Elder Care and Cognition: Resources for Healthcare Providers

According to the World Health Organization (WHO), 22% of the global population will be over 60 by 2050. To keep up with this increase in senior citizens, health care organizations and providers will need to dedicate additional time and resources to elder care services.

In this article, we will explore practical tools and strategies for supporting older adults, including:

• Different assistance programs and home care services
• Scientifically-backed tools for testing cognitive function and mental health
• Best practices for effective elder care from healthcare providers
• Medicaid and Medicare benefits and reimbursements

What is Elder Care?

Elder care describes the different types of personal and medical support that are given to adults as they age. This includes health care services as well as support with household tasks and activities of daily living (ADLs) (Edemekong, 2023). Quality elder care takes a whole person approach, taking physical, mental, cognitive, social, and spiritual health into consideration.

Elder care aims to ensure the safety, health, and wellbeing of older adults, and includes services such as:

• Cognitive and mental health care
• Primary care and annual wellness visits
• Medication management
• Physical therapy and exercise
• Money management support
• Meal preparation and house cleaning
• Home remodeling for safely aging in place
• Transportation
• Support for caregivers
• Community services and programs
• Companionship volunteer services
• End of life planning and palliative care
• Access to providers such as registered nurses, social workers, personal support workers, geriatricians, cognitive health specialists, and general practitioners

Seniors can receive these services either at home or within assisted living facilities. 77% of adults over 50 prefer to age in place, which makes home health services especially important as the elderly population continues to increase worldwide (Forbes, 2024).

What Is the Most Requested Support Service for the Elderly?

Elder care needs vary from person to person, but some of the most commonly requested services for senior citizens include:

• Medical and health services such as annual wellness visits, management of chronic conditions, physical therapy, and nursing care. One study found that senior citizens without family doctors had significantly higher in-hospital mortality rates, emphasizing the importance of access to regular health check ups (Peel, 2019).
• Personal and home care assistance with activities of daily living, such as bathing, dressing, meal preparation, housekeeping, and medication management. Seniors who choose to stay in their own homes can receive these services from home care aides or personal care attendants.
• Cognitive health support. One survey found that 17.5% of seniors were very concerned about developing Alzheimer’s disease or dementia (Tang et al., 2017). Cognitive assessment tools and scientifically backed protocols help track cognitive wellness. Primary care providers can also educate older people on dementia prevention strategies like exercise, social engagement, dietary modifications, and more.
• Transportation for errands, medical appointments, and social activities. It is not always safe for seniors to continue driving, but the loss of a license is associated with negative health outcomes including cognitive decline, depression, and up to 51% decrease in social circles (Chihuri et al., 2016). Regular and accessible transportation services keep seniors mobile and active in their communities.
• Social and recreational community programs with special activities, classes, and events to prevent isolation. One study found that a variety of rich social connections made seniors 46% less likely to develop incidental dementia (Saito et al., 2017).

Should an older adult discover they have cognitive impairment, creating a care plan alongside caregivers and healthcare providers can determine which elder care services would be most beneficial.

Cognitive Health Resources for Delivering Elder Care

The Alzheimer’s Association’s 2022 Alzheimer’s Facts and Figures Special Report revealed that up to 18% of adults over 60 are living with mild cognitive impairment (MCI). Along with this, 10-15% of older adults with MCI develop dementia each year.

However, 40% of primary care providers report that they do not feel confident when it comes to making these diagnoses (Alzheimer’s Association, 2024). Cognitive health tools, such as assessments and care plans, enable providers to effectively diagnose and provide care for elderly patients.

Cognitive Screening

With the 10 million patients diagnosed with dementia each year, cognitive screening is an important component of doctors’ appointments for senior citizens (Alzheimer’s Association, 2024). In fact, under Medicare Advantage, it’s a required part of patients’ annual wellness appointments.

Creyos offers accessible, scientifically-backed cognitive screening tools can help providers:

• Reduce their administrative burden with automated reports and EHR integration
• Increase patient completion rates with gamified tools
• Administer screens at home to get more time talking with patients
• Feel more confident diagnosing patients with cognitive disabilities

Many older adults and their families report being overwhelmed by a lack of coordination between providers, and rely on their primary care provider to manage and coordinate care (Stolee et al., 2021). However, family doctors report spending 19 hours a week on administrative tasks, which reduces their capacity to give patients the highest quality care (OFP, 2024).

Standardized, integrated assessment tools and reports cut down that burden, and improve quality of life for patients and providers alike.

Dementia Assessment

Historically, the Montreal Cognitive Assessment (MoCA) has been the go-to screening tool for signs of dementia. However, this test does not always catch the earliest signs of cognitive decline, and often requires a further neuropsychological exam.

Along with this, the MoCA was developed and standardized with educated patients, which can lead to inaccurate results for patients with lower education levels (Julayanont et al., 2017). Poverty is a major factor in the quality of healthcare, and equitable elder care can improve outcomes for low-income patients (2018).

In contrast to the MoCA, cognitive tasks and assessments from Creyos: 

• May detect earlier or more subtle signs of dementia and cognitive impairment
• Consider comorbidities such as mental health factors
• Don’t require special training for providers
• Will not be radically affected by social factors such as education level
• Are more telemedicine-friendly

Cognitive Care Planning

Once a screener or assessment has detected signs of cognitive impairment or dementia, older adults and their families can experience anxiety about what comes next (Alzheimer’s Society). Cognitive care planning helps to determine the next steps for patients and provide elder care resources for their caregivers.

Creating a care plan typically happens in three steps:

• Assess patient cognition and symptoms. Cognitive tasks and assessments such as an IADL questionnaire determine patients’ cognitive function and how it impacts their ability to live independent lives.

• Evaluate the needs of caregivers. Over 66.% of unpaid caregivers for older adults reported mental health struggles, with 30.7% seriously considering suicide during the COVID-19 pandemic (APA, 2020). Care planning can explore how care homes, skilled nursing facilities, or home health care support can ease those challenges.

• Build a care plan report. 35% of Americans do not have the level of health literacy needed to read instructions on a pill bottle or comprehend a healthcare plan (Yen et al., 2019). Documenting the findings of cognitive screens and next steps, as well as providing educational resources, can increase compliance with care plans.

Care planning might include exploring and documenting:

• A patient’s capacity to complete independent tasks 
• Which elder care services are covered by Medicaid or Medicare benefits
• Options for living facilities or adaptations for seniors’ own homes
• Resources for caregiver wellness
• Therapies and medications

Cognitive care plans will all look different depending on the needs of patients and their families, but assessment tools can streamline early parts of the process. When a patient completes the dementia screener and assessment with Creyos, their health care provider can automatically upload the results into a care plan that’s integrated into the patient’s health records.

Mental Health Questionnaires

In one review, participants with symptoms of depression were 28% more likely to progress from mild cognitive impairment to dementia (Mourao et al., 2015). Mental health assessments are a crucial part of elder care, and can make the difference in cognitive health outcomes.

Some mental and behavioral health questionnaires for seniors include:

• General Anxiety Disorder Questionnaire (GAD-7)
• Patient Health Questionnaire (PHQ-9)
• Perceived Stress Scale (PSS)
• Mood Disorder Questionnaire (MDQ)

Anxiety and agitation are common early symptoms of Alzheimer’s disease (Alzheimer’s Association). Using multiple cognitive and behavioral assessments can help prevent misdiagnosis and discover the root of the problem. If it turns out a patient’s challenges are emotional rather than cognitive, providers have important data to help provide compassionate care.

For example, in one study, physicians reported that elderly patients often have unique emotional responses to health care settings like hospitals (Samra et al., 2015). Some display intense anxiety that makes it hard to retain treatment information, while others rely on health care settings as a place for social connection (Mah et al., 2023). If a patient is exhibiting ongoing loneliness, connecting them with companionship services from trained volunteers could increase their overall wellness.

Characteristics of Effective Elder Care

There are a few key characteristics of effective elder care services:

Continuity of Care

Elder care often requires a multidisciplinary team of coordinators, such as physicians, neurologists, and social workers. Continuity of care ensures that elderly patients have as seamless an experience as possible, which is especially important when managing confusion that comes with cognitive impairment (Gulliford et al., 2006).

Integrating test results into patients’ health records keeps providers in the loop, and reduces administrative strain in the long run.

Efficient Appointments

One study showed that 15.6% of patients who avoid seeking health care reported doing so because of time constraints (Taber et al., 2015). Whether it’s an annual wellness visit or a specialist appointment, patients want their time to be used effectively. For older adults who might have a harder time getting out of the house, this is even more important.

Clear Communication

According to the National Institute on Aging, speaking plainly, avoiding rushing, and writing down information are a few key ways to improve communication with elderly patients. Efficient computerized cognitive assessments are one way to cut down on screening time so providers can dedicate the time necessary for senior citizens’ communication needs.

Along with this, listening to patients’ concerns and clearly communicating test results are key components of evidence-based practice. For GT Healthcare, behavioral health questionnaires provided patients with data to validate their diagnoses. This measurable data built more trust than subjective opinions alone, and empowered patients to engage with their treatment plan.

Collaboration With Caregivers

When patients with Alzheimer’s disease or other types of dementia begin to experience notable cognitive decline, providers often end up collaborating with their caregivers. This might involve suggesting options for adult day programs and home health care, or educating family members on common symptoms of dementia. The Alzheimer’s Association provides resources for caregivers of Alzheimer’s patients at all stages.

Many caregivers of seniors are senior citizens themselves—34% of all caregivers aged 65 and older provide care for a spouse or partner (StatCan, 2020). Checking in on caregivers plays a crucial role in the long-term wellness of both partners.

Patient-Centered Approach

The patient-centered care model has a several key components:

• Patients and their family members are encouraged to participate
• Factors like financial capacity, religious and cultural backgrounds, emotional needs, values, and personal preferences are taken into consideration
• Health care is accessible and organized
• Information is shared in an open and efficient manner

Many seniors have embraced technology, but electronic device usage is still lower in older adults compared to younger adults, which can be a challenge as telehealth continues to become more prevalent in elder care and beyond (2017). Yukon Neurology found that the gamified, easy-to-use cognitive assessments from Creyos helped to reduce patient anxiety. Along with this, it gave patients the information they needed to engage with their treatment plan.

Reimbursement and Insurance Considerations

With the increasing need for elder care, a doctor’s office that can provide services specifically designed for seniors is more likely to be financially sustainable in the long run (World Health Organization). A key part of this process is understanding which services are covered by insurance providers so clinicians can get proper reimbursement.

There are several CPT codes for older adults that providers can bill for. CPT code 99483 covers assessment and care planning for patients with cognitive impairment including MCI, Alzheimer’s disease at any stage, and other types of dementia. For visits that exceed the 60-minute timeframe, providers can use HCPCS code G2212.

On a patient-facing level, patients and their families will often inquire about which services are covered by Medicare and Medicaid. 

Medicare

Some elder care services that are covered by Medicare benefits include:

• Some short-term home health services from approved agencies
• Occasional short-term meal delivery under certain circumstances
• Transportation for emergency medical care and doctor’s appointments
• Most of the cost of hospice for up to five consecutive days of respite care in a skilled nursing facility or hospital setting
• Some mental health care costs

For a more comprehensive look, the Medicare website includes a tool that helps patients and providers find local services that are covered.

Medicaid

Some elder care services that are covered by Medicaid benefits include:

• Home health services that vary by state
• Some home delivered meal services for eligible patients
• Transportation via ambulance for emergencies and limited non-emergencies
• Some emergency medical alert systems
• Some hospice services
• Some adult day care
• Some mental health care costs

Delivering Care to Elderly Adults and Their Families

As the senior population continues to grow on a global scale, elder care is more important than ever. With comprehensive resources and standardized assessments, doctors can support older adults with cognitive health care and beyond.

Contact us today to learn more about how Creyos offers scientifically-backed assessment tools that can help your elderly patients.