crónica a PM2.5 estuvo asociada con hospitalizaciones por demencia con cuerpos de Lewy”, dijo Xiao Wu, autor del estudio y bioestadístico de la Escuela de Salud Pública Mailman de la Universidad de Columbia.

Después de controlar diferencias socioeconómicas y otros factores, los investigadores hallaron que la tasa de hospitalización por esta causa era 12% mayor en los condados de Estados Unidos con las peores concentraciones de PM2.5 en comparación con los que tenían los niveles más bajos.

Para ayudar a confirmar sus hallazgos, los investigadores administraron PM2.5 por vía nasal a ratones de laboratorio, los cuales, después de 10 meses, mostraron “claros déficits similares a los de la demencia”, escribió por correo electrónico el autor principal, Xiaobo Mao, neurocientífico de la Escuela de Medicina de la Universidad Johns Hopkins.

Los ratones se perdían en laberintos que antes recorrían con facilidad. Antes construían sus nidos de manera rápida y ordenada; después de la exposición los hacían de forma descuidada y desorganizada. En la autopsia, dijo Mao, sus cerebros mostraban atrofia y acumulaciones de la proteína alfa-sinucleína, asociada con los cuerpos de Lewy en cerebros humanos.

Un tercer análisis, publicado este verano en The Lancet, incluyó 32 estudios realizados en Europa, América del Norte, Asia y Australia. También halló que “un diagnóstico de demencia se asocia significativamente con la exposición prolongada al PM2.5” y a ciertos otros contaminantes.

Si la contaminación del aire exterior —la llamada contaminación ambiental— aumenta el riesgo de demencia por inflamación u otros mecanismos fisiológicos, es una pregunta que aún necesita más investigación para responderse.

Aunque la contaminación del aire ha disminuido en Estados Unidos en las últimas dos décadas, los científicos piden políticas aún más estrictas para promover un aire más limpio. “La gente dice que mejorar la calidad del aire es caro”, comentó Lee. “También lo es el cuidado de personas con demencia”.

Sin embargo, el presidente Donald Trump volvió al poder con la promesa de aumentar la extracción y el uso de combustibles fósiles, y de frenar la transición hacia las energías renovables. Su administración eliminó los incentivos fiscales para instalaciones solares y vehículos eléctricos, señaló Balmes, y agregó: “Están promoviendo continuar con la quema de carbón para la generación de energía”.

El gobierno también frenó nuevos proyectos de energía eólica marina, anunció perforaciones de petróleo y gas en el Refugio Nacional de Vida Silvestre del Ártico, en Alaska, y tomó medidas para detener el plan de California de hacer la transición a autos eléctricos para 2035. (El estado impugnó esa acción en los tribunales).

“Si las políticas van en la dirección opuesta, con más contaminación del aire, eso representa un gran riesgo para la salud de las personas mayores”, advirtió Wu.

El año pasado, durante la administración Biden, la Agencia de Protección Ambiental (EPA) estableció estándares anuales más estrictos para el PM2.5, señalando que “la evidencia científica disponible y la información técnica indican que los estándares actuales podrían no ser adecuados para proteger la salud pública y el bienestar, como lo exige la Ley de Aire Limpio (Clean Air Act)”.

En marzo, el nuevo director de la EPA anunció que la agencia “volvería a evaluar” esos estándares más estrictos.

The New Old Age se produce a través de una alianza con The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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