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IntroductionA national consensus panel was convened to develop recommendations on future directions for home-based dementia care (HBDC).MethodsThe panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus-based recommendations.ResultsThe panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed.DiscussionHBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC.

Introduction Policies around the world to address hearing loss have followed an advancing scientific understanding of the impact of hearing loss on health. Since the 1990s, worldwide efforts to screen [...], As the proportion of older adults in the world's total population continues to grow, the adverse health outcomes of age-related hearing loss are becoming increasingly recognized. While research has shown that age-related hearing loss is the single greatest modifiable risk factor for dementia, use of hearing aids remains low worldwide, even in many middle- and high-income countries. Reasons for poor uptake of hearing aids are likely to involve a combination of factors, ranging from increasing costs of hearing aid technology to a widespread lack of insurance coverage. This article aims to identify the current state of access to hearing aids, focusing on eight middle- and high-income countries. We discuss how to facilitate greater access to hearing aids for patients by addressing changes in how devices are regulated, technological advancements in hearing devices, the need to adjust reimbursement schemes and the importance of adaptation among the community workforce for hearing-care. Alors que la proportion de personnes agees au sein de la population mondiale totale continue a croitre, les effets nefastes sur la sante de la perte de l'acuite auditive liee a l'age sont de plus en plus reconnus. Bien que la recherche ait demontre que la perte de l'acuite auditive liee a l'age est le principal facteur de risque modifiable de la demence, l'utilisation de protheses auditives reste limitee a l'echelle mondiale, y compris dans de nombreux pays a revenu intermediate et eleve. Les raisons de ce recours limite aux protheses auditives tiennent probablement a une combinaison de facteurs qui vont des couts croissants de la technologie des appareils auditifs a un manque generalise de couverture medicale. Cet article vise a determiner l'etat actuel de l'acces aux protheses auditives en se concentrant sur huit pays a revenu intermediate et eleve. Nous etudions comment permettre aux patients d'acceder plus facilement aux protheses auditives en tenant compte de la reglementation applicable aux appareils, des progres technologiques relatifs aux appareils auditifs, de la necessite d'ajuster les systemes de remboursement et de l'importance de l'adaptation au sein de la main-d'reuvre locale pour les soins auditifs. A medida que la proporcion de adultos mayores en la poblacion total del mundo continua creciendo, los resultados adversos para la salud de la perdida de audicion relacionada con la edad son cada vez mas reconocidos. Aunque las investigaciones han demostrado que la perdida de audicion relacionada con la edad es el mayor factor de riesgo modificable para la demencia, el uso de audifonos sigue siendo bajo en todo el mundo, incluso en muchos paises de ingresos medios y altos. Las causas de la escasa aceptacion de los audifonos pueden ser una combinacion de factores, que van desde el aumento de los costes de la tecnologia de los audifonos hasta la falta generalizada de cobertura de seguro. Este articulo pretende identificar el estado actual del acceso a los audifonos, centrandose en ocho paises de ingresos medios y altos. Discutimos como facilitar un mayor acceso a los audifonos para los pacientes abordando los cambios en como se regulan los dispositivos, los avances tecnologicos en los audifonos, la necesidad de ajustar los esquemas de reembolso y la importancia de la adaptacion entre los trabajadores de la comunidad para el cuidado de la audicion.

Objectives Vision and hearing impairments are highly prevalent conditions among older adults, and well-established links exist between sensory impairment and household, mobility, and self-care activity limitations. However, studies examining the impact of unmet long-term services and supports (LTSS) needs have not considered the role of vision and hearing impairment on the risk of experiencing adverse consequences, including wetting or soiling oneself. Method Using Rounds 1 and 5 of the National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries aged 65 and older, we examine the association of vision and hearing impairment on the odds of experiencing an adverse consequence while accounting for other sociodemographic and health status factors. Results Among a weighted population of 49,770,947 community-living older adults with limitations in household, mobility, or self-care activities, 20.1% (95% CI: 19.2–21.0) experienced an adverse consequence as a result of unmet LTSS needs. In the fully adjusted regression, individuals with vision or hearing impairment had 96% (odds ratio [OR]: 1.96; 95% CI: 1.64–2.34) and 43% increased odds (OR: 1.43; 95% CI: 1.24–1.65), respectively, of experiencing any adverse consequence. Hearing impairment was associated with higher odds of household or self-care adverse consequences, while vision impairment was associated with higher odds of mobility or self-care adverse consequences. Discussion Sensory impairment may increase the risk for adverse consequences for older adults with unmet LTSS needs. Activities that support older adults living safely in the community should consider the role of sensory impairment and how to address the unique needs of those with hearing or vision impairment. [ABSTRACT FROM AUTHOR]