GSA Voices Support for Aging-Related Initiatives Outlined in SOTU Address

Following President Joe Biden’s 2022 State of the Union (SOTU) Address, The Gerontological Society of America (GSA) — the nation’s largest interdisciplinary organization devoted to the field of aging — applauds his administration’s call to advance many policies that will impact the nation’s well-being across multiple dimensions.

Affordable Care Act Expansion
GSA supports the expansion of the Affordable Care Act (ACA). Research published in GSA’s journal The Gerontologist provides evidence that ACA Medicaid expansions have improved access to medical care and health status of poor adults aged 60 to 64 years. It also indicates missed opportunities to address barriers to care and unmet health needs for this population in states that have not yet expanded Medicaid.?Furthermore, lack of health insurance during working-age years has implications for population health and aging. Failure to expand Medicaid means that working-age residents in non-expansion states have less access to preventive, chronic, and acute care, potentially resulting in higher risks of disability, chronic health conditions, and premature mortality as we age.

Education Support
GSA supports increased access to education opportunities. One recent study in GSA’s?The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences?found that?people with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Another study points to the potential value of education both for reducing overall dementia burden in the older population and also for decreasing race disparities — reporting that?dementia experience and dementia burden differ dramatically along race–education lines, and that race and education combine to exaggerate disparities and they both have enduring effects.

Another series of papers found that among sociodemographic determinants of cognitive health, educational attainment is a particularly salient factor. They also demonstrate how the educational attainment of close family members influences cognitive aging above and beyond one’s own education, and that the effects of education on cognitive aging are deeply intertwined with other stratification systems, including racial and gender inequalities. 

Paid Leave
GSA supports a national paid family and medical leave program that meets basic standards to protect and support all types of caregivers. According to “Caregiving in the United States 2020,” a joint report from AARP and the National Alliance for Caregiving, “one in 10 working caregivers have had to give up work entirely or retire early. When this happens, caregivers more often face financial impacts and are twice as likely to report high financial strain.” It is also important to recognize the role of national paid family and medical leave policies in promoting health equity for older adults and their caregivers.

Nursing Home Reform
GSA supports efforts to improve safety and quality of care in our nation’s nursing homes as it especially impacts older people and people with disabilities. GSA also supports initiatives to enhance accountability, oversight, and transparency of nursing home performance to make quality improvements in care and services for nursing home residents — especially the programs that recognize the importance of creating pathways to ensure affordable nurse aide training, supporting state efforts to improve staffing and workforce sustainability, and conduct the robust campaign to recruit, train, and retain workers into long-term care careers. GSA partners with several national organizations to offer Careers in Aging Week with the goal of bringing greater awareness and visibility to the wide-ranging career opportunities in the field of aging. 

Further, people over the age of 65 are disproportionately affected by the COVID-19 pandemic. Immunosenescence results in the reduced efficacy of vaccines in older adults — the population that needs protection the most. GSA commends the Biden-Harris administration for continued COVID-19 vaccination supports and strengthening the on-site infection preventionists standards. It is incumbent upon those developing policy and working in long-term services and supports to not only to ensure that residents and staff have access to COVID-19 vaccines but also continue to increase the vaccination rate for routine vaccines. In a 2018, GSA convened a one-day stakeholder meeting focused on successes and needs to chart a path to increase immunization rates in post-acute and long-term care settings, and the Society continues its dedication to bring the diverse interdisciplinary team together to increase reverence for vaccines through the GSA National Adult Vaccination Program.  

GSA also appreciates the work of the Centers for Medicare and Medicaid Services (CMS) National Partnership to Improve Dementia Care in Nursing Homes in achieving a dramatic decrease in the use of antipsychotic drugs in nursing homes in recent years. As CMS launches its new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications, GSA calls attention to the work of its Dementia-Related Psychosis Workgroup. While there is consensus in the clinical community that nonpharmacologic interventions should be first-line treatment of dementia-related psychosis, the use of antipsychotic medications is clinically warranted in some cases. GSA welcomes continued discussion with the administration to avoid unintended consequences of a long-standing policy. 

Advanced Research Projects for Health
GSA supports the creation of the Advanced Research Projects Agency for Health (ARPA-H), which will enable opportunities for a culture of collaboration allowing multiple government agencies and private sector partners to propel findings rapidly. GSA believes it will complement the established biomedical research community, and is encouraged by the recognition of the importance of a strong relationship between the current research ecosystem and the enterprising opportunities that exist with ARPA-H.

As GSA imagines the opportunities to catalyze new approaches to solve the vexing challenges of today, it draws attention to the intersection of aging and chronic disease.  GSA looks forward to continued stakeholder engagement opportunities. The Society recommends that ARPA-H embrace a geroscience approach, which will further understanding of how the aging process contributes to the many chronic diseases that accompany older ages. GSA believes it is essential to embrace and pursue solutions driven by new insights derived from the behavioral and social sciences along with a biomedical approach.

As ARPA-H moves forward, investment should not come at the cost of the existing entities conducting and supporting the research ecosystem. Making the most of scientific breakthroughs requires coordination across regulatory and policy mechanisms, to speed application and ensure broad access.  This will enable society to realize its full benefit.

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The Gerontological Society of America (GSA) is the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society.