5 Questions with Yuchi Young: Aging and Long-Term Care
ALBANY, N.Y. (Dec. 2, 2022) - Yuchi Young is an associate professor in the Department of Health Policy, Management and Behavior whose work focuses on health outcome evaluation and long-term care in the aging population. We sat down with her to learn more about her work and recent changes in long-term care and aging.
How did you become interested in aging and long-term care?
When I was younger, I noticed older adults had different features, traits, and characteristics. They were thin, frail, and vulnerable as they took their time to get up from a chair, leaned on a walking stick, and often had a shuffling walk. They were slow, but calm and wise.
In graduate school, the classes I found most interesting related to the aging population and long-term care. For example, I enjoyed a course called “epidemiology of aging” which described different aging populations and the conditions which accompany aging, like high blood pressure, hip fracture, and dementia. I also enjoyed the biology of aging and the continuum of long-term care options. I could relate to my coursework because I had paid attention to older adults as a child. The memories I carried with me connected me to my work and prompted me to dive into this area more.
Why is this area of public health so important for us to study?
Who will take care of older adults? The growing proportion of the aging population, increased life expectancy, and low birth rates lead to significant issues related to long-term care services, financing mechanisms, and the health workforce shortage.
The disease burden of Alzheimer’s disease & dementia (AZ/D) is multi-dimensional. Increasing age is associated with a higher prevalence of AZ/D. These patients suffer progressive cognitive, behavioral, and functional impairments, which results in a heavy burden to patients, families, their caregivers, and the healthcare system. The costs of long-term care associated with AZ/D are prohibitive. Given the shortage of direct care workers, individuals with AZ/D will rely more on informal caregivers, AI, and assistive robots.
Can you tell us a little bit about one of your current projects?
Work-related injuries among direct care workers in long-term care settings are common. About 70-80% of the 4,500,000 direct care workers are home health aides, personal care aides, and certified nursing aids who provide the majority of long-term care to persons with disabilities. Their work involves helping with daily tasks (e.g., changing clothes and bathing). These daily tasks require repetitive heavy lifting and transferring, often leading to work-related injuries. OSHA estimated the cost associated with workers’ compensation alone to be more than $50 billion annually, yet, work-related injuries are potentially preventable. Using sensors that track movement, we found that workers often used risky lifting techniques despite having gone through training. We continue to collect data and develop algorithms to calculate metrics in real-time. The ultimate goal is to develop wearable technology to prevent unnecessary work-related injuries among direct care workers.
How has the pandemic changed aging and long-term care?
The COVID-19 pandemic has created tremendous pressure on our healthcare system, but the most tragic impact has been on long-term care services. Although COVID-19 has affected individuals of all ages, older adults in nursing homes experienced much higher infection and mortality rates. The risk curve is shaped like a hockey stick—older adults age 85+ were 340 times more likely to die than a young adult. Nursing home residents are particularly vulnerable to infection due to their older age, comorbidities, and immunocompromised conditions, complicated by a group setting environment that limits their ability to practice social distancing. Yet, when hospital ICU and emergency departments become swamped with COVID-19 cases, many nursing homes created COVID-19 isolation units to absorb patients leaving hospitals. The pandemic taught us that long-term care is an integral part of the healthcare continuum and is not a stepchild of the acute care-oriented healthcare system. The COVID-19 pandemic provides an opportunity to modernize the long-term care infrastructure, financing, and service delivery.
What changes would you like to see in terms of aging and long-term care?
Improving the quality of long-term care and services to people with functional disabilities and cognitive functional impairments is a top priority. Quality of long-term care requires better educated, better-trained, and better-paid direct care workers; these include home health aides, personal care aides, and certified nursing aids who provide the majority of long-term care services related to daily tasks to maintain independent living. Without proper education and training and better financial incentives, expectation and demand for quality long-term care from the frontline direct care workers is a pie in the sky, and this is a health delivery system failure.