The Silent Crisis: Addressing Behavioral Health Challenges Among Older Adults

As the older generation continues to age, the demographic landscape of the United States is shifting dramatically. As of 2024, there are currently approximately 62 million adults ages 65 and older living in the U.S., according to the research released by the Pew Research Center, leading to Older adults now making up over 18 percent of the population.  Recent studies predict that the U.S. Centenarian population is expected to quadruple over the next 30 years and with this growth comes a critical need to address their behavioral health concerns. The recent SAMHSA report, “Behavioral Health among Older Adults: Results from the 2021 and 2022 National Surveys on Drug Use and Health,” sheds light on the pressing issues of substance use and mental health in this age group, revealing a silent crisis that demands our attention.

Unveiling the Statistics

The SAMHSA report provides a comprehensive analysis of substance use and mental health issues among older adults. According to the report, approximately 12.5% of older adults had a mental illness in the past year, with serious mental illness affecting around 2%. Substance use disorders were prevalent in 9.1% of this population, with 5.6% experiencing alcohol use disorder and 4.1% facing drug use disorder.

  • About 1 in 25 older adults had a drug use disorder (DUD) in the past year.
  • Fewer than 1 in 3 older adults that were classified as needing substance use treatments actually received it.
  • Of the older adults that received substance use treatments, nearly all (97%) did not think they needed it.
  • 2.7 million older adults had a major depressive episode in the past year, with females being twice as likely to experience one over their male counterparts.
  • About 1 in 50 older adults had serious thoughts of suicide in the past year.

These statistics are alarming, yet they reflect only a portion of the problem. Older adult females are more likely to suffer from mental illness, while older adult males have higher rates of substance use disorders. This gender disparity underscores the need for tailored interventions that address the specific needs of men and women in this age group.

Barriers to Treatment

Despite the high prevalence of mental health and substance use disorders, treatment remains elusive for many older adults. The SAMHSA report highlights that fewer than one-third of older adults who needed substance use treatment received it in the past year. Similarly, only about 46% of those living with any mental illness received treatment.

Several factors contribute to this treatment gap. Medical conditions associated with aging, significant life changes, and social isolation can exacerbate mental health issues. Additionally, stigma, cost, transportation difficulties, and challenges navigating the healthcare system pose significant barriers to accessing care. As noted in the report, “Older adults who might benefit from treatment also typically did not perceive that they needed it.”

The Impact of Loneliness

Loneliness is a significant concern for older adults, as highlighted in both the SAMHSA report and a study by researchers at the Indiana University School of Medicine. The study found that loneliness is significantly associated with lower mental and physical quality of life among older adults. This finding aligns with the broader themes of the SAMHSA report, which emphasizes the adverse effects of social isolation on mental health.

The U.S. Surgeon General’s 2023 report on social connection further underscores the importance of addressing loneliness. It emphasizes the need for supportive connections, including friendships, community involvement, and the mental health benefits of connecting with pets. As we celebrated the first inauguration of Older Americans Month in May, this year’s theme, “Powered by Connection,” aptly highlights the multifaceted benefits of social interactions.

Gender Differences in Behavioral Health

The SAMHSA report and other studies consistently show gender differences in behavioral health among older adults. Women are more likely to experience mental health issues, while men have higher rates of substance use disorders. Understanding these differences is crucial for developing effective interventions.

In a comprehensive review by the University  of St. Augustine for Health Sciences (USAHS), it was noted that “33.5% of adults with a mental illness also reported a substance use disorder in 2021.” This statistic highlights the complex interplay between mental health and substance use, particularly among older adults. Addressing these co-occurring disorders requires a holistic approach that considers both mental and physical health.

The Role of Primary Care

Primary care clinicians play a pivotal role in addressing the behavioral health needs of older adults. As suggested by the Indiana University study, clinicians should actively discuss loneliness with their older patients and provide resources to help them develop and maintain meaningful social relationships. This proactive approach can help mitigate the adverse effects of loneliness and improve overall mental health.

Moving Forward

Addressing the behavioral health challenges among older adults requires a multifaceted approach that includes increasing awareness, reducing stigma, and improving access to care. Service providers must focus on:

  1. Education and Awareness: Educating older adults about the risks of substance use and the importance of mental health care is crucial. Reducing stigma around these issues can encourage more individuals to seek help.
  2. Improving Access: Addressing barriers such as cost, transportation, and healthcare navigation is essential to ensure that older adults receive the care they need.
  3. Targeted Interventions: Developing interventions tailored to high-risk groups, particularly older males for substance use disorders and older females for mental health issues, can help mitigate these problems effectively.
  4. Support for Caregivers: Providing resources and support for caregivers is vital, as they play a key role in the well-being of older adults.

As the population of older adults continues to grow, addressing their behavioral health needs becomes increasingly urgent. By understanding and addressing the challenges highlighted in the SAMHSA report and other studies, we can improve the quality of life for this vulnerable population and ensure they receive the care and support they deserve.


Navigating the Delicate Balance: Antihypertensive Medications and the Risk of Falls and Fractures in Older Adults

In the intricate landscape of older adult care, the management of hypertension presents a significant challenge, especially when weighed against the risks of falls and fractures. Recent studies have shed light on the delicate balance healthcare providers must maintain to safeguard the health of older adults, particularly those residing in long-term care centers and those with dementia.

Elevated Risks with Antihypertensive Medications

A comprehensive study published in JAMA Internal Medicine highlights a stark reality: aging adults in long-term care centers who start antihypertensive medications face significantly higher risks of falls and fractures. This study, involving data from over 29,000 older adults in long-term care centers in the Veterans Health Administration, revealed that the incidence rate of fractures in those initiating antihypertensive therapy was 5.4 per 100 person-years, compared to just 2.2 in those not on these medications.

Dr. Muna Thalji Canales, a researcher at the Malcom Randall VA Medical Center, emphasized the need for caution. “Ultimately, the question of how to treat blood pressure in older adults remains one that must be individualized,” she noted. The study’s findings underscore the necessity for additional monitoring and a tailored approach when managing hypertension in this vulnerable population.

Specific Vulnerabilities: Dementia and Blood Pressure Thresholds

The risks are particularly pronounced among older adults with dementia. The same study found that for those with dementia, the hazard ratio for fractures skyrocketed to 3.28. Additionally, older adults with systolic blood pressure of 140 mm Hg or higher and diastolic blood pressure of 80 mm Hg or higher faced even greater risks, with hazard ratios of 3.12 and 4.41, respectively.

These statistics are echoed in multiple other studies, including one from HCPLive, which linked antihypertensive medication with an increased fracture risk among older adults. Similarly, research published in Wiley Online Library highlighted that hypertensive older adults are at a heightened risk of falls and fractures following the initiation of these drugs.

Practical Implications for Long-term Care Centers

The practical implications of these findings are profound. As Dr. Thalji Canales suggests, healthcare practitioners in long-term care centers should avoid rapid intensification of antihypertensive medication, allowing at least a month for older adults to acclimate to new doses. Monitoring orthostatic vitals around changes in blood pressure management, particularly in the first week, is also recommended. However, these ideal practices often face the harsh reality of limited staffing and resources in many long-term care centers.

A study published on BMJ Open supports these recommendations, showing that older adults face an increased risk of injurious falls when initiating antihypertensive medication. The necessity for continuous and thorough medication management cannot be overstated, especially in settings where older adults safety is paramount.

Balancing Benefits and Risks

The overarching theme across these studies is the critical need to balance the benefits of antihypertensive medications against their potential risks. While controlling high blood pressure is essential to prevent strokes and other cardiovascular events, the accompanying increase in fall and fracture risks must be carefully managed.

A thought-provoking commentary in Pharmacy Times stresses the importance of reviewing older adults histories before prescribing antihypertensive medications. This step is crucial to tailor treatment plans, a primary tenet of person-centered care, that minimize risks while effectively managing hypertension.

Moving Forward: Individualized Care Plans

The path forward involves a commitment to individualized care plans, where the unique health profiles and needs of older adults are meticulously considered. Healthcare providers must be person-centered focused, and vigilant in monitoring and adjusting treatment plans, ensuring that the initiation of antihypertensive medication does not inadvertently compromise patient safety.

In conclusion, the intersection of antihypertensive medication use and fall/fracture risks in older adults, especially those living with dementia, highlights a critical area of older adult care. By embracing a patient-centric approach and advocating for the necessary resources and staffing, we can better navigate this delicate balance, ultimately enhancing the quality of life and safety for our elderly population.


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Combatting Food Insecurity: How Medically Tailored Meals Transform Lives of Older Adults

In a country where food insecurity remains a persistent issue, particularly among older adults, initiatives like Mom’s Meals’ recent donation of 30,000 medically tailored meals are beacons of hope. This donation, part of the Hunger Challenge initiative, is more than a charitable act—it’s a strategic move to address a critical social determinant of health.

The Food Insecurity Challenge

Food insecurity is a widespread problem in the United States, affecting millions of households, including a significant number of older adults. According to the Food Research & Action Center (FRAC), older adults, especially those aged 50-59, face higher rates of food insecurity than those aged 65 and older. Structural factors, such as systemic racism, exacerbate these disparities, particularly among Black, Latinx, and LGBT older adults.

“Health care providers recognize the critical role of food security in patient health,” notes a FRAC survey, highlighting that nearly all respondents agreed that screening for food insecurity is important, and that it contributes to poor health outcomes among older adults.

Medically Tailored Meals: A Proven Solution

Medically tailored meals (MTMs) are designed to meet the specific dietary needs of individuals with chronic illnesses. These meals are not just about providing calories—they ensure recipients get the necessary nutrients to manage their health conditions effectively.

A study published in the Journal of General Internal Medicine showed that for food-insecure individuals with diabetes, medically tailored meals improved dietary quality, reduced food insecurity, and decreased hypoglycemia incidents. The meals were customized to the medical needs of each participant, demonstrating significant health benefits.

“Medically tailored meals go further,” says a report from Meals on Wheels, “providing nutritional support that aids in patient recovery and helps older adults maintain their independence.”

Bridging the Gap with Public-Private Partnerships

Mom’s Meals’ initiative underscores the importance of public-private partnerships in tackling food insecurity. Chris Choi, CEO of Mom’s Meals, emphasizes this point: “Private-public partnerships are really critical. We’re trying to work more closely with government leaders to provide more coverage and access to nutrition.”

Federal initiatives, like the Food is Medicine project by the Department of Health and Human Services (HHS), are pivotal in integrating nutrition into healthcare systems. These initiatives recognize that access to nutritious food is essential for health and resilience, a concept Mom’s Meals is putting into practice with their donation.

The Broader Impact on Healthcare

Addressing food insecurity through medically tailored meals has broader implications beyond individual health benefits. Research shows that food insecurity leads to increased use of health services. By providing nutritious meals, healthcare costs associated with diet-related diseases can be reduced significantly.

The FRAC survey found that healthcare providers need more support, including training on connecting patients to nutrition programs and resources, integrating screening efforts into electronic health records, and securing funding for food insecurity interventions.

A Call to Action

The commitment of Mom’s Meals to donate 30,000 meals—more than double their previous year’s contribution—highlights the growing recognition of the role nutrition plays in healthcare. It is a call to action for more stakeholders to join the fight against food insecurity.


Medically tailored meals represent a critical intervention for food-insecure older adults, offering a lifeline that supports their health and independence. Initiatives like those by Mom’s Meals, backed by strategic public-private partnerships and robust policy support, are essential to addressing this pressing issue. As we look towards a future where food is recognized as medicine, it is clear that these efforts are not just beneficial—they are vital.

By recognizing the profound impact of medically tailored meals, we can better support our aging population, ensuring that no one has to choose between hunger and health.


  1. Food Research & Action Center. (2023). Addressing Food Insecurity Among Older Adults: Health Care Provider Beliefs, Practices, and Resources Needed. Retrieved from FRAC Report.
  2. Meals on Wheels People. (2024, February). Medically Tailored Meals Aid Patient Recovery. Retrieved from Meals on Wheels People.
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  4. Food Research & Action Center. (2017). Hunger & Health: The Impact of Poverty, Food Insecurity, and Poor Nutrition on Health and Well-Being. Retrieved from FRAC Report.
  5. Meals on Wheels America. (2023). An Evidence-Based Solution to Senior Hunger and Isolation. Retrieved from Meals on Wheels America.

Transcranial Direct Current Stimulation: A Beacon of Hope for Older Adult Mental Health

In the older years of life, when the mind should be free to enjoy peace and wisdom, many older adults find themselves battling the shadows of depression and anxiety. The conventional arsenal of medications often brings a slew of unwelcome side effects, leaving a growing number of older adults and their caregivers desperate for safer, more effective treatments. This is where transcranial direct current stimulation (tDCS) has really shined brightly—a groundbreaking approach that illuminates a new path forward in mental health care for older adults. This innovative therapy promises to ease the burdens of mental health symptoms with minimal side effects, offering not just relief but also renewed hope to those who have often felt overlooked by traditional psychiatric interventions.

The Promise of tDCS: A Closer Look at Its Impact on Older Adult Mental Health

Imagine a treatment as straightforward as sitting comfortably while a device gently stimulates the brain through electrodes placed on the head. This is the reality of transcranial direct current stimulation (tDCS), a method that’s both non-invasive and surprisingly simple. It uses a steady, low level of electrical current to subtly enhance brain activity, specifically targeting the areas that influence mood and cognitive function.

tDCS works by modulating the activity of neurons—the brain’s nerve cells responsible for transmitting information throughout the body. By adjusting how excitable these neurons are, tDCS can potentially alleviate symptoms of mental disorders like depression and anxiety, conditions that disproportionately affect older adults.

Consider the example of an older adult woman, once vibrant and social, who began to withdraw and succumb to the symptoms of depression. Traditional medications may have offered some relief but at the cost of side effects like fatigue and confusion. tDCS presents a different option. In a significant study conducted by the University of Florida, researchers demonstrated how regular sessions of tDCS over several weeks could lead to notable improvements. Participants, much like our example subject, reported feeling brighter and more engaged with life, without the side effects typical of conventional drugs.

Published in the respected journal Brain Stimulation, this study is not an isolated case of academic interest but a beacon of practical hope. It suggests that with regular application, tDCS could help restore a level of mental wellness that many older adults thought was lost, offering them a chance to live their later years with improved emotional health and greater cognitive clarity. This type of therapy could be a game-changer, making daily life not enjoyable again for many older adults.

Integrating Mindfulness and tDCS: A Dual Approach to Enhancing Older Adult Care

Innovations in treating mental health often come from combining tried and true methods with new technologies. One such promising combination is integrating mindfulness-based stress reduction (MBSR) with transcranial direct current stimulation (tDCS). Here’s how this integration can make a real-world difference, especially for older adults.

Understanding the Components:

  • Mindfulness-Based Stress Reduction (MBSR): This technique involves guided activities like meditation and yoga to promote mindfulness—a mental state of awareness and calm achieved by focusing one’s awareness on the present moment. For older adults, this can mean better stress management, less anxiety, and a decrease in depressive symptoms.
  • Transcranial Direct Current Stimulation (tDCS): As previously described, tDCS uses a low-level electric current to stimulate specific parts of the brain. This can enhance neuronal activity, leading to improved mood and cognitive function.

Imagine combining these two approaches. For example, consider an older man dealing with anxiety and memory issues. Traditional therapy sessions might help, but he continues to struggle with day-to-day stress and forgetfulness. By participating in a program that combines mindfulness exercises, which ground him in the present moment, with tDCS, which actively enhances brain function, he experiences a more robust improvement in his mental health and cognitive abilities.

Evidence from Research: A study highlighted in the journal Mindfulness shows that when these two methods are combined, they not only complement each other but may also amplify each other’s effects. The research observed that participants who engaged in both MBSR and tDCS showed more significant improvements in handling stress, reducing anxiety, and lifting depressive moods compared to those who only received one of the treatments.

This dual approach offers a holistic treatment plan that could be particularly beneficial in older adult care settings. For instance, in a senior living community, implementing a combined MBSR and tDCS program could help older adults manage the emotional challenges of aging while also maintaining their cognitive health.

In essence, this innovative combination leverages the calming, centering effects of mindfulness with the stimulating, mood-enhancing effects of tDCS to offer a comprehensive, non-pharmacological treatment option. It’s a cutting-edge example of how modern science can intersect with traditional wellness practices to support the mental health of the older adult, potentially transforming their quality of life.

Expanding the Horizon: tDCS and Its Broader Impact on Older Adult Mental Health

Transcranial direct current stimulation (tDCS) is not just about alleviating depression and anxiety. It also extends its potential benefits to improving cognitive functions and daily living activities in older adults, addressing a wider spectrum of mental health challenges that often accompany aging.

Cognitive Functions and Daily Activities: Cognitive decline is a common concern in the aging population, affecting memory, problem-solving skills, and the ability to perform daily tasks. tDCS offers a promising solution by stimulating the brain areas involved in cognitive processes.

Real-World Impact: Imagine an aging woman struggling with the early stages of dementia. She finds it challenging to remember names, manage her finances, or keep track of her medications. Traditional treatments might provide limited help, focusing primarily on slowing the progression rather than enhancing her current cognitive abilities.

Research Findings: A study published in Frontiers in Molecular Neuroscience sheds light on how tDCS could be a game changer for such individuals. Researchers observed that beyond managing symptoms like pain and depression, tDCS could notably enhance cognitive functions. This means that for our aging woman example, regular tDCS sessions could lead to improvements in memory and task management, potentially making her daily life both easier and more independent.

Enhancing Daily Living: By improving cognitive functions, tDCS not only helps with mental health but also empowers older adults to perform daily activities with greater competence and confidence. This could range from better management of personal care to improved social interactions, which are crucial for maintaining a high quality of life in older adults.

In essence, tDCS serves as a multifaceted tool that not only addresses primary mental health conditions like depression and anxiety but also enhances cognitive capabilities and daily functioning. This broader approach could significantly improve the overall well-being and autonomy of aging individuals, making it a valuable addition to older adult care programs.

Clinical Trials and Future Research: Shaping the Future of tDCS in Elderly Care

The increasing recognition of transcranial direct current stimulation (tDCS) as a potential tool for improving mental health in older adults has led to a surge in clinical trials. These trials are critical as they help define the most effective ways to use tDCS, from determining the right amount of electrical current (dosage) to figuring out how often sessions should be conducted (session timing).

Importance of Future Research: As noted in a study published in Brain Sciences, the goal of these trials is not just to prove that tDCS works but to establish a standardized way of using it that healthcare providers can reliably follow. This standardization is crucial because it ensures that when tDCS is administered to older adults across different healthcare settings, it is both safe and effective.

Impact on Older Adult Care: The development of a standardized tDCS protocol means that older adults everywhere could have access to a new treatment option that has been rigorously tested and tailored to their needs. This is especially important for those who may not respond well to traditional treatments for depression, anxiety, or cognitive decline.

In summary, ongoing and future clinical trials are essential for fine-tuning tDCS applications, ensuring that as many older adults as possible can benefit from this promising technology. These studies will help integrate tDCS into everyday clinical practice, potentially transforming it into a cornerstone of older adult mental health care.

Conclusion: A Future with Non-Invasive Mental Health Care

The integration of tDCS into mental health care for older adults represents a significant shift towards non-invasive, patient-friendly treatment modalities. As researchers continue to explore and refine this technique, the hope is that tDCS will become a cornerstone treatment that offers new life to those grappling with the challenges of mental health conditions in their later years.

By turning to innovative technologies like tDCS, the medical community can offer solutions that not only alleviate symptoms but also enhance the quality of life for older adults, giving them the dignity and care they deserve in their twilight years. This represents not just a shift in treatment but a transformative approach to caring for our aging population.

As we advance, it is crucial that these innovations are accessible and adapted to the needs of those who stand to benefit the most. The journey of integrating tDCS into mainstream mental health care is just beginning, but the path ahead is bright with promise.


  1. “Efficacy of Transcranial Direct Current Stimulation in Improving Symptoms of Depression in the Elderly.” Brain Stimulation journal. Available online: Brain Stimulation Journal
  2. “The Integration of MBSR and tDCS Could Potentially Enhance the Therapeutic Effects, Providing a Dual Approach That Supports Mental Health in Older Adults.” Mindfulness journal. Available online: Mindfulness Journal
  3. “Potential of tDCS to Improve Cognitive Functions and Daily Living Activities in the Elderly.” Frontiers in Molecular Neuroscience. Available online: Frontiers in Molecular Neuroscience
  4. “Importance of Clinical Trials for Establishing a Standardized Protocol for tDCS Application.” Brain Sciences journal. Available online: Brain Sciences Journal

Enhancing Respect and Appreciation: Strategic Approaches to Boosting Retention of Direct Care Workers in Baltimore

Across the country, the struggle to retain direct care workers in long-term services and supports (LTSS) is reaching a crisis point. This article combines insights from a comprehensive Baltimore-focused report with recent research to explore the complexities behind this workforce crisis.

The Baltimore Report: A Spotlight on Two Key Systemic Issues

The recent report released by the Maryland Regional Direct Services Collaborative offers a framework for improving job quality and creating a highly trained direct care and services workforce for organizations serving older adults across the state of Maryland. This report paints a concerning picture of the challenges faced by direct care workers in Baltimore, emphasizing the harsh realities of inadequate compensation and insufficient staffing. These two key issues are central to understanding the dissatisfaction and high turnover rates in the workforce, a shared sentiment experienced by long-term care providers across the nation.

“There are some sectors of the labor force, however, where short staffing is much more than an inconvenience. One such sector is the subject of this report: the direct care and services workers (DSWs) who serve older adults and individuals with disabilities in long-term services and supports (LTSS) settings.” — Maryland Regional Direct Services Collaborative

Inadequate Compensation: Imagine a scenario where direct care workers are paid less than employees at local retail stores or fast-food restaurants. This comparison is stark in Baltimore, where the pay for these vital healthcare roles often does not meet basic living wage standards. For example, if a direct care worker earns significantly less than what is required to cover basic living costs in the city, they may be forced to work multiple jobs or leave the sector altogether for better-paying opportunities. This not only affects their financial stability but also impacts their ability to provide attentive, consistent care to the elderly.

Poor Staffing Ratios: Consider a nursing home where there are too few caregivers for a large number of older adults. This scenario can lead to each worker being responsible for more older adults than they can feasibly manage, increasing stress and reducing the quality of care. For instance, if a caregiver is overwhelmed, they might have less time to spend with each older adult, potentially overlooking critical needs or changes in health conditions. This can lead to errors, decreased quality of life for older adults, and ultimately, a feeling of dissatisfaction and burnout among workers.

“Nearly all DSWs (direct care and services workers) in these settings report dissatisfaction with staffing ratios. Many say that these low ratios make it very difficult to provide the level of care that they want, or are able, to provide.”— Maryland Regional Direct Services

These systemic issues highlighted in the Baltimore report have direct implications not only for the workers but also for the older adults in their care. When caregivers are underpaid and overstretched, it’s not just their job satisfaction that suffers— the quality of care they can provide is also compromised. As a result, addressing these challenges is crucial for improving the well-being of both direct care workers and the older adults who rely on their services.

Let’s Dive Deeper: Compensation and Economic Pressures— the Impact on Direct Care Workers and Older Adult Care

Direct care workers, essential in providing support and care to older adults, often earn wages that do not meet the basic living standards in many areas, including Baltimore. This gap between their earnings and the necessary living wage contributes significantly to job dissatisfaction and high turnover rates in the sector.

Real-World Impact: Considering a direct care worker in Baltimore who earns around $13 per hour, the reality becomes stark when aligned with the SmartAsset 2024 report which identifies the salary needed for a single adult in Baltimore to live comfortably as $84,989 annually. This translates to approximately $40.86 per hour—far above the earnings of many caregivers.

This disparity between actual earnings and the required living wage significantly impacts workers’ financial stability and overall well-being. For example, a caregiver earning less than half the hourly wage needed for a comfortable life might struggle with basic expenses such as housing and healthcare. This financial pressure can lead to physical and emotional exhaustion, impacting their job performance and ability to provide quality care. Consequently, the older adults and  individuals living with disabilities they care for may experience a decline in the quality of attention and support received, affecting their overall well-being and quality of life.

Such economic pressures underscore the critical need for wage adjustments in the direct care sector to ensure both caregiver well-being and high-quality older adult care in Baltimore and beyond.

Broader Implications: This issue extends beyond Baltimore. Research published in The Gerontologist indicates that low pay in care settings is a national problem, affecting the stability of care services across the United States. Workers who are not compensated fairly are more likely to leave their jobs in search of better-paying opportunities. This not only leads to a shortage of experienced caregivers but also impacts the continuity of care for older adults, who benefit from building trusting relationships with their caregivers.

Example from The Gerontologist: Studies have shown that better-paid caregivers are more likely to stay in their roles, which leads to higher continuity of care and better outcomes for the health and well-being of the older adults they support. The quality of care is crucial in settings where older adults rely on caregivers for daily activities, medical needs, and emotional support.

The link between adequate compensation and the quality of older adult care is clear: paying caregivers a living wage is not just a matter of economic fairness but also crucial in maintaining a stable, qualified workforce to care for our aging population.

Staffing Ratios and Worker Burnout: Understanding the Impact

Low staffing ratios in long-term care settings like those in Baltimore mean that there are too few caregivers for a large number of residents. This imbalance increases the workload on each caregiver, leading to physical and emotional exhaustion, commonly known as burnout. For instance, a caregiver responsible for too many older adults may not have enough time to adequately attend to each individual’s needs, which can lead to mistakes, reduced quality of care, and ultimately dissatisfaction with their job.

Burnout not only affects the caregivers’ health and job satisfaction but also impacts the quality of care that the older adults receive. Caregivers under stress may not be able to provide the compassionate, attentive care that is crucial for the well-being of older adults. Addressing staffing ratios by hiring more caregivers can alleviate these pressures, leading to better job satisfaction for workers and improved care for residents, as highlighted in a recent article published in The Gerontologist journal. This adjustment helps create a healthier work environment and a higher standard of care.

Organizational Practices and Respect: Key to Caregiver Retention

Respect and appreciation in the workplace are crucial for retaining caregivers. Beyond just increasing salaries, creating a respectful and supportive work environment is essential. For example, when caregivers feel valued by their supervisors and part of a positive organizational culture, they are more likely to be satisfied with their jobs and less likely to leave. This positive work environment not only enhances caregiver morale but also improves the consistency and quality of care that older adults receive, as caregivers are more engaged and committed to their roles. Studies have shown that such an environment significantly reduces turnover intentions among staff.

Broader Implications and Calls for Policy Reform

The challenges faced by direct care workers in Baltimore are not isolated incidents but part of wider systemic issues that stem from current state and federal policies. These policies directly affect how long-term services and supports (LTSS) are funded, which in turn impacts the compensation and working conditions of caregivers. For example, insufficient funding levels can lead to lower wages and inadequate staffing ratios, contributing to job dissatisfaction and high turnover rates. Experts, like those from the Commonwealth Fund, advocate for policy reforms that could improve the financing mechanisms of LTSS, thereby enhancing both compensation and the overall work environment for direct care workers. Such reforms would not only benefit the workers but also improve the quality of care received by older adults.

Conclusion: Towards Comprehensive Solutions

To tackle the retention crisis effectively, a multifaceted approach is required—one that includes policy reform, better compensation, improved staffing ratios, and enhanced workplace respect. Addressing these issues will not only stabilize the workforce but also improve the quality of care provided to Baltimore’s aging population.

This research reveals that while the challenges are daunting, they are not insurmountable. With concerted effort and comprehensive strategies, it is possible to transform the working conditions for direct care workers and, by extension, the care quality for older adults in Baltimore and beyond.


  1. Maryland Regional Direct Services Collaborative. (2023). Report on Direct Care and Services Workers in Baltimore. Maryland Regional Direct Services Collaborative.
  2. The Gerontologist. (Various Dates). Studies on Long-Term Care and Staffing Issues. [Journal Article]. Oxford Academic. Available at: The Gerontologist
  3. Commonwealth Fund. (Various Dates). Research on Health Policy and Long-Term Care Financing. [Research Articles]. Available at: The Commonwealth Fund
  4. SmartAsset. (2024). Salary Needed to Live Comfortably in U.S. Cities. Available at: SmartAsset

The Economic and Health Toll of Ageism on Older Adults: Research Points to Ageism Costing the US $63 Billion Annually

In our society, the rising population of older adults brings to light the critical issue of ageism—not only as a prevalent form of discrimination but also as a significant contributor to economic and health dilemmas. Groundbreaking research has begun to quantify the profound effects of ageism, revealing a staggering economic burden alongside severe health consequences for older adults.

A seminal study published in The Gerontologist emphasizes the substantial economic costs and the exacerbation of health conditions due to ageism in the United States. It reports a jaw-dropping $63 billion annual cost attributed to ageism, affecting eight major health conditions among individuals aged 60 and older. This figure represents about 15.4% of the total expenditure on these conditions, underlining ageism’s hefty toll on the healthcare system.

The research categorizes ageism into three predictors: age discrimination (detrimental treatment based on age), negative age stereotypes (negative beliefs about older individuals), and negative self-perceptions of aging (older persons’ adverse beliefs about their own aging process). The interaction of these factors not only inflates healthcare costs significantly but also leads to an estimated 17.04 million cases of health conditions directly attributable to ageist attitudes.

Figure 1 Health care costs of age discrimination, negative age stereotypes,
and negative self-perceptions of aging in 1 year

Let’s illustrate the impact of ageism with the story of Michael a 65-year-old who, after being laid off due to company “restructuring,” struggled to find new employment. Encounters with subtle age discrimination during job interviews, where younger interviewers doubted her tech-savviness and ability to adapt, led Michael to internalize these ageist stereotypes, affecting her mental and physical health. This narrative is not uncommon and showcases the interplay of external discrimination and internalized ageism, culminating in adverse health outcomes.

Moreover, the study sheds light on the direct linkage between ageist perceptions and various health conditions. For example, older adults facing discrimination or harboring negative self-views about aging are more likely to develop cardiovascular diseases, diabetes, and musculoskeletal disorders, among others. This link underscores the physiological toll that psychological and social factors of ageism can exact on individuals.

Table 1 Based on population of Americans aged 60 or older in 2013.

It is crucial to highlight that the implications of ageism extend beyond individual experiences to broader societal losses. Economic ramifications are palpable in diminished productivity, increased healthcare spending, and lost opportunities for growth. The study calls for a concerted effort to combat ageism, suggesting that even a 10% reduction in ageist attitudes could prevent 1.7 million cases of health conditions among older adults.

The narrative of Clara, an 80-year-old who joined a community program challenging age stereotypes through intergenerational activities, exemplifies successful intervention. By sharing her extensive knowledge and life experiences, Clara not only contributed to the community’s enrichment but also improved her self-perception of aging, leading to better health outcomes.

This comprehensive study not only quantifies the cost of ageism in stark economic and health terms but also calls for a shift in societal attitudes towards older adults. By fostering an environment of respect, inclusion, and opportunity for all ages, we can mitigate the detrimental impacts of ageism, benefiting both individuals and society at large. As we advance, let us remember the invaluable contributions of older adults and work towards dismantling the barriers of ageism, paving the way for a healthier, more inclusive future.


Levy, Becca R et al. “Ageism Amplifies Cost and Prevalence of Health Conditions.” The Gerontologist vol. 60,1 (2020): 174-181. doi:10.1093/geront/gny131 

Navigating the Tide of Time: Preparing for the Centenarian Surge in Older Adult Care

As we navigate a time marked by remarkable longevity, where the glow of a hundred birthday candles is becoming a familiar sight, we stand on the cusp of a demographic revolution that is reshaping our understanding of life’s later years. The Centenarian Surge is not just a phenomenon; it’s a testament to human resilience and the triumph of healthcare innovation. As we witness an unprecedented increase in the number of individuals celebrating their 100th birthday, the fabric of older adult care is being rewoven with threads of longevity, vitality, and an unyielding zest for life.

This article delves deep into the heart of this demographic shift, exploring the profound implications it holds for older adult care operators, caregivers, and the older adults they serve. Drawing from a rich tapestry of research and real-world insights, we unravel the complexities of catering to a generation that’s redefining what it means to age gracefully. From the nuanced needs of centenarians to the evolving landscape of older adult care, we embark on a journey to understand, adapt, and innovate in an age where a century is not the end, but a new beginning. Join us as we explore the future of older adult care – a future where every year is a milestone, and every life, a celebration of enduring legacies and new possibilities.

The Centenarian Surge: A Demographic Phenomenon

Imagine celebrating a 100th birthday – not as a rarity, but as a common occurrence. This is becoming our new reality, thanks to remarkable advancements in healthcare and significant improvements in our daily living conditions. The world is witnessing a remarkable increase in the number of people living to 100 years and beyond, a group we affectionately term ‘centenarians’.

To put this into perspective, let’s consider a real-world example. Think about a typical neighborhood. A few decades ago, it might have been rare to know someone who had reached their 100th birthday. Today, however, it’s increasingly likely that in this same neighborhood, there could be several centenarians, each with their own rich tapestry of life experiences.

Henri Leridon’s study delves into this phenomenon. It’s not just about counting how many people reach 100 or even 110 years (the super-centenarians), but understanding what this means for our society. This increase in centenarians is a clear sign of how far we’ve come in terms of medical advancements and quality of life improvements.

For those providing care to older adults, this trend is particularly significant. It means preparing for a future where the care needs of centenarians might become as common as those of the current rapidly rising aging population. This could involve understanding unique health challenges, adapting living spaces for longer lifespans, and even rethinking social services to cater to a much older population.

In essence, the rise of centenarians is not just a statistic; it’s a reflection of how our lives are changing. It’s about recognizing that reaching 100 years old can be the start of a new chapter, rather than the closing of a book. For caregivers and service providers, it’s a call to action to innovate and adapt, ensuring that our communities are ready to celebrate more centennial birthdays than ever before.

Implications for Older Adult Care

The growing number of people living to 100 years and beyond is reshaping the landscape of older adult care. This isn’t just about having more older adults; it’s about understanding and meeting their unique needs. Let’s break this down with some practical examples to illustrate what this means for those involved in older adult care.

Firstly, consider Anthony Medford’s research published by Duke University, which highlights that not all centenarians are the same. For instance, the health and lifestyle needs of someone who is 100 years old can be quite different from those of an 85-year-old. This means older adult care centers need to offer more personalized care plans. Imagine a care center where activities, healthcare, and nutrition plans are not just based on age, but on the individual health and lifestyle of each older adult.

Zhongping Mao’s study published in the PLOS ONE Journal, focuses on a specific aspect of aging – hearing. This research reminds us that sensory changes, like hearing loss, are common in centenarians. So, an older adult care center might need to invest in better sound systems, hearing aid-compatible technology, and staff trained in communication strategies for the hearing impaired. Picture a dining room in an older adult care center where the acoustics are designed so that even those with hearing challenges can enjoy conversations with their friends.

These studies collectively underscore the need for older adult care centers and living communities to evolve. It’s not just about adding more beds or expanding care centers. It’s about rethinking the entire approach to care to ensure it meets the diverse and complex needs of an aging population that is living longer than ever before.

For caregivers and those providing indirect care, this means staying informed about the unique challenges faced by centenarians and advocating for environments that support their health and well-being. It’s about creating spaces where centenarians can not only live but thrive.

A Call to Action for Older Adult Care Operators: Adapting to a New Era

The older adult care industry is at a pivotal juncture, facing a significant demographic shift with the increasing number of people living beyond 100 years. This change calls for a proactive and thoughtful approach from older adult care operators. Let’s explore what this means in practical terms.

Imagine an older adult care community that has been primarily catering to the current generation of aging adults due to rise in birth rates in the years following World War II, who are currently in their 60s and 70s. As some experts points out, while it’s crucial to meet the current needs of these older adults, operators must also look ahead. In the near future, many of these older adults will become nonagenarians (in their 90s) and centenarians. This shift means that the services and care provided need to evolve to address the challenges and requirements of much older residents.

For example, an older adult care community that once focused on providing vibrant social activities and moderate-level care must now consider more comprehensive healthcare services, advanced mobility aids, and perhaps even specialized memory care units. It’s about anticipating that the older adults will require more intensive care and support as they age.

A recent study published in the International Society on Aging and Disease underscores the importance of understanding the diverse needs of an aging population. This means recognizing that a one-size-fits-all approach won’t work. Older adult care operators need to consider factors like gender-specific health issues, varying degrees of mobility, and different cognitive abilities. For instance, a fitness program in the community might need to offer different intensity levels or types of exercise to cater to both relatively active 70-year-olds, as well as centenarians.

In essence, older adult care centers are being called to not only adapt their care centers and services for an aging population but to do so in a way that respects the individuality and specific needs of each older adult. This involves a shift from a general approach to older adult care to a more personalized and nuanced model, ensuring that every older adult, regardless of their age, receives the care and support they need to live their best life in their later years.

Looking Ahead: Redefining Older Adult Care for a New Generation

The future of older adult care is poised for a transformative shift, one that goes beyond merely accommodating more centenarians. It’s about reimagining how we care for our oldest citizens in a way that’s as dynamic and diverse as they are.

Let’s take a practical look at what this means. Consider an older adult care center that’s been operating with a traditional model: it’s equipped to handle basic healthcare needs and offers a range of recreational activities. But as we move into a future where more residents are not just in their 70s or 80s, but reaching 100 and beyond, this model needs a significant overhaul.

Kevin G. Kinsella’s research, published in Journal of the American Geriatrics Society, highlights that longevity is influenced by a complex interplay of factors, including genetics and physiology. This means that older adult care communities need to think beyond the standard care models. For example, they might need to integrate more advanced medical care and rehabilitation services, considering that a centenarian’s body will have different physiological needs and challenges compared to someone in their 70s.

But it’s not just about healthcare. As we redefine aging, we also need to reshape our approach to the overall well-being of our older adults. This could mean offering more diverse and adaptable social activities, learning opportunities, and even technological engagement that cater to a wide range of physical abilities and cognitive levels. Imagine a community where a 102-year-old can enjoy a virtual reality tour, participate in a gentle yoga class, or join a book club discussion, all within the same day.

In essence, the rise of centenarians is not just a challenge but an opportunity for the older adult care industry to lead the way in innovative and compassionate care. It’s about creating environments where our oldest citizens can thrive, not just survive. As we navigate this new era, the industry must stay agile and empathetic, ensuring that our centenarians are not only cared for but also celebrated and respected in their older years.


The insights and perspectives in this article are informed by a comprehensive review of current research and studies. These works delve into the demographic shifts in the aging population, particularly the significant increase in centenarians, and the implications for the older adult care industry. Key references include:

  • Leridon, Henri. “The many states of aging: a meeting and some demographic aspects.” Comptes rendus biologies vol. 325,6 (2002): PubMed.
  • Medford, Anthony et al. “A Cohort Comparison of Lifespan After Age 100 in Denmark and Sweden: Are Only the Oldest Getting Older?.” Demography vol. 56,2 (2019): 665-677. doi:10.1007/s13524-018-0755-7
  • Mao, Zhongping et al. “How well can centenarians hear?.” PloS one vol. 8,6 e65565. 5 Jun. 2013, doi:10.1371/journal.pone.0065565
  • Aiello, Anna et al. “Age and Gender-related Variations of Molecular and Phenotypic Parameters in A Cohort of Sicilian Population: from Young to Centenarians.” Aging and disease vol. 12,7 1773-1793. 1 Oct. 2021, doi:10.14336/AD.2021.0226
  • Kinsella, Kevin G. “Future longevity-demographic concerns and consequences.” Journal of the American Geriatrics Society vol. 53,9 Suppl (2005): S299-303. doi:10.1111/j.1532-5415.2005.53494.x

Combating Caregiver Burnout in Older Adult Care: A Path to Resilience and Quality Care

Imagine being a caregiver of older adults, a role that demands not just professional skills but a deep well of compassion and resilience. Every day, these caregivers navigate a complex emotional landscape, balancing the needs of those they care for with their own well-being. It’s a journey marked by both fulfillment and fatigue, a path of service where the line between caring for others and caring for oneself often blurs. This article takes a closer look at the reality of caregiver burnout, an issue that quietly simmers under the surface, impacting the lives of caregivers and the quality of care received by older adults. We’ll explore the challenges, emotional dilemmas, and coping strategies, highlighting the need for a supportive and understanding approach in the world of older adult care.

The Reality of Caregiver Burnout: A Closer Look

Caregiver burnout is a common yet complex issue in the world of older adult care. It’s like running a marathon where the finish line keeps moving further away. You might feel tired and frustrated, but you keep going because you care about reaching the end. This is similar to what caregivers experience: they often feel emotionally drained (or emotional exhaustion) and may start to view their job with a sense of negativity. However, a recent study in the Medical Care Research and Review journal offers an interesting insight: even though many caregivers feel this way, the quality of care they provide to older adults doesn’t necessarily drop.

Imagine a seasoned nurse named Sarah who has been working in older adult care for years. She often feels overwhelmed by her workload and sometimes questions the impact of her efforts. This is the emotional exhaustion and cynicism talking. However, when it comes to her duties — like administering medication on time, attending to the needs of older adults, or lending a sympathetic ear to a lonely older adult — Sarah is as diligent and compassionate as ever. She hasn’t lost her touch or commitment to her job; this is what the study refers to as “professional efficacy.”

Sarah’s ability to maintain high-quality care even when feeling burnt out is a testament to her resilience. Resilience is like a shield; it helps caregivers like Sarah weather the storm of burnout and continue to provide the best care to the older adults who rely on them. It’s a mix of inner strength and a positive attitude, often bolstered by a supportive work environment and personal coping strategies. This resilience is crucial because it ensures that the quality of care for the older adult remains high, even when the caregivers themselves are going through tough times.

Recognizing the heavy emotional weight caregivers carry, especially when making critical decisions about a loved one’s care, highlights an urgent need for comprehensive support structures. This necessity paves the way for exploring the various symptoms of caregiver stress and burnout, as well as effective coping strategies, to better equip caregivers in managing these challenges.Top of Form

Emotional Impact and Decision-making Dilemmas

Making decisions as a caregiver can often feel like navigating a maze with no clear right or wrong turn. One of the most heart-wrenching decisions is whether to move a loved one, such as an aging parent, into a long-term care center. This kind of decision, as highlighted by Namirah Jamshed, M.D., Director of the Geriatric Medicine Fellowship Program at UT Southwestern Medical Center mentions in a recent article, can weigh heavily on a caregiver’s heart and mind.

For instance, consider Maria, who cares for her father who is living with Alzheimer’s. After much deliberation, she decides to move him to a nursing home for specialized care. Despite this being a logical choice for his well-being, Maria is swamped with feelings of guilt and stress. She wonders if she has made the right decision and worries about his adjustment to the new environment. This emotional burden, which many caregivers like Maria face, can take a toll on their mental and physical health.

This stress isn’t just a personal issue. It can spill over into the care they provide. For example, a caregiver overwhelmed with guilt and exhaustion might forget to administer medication on time or miss important signs of distress in their loved one. This real-world consequence underscores why it’s vital to have strong support systems and wellness programs in place. These resources help caregivers like Maria navigate their emotional journeys, making them better equipped to handle the responsibilities of caregiving without compromising the quality of care for their loved ones.

Symptoms and Coping Strategies: A Practical Understanding

Imagine a caregiver named John, who looks after his aging mother who is living with dementia. Over time, John starts feeling constantly worried (anxiety), loses interest in activities he once enjoyed (depression), and always feels tired, even after a night’s sleep (physical exhaustion). These are classic signs of caregiver stress and burnout, as detailed by It’s like a battery slowly draining without being recharged. John’s experience is common among caregivers, and recognizing these signs early is crucial for taking action before they worsen.

To address these symptoms, experts recommend two main coping strategies: empowerment and acceptance. Empowerment for John means realizing he has control over his own well-being. He might start setting boundaries, like dedicating specific times for self-care, or asking other family members to share caregiving responsibilities. Acceptance involves John acknowledging the reality of his situation — understanding that some aspects of his mother’s condition and his role as a caregiver are not within his control, and that’s okay.

In addition to these strategies, many experts advise caregivers to seek external help and take regular breaks. For John, this could mean joining a support group where he can share his experiences with others in similar situations, or finding a professional caregiver to provide respite care so he can take time off. These steps are crucial in helping caregivers like John recharge their batteries, maintain their own health, and continue providing the best care to their loved ones.

Understanding Caregiver Resilience and the Need for Support: A Real-World Approach

The studies we’ve looked at converge on a key point: caregivers are resilient. Imagine a caregiver, Lisa, who works at a older adult care center. Despite feeling overwhelmed and emotionally drained (burnout), she continues to provide high-quality care to the older adults in her care. Lisa’s ability to keep performing her duties effectively, even under stress, is a testament to her resilience. It’s like a tree standing strong in a storm; the winds are harsh, but it holds its ground.

However, Lisa’s resilience doesn’t mean she doesn’t need support. Just like the tree that needs good soil and water to remain strong, caregivers need support to manage their stress and maintain their health. This is where aging services play a crucial role.

Organizations can provide various support mechanisms:

  1. Support & Skills Training Programs: These are like the tools and knowledge Lisa needs to stay strong. Programs teaching emotional intelligence help her understand and manage her feelings. Stress management training equips her with strategies to deal with daily pressures, and resilience training teaches her how to bounce back from tough days.
  2. Empowerment through Resources: Imagine Lisa having a toolbox. In it, she finds access to mental health resources, counseling services, and peer support groups. These resources are her tools to fix the small leaks and cracks that stress and burnout cause in her well-being.
  3. Work-Life Balance: This is like ensuring Lisa has time to rest and rejuvenate. Encouraging her to maintain a balance between work and personal life, and providing time off, ensures that she doesn’t reach a point of exhaustion. It’s like giving the tree time to recover after a storm.
  4. Employee Engagement Initiatives: Involving Lisa in decisions that affect her work and acknowledging her hard work makes her feel valued. It’s like the sun shining on the tree, giving it the energy to grow and thrive.

By implementing these strategies, older adult care centers can ensure that caregivers like Lisa don’t just stand strong in the storm of caregiver burnout, but also continue to grow and provide the best possible care to older adults.


Navigating the complexities of caregiver burnout requires more than just awareness; it demands action. The resilience of caregivers, akin to a steadfast tree in a storm, is a remarkable trait. Yet, it’s essential to remember that even the strongest trees need nurturing. Older adult care providers and families alike must recognize the signs of burnout and provide a nurturing environment for caregivers. Through a combination of support & skills training, empowerment resources, balanced work-life approaches, and employee engagement initiatives, we can create a sustainable caregiving environment. This holistic approach not only shields caregivers from the storm of burnout but also ensures that they continue to grow, thrive, and provide the highest quality care to our older adults. In this mutual nurturing, we find a harmonious path forward, where both caregivers and those they care for can flourish.

References (2023). “Caregiver Stress and Burnout.” Retrieved from website. Accessed on January 26, 2024.

McKnight’s Long-Term Care News. (2023). “Caregiver burnout not harming patient care, study shows.” Retrieved from McKnight’s Long-Term Care News website. Accessed on January 26, 2024.

UT Southwestern Medical Center. (2023). “Caregiver burden: Easing the physical and mental toll.” Retrieved from UT Southwestern Medical Center website. Accessed on January 26, 2024.

Navigating the New Workforce: Understanding and Embracing the Rise of Gen Z

In the ever-evolving landscape of the modern workplace, a seismic shift is on the horizon. Generation Z, a cohort defined by its technological fluency and progressive values, is set to overtake older adults in the U.S. workforce by 2024, according to a recent Glassdoor trend forecast report. This demographic shift is not just a numerical change; it’s a transformation that carries “pretty sweeping implications for what employers prioritize,” as noted by Glassdoor chief economist Aaron Terrazas.

The Gen Z Influence: A New Era in the Workplace

The ascent of Generation Z into the workforce heralds a transformative era, one characterized by a set of values and expectations starkly different from their predecessors. Having grown up amidst political turmoil and the Covid-19 pandemic, Gen Z enters the professional world with a unique perspective. They are not just looking for a job; they are seeking roles that allow them to make an impact, with a preference for employers demonstrating a strong social conscience, upward mobility, and creative opportunities.

For instance, in the realm of older adults care nursing, this translates to a desire for roles that go beyond traditional caregiving. Gen Z nurses might seek positions where they can implement innovative care strategies, participate in policy advocacy for older adult health issues, or engage in community outreach programs that enhance the well-being of older adults. They might be drawn to employers who support continuous learning and offer opportunities to specialize in gerontology or palliative care, reflecting their aspiration for upward mobility and specialization.

A study on illegitimate tasks and work withdrawal behavior among Generation Z employees reveals a critical insight: Gen Z is sensitive to tasks they perceive as illegitimate or beneath their qualifications, leading to higher turnover or disengagement. This finding underscores the need for employers to align job roles and responsibilities with Gen Z’s expectations and values to maintain a motivated and engaged workforce.

In the context of older adult care nursing, this could mean reevaluating job descriptions and duties to ensure they are meaningful and align with Gen Z’s values. For example, a Gen Z nurse might find it disengaging to perform repetitive administrative tasks that could be automated or streamlined. Instead, they would find value in roles that allow them to interact meaningfully with patients, contribute to treatment planning, and participate in interdisciplinary teams to improve patient outcomes.

Employers might also consider offering rotational programs where Gen Z nurses can experience different aspects of older adult care, from in-home care settings to specialized dementia units, to align with their desire for diverse experiences and continuous growth. Providing platforms for Gen Z nurses to lead or contribute to projects, such as developing new care protocols or community health initiatives, can also satisfy their need for creativity and impact.

In embracing the Gen Z influence, older adult care facilities and healthcare organizations must recognize and adapt to these new expectations. By doing so, they can foster a work environment that not only attracts and retains this new generation of healthcare professionals but also enhances the quality of care provided to older adults. As Gen Z nurses bring their tech-savviness, empathy, and innovative thinking to the forefront, the potential to revolutionize older adult care and create a more holistic, patient-centered approach is immense.

Adapting to Change: What Employers Need to Know

As Generation Z becomes a more dominant force in the workforce, particularly in critical sectors like older adult care, employers must adapt to accommodate their distinct needs and preferences. The traditional hierarchical structures and rigid work environments are unlikely to appeal to this new generation of workers. Instead, they value flat organizational structures, seek meaningful engagement, and prefer flexible work arrangements that allow for a healthy work-life balance.

For example, in eldercare nursing, a flat organizational structure might mean more collaborative decision-making processes where Gen Z nurses feel their opinions and insights are valued and considered in patient care strategies. This could involve regular team huddles where all staff, regardless of rank, are encouraged to share ideas and feedback. Employers might also establish nurse-led councils that empower Gen Z nurses to spearhead initiatives or improvements in patient care.

Meaningful engagement for Gen Z in older adult care could involve opportunities to connect with patients on a deeper level. This might include assigning nurses to the same patients over time to build relationships and provide continuity of care, or creating roles focused on patient advocacy and family liaison, which allow nurses to work closely with patients’ families and other healthcare providers to coordinate holistic care.

Flexible work arrangements are particularly crucial in the demanding field of nursing. Employers might offer Gen Z nurses more control over their schedules, such as self-scheduling systems, flexible shift options, or part-time positions that allow for a better work-life balance. Some facilities might explore job-sharing arrangements or offer opportunities for remote work in roles that don’t require direct patient care, such as case management or telehealth services.

However, this doesn’t mean Gen Z is shying away from in-person interactions. Studies show that despite their digital nativity, many Gen Zers favor face-to-face interactions, albeit in more flexible settings like coffee shops or co-working spaces. This paradoxical preference highlights the complexity of catering to this generation’s needs and the importance of offering diverse and adaptable working environments.

In older adult care, this might translate to creating more welcoming and versatile staff areas that mimic the comfort of a coffee shop or co-working space, where nurses can relax, collaborate, or catch up on administrative tasks. Employers might also consider how technology can facilitate better in-person care, such as using tablets or mobile devices to allow nurses more mobility and time with patients instead of being tethered to a stationary nursing station.

Additionally, providing opportunities for Gen Z nurses to engage in community outreach or health education programs can offer the in-person interaction they crave while also promoting public health and strengthening the bond between healthcare providers and the communities they serve.

In adapting to these changes, it’s crucial for employers in older adult services to recognize the unique blend of digital fluency, desire for meaningful work, and need for flexibility that characterizes Gen Z. By creating a supportive, adaptable, and collaborative work environment, older adult centers can not only attract and retain this new generation of nurses but also enhance the quality of care and innovation in the services they provide.

Leadership and Development: Key to Retention

In the realm of nursing and services for older adults, one of the most critical areas for employers to focus on is leadership and development. The study “Improving Millennial Employees’ OCB” provides valuable insights that can also be applied to Gen Z. It found that ethical leadership positively predicts Organizational Citizenship Behavior (OCB), with the mediating effects of ethical climate and affective well-being playing significant roles. This suggests that Gen Z, much like Millennials, will respond positively to ethical, transparent, and supportive leadership.

For instance, in older adult care settings, ethical leadership might manifest as administrators who not only uphold high standards of patient care but also actively advocate for the well-being and professional growth of their staff. This could involve implementing transparent communication channels where nurses feel heard and respected, or establishing ethical guidelines that ensure patients and staff are treated with dignity and compassion.

Moreover, continuous feedback and professional development opportunities are non-negotiable for Gen Z. They are not afraid to leave a job where they feel undervalued or where their growth is stifled. In older adult care, this might mean offering regular one-on-one meetings with supervisors where nurses can discuss their career goals, receive constructive feedback, and map out a clear path for advancement. It could also involve providing access to continuing education courses, workshops, and seminars that keep staff updated on the latest in older adult care research, technology, and best practices.

As noted in the research examining job satisfaction among millennial nurses, fostering a workplace that nurtures empathy, respect, and continuous learning is crucial for retention and engagement. In practical terms, this could translate to mentorship programs where experienced nurses guide newer staff, sharing knowledge and offering support as they navigate the complexities of older adult care. It might also involve recognizing and rewarding staff who go above and beyond in their care for patients, whether through formal awards, bonuses, or simple acknowledgments in team meetings.

Creating a culture of continuous learning and improvement can also be achieved through regular team debriefs where staff can collaboratively discuss what went well and what could be improved in their care delivery. This not only fosters a sense of team cohesion and mutual support but also encourages a proactive approach to enhancing the quality of care.

In essence, for older adult care centers and service providers for older adults, investing in ethical, supportive leadership and robust development opportunities is not just a strategy for retention; it’s a commitment to creating a work environment where Gen Z nurses and caregivers can thrive, grow, and continue to provide compassionate, high-quality care to the older adults they serve. By doing so, employers not only retain their workforce but also enhance the overall standard of care and well-being for both staff and patients alike.

Conclusion: Embracing the Future

The rise of Generation Z in the workforce, particularly in sectors like older adult care nursing and services for older adults, represents not a challenge but a profound opportunity. It’s a chance for healthcare centers, nursing homes, and service providers to innovate, to redefine their corporate cultures, and to build a more dynamic, inclusive, and forward-thinking workplace. By understanding and embracing the values and expectations of Gen Z, employers can unlock a new wave of productivity, creativity, and growth.

For example, in older adult care, embracing the future might mean integrating technology in ways that resonate with Gen Z’s digital fluency. This could involve using advanced health monitoring systems that allow for more efficient patient care or adopting communication platforms that enable staff to collaborate more effectively and share insights in real-time.

Redefining corporate culture in older adult care could involve creating more inclusive and diverse environments that reflect the values of Gen Z. This might mean actively promoting diversity in hiring, providing cultural competency training to staff, and ensuring that all patients, regardless of their background, receive care that is respectful and sensitive to their needs.

Building a dynamic and forward-thinking workplace in older adult care also means being open to new ideas and innovations. Employers can encourage Gen Z staff to contribute their perspectives and suggestions, perhaps through regular innovation labs or brainstorming sessions where all team members are invited to propose new ways to enhance patient care and operational efficiency.

By embracing these changes, older adult care centers and service providers can not only attract and retain Gen Z talent but also improve their services and care for older adults. This generation’s drive for meaningful work, their technological savvy, and their fresh perspectives can lead to improved patient outcomes, more efficient operations, and a more positive and supportive work environment for all staff.

As we stand on the brink of this new era, the message is clear: adapt, engage, and thrive. The future belongs to those ready to embrace the change. For older adult care providers, this means recognizing the unique contributions Gen Z can make, valuing their input and ideas, and creating a workplace that not only meets their needs but also leverages their strengths. In doing so, the sector can ensure that it not only survives but thrives in the years to come, providing compassionate, innovative care to the older adults who depend on it.


The entry of Generation Z into the workforce, especially in eldercare nursing and services for older adults, is a pivotal opportunity for innovation and cultural transformation. Gen Z’s unique values, technological fluency, and desire for meaningful work necessitate a shift from traditional hierarchical structures to more inclusive, flexible, and collaborative work environments. Employers must adapt by offering ethical leadership, continuous development, and opportunities for meaningful engagement. Embracing these changes will not only attract and retain Gen Z talent but also enhance the quality of care and service for older adults, ensuring a dynamic, productive, and compassionate future in eldercare.


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The Lifesaving Bond: Exploring the Crucial Role of Friendships in the Well-Being of Older Adults

In the golden years of life, the tapestry of human connections becomes even more precious. Recent studies have illuminated a profound truth: for older adults, friendships are not just a source of joy but a cornerstone of health and longevity. As caregivers and leaders in long-term care, understanding and nurturing these bonds can be a vital part of our mission.

The Science of Friendship and Health

A compelling study published in Epidemiology and Psychiatric Sciences reveals that friendships in older adults are linked with better physical and mental health. Analyzing surveys from nearly 13,000 individuals over 50, researchers found that high-quality friendships reduced the risk of depression by 17% and stroke by 19% and increased the likelihood of exercise by 9%​​.

Daily Interactions: A Source of Joy and Comfort

But what does it mean to have a friend in the later stages of life? A study in PubMed explored this, discovering that older adults reported more pleasantness and better mood when in contact with friends, as compared to other social partners or when alone​​. This finding is crucial for long-term care centers, where daily interactions can be intentionally crafted to promote these positive experiences.

The Dark Side of Isolation

Conversely, the absence of these connections can have dire consequences. The National Institute on Aging estimates that a quarter of older adults experience social isolation, defined as having few regular interactions and social contacts. This isolation is linked with an array of negative health outcomes, including heart disease, obesity, and depression. Alarmingly, a study in the Journal of the American Geriatrics Society found that social isolation was associated with a 28% higher risk of dementia​​​​.

Balancing the Scales: The Introvert-Extrovert Spectrum

Not everyone thrives in social butterflies’ environments, and this is especially true in the diverse world of older adults. Studies show that while extroverts naturally draw energy from social interactions, introverts may not need as many interactions to feel content​​. This diversity necessitates a nuanced approach in fostering social connections within care settings.

Fostering Connections in Care Settings

What can be done in long-term care settings to cultivate these life-enhancing connections? Creating opportunities for older adults to engage in meaningful activities and conversations is a start. Whether it’s through group activities, shared meals, or simply encouraging conversations, every interaction counts.

Leveraging Technology: Bridging the Gap

In today’s digital age, technology also plays a crucial role. With many older adults embracing email, texting, and social media, these tools can serve as bridges to maintain existing relationships and forge new ones. As caregivers, facilitating access to these technologies can be a simple yet powerful way to combat isolation.

Conclusion: A Call to Action

The evidence is clear: friendships and social connections are indispensable for the well-being of older adults. As leaders and caregivers, we have a unique opportunity and responsibility to foster these connections. By understanding the diverse needs of older adults and creating environments that encourage social interaction, we can not only enhance their quality of life but also potentially extend it.

In the words of William Chopik, associate professor of psychology at Michigan State University, “Having good friends is associated with a whole lot of positive health behaviors and benefits”​​. Let’s take this knowledge and translate it into action, making every effort to weave a fabric of friendship and connection in the lives of those we care for.

The health and happiness of our older adults depend on it.

TL;DR: This article delves into the crucial role of friendships and social connections in the well-being and health of older adults. Highlighting recent studies, it underscores how friendships can lead to higher levels of happiness, life satisfaction, and physical health benefits, including reduced risks of depression and dementia. The article emphasizes the negative impact of social isolation and the importance of maintaining social interactions to prevent cognitive decline. It also discusses the varying needs of extroverts and introverts in social settings and suggests practical ways for long term care professionals to foster meaningful social connections among older adults. The article concludes with a call to action  to prioritize and facilitate these essential social bonds, underlining their significant role in enhancing and potentially extending the lives of older adults.


Kim, E. S., Chopik, W. J., Chen, Y., Wilkinson, R., & VanderWeele, T. J. (2023). United we thrive: Friendship and subsequent physical, behavioural and psychosocial health in older adults (an outcome-wide longitudinal approach). Epidemiology and Psychiatric Sciences, e65. Cambridge University Press. 10.1017/S204579602300077X . Accessed November 22, 2023.

“Friendships in Old Age: Daily Encounters and Emotional Well-Being – PubMed.” [Online]. Available: Accessed November 22, 2023.

“Close friends can help you live longer but they can spread some bad habits too | WGCU PBS & NPR for Southwest Florida.” [Online]. Available: Accessed November 22, 2023.

“New research links isolation in old age to negative health outcomes | Hub.” [Online]. Available: Accessed November 22, 2023.

“Why Friends Are Good for Your Health and Well-Being.” [Online]. Available: AARP website or the PDF provided by the user. Accessed November 22, 2023.