Otros conductores se detuvieron, rompieron la ventana del auto y lo llevaron a un lugar seguro. Un bombero voluntario que pasaba por allí le practicó reanimación cardiopulmonar hasta que llegó una ambulancia que trasladó a Masterson al hospital UPMC Mercy.

Pasó 18 días en la unidad de cuidados intensivos (UCI), 14 de ellos conectado a un ventilador. Desarrolló delirio, una condición común en terapia intensiva, y necesitó medicamentos antisicóticos. A pesar de tener una sonda de alimentación, perdió peso. “Sinceramente, no estábamos seguros de que fuera a sobrevivir”, dijo Ron Dedes, su cuñado.

Pero sobrevivió. Masterson fue dado de alta el 1 de febrero y regresó a casa con apoyo familiar casi constante. Trabajando con varios tipos de terapeutas, ha recuperado la capacidad de caminar, aunque aún tiene debilidad, y puede ocuparse de su cuidado personal. Su habla, que antes era confusa, ha mejorado notablemente. Puede prepararse un sándwich.

Ahora, “nuestra mayor preocupación es su memoria”, dijo Dedes. Masterson, quien hasta hace poco manejaba asuntos legales complejos, olvida conversaciones y eventos que ocurrieron unas horas antes, explicó Patti Dedes, su hermana. Aún no puede usar un microondas ni hacer una llamada telefónica.

En una entrevista, se describió a sí mismo, con precisión, como “mucho, mucho mejor de lo que estaba”, pero se equivocó al decir su edad. Las pruebas de evaluación tras el alta indicaron deterioro cognitivo y depresión.

Entre los médicos de cuidados críticos, los síntomas prolongados como los suyos se conocen como “síndrome post-cuidados intensivos” o PICS (por sus siglas en inglés). Las secuelas pueden ser físicas o psicológicas, además de cognitivas, y pueden durar meses o años.

Más de 5 millones de personas son admitidas cada año en terapias intensivas en unos 5.000 hospitales en Estados Unidos, y las investigaciones muestran que más de la mitad experimenta estos efectos secundarios. La edad avanzada aumenta las probabilidades.

Los pacientes y sus familias suelen sorprenderse por estas dificultades persistentes. “La creencia es que saldrán del hospital y en dos o tres semanas volverán a la normalidad”, dijo Brad Butcher, quien fue el doctor de Masterson y escribió recientemente sobre el PICS en la revista médica JAMA. “Eso no se corresponde con la realidad”.

De hecho, con un mayor uso de las UCI y mejores tratamientos, la población que puede enfrentar este síndrome está creciendo. La Sociedad de Medicina de Cuidados Críticos (Society of Critical Care Medicine, SCCM) estima que entre el 70% y el 90% de los adultos ahora sobreviven a la terapia intensiva.

“Todos están agradecidos de que el paciente haya sobrevivido”, dijo Lauren Ferrante, doctora en cuidados críticos pulmonares e investigadora en la Facultad de Medicina de Yale (Yale School of Medicine). “Pero ese es solo el comienzo de un largo camino de recuperación”. En un estudio de pacientes de 70 años o más, del que fue coautora, dentro de los seis meses posteriores al alta solo alrededor de la mitad había recuperado su capacidad funcional previa a su paso por la UCI.

Los pacientes de cuidados intensivos enfrentan una larga lista de desafíos. Los síntomas del PICS van desde los físicos —debilidad, dolor, neuropatía (hormigueo en brazos y piernas) y desnutrición— hasta problemas de salud mental, principalmente ansiedad y depresión. Las dificultades cognitivas como las de Masterson son comunes, incluidos problemas de memoria, atención y concentración, y lenguaje.

“Para muchas personas, sobrevivir a una enfermedad crítica es una experiencia que cambia la vida”, afirmó Butcher. Los pacientes en cuidados intensivos después de cirugías de emergencia o programadas también presentan altas tasas de nuevos problemas físicos, mentales y cognitivos un año después.

Los mismos tratamientos intensivos que salvan vidas contribuyen al síndrome. Los pacientes en cuidados intensivos “tienen algún tipo de falla grave de órganos que requiere atención inmediata” y monitoreo constante, explicó Carla Sevin, doctora en cuidados críticos pulmonares que dirige el Centro de Recuperación de UCI en el Centro Médico de la Universidad de Vanderbilt.

Eso puede implicar un tubo de respiración conectado a un ventilador, lo que a su vez suele requerir medicamentos sedantes. La sedación “puede provocar delirio, y el delirio es el factor clave en los síntomas cognitivos”, dijo Butcher.

Tampoco ayuda que los pitidos constantes de los monitores y la iluminación brillante las 24 horas interrumpan el sueño, ni que las restricciones en las visitas familiares priven a los pacientes de rostros y voces tranquilizadoras.

Gregory Matthews, un contador jubilado en St. Petersburg, Florida, pasó casi un mes en una UCI tras un trasplante de pulmón en 2014. Aún recuerda con claridad sus alucinaciones, incluidas imágenes de ratones corriendo por la pared y alguien intentando incriminarlo por tráfico de drogas.

“Un día, pensé que un doctor era un asesino; podía ver el rifle”, dijo Matthews, ahora de 80 años. “Así que salté de la cama”, contó, y se arrancó las vías intravenosas. El personal tuvo que sujetarle los brazos durante varios días.

Pero la inmovilización también tiene consecuencias, ya que los pacientes pierden rápidamente masa muscular y fuerza. “Nuestros cuerpos no están hechos para estar acostados todo el día”, señaló Ferrante.

En el plano psicológico, “el trastorno de estrés postraumático es bastante común, similar al que se observa en veteranos de combate o sobrevivientes de agresión sexual”, dijo Sevin. Las familias también pueden sufrir ansiedad y depresión junto con los pacientes.

Alarmados por estos hallazgos, médicos y administradores de unos 35 hospitales en Estados Unidos han establecido clínicas post-UCI, donde equipos de doctores, enfermeros, farmacéuticos, terapeutas (físicos, ocupacionales, cognitivos, del habla) y trabajadores sociales evalúan múltiples condiciones y ayudan a los pacientes a enfrentarlas.

La clínica de Vanderbilt atendió a su primer paciente en 2012. El Centro de Recuperación de Enfermedades Críticas del Centro Médico de la Universidad de Pittsburgh —fundado por Butcher en 2018— trabaja con unos 100 pacientes al año, incluido Masterson. Yale abrió su clínica en 2022.

Estas clínicas aplican seis prácticas recomendadas por la Sociedad de Medicina de Cuidados Críticos que han demostrado reducir de forma significativa los síntomas posteriores a la UCI. Las medidas incluyen usar sedación más ligera, hacer que los pacientes se levanten y se muevan antes, evaluar su respiración diariamente para retirar el ventilador más pronto y eliminar restricciones en las visitas familiares.

Las clínicas suelen ofrecer grupos de apoyo para pacientes y familias. Hay evidencia de que llevar un diario de la UCI, en el que pacientes y cuidadores registran sus experiencias, y participar en ejercicio y rehabilitación física mejora la salud mental después del alta.

También se abordan conversaciones sobre qué otras opciones preferirían los pacientes si enfrentan otra enfermedad crítica, como ocurre con muchos. ¿Aceptarían nuevamente cuidados intensivos y el riesgo de sus secuelas? ¿O elegirían cuidados paliativos, que priorizan la comodidad en lugar de la curación? Algunos pacientes quedan con discapacidades permanentes después de la UCI.

Butcher, aunque señaló que estas nuevas prácticas deben ampliarse mucho más, se mostró optimista sobre el futuro de los cuidados críticos. “Vamos a encontrar mejores herramientas de diagnóstico, mejores estrategias de prevención y mejores tratamientos”, dijo.

Por ahora, sin embargo, la experiencia en la UCI sigue siendo desorientadora y a veces traumática. Cuando Butcher preguntó a 117 pacientes en su clínica post-UCI sobre qué harían en el futuro, muchos querían poner límites a las intervenciones médicas.

Alrededor de un tercio preferiría reducir el nivel de atención agresiva. De ellos, cerca de una cuarta parte optaría por órdenes de “no resucitar” y “no intubar”, y casi el 7% dijo que no querría volver nunca a una UCI.

Masterson sigue trabajando en su recuperación. “No he salido mucho”, dijo. “He estado más bien en casa”. Espera recuperar la fuerza suficiente para volver a correr; antes solía correr entre 3 y 4 millas varias veces por semana.

El futuro de los pacientes con síndrome post-UCI suele depender de su estado físico, mental y cognitivo antes de la hospitalización. La buena condición física previa de Masterson y su trabajo exigente a nivel cognitivo son factores positivos para su recuperación, señaló Butcher.

Su familia oscila entre la esperanza y la preocupación. “Quién sabe cómo estará más adelante”, dijo Dede, su cuñado. “Vamos día a día”.

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Other drivers stopped, broke the car window, and pulled him to safety. A passing volunteer firefighter performed CPR until an ambulance arrived to take Masterson to UPMC Mercy hospital.

He spent 18 days in the medical intensive care unit there, 14 of them on a ventilator. He developed delirium, a common ICU condition, and needed antipsychotic drugs. Despite a feeding tube, he lost weight. “We honestly weren’t confident that he would pull through,” said Ron Dedes, his brother-in-law.

But he did. Masterson was discharged Feb. 1 and returned home with near-constant family support. Working diligently with several kinds of therapists, he has regained his ability to walk, despite lingering weakness, and to manage his personal care. His once-garbled speech has markedly improved. He can make himself a sandwich.

Now, “our biggest concern is his memory,” Dedes said. Masterson, who so recently handled complex legal matters, forgets conversations and events that happened a few hours earlier, said Patti Dedes, his sister. He can’t yet operate a microwave or place a phone call.

In an interview, he described himself, accurately, as “much, much better than I was” — but misstated his age. Screening tests after his discharge indicated cognitive impairment and depression.

Among critical-care doctors, prolonged symptoms like his are known as “post-intensive care syndrome,” or PICS. The fallout can be physical or psychological, as well as cognitive, and can persist for months or years.

More than 5 million people annually are admitted to intensive care across about 5,000 American hospitals, and research shows that more than half experience such aftereffects. Older age increases the odds.

Patients and families are often startled by these continuing difficulties. “The belief is that they’ll be discharged from the hospital and in two or three weeks, they’ll be back to normal,” said Brad Butcher, who was Masterson’s doctor and wrote about PICS recently in the medical journal JAMA. “That doesn’t comport with reality.”

In fact, with greater ICU use and improved treatments — the Society of Critical Care Medicine estimates that 70% to 90% of adults now survive their stays — the population likely to encounter the syndrome is growing.

“Everyone is grateful that the patient has survived,” said Lauren Ferrante, a pulmonary critical-care doctor and researcher at the Yale School of Medicine. “But that’s just the start of a long road to recovery.” In a study of patients 70 and older that she co-authored, within six months after discharge only about half had returned to their pre-ICU functional ability.

Intensive care patients face a long list of challenges. PICS symptoms range from the physical — weakness, pain, neuropathy (tingling in arms and legs), and malnutrition — to mental health concerns, primarily anxiety and depression. Cognitive difficulties like Masterson’s are commonplace, including problems with memory, attention and concentration, and language.

“For many people, surviving a critical illness is a life-altering experience,” Butcher said. Patients in intensive care after emergency or elective surgery also have high rates of new physical, mental, and cognitive problems a year later.

The same aggressive treatments that save lives contribute to the syndrome. Intensive care patients “have some sort of dramatic organ failure that requires immediate attention” and constant monitoring, explained Carla Sevin, a pulmonary critical-care doctor who directs the ICU Recovery Center at Vanderbilt University Medical Center.

That could mean a breathing tube attached to a ventilator, which in turn often requires sedating drugs. Sedation “can precipitate delirium, and delirium is the key factor in cognitive symptoms,” Butcher said.

It doesn’t help that constant beeps and alarms from monitors and round-the-clock bright lighting disrupt sleep, and that restrictive family visiting hours deprive patients of reassuring faces and voices.

Gregory Matthews, a retired accountant in St. Petersburg, Florida, spent nearly a month in an ICU after a lung transplant in 2014. He still vividly remembers his hallucinations, including mice running across the wall and someone trying to frame him for drug running.

“One day, I thought a doctor was an assassin — I could see the rifle,” said Matthews, now 80. “So I jumped out of bed,” he said, and yanked out his IVs. The staff put his arms in restraints for days.

But immobilization exacts its own toll as patients quickly lose muscle mass and strength. “Our bodies were not meant to lie in bed all day,” Ferrante said.

Psychologically, “PTSD is pretty common, similar to what’s seen in combat veterans or sexual assault survivors,” Sevin said, referring to post-traumatic stress disorder. Families can suffer anxiety and depression along with the patients.

Alarmed by such discoveries, doctors and administrators at about 35 U.S. hospitals have established post-ICU clinics, where teams of doctors, nurses, pharmacists, therapists (physical, occupational, cognitive, speech), and social workers screen for a host of conditions and help guide patients through them.

Vanderbilt’s clinic saw its first patient in 2012. The Critical Illness Recovery Center at the University of Pittsburgh Medical Center, which Butcher founded in 2018, works with about 100 patients a year, including Masterson. Yale opened its clinic in 2022.

They rely on six practices recommended by the Society of Critical Care Medicine that are shown to significantly reduce post-ICU symptoms. The measures call for changes such as using lighter sedation, getting patients up and moving earlier, testing their breathing daily to wean them from ventilators sooner, and removing restrictions on family visiting.

Clinics often offer support groups for patients and families. There’s evidence that keeping an ICU diary, in which patients and caregivers record their experiences, and engaging in exercise and physical rehabilitation improve mental health after discharge.

Also on the clinics’ agenda: discussions of what other options patients might prefer if they face another critical illness, as many do. Would they agree to undergo intensive care and risk its aftereffects again? Or choose palliative care, which emphasizes comfort rather than cure? Some post-ICU patients remain permanently impaired.

Butcher, although he said that the use of the new practices needed to expand dramatically, sounded optimistic about the future of critical care. “We’re going to find better diagnostic tools, better preventive strategies, and better therapies,” he said.

For now, though, the ICU experience remains disorienting and sometimes traumatic. When Butcher asked 117 patients in his post-ICU clinic those next-time questions, many wanted to place limits on further medical interventions.

About a third would want to lower the level of aggressive care. Of those, about a quarter would want “do not resuscitate” and “do not intubate” orders, and almost 7% said they never wanted to return to an ICU.

Masterson is working hard to further his recovery. “I haven’t been out and about much,” he said. “I’ve been kind of homebound.” He hopes to get strong enough to resume running — he used to log 3 to 4 miles several times a week.

The future for patients contending with post-ICU syndrome often depends on their physical, mental, and cognitive health before their admission. Masterson’s previous fitness and cognitively demanding work bode well for his further progress, Butcher said.

His family remains alternatively hopeful and worried. “Down the road, what’s it going to be like?” Dedes, his brother-in-law, wondered. “We just take it day by day.”

The New Old Age is produced through a partnership with The New York Times.

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Mientras revisaba su historial y signos vitales, Supiano, geriatra en la Universidad de Utah, observó una señal preocupante: su presión arterial era de 148/86, por encima de lo normal a pesar de que tomaba dos medicamentos para bajarla. “Claramente era demasiado alta”, dijo recientemente.

Varios factores podrían haber contribuido a ese número, incluidos el medicamento antiinflamatorio que la mujer de 78 años tomaba para el dolor de artritis, una dieta alta en sodio y la falta de ejercicio regular. También le dijo a Supiano que solía beber un par de copas de vino cada noche.

Después de que Supiano hablara con ella sobre formas de reducir su riesgo, la mujer y su esposo se inscribieron en un gimnasio. Dejó el antiinflamatorio y redujo la sal y el alcohol, lo que llevó su presión sistólica a un rango de 130 a 140 —todavía hipertensión, según las guías publicadas por la Asociación Americana del Corazón (AHA) y el Colegio Americano de Cardiología (ACC) a finales de ese año, pero más aceptable. (La sistólica es el número superior en la medición de la presión arterial y el más importante desde el punto de vista clínico).

Sin embargo, para 2019, la paciente tenía un diagnóstico de deterioro cognitivo leve y comenzaban a surgir evidencias médicas sobre la relación entre la hipertensión (el término médico para presión arterial alta) y la demencia. “No fui tan agresivo como debí haber sido”, recordó Supiano. Agregó un tercer medicamento para la hipertensión y sus cifras bajaron a 120 o menos.

Las guías cambiantes para el control de la presión arterial pueden recordar a las personas de mayor edad un baile de moda en su juventud: el limbo. Como decía Chubby Checker: “¿Qué tan bajo puedes llegar?”

Durante más de 25 años, una lectura de 140/90 o menos se consideró normal, según las guías de la AHA/ACC. Pero la actualización de 2017 introdujo cambios importantes, respaldados por los resultados del ensayo SPRINT, que incluyó a adultos mayores de 50 años con alto riesgo cardiovascular.

El ensayo SPRINT encontró que un tratamiento intensivo dirigido a reducir la presión sistólica por debajo de 120 disminuía el riesgo de ataques cardíacos, accidentes cerebrovasculares, otras enfermedades cardiovasculares y la mortalidad general de manera tan significativa que los investigadores detuvieron el estudio antes de tiempo para ofrecer recomendaciones.

Consideraron que no era ético negar a la mitad de los participantes los beneficios del tratamiento intensivo. Por eso, las guías de 2017 recomendaron medicación para quienes tenían una presión sistólica superior a 130.

Las revisiones más recientes, publicadas a finales del año pasado, promueven un control aún más estricto. Recomiendan que los pacientes con riesgo cardiovascular busquen cifras sistólicas por debajo de 120 y también consideran ese objetivo “razonable” incluso para quienes no tienen alto riesgo.

Lecturas que no hace mucho se consideraban normales; ahora se definen como hipertensión.

La presión arterial normalmente aumenta con la edad porque “con el endurecimiento de las arterias, el corazón tiene que bombear con más fuerza”, dijo Erica Spatz, directora del programa de salud cardiovascular preventiva de la Facultad de Medicina de Yale. Entre 2021 y 2023, alrededor de dos tercios de los adultos mayores de 65 años tenían hipertensión, según la definición vigente en ese momento.

Pero las revisiones recientes podrían “definir a muchas más personas como hipertensas”, señaló Rita Redberg, cardióloga de la Universidad de California en San Francisco (UCSF).

Para Supiano, estudios recientes en Estados Unidos y China que muestran beneficios cognitivos con cifras más bajas “han inclinado la balanza” para los adultos mayores. “Lo que es bueno para el corazón es bueno para el cerebro”, dijo, calificando esos hallazgos como “una forma de lograr que las personas presten más atención a su presión arterial. Puede que no quieran vivir más tiempo, pero sí quieren mantener su capacidad cognitiva por más tiempo”.

Casi todas las principales asociaciones médicas, incluida la Sociedad Americana de Geriatría (AGS), de cuya junta Supiano es presidente, han respaldado las nuevas guías.

“Antes era más flexible con muchos de mis pacientes mayores”, dijo John Dodson, cardiólogo e investigador en NYU Langone Health. “Si trataba en exceso la presión arterial alta, podían ocurrir cosas malas”.

Una presión arterial demasiado baja —hipotensión— puede causar mareos, desmayos o lesiones por caídas.

Ahora, dijo Dodson, “trato a mis pacientes mayores de manera más agresiva”.

Los estudios han demostrado que tratar la hipertensión beneficia incluso a adultos mayores frágiles. Y aunque los adultos mayores en el ensayo SPRINT tuvieron más lesiones por caídas, la tasa no fue mayor en quienes recibieron tratamiento intensivo que en quienes tuvieron el tratamiento estándar. Entre los mayores de 75 años, fue de aproximadamente el 5% en ambos grupos.

Otro cambio importante: las nuevas guías recomiendan el monitoreo en casa.

“La presión arterial es complicada”, señaló Spatz. “Varía a lo largo del día, dependiendo de si una persona acaba de despertarse, de comer o si hace calor”. Las cifras sistólicas pueden variar 30 puntos o más en un solo día.

Y casi siempre son más altas en el consultorio. “No quiero basarme demasiado en una sola medición”, dijo Spatz.

“Tal vez el paciente tiene síndrome de bata blanca”, explicó, refiriéndose a la ansiedad ante médicos y exámenes, “o tuvo una discusión con el encargado del estacionamiento” antes de llegar.

Spatz pide a los pacientes que registren su presión arterial dos veces al día durante una o dos semanas antes de sus citas. Algunos doctores recetan monitores de 24 horas para el hogar.

¿Adoptarán los pacientes el monitoreo en casa y un tratamiento más agresivo? Los cardiólogos señalan que la hipertensión, casi siempre sin síntomas, sigue siendo tratada de forma insuficiente a pesar de las nuevas guías.

Es poco probable que el costo sea un obstáculo. La mayoría de los pacientes necesita dos o tres medicamentos para bajar la presión arterial, pero como son genéricos, “son muy baratos, alrededor de $5 al mes”, y rara vez interactúan con otros medicamentos que suelen tomar los adultos mayores, dijo Supiano. Un monitor de presión arterial para uso en casa cuesta unos $35 o un poco más si transmite datos digitalmente.

Aunque algunos efectos secundarios son graves —una caída puede cambiar la vida—, la mayoría de las complicaciones “afortunadamente son transitorias, reversibles y bastante leves”, dijo.

Sin embargo, las guías también tienen críticos. Redberg, por ejemplo, aconseja a sus pacientes mayores sobre dieta, ejercicio y pérdida de peso, pero no les recomienda iniciar medicamentos para reducir una presión sistólica de 135 a menos de 120.

Ya parecen demasiado preocupados por su presión arterial, dijo, y agregó: “Los animo a salir y disfrutar”.

“¡Tomen una clase! ¡Vayan a un museo!”, dijo. “No pueden hacer eso si están en casa midiéndose la presión cinco veces al día”.

Aunque los ensayos y las guías abordan beneficios para la población en general —incluso pequeñas reducciones en la demencia tendrían un gran impacto— no sirven para predecir resultados individuales.

La calculadora PREVENT, usada para estimar si una persona obtendría beneficios cardiovasculares del tratamiento de la hipertensión, no ha sido validada en personas mayores de 79 años y no considera los beneficios cognitivos, indicó Supiano.

Para personas con otras enfermedades graves —pacientes con cáncer o residentes de hogares de cuidado con demencia, por ejemplo— controlar la presión arterial puede no ser una prioridad.

El tiempo también es un factor al evaluar riesgos y beneficios. Un metaanálisis de pacientes mayores realizado por Sei Lee, geriatra en UCSF, y sus colegas encontró que, por cada 200 pacientes en tratamiento intensivo para la hipertensión, se necesitarían 1,7 años para prevenir un solo accidente cerebrovascular.

Reducir una presión arterial muy alta es más sencillo y más importante que intentar bajar una cifra de 130 a menos de 120, explicó Lee. “Habría que esforzarse mucho más, agregar un tercer o cuarto medicamento y el riesgo de efectos secundarios es mayor”.

La paciente de 78 años de Supiano sí alcanzó ese objetivo y se mantuvo bien durante seis o siete años. Luego, como ocurre con muchos pacientes con deterioro cognitivo leve, comenzó a empeorar y finalmente recibió un diagnóstico de Alzheimer.

Dado lo que informan los investigadores sobre los beneficios cognitivos de tratar la hipertensión, “tal vez le dio un par de años más de buena calidad”, reflexionó. “Tal vez retrasó la progresión”. O tal vez, dijo, debería haber iniciado el tratamiento intensivo antes.

The New Old Age se produce en colaboración con The New York Times.

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While taking her history and vital signs, Supiano, a geriatrician at the University of Utah, saw one disturbing signal: Her blood pressure was 148/86, above normal despite her taking two medications intended to lower it. “Clearly that was too high,” he said recently.

Several factors could have contributed to the high reading, including the anti-inflammatory drug the 78-year-old woman took for arthritis pain, a high-sodium diet, and a lack of regular exercise. She had also told Supiano that she typically drank a couple of glasses of wine each evening.

After Supiano discussed ways to lower her risk, the woman and her husband joined a gym. She stopped taking the anti-inflammatory and cut back on salt and alcohol, bringing her systolic blood pressure readings into the 130-to-140 range — still hypertension, according to the guidelines issued by the American Heart Association and the American College of Cardiology later that year, but more acceptable. (Systolic is the top number in the blood pressure ratio and the more clinically important number.)

By 2019, though, the patient had a diagnosis of mild cognitive impairment, and medical evidence was emerging about a connection between hypertension (the medical term for high blood pressure) and dementia. “I was not as aggressive as I should have been,” Supiano recalled. He added a third drug for high blood pressure to the woman’s regimen, and her readings fell to 120 or lower.

The shifting guidelines for blood pressure control may remind those at advanced ages of a dance fad from their youth, the limbo. As Chubby Checker once intoned, “How low can you go?”

For more than 25 years, a reading of 140/90 or below was considered normal, according to the AHA/ACC guidelines. But the 2017 update introduced major changes, backed by results from the landmark SPRINT trial, which enrolled adults over 50 who were at high cardiovascular risk.

The SPRINT trial found that intensive treatment aimed at bringing the systolic number below 120 reduced the risk of heart attacks, strokes, other cardiovascular illnesses, and overall mortality so substantially that the investigators stopped the study early.

It was unethical, they decided, to deny half the trial participants the benefits of intensive treatment. The 2017 guidelines, therefore, recommended medication for those with a systolic blood pressure over 130.

The most recent revisions, issued last year, encourage still tighter control. They call for patients at cardiovascular risk to strive for systolic readings below 120, and they also call that target “reasonable” even for those who are not at high risk. Readings considered normal not so long ago are now defined as hypertension.

Blood pressure normally rises with age because “with stiffening of the arteries, the heart has to pump harder,” said Erica Spatz, the director of the preventive cardiovascular health program at the Yale School of Medicine. From 2021 to 2023, about two-thirds of adults over 65 had hypertension, according to the operative definition at the time.

But recent revisions could “define a lot more people as having high blood pressure,” said Rita Redberg, a cardiologist at the University of California-San Francisco.

To Supiano, recent studies in the United States and in China that show cognitive benefit for the lower readings “have tipped the scales” for older adults. “What’s good for the heart is good for the brain,” he said, calling those findings “a lever to get people to pay more attention to their blood pressure. They may not want to live longer, but they want to hold on to their cognition longer.”

Nearly all major medical associations, including the American Geriatrics Society (Supiano is the chair of the organization’s board), have endorsed the latest guidelines.

“I used to be lenient in many of my older patients,” said John Dodson, a cardiologist and researcher at NYU Langone Health. “If I overtreated high blood pressure, bad things were going to happen.”

Blood pressure that drops too low — hypotension — can cause dizziness and fainting or injuries from falls.

Now, Dodson said, “I’m treating my older patients more aggressively.” Studies have shown that treating high blood pressure benefits even frail older adults. And while older adults in the SPRINT trial had more fall injuries, the rate wasn’t higher in those receiving intensive treatment than in those undergoing standard treatment. Among those over 75, it was about 5% for both groups.

Another significant change: The new guidelines recommend at-home monitoring.

“Blood pressure is tricky,” Spatz pointed out. “It varies throughout the day, depending on whether a person is just waking up or just ate or it’s hot outside.” Systolic readings can bounce around by 30 points or more in a single day.

And they’re almost always higher in a doctor’s office. “I don’t want to put much stock in one reading,” Spatz said.

“Maybe the patient has white-coat syndrome,” she added, referring to anxiety about doctors and testing, “or they had a fight with the parking attendant” on the way in.

She asks patients to record their blood pressure twice a day for a week or two before their appointments. Some doctors prescribe a 24-hour home monitor.

Will patients adopt home monitoring and more aggressive treatment? Cardiologists argue that high blood pressure, almost always asymptomatic, remains undertreated despite the newer guidelines.

Price is not likely to present an obstacle. Most patients need two or three drugs to lower blood pressure, but as generics they’re “dirt cheap, about $5 a month,” and rarely interact with the other drugs that are often prescribed for older people, Supiano said. A blood pressure monitor for home use runs $35, or more for those that digitally transmit data.

Although some side effects are serious — a fall can be life-altering — most complications “thankfully are transient and reversible and rather mild,” he said.

Yet the guidelines have skeptics, too. Redberg, for example, counsels older patients about diet, exercise, and weight loss but does not urge them to start medication to reduce a 135 systolic reading to below 120.

They already seem overanxious about their blood pressure, she said, adding, “I encourage them to go out and enjoy themselves.”

“Take a class! Go to a museum!” she said. “You can’t do that if you’re at home taking your blood pressure five times a day.”

While trials and guidelines address benefits for the population as a whole — even small reductions in dementia would have an enormous impact — they are not useful for predicting individual outcomes. The PREVENT calculator, used to gauge whether someone would see cardiovascular benefit from hypertension treatment, has not been validated for people over 79 and does not factor in cognitive benefits, Supiano noted.

For people with other serious illnesses — cancer patients or frail nursing home residents with dementia, for instance — controlling blood pressure may be far down the list of concerns.

Time is also a factor in weighing risks versus benefits. A meta-analysis of older patients by Sei Lee, a geriatrician at UCSF, and colleagues found that for 200 patients in intensive treatment for hypertension, it would take 1.7 years to prevent a single stroke.

Reducing very high blood pressure is simpler and more important than trying to lower a 130 reading to below 120, Lee added. “You’d have to work a lot harder, add a third or fourth medication, and the risk of side effects is higher.”

Supiano’s 78-year-old patient did hit that target and did well for six or seven years. Then, as happens with many patients with mild cognitive impairment, she began to decline and eventually received an Alzheimer’s diagnosis.

Given what researchers are reporting about the cognitive benefits of treating high blood pressure, “maybe it gave her another couple of good years,” he mused. “Maybe it delayed the progression.” Or maybe, he added, he should have started intensive treatment earlier.

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“La persona dijo que era un oficial del Departamento de Investigaciones Criminales que trabajaba en un caso de tráfico de drogas y lavado de dinero”, recordó la mujer. Parecía saber mucho sobre ella: los estados donde ella y su difunto esposo habían vivido, el nombre y la ocupación de él y su dirección actual en el condado de Washington, en Rhode Island.

En el teléfono, él le mostró una placa convincente y una identificación con su nombre (“Frank algo”), además de un artículo que describía la supuesta investigación. La mujer, una jubilada de 76 años, negó cualquier participación.

“Puede contratar a un abogado penal muy caro o bien cooperar conmigo”, le dijo Frank.

“Ahora, cuando uno lo piensa, no tiene ningún sentido”, reconoció recientemente la mujer. Pero convencida por la placa y la identificación, aceptó cooperar. De lo contrario, “pensé que iban a venir a arrestarme”.

Frank llamaba cada mañana para saber a dónde iba y qué estaba haciendo. Su equipo estaría vigilando, le advirtió. La mujer, sintiéndose “aterrada”, empezó a mirar a su alrededor mientras asistía a las reuniones del club de jardinería. ¿La estaría siguiendo alguien?

Todo era una estafa.

La falta de denuncias, muchas veces motivada por la vergüenza, dificulta estimar la magnitud de la explotación financiera de las personas mayores. La Comisión Federal de Comercio (FTC, por sus siglas en inglés) estimó que las pérdidas reportadas fueron de $2.400 millones en 2024, principalmente debido a estafas románticas e inversión, así como a robos de identidad. Las pérdidas totales, sin embargo, son mucho mayores.

Los estadounidenses mayores de 60 años pierden más de $28.000 millones cada año por explotación financiera, estimó AARP (American Association of Retired Persons) en 2023.

A medida que estas cifras aumentan, debido al envejecimiento de la población y a que los estafadores se vuelven cada vez más ingeniosos, los bancos y las firmas de inversión se están convirtiendo en la primera línea de defensa.

El objetivo inicial de Frank era la cuenta de la mujer en Fidelity Investments. Le indicó que transfiriera alrededor de $250.000 a su cuenta corriente y que le dijera al asesor financiero de la oficina local que ella y su familia planeaban comprar propiedades.

Ese plan fracasó cuando el asesor dijo que Fidelity no podía aprobar la transacción sin más información sobre la propiedad.

Entonces Frank la envió a su sucursal local de Washington Trust Company para retirar $70.000 en efectivo de una línea de crédito sobre el valor acumulado de su vivienda. “No entregamos tanto efectivo”, dijo la cajera, mientras mandaba discretamente un mensaje al gerente de la sucursal, quien conocía a la mujer y a su esposo desde hacía años.

El gerente llevó a la mujer a su oficina para conversar y allí se detuvo la estafa, con una llamada a la policía local. Los bienes de la mujer permanecieron intactos, pero la experiencia fue tan humillante que ella ni siquiera le ha contado a su familia lo cerca que estuvo de perder gran parte de los ahorros de toda su vida. The New York Times (donde originalmente se publica esta columna) decidió no utilizar su nombre para evitarle más vergüenza.

“Me sentí tan tonta”, dijo. “Me sentí como una ingenua”.

Los estafadores financieros que atacan a los adultos mayores representan “una prioridad mayor para nosotros ahora”, dijo Mary Noons, presidenta y directora de operaciones de Washington Trust.

Como banco comunitario regional, Washington Trust intensificó sus esfuerzos el otoño pasado para asesorar a los clientes mayores y a sus familias sobre temas financieros, incluidos los peligros del fraude y de la explotación de la gente mayor. También publicaron y distribuyeron un folleto titulado “Envejecer con sabiduría” y llevaron a un experto en demencia para capacitar a su personal.

El Washington Trust se convirtió en una de las 1.500 instituciones financieras que, hasta la fecha, han utilizado Bank Safe, un programa gratuito de videos de AARP que capacita a los empleados que atienden directamente al público para detectar señales de alerta que indiquen la posible explotación de personas mayores y así intervenir a tiempo. Todos los empleados de la sucursal donde la mujer de 76 años tenía su cuenta habían recibido esa capacitación.

“Algunos clientes mayores visitan su banco con mucha más frecuencia de la que ven a sus proveedores de atención médica”, señaló la señora Noons.

Hasta hace pocos años, las instituciones financieras ponían “más énfasis en la autonomía del cliente”, dijo Pamela Teaster, directora del Centro de Gerontología de Virginia Tech e investigadora especializada en abuso a personas mayores. Su enfoque era: “un adulto tiene la capacidad de tomar malas decisiones y vamos a permitir que las tome”, agregó.

Pero cambios en políticas y prácticas del gobierno y de la industria han impulsado una mayor vigilancia. El Congreso aprobó la ley Senior Safe en 2018, que protege a bancos y firmas financieras de responsabilidad legal si reportan a las autoridades sospechas de explotación.

Ese mismo año, la Autoridad Reguladora de la Industria Financiera (FINRA) comenzó a exigir que las firmas miembro pidan un contacto de confianza cuando los inversionistas abren o actualizan una cuenta (aunque el titular de la cuenta no está obligado a proporcionarla). Desde 2022, se permite que las entidades pongan en pausa las transacciones de clientes mayores si sospechan que los están tratando de estafar.

Aproximadamente la mitad de los estados han promulgado leyes que permiten a las instituciones financieras rechazar transacciones sospechosas o suspenderlas por un plazo definido para que puedan investigarse, dijo Jilenne Gunther, directora de Bank Safe.

“Esto les pone un freno”, explicó. “Con un poco de tiempo de por medio, el delincuente se pone nervioso y puede que vaya a buscar a otra persona. Y la posible víctima tiene tiempo para detenerse y pensar”.

El análisis de la doctora Teaster sobre datos de BankSafe, durante un programa piloto de seis meses en 82 instituciones financieras, encontró que era más probable que quienes participaban del programa reportaran casos sospechosos y protegieran el dinero de los clientes que un grupo de control.

No todas las pérdidas de los adultos mayores se deben a estafadores. También pueden, por sí solos, dejarse llevar por modas de inversión, asumir demasiadas deudas o tomar decisiones poco prudentes, incluso sin que haya delincuentes manipulándolos ni familiares vaciándoles las cuentas.

Administrar las finanzas implica desafíos cognitivos complejos, dijo el doctor Mark Lachs, codirector de geriatría y medicina paliativa en Weill Cornell Medicine. “Es una tarea que pone a trabajar muchas funciones del cerebro”, explicó: “Memoria para recordar que hay una factura que vence. Función ejecutiva, capacidad de organizar el tiempo. Abstracción, poder proyectarse hacia el futuro”.

Agregó: “No pocas veces los errores financieros son la primera señal de una demencia incipiente o de un trastorno neurocognitivo”.

Un estudio de 2024 del Banco de la Reserva Federal de Nueva York, por ejemplo, encontró una mayor probabilidad de pagos atrasados y de deterioro en las calificaciones crediticias en los cinco años previos a un diagnóstico de demencia.

Esos errores pueden reducir el acceso al crédito de las personas mayores y aumentar las tasas de interés de sus préstamos justo en el momento en que los gastos de cuidado tienden a aumentar.

El doctor Lachs ha recomendado a otros médicos que reconozcan lo que él llama Vulnerabilidad Financiera Asociada a la Edad, un síndrome que puede afectar incluso a personas mayores con cognición normal, especialmente si enfrentan enfermedades, déficits sensoriales o aislamiento social.

Y sigue siendo escéptico respecto a que  la industria financiera preste mayor atención a sus clientes de más edad. “Todavía veo que se ejecutan transacciones financieras preocupantes sin el nivel de revisión que deberían haber recibido”, dijo.

Capacitar a más empleados de tratan directamente con los clientes y poner mayor énfasis en establecer contactos de confianza para personas mayores ayudaría, opinó la señora Gunther, porque “una vez que el dinero sale de la cuenta, es casi imposible recuperarlo”. Más estados podrían aprobar leyes que les permitan a las instituciones financieras rechazar o frenar por un plazo las transacciones sospechosas.

En el Congreso avanzan varios proyectos de ley relacionados al tema, con apoyo bipartidista. La National Strategy for Combating Scams Act requeriría que el FBI asumiera la coordinación de los esfuerzos para proteger a las personas mayores. Un proyecto de ley que restableciera una deducción del Servicio de Impuestos Internos (IRS) al menos ofrecería el consuelo de eximir a las víctimas de estafas de pagar impuestos sobre un dinero que ya no tienen.

Sin embargo, nuevas herramientas como la clonación de voz con inteligencia artificial —en la que el supuesto nieto que llama desesperado desde otro estado pidiendo con urgencia $5.000 en tarjetas de regalo suena igual que el nieto real de la víctima— les quitan el sueño a defensores y banqueros.

En la sucursal de Washington Trust donde la mujer de Rhode Island pudo salvar su dinero, días antes los empleados habían detenido una estafa similar.

Pero, más recientemente, nadie detectó señales de peligro cuando otra mujer mayor retiró $9.000 para una remodelación de cocina, hasta que el dinero terminó en manos de un estafador en lugar de un contratista.

The New Old Age se produce en colaboración con The New York Times.

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“The person said he was an officer of the Department of Criminal Investigations looking into drug trafficking and money laundering,” the woman recalled. He seemed to know a lot about her: the states where she and her late husband had lived; his name and occupation; and her current address in Washington County, Rhode Island.

On her phone, he showed her a convincing badge and a photo ID with his name (“‘Frank’ something”), plus an article describing the supposed investigation. The woman, a 76-year-old retiree, denied any involvement.

“You can hire a very expensive criminal defense attorney, or you can cooperate with me,” Frank told her.

“Now, when you think about it, it doesn’t make any sense,” the woman acknowledged recently. But persuaded by the badge and ID, she agreed to cooperate. Otherwise, “I thought they were going to come and arrest me.”

Frank called each morning to learn where she was going, what she was doing. His team would be watching, he warned. The woman, feeling “petrified,” started looking around as she drove to garden club meetings. Was somebody following her?

It was all a scam.

Because victims’ sense of shame often leaves them reluctant to report such crimes, the extent of elder financial exploitation is hard to calculate. The Federal Trade Commission reported losses of $2.4 billion in 2024, largely driven by investment and romance scams and impersonations, with total losses much higher.

Americans age 60 and older lose more than $28 billion annually to financial exploitation, AARP estimated in 2023.

As those numbers rise, because the population is aging and predators are growing increasingly resourceful, banks and investment firms are becoming the first line of defense.

Frank’s initial target: her account at Fidelity Investments. He instructed her to shift about $250,000 into her checking account, telling the financial adviser at her local office that she and her family intended to buy real estate.

That scheme fizzled when the adviser said Fidelity could not approve the transaction without more information on the property.

So Frank sent her to her local branch of Washington Trust Company to take $70,000 in cash from a home-equity line of credit. “We don’t give out that much in cash,” the teller said, quietly messaging the branch manager, who had known the woman and her husband for years.

The manager ushered the woman into her office to talk, and the scam stopped there, with a call to the local police. The woman’s assets remained intact, but the experience proved so mortifying that she has not told even her family how close she came to losing much of her life savings. The New York Times is withholding her name to spare her embarrassment.

“I felt so stupid,” she said. “I felt like a fool.”

Financial predators targeting older adults represent “a heightened focus for us now,” said Mary Noons, president and chief operating officer of Washington Trust.

A regional community bank, Washington Trust cranked up its efforts last fall to advise older customers and their families about finances, including the dangers of elder fraud and exploitation. It published and distributed a booklet called “Age With Wisdom” and brought in an expert on dementia to speak with staff members.

And it became one of the 1,500 financial institutions to date to use BankSafe, a free AARP video program that trains front-line employees to spot the red flags indicating possible elder exploitation and to intervene. Everyone at the branch where the 76-year-old banked had taken the training.

“Some older customers visit their bank far more frequently than they see their health care providers,” Noons pointed out.

Until recent years, financial institutions placed “more of an emphasis on the autonomy of the client,” said Pamela Teaster, director of the Virginia Tech Center for Gerontology and an elder abuse researcher. Their approach was, “an adult has the capacity to make poor choices, and we’re going to let them make them,” she added.

But changes in government and industry policies and practices have encouraged greater vigilance. Congress passed the Senior Safe Act in 2018, protecting banks and financial firms from liability if they reported suspected exploitation to authorities.

That year, the Financial Industry Regulatory Authority began requiring member firms to ask for a trusted contact person when investors open or update accounts. (The account holder isn’t obliged to provide one, however.) And since 2022, it has allowed firms to place holds on older investors’ transactions if they suspect exploitation is involved.

About half of states have enacted laws that permit financial institutions to deny suspicious transactions or impose holds for specified periods to allow investigations, said Jilenne Gunther, the director of BankSafe.

“It adds friction,” she explained. “With space and time, the criminal gets worried and might move on. And the potential mark has time to stop and think.”

Teaster’s analysis of data from BankSafe, during a six-month pilot in 82 financial institutions, found that participants were much more likely to report suspected cases and save customers money than a control group was.

Not all of older adults’ losses result from predators, however. They can, on their own, get caught up in investment fads, take on too much debt, or make otherwise unwise decisions, even without criminals pulling the strings or relatives looting their accounts.

Managing finances presents complex cognitive challenges, said Mark Lachs, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine. “It requires a lot of brain,” he said, including: “Memory, remembering that a bill is due. Executive function, the ability to manage your time. Abstraction, hypothesizing about your future.”

He added, “Financial errors are not infrequently the first sign of impending dementia or a neurocognitive disorder.”

A 2024 study by the Federal Reserve Bank of New York, for instance, found an increased probability of delinquent payments and deteriorating credit ratings in the five years before a dementia diagnosis. Those errors can reduce seniors’ access to credit and raise their interest rates on loans at the very point when caregiving expenses are likely to soar.

Lachs has called on fellow doctors to recognize what he calls Age-Associated Financial Vulnerability, a syndrome that can affect even older people with normal cognition, especially if they contend with medical illnesses, sensory deficits, or social isolation.

And he remains skeptical about the financial industry’s claims of heightened attention to its oldest customers. “I still see concerning financial transactions executed that should have received far greater scrutiny,” he said.

Training more front-line staff members and increasing emphasis on establishing trusted contacts for older customers would help, Gunther said, because “once the money leaves the account, it’s near impossible to ever retrieve it.” More states could enact laws allowing financial institutions to deny suspicious transactions or impose holds.

Several related bills with bipartisan support are working their way through Congress. The National Strategy for Combating Scams Act would require the FBI to coordinate efforts to protect seniors. A bill that restores an IRS deduction would at least provide the consolation of excusing scam victims from paying taxes on money they no longer have.

However, new weapons like artificial-intelligence voice cloning — in which the supposed grandson four states away who urgently needs $5,000 in gift cards actually sounds like the victim’s grandson — keep advocates and bankers awake at night.

In the Washington Trust branch where the Rhode Island woman didn’t lose her money, employees just days earlier had stopped a scam similar to the one that had targeted her.

But more recently, nobody spotted any danger signs when an older woman withdrew $9,000 for a kitchen renovation, until it went to a scammer instead of a contractor.

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“I was kind of a mess,” recalled Abrams, 69. Trying to cope, “I was eating myself into oblivion.” As her weight hit 270 pounds and her blood pressure, cholesterol, and blood glucose levels climbed, “I knew I was in trouble health-wise.”

What came to mind? “Oh, oh, oh, Ozempic!” — the tuneful ditty from television commercials that promoted the GLP-1 medication for diabetes. The ads also pointed out that patients who took it lost weight.

Abrams remembered the commercials as “joyful” and sometimes found herself humming the jingle. They depicted Ozempic-takers cooking omelets, repairing bikes, playing pickleball — “doing everyday activities, but with verve,” she said. “These people were enjoying the hell out of life.”

So, just as such ads often urge, even though she had never been diagnosed with diabetes, she asked her doctor if Ozempic was right for her.

Small wonder Abrams recalled those ads. Novo Nordisk, which manufactures Ozempic, spent an estimated $180 million in direct-to-consumer advertising in 2022 and $189 million in 2023, according to MediaRadar, which monitors advertising.

By last year, the sum — including radio and TV commercials, billboards, and print and digital ads — had reached an estimated $201 million, and total spending on direct-to-consumer advertising of prescription drugs topped $9 billion, by MediaRadar’s calculations.

Novo Nordisk declined to address those numbers.

Should it be legal to market drugs directly to potential patients? This controversy, which has simmered for decades, has begun receiving renewed attention from both the Trump administration and legislators.

The question has particular relevance for older adults, who contend with more medical problems than younger people and are more apt to take prescription drugs. “Part of aging is developing health conditions and becoming a target of drug advertising,” said Steven Woloshin, who studies health communication and decision-making at the Dartmouth Institute.

The debate over direct-to-consumer ads dates to 1997, when the FDA loosened restrictions and allowed prescription drug ads on television as long as they included a rapid-fire summary of major risks and provided a source for further information.

“That really opened the door,” said Abby Alpert, a health economist at the Wharton School of the University of Pennsylvania.

The introduction of Medicare Part D, in 2006, brought “a huge expansion in prescription drug coverage and, as a result, a big increase in pharmaceutical advertising,” Alpert added. A study she co-wrote in 2023 found that pharmaceutical ads were much more prevalent in areas with a high proportion of residents 65 and older.

Industry and academic research have shown that ads influence prescription rates. Patients are more apt to make appointments and request drugs, either by brand name or by category, and doctors often comply. Multiple follow-up visits may ensue.

But does that benefit consumers? Most developed countries take a hard pass. Only New Zealand and, despite the decadelong opposition of the American Medical Association, the United States allow direct-to-consumer prescription drug advertising.

Public health advocates argue that such ads encourage the use and overuse of expensive new medications, even when existing, cheaper drugs work as effectively. (Drug companies don’t bother advertising once patents expire and generic drugs become available.)

In a 2023 study in JAMA Network Open, for instance, researchers analyzed the “therapeutic value” of the drugs most advertised on television, based on the assessments of independent European and Canadian organizations that negotiate prices for approved drugs.

Nearly three-quarters of the top-advertised medications didn’t perform markedly better than older ones, the analysis found.

“Often, really good drugs sell themselves,” said Aaron Kesselheim, senior author of the study and director of the Program on Regulation, Therapeutics, and Law at Harvard University.

“Drugs without added therapeutic value need to be pushed, and that’s what direct-to-consumer advertising does,” he said.

Opponents of a ban on such advertising say it benefits consumers. “It provides information and education to patients, makes them aware of available treatments and leads them to seek care,” Alpert said. That is “especially important for underdiagnosed conditions,” like depression.

Moreover, she wrote in a recent JAMA Health Forum commentary, direct-to-consumer ads lead to increased use not only of brand-name drugs but also of non-advertised substitutes, including generics.

The Trump administration entered this debate last September, with a presidential memorandum calling for a return to the pre-1997 policy severely restricting direct-to-consumer drug advertising.

That position has repeatedly been urged by Health and Human Services Secretary Robert F. Kennedy Jr., who has charged that “pharmaceutical ads hooked this country on prescription drugs.”

At the same time, the FDA said it was issuing 100 cease-and-desist orders about deceptive drug ads and sending “thousands” of warnings to pharmaceutical companies to remove misleading ads. Marty Makary, the FDA commissioner, blasted drug ads in an essay in The New York Times.

“There’s a lot of chatter,” Woloshin said of those actions. “I don’t know that we’ll see anything concrete.”

This month, however, the FDA notified Novo Nordisk that the agency had found its TV spot for a new oral version of Wegovy false and misleading. Novo Nordisk said in an email that it was “in the process of responding to the FDA” to address the concerns.

Meanwhile, Democratic and independent senators who rarely align with the Trump administration also have introduced legislation to ban or limit direct-to-consumer pharmaceutical ads.

Last February, independent Sen. Angus King of Maine and two other sponsors introduced a bill prohibiting direct-to-consumer ads for the first three years after a drug gains FDA approval.

King said in an email that the act would better inform consumers “by making sure newly approved drugs aren’t allowed to immediately flood the market with ads before we fully understand their impact on the general public.”

Then, in June, he and independent Sen. Bernie Sanders of Vermont proposed legislation to ban such ads entirely. That might prove difficult, Woloshin said, given the Supreme Court’s Citizens United ruling protecting corporate speech.

Moreover, direct-to-consumer ads represent only part of the industry’s promotional efforts. Pharmaceutical firms actually spend more money advertising to doctors than to consumers.

Although television still accounts for most consumer spending, because it’s expensive, Kesselheim pointed to “the mostly unregulated expansion of direct-to-consumer ads onto the web” as a particular concern. Drug sales themselves are bypassing doctors’ practices by moving online.

Woloshin said that “disease awareness campaigns” — for everything from shingles to restless legs — don’t mention any particular drug but are “often marketing dressed up as education.”

He advocates more effective educational campaigns, he said, “to help consumers become more savvy and skeptical and able to recognize reliable versus unreliable information.”

For example, Woloshin and Lisa Schwartz, a late colleague, designed and tested a simple “drug facts box,” similar to the nutritional labeling on packaged foods, that summarizes and quantifies the benefits and harms of medications.

For now, consumers have to try to educate themselves about the drugs they see ballyhooed on TV.

Abrams read a lot about Ozempic. Her doctor agreed that trying it made sense.

Abrams was referred to an endocrinologist, who decided that her blood glucose was high enough to warrant treatment. Three years later and 90 pounds lighter, she feels able to scramble after her 2-year-old grandson, enjoys Zumba classes, and no longer needs blood pressure or cholesterol drugs.

So Abrams is unsure, she said, how to feel about a possible ban on direct-to-consumer drug ads.

“If I hadn’t asked my new doctor about it, would she have suggested Ozempic?” Abrams wondered. “Or would I still weigh 270 pounds?”

The New Old Age is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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During procedures, he seemed “hesitant, not sure of how to go on to the next step without being prompted” by assistants, said Mark Katlic, director of the Aging Surgeon Program at Sinai Hospital in Baltimore.

The chief of surgery, concerned about the doctor’s cognition, “would not sign off on his credentials to practice surgery unless he went through an evaluation,” Katlic said.

Since 2015, when Sinai inaugurated a screening program for surgeons 75 and older, about 30 from around the country have undergone its comprehensive two-day physical and cognitive assessment. This surgeon “did not come of his own accord,” Katlic recalled.

But he came. The tests revealed mild cognitive impairment, often but not necessarily a precursor to dementia. The neuropsychologist’s report advised that the surgeon’s difficulties were “likely to impact his ability to practice medicine as he is doing presently, e.g. conducting complex surgical procedures.”

That didn’t mean the surgeon had to retire; a variety of accommodations would allow him to continue in other roles. “He retained a lifetime of knowledge that had not been impacted by cognitive changes,” Katlic said. The hospital “took him out of the OR, but he continued to see patients in the clinic.”

Such incidents are likely to become more common as America’s physician workforce ages rapidly. In 2005, more than 11% of doctors who were seeing patients were 65 or older, the American Medical Association said. Last year, the proportion reached 22.4%, with nearly 203,000 older practitioners.

Given physician shortages, especially in rural areas and key specialties like primary care, nobody wants to drive out veteran doctors with skills and experience.

Yet researchers have documented “a gradual decline in physicians’ cognitive abilities starting in their mid-60s,” said Thomas Gallagher, an internist and bioethicist at the University of Washington who has studied late-career trajectories.

At older ages, reaction times slow; knowledge can become outdated. Cognitive scores vary greatly, however. “Some practitioners continue to do as well as they did in their 40s and 50s, and others really start to struggle,” Gallagher said.

A few health organizations have responded by establishing late-career practitioner programs mandating that older doctors be screened for cognitive and physical deficits.

UVA Health at the University of Virginia began its program in 2011 and has screened about 200 older practitioners. Only in four cases did the results significantly change a doctor’s practice or privileges.

Stanford Health Care launched its late-career program the following year. Penn Medicine at the University of Pennsylvania also put in place a testing program.

Nobody has tracked how many exist; Gallagher guesstimated as many as 200. But given that the United States has more than 6,000 hospitals, those with late-career programs constitute “a vast minority,” he said.

The number may actually have shrunk. A federal lawsuit, along with the profession’s lingering reluctance, appears to have put the effort to regularly assess older doctors’ abilities in limbo.

Late-career programs typically require those 70 and older to be evaluated before their privileges and credentials are renewed, with confirmatory testing for those whose initial results indicate problems. Thereafter, older doctors undergo regular rescreening, usually every year or two.

It’s fair to say such efforts proved unpopular among their intended targets. Doctors frequently insist that “‘I’ll know when it’s time to stand down,’” said Rocco Orlando, senior strategic adviser to Hartford HealthCare, which operates eight Connecticut hospitals and began its late-career practitioner program in 2018. “It turns out not to be true.”

When Hartford HealthCare published data from the first two years of its late-career program, it reported that of the 160 practitioners 70 and older who were screened, 14.4% showed some degree of cognitive impairment.

That mirrored results from Yale New Haven Hospital, which instituted mandatory cognitive screening for medical staff members starting at age 70. Among the first 141 Yale clinicians who underwent testing, 12.7% “demonstrated cognitive deficits that were likely to impair their ability to practice medicine independently,” a study reported.

Proponents of late-career screening argued that such programs could prevent harm to patients while steering impaired doctors to less demanding assignments or, in some cases, toward retirement.

“I thought as we got the word out nationally, this would be something we could encourage across the country,” Orlando said, noting that Hartford’s program cost only $50,000 to $60,000 a year.

Instead, he has seen “zero progress” in recent years. “Probably we’ve gone backward,” he said.

A key reason: In 2020, the federal Equal Employment Opportunity Commission sued Yale New Haven over its testing efforts, charging age and disability discrimination. The legal action continues (the EEOC declined to comment on its status), as does the hospital’s late-career program.

But the suit led several other organizations to pause or shut down their programs, including those at Hartford HealthCare and at Driscoll Children’s Hospital in Corpus Christi, Texas, while few new ones have emerged.

“It made lots of organizations uncomfortable about sticking their necks out,” Gallagher said.

Instituting later-career programs has always been an uphill effort. “Doctors don’t like to be regulated,” Katlic acknowledged. Late-career programs have “in some cases been very controversial, and they’ve been blocked by influential physicians,” he said.

As health systems wait to see what happens in federal court, most national medical organizations have recommended only voluntary screening and peer reporting.

“Neither works very well at all,” Gallagher said. “Physicians are hesitant to share their concerns about their colleagues,” which can involve “challenging power dynamics.”

As for voluntary evaluation, since cognitive decline can affect doctors’ (or anyone’s) self-awareness, “they’re the last to know that they’re not themselves,” he added.

In a recent commentary in The New England Journal of Medicine, Gallagher and his co-authors recommended procedural policies to promote fairness in late-career screening, based on an analysis of such programs and interviews with their leaders.

“How can we design these programs in a way that’s fair and that therefore physicians are more apt to participate in?” he said. The authors emphasized the need for confidentiality and safeguards, such as an appeals process.

“There are all sorts of accommodations” for doctors whose assessments indicate the need for different roles, Gallagher noted. They could adopt less onerous schedules or handle routine procedures while leaving complex six-hour surgeries to their colleagues. They might transition to teaching, mentoring, and consulting.

Yet a substantial number of older doctors head for the exits and retire rather than face a mandated evaluation, he said.

The future, therefore, might involve programs that regularly screen every practitioner. That would be inefficient (few doctors in their 40s will flunk a cognitive test) and, with current tests, time-consuming and consequently expensive. But it would avoid charges of age discrimination.

Faster reliable cognitive tests, reportedly in the research pipeline, may be one way to proceed. In the meantime, Orlando said, changing the culture of health care organizations requires encouraging peer reporting and commending “the people who have the courage to speak up.”

“If you see something, say something,” he continued, referring to health care professionals who witness doctors (of any age) faltering. “We are overly protective of our own. We need to step back and say, ‘No, we’re about protecting our patients.’”

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Finally, after decades of advocacy, the Biden administration in 2023 tackled the problem of perennial understaffing of long-term care facilities. Officials backed a Medicare regulation that would mandate at least 3.48 hours of care from nurses and aides per resident, per day, and would require a registered nurse on-site 24 hours a day, seven days a week.

The mandated hours were lower than supporters hoped for, said Hunter, who directs Washington state’s long-term care ombudsman program. But “I’m a pragmatic person, so I thought, this is a good start,” she said. “It would be helpful, for enforcement, to have a federal law.”

In 2024, when the Centers for Medicare & Medicaid Services adopted the standards, advocates celebrated. But industry lawsuits soon blocked most of the rule, with two federal district courts finding that Medicare had exceeded its regulatory authority.

And after the 2024 elections, Hunter said, “I was concerned about the changing of the guard.” Her concerns proved well founded.

In July, as part of Republicans’ One Big Beautiful Bill Act, Congress prohibited Medicare from implementing the staffing standards before 2034. Last month, CMS repealed the standards altogether. They never took effect.

“It was devastating,” Hunter said.

As with environmental law and consumer protections, the Trump administration’s enthusiasm for deregulation has undone long-sought rules to improve care for the aged. And it has introduced a Medicare experiment for prior authorizations, now getting underway in six states, that has alarmed advocates, congressional Democrats, and a good number of older Americans.

Taken together, the moves will affect many of the facilities and workers providing care and introduce complications in health coverage in several states.

On the nursing home front, “it’s clear CMS has no interest in ensuring adequate staffing,” said Sam Brooks, the director of public policy for the National Consumer Voice for Quality Long-Term Care.

“They’re repealing a regulation that could have saved 13,000 lives a year,” he added, citing an analysis by University of Pennsylvania researchers.

Industry groups argued that nursing homes, with high rates of staff turnover, were already struggling to fill vacancies.

The staffing mandate “was requiring nursing homes to hire an additional 100,000 caregivers that simply don’t exist,” said Holly Harmon, a senior vice president at the American Health Care Association.

The organization had brought one of the suits that largely vacated the rule. “Facilities would have been forced to limit admissions or downsize to comply with the requirements, or close altogether,” Harmon said.

For supporters, the action is now likely to shift to updating requirements in 35 states, along with the District of Columbia, that have already established some nursing home staff standards, and to developing them in those that haven’t.

Rules for Home Help

A second rescinded regulation, this one more unexpected, brought about upheaval in July, when the Labor Department announced a return to a policy excluding home care workers from the federal Fair Labor Standards Act.

Some history: Dating back to the New Deal, the FLSA mandated that workers receive the federal minimum wage (currently $7.25 an hour) and overtime pay. It exempted most “domestic service workers” until 1975, when a new Labor Department regulation included them — with the exception of home care workers.

“There was a misinterpretation of home care work as being casual, nonprofessional, non-skilled,” the equivalent of teenage babysitting, said Kezia Scales, a vice president at PHI, a national research and advocacy organization. “Just someone popping into your mother’s house now and then and keeping her company.”

For almost 40 years, workers and their supporters lobbied to change the rule, seeing it as a contributor to the low wages and meager benefits of a swiftly growing workforce, one made up primarily of women and minority groups, with many immigrants.

In 2013, the Labor Department responded with a rule that brought home care workers under the labor act, entitled to minimum wage, time and a half for overtime work, and payment for travel time between clients.

After industry lawsuits failed to overturn it, “everything settled down,” Scales said. “It was in place successfully for a decade.”

Home care workers brought hundreds of compliance complaints annually. In 87% of them, the Labor Department found violations of the labor act, according to a 2020 Government Accountability Office report.

Since 2013, home care agencies have paid about $158 million in back wages, PHI has calculated.

Then in July, the Labor Department abruptly announced that it would return to the 1975 regulations and stop enforcing the 2013 rule, which it said “had negative effects on the ground” and hindered consumer access to care.

The agencies employing most home care workers, primarily funded through Medicaid, would agree. “Many workers never got any benefit from this,” said Damon Terzaghi, a vice president at the National Alliance for Care at Home.

“States made a lot of moves to essentially absolve themselves of any responsibility,” he said. A 2020 federal report, for example, found that 16 states had capped Medicaid-covered home care hours at 40, thus averting overtime payment.

The alliance, which estimates that the number of impacted agencies and businesses has declined by 30% since 2013, supported the rescission. Scales, who hopes for congressional action, called it “a shocking step backward.”

Where they concur is that the United States has never really committed to sufficiently funding long-term care at home. With the July legislation setting the stage for a $914 billion cut to Medicaid over the coming decade, that seems unlikely to change anytime soon.

Medicare’s AI Referee

Beyond rolling back policies for care of the aged, the Trump administration has established a pilot program to introduce one to traditional Medicare: prior authorization, using artificial intelligence and machine learning technologies.

Touting it as a boon to taxpayers, Medicare calls it WISeR — Wasteful and Inappropriate Service Reduction.

Prior authorization, in which private insurers review proposed treatments before agreeing to pay for them, is widely used in Medicare Advantage plans despite its unpopularity with patients, doctors, and health care organizations. It has rarely been used in traditional Medicare.

This month, however, WISeR debuts in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington) in a six-year trial to determine whether review by tech companies can reduce costs and improve efficiency, while maintaining or improving quality of care.

Initially, WISeR targets 17 items and services that CMS said “historically have had a higher risk of waste, fraud and abuse.” The list includes knee arthroscopy for arthritis, electrical nerve stimulation devices for several conditions, and treatment for impotence.

The pilot program excludes emergency services and inpatient hospital care, or care where delay poses “a substantial risk.” Algorithmic denials will trigger review by “an appropriately licensed human clinician.” The tech companies get “a share of averted expenditures.”

“It injects some of the worst of Medicare Advantage into traditional Medicare,” said David Lipschutz, co-director of the Center for Medicare Advocacy. The six vendors that approve or reject treatments “have a financial stake in the outcomes,” he said, and therefore “an incentive to deny care.”

Moreover, the CMS Innovation Center overseeing the pilot could theoretically bypass Congress and expand prior authorization to include more medical services in more states.

The agency did not respond to questions about what kind of human clinicians would review denials, except to say that they would have “relevant experience” and that tech companies would be “financially penalized for inappropriate denials, high appeal rates or poor performance.”

It plans an “independent, federally funded evaluation” and will release public reports annually.

Democrats in Congress have introduced bills in both houses to repeal WISeR. “We should be reducing red tape in Medicare, not creating new hurdles that second-guess health care providers,” said Rep. Suzan DelBene of Washington, one of the bill’s sponsors.

For now, though, WISeR has opened for business, receiving prior authorization requests through its electronic portals.

“The New Old Age” is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Finalmente, después de décadas de lucha y presión, en 2023 la administración Biden abordó el problema crónico de la falta de personal en los centros de cuidado a largo plazo.

Las autoridades respaldaron una norma de Medicare que exigía que cada residente recibiera al menos 3,48 horas diarias de atención, brindada por enfermeras y asistentes. Además, establecía que debía haber una enfermera calificada en el lugar durante las 24 horas del día, los siete días de la semana.

Sin embargo, las horas obligatorias de cuidado resultaron ser menos de lo que esperaban quienes apoyaron la medida, dijo Hunter, directora del programa de defensoría de cuidados a largo plazo del estado de Washington. Pero explicó: “Soy una persona pragmática, así que pensé que era un buen comienzo. Y que tener una ley federal ayudaría a hacer cumplir la norma”.

En 2024, cuando los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés) adoptaron estos estándares, los defensores celebraron. Sin embargo, luego, demandas de la industria bloquearon la mayor parte de la ley: dos cortes federales dictaminaron que Medicare se había excedido en sus atribuciones regulatorias.

Tras las elecciones de 2024, “me preocupaba el cambio de mando”, dijo Hunter. Sus preocupaciones estaban justificadas.

En julio, como parte de la ley republicana conocida como One Big Beautiful Bill Act, el Congreso prohibió que Medicare implementara los estándares de personal antes de 2034. En diciembre, los CMS revocaron los estándares por completo. Nunca llegaron a entrar en vigencia.

“Fue devastador”, lamentó Hunter.

Como ocurrió con la legislación medioambiental y la protección de los consumidores, el entusiasmo de la administración Trump por la desregulación ha deshecho normas para mejorar la atención a las personas mayores que se estaban esperando hacía tiempo.

Además, introdujo un programa experimental de Medicare con autorizaciones previas, que ya se está llevando a cabo en seis estados y ha generado alarma entre defensores, legisladores demócratas del Congreso y muchas personas mayores.

En conjunto, estas decisiones afectarán a muchos centros de cuidado y a trabajadores que prestan servicios de salud, y complicarán la cobertura médica en varios estados.

En lo que respecta a los hogares de adultos mayores, “está claro que los CMS no tienen interés en garantizar una dotación adecuada de personal”, dijo Sam Brooks, director de políticas públicas de National Consumer Voice for Quality Long-Term Care.

“Están derogando una regulación que podría haber salvado 13.000 vidas al año”, agregó Brooks, citando un análisis de investigadores de la Universidad de Pennsylvania.

Los grupos de la industria argumentaron que los hogares de adultos mayores, que tienen altas tasas de rotación de personal, ya se veían en dificultades para cubrir las vacantes.

El mandato exigía “que los hogares de adultos mayores contrataran a 100.000 cuidadores adicionales que simplemente no existen”, sostuvo Holly Harmon, vicepresidenta sénior de la American Health Care Association.

Esa organización fue una de las que presentaron las demandas que, en gran medida, terminaron anulando la norma. “Para cumplir con los requisitos, los centros se habrían visto obligados a limitar las admisiones, reducir su tamaño o incluso cerrar por completo”, agregó Harmon.

Para quienes apoyan la regulación, ahora la atención se centrará en actualizar los requisitos sobre el personal de estos hogares en los 35 estados, más el Distrito de Columbia, que ya tienen ciertos estándares. Y, también, en desarrollarlos en aquellos estados que aún no los tienen.

Reglas para ayuda en el hogar

En julio, la inesperada anulación de una segunda norma provocó una fuerte conmoción. El Departamento de Trabajo anunció el regreso a una política que excluye a los trabajadores que brindan cuidados en el hogar de la Ley federal de Normas Justas de Trabajo (Fair Labor Standards Act, FLSA).

Un poco de contexto: en la época del New Deal, la FLSA estableció que los trabajadores debían recibir el salario mínimo federal (actualmente 7,25 dólares por hora) y cobrar por las horas extra. Pero la ley excluyó a la mayoría de los llamados “trabajadores de servicios domésticos”.  Recién en 1975 una norma del Departamento de Trabajo los incorporó, aunque dejó afuera a quienes se dedicaban al cuidado a domicilio.

“Hubo una mala interpretación del trabajo de cuidado en el hogar, como si fuera algo informal, no profesional, y sin calificación”, dijo Kezia Scales, vicepresidenta de PHI, una organización nacional de investigación y defensa. “Algo equivalente a una adolescente que cuida ocasionalmente niños. Alguien que pasa por la casa de tu mamá de vez en cuando y le hace compañía”.

Durante casi 40 años, los trabajadores y sus defensores lucharon por cambiar esa norma, ya que contribuía a los bajos salarios y escasos beneficios de una fuerza laboral en rápido crecimiento, compuesta en su mayoría por mujeres y personas de grupos minoritarios, con una gran presencia de inmigrantes.

En 2013, el Departamento de Trabajo respondió con una norma que incorporó a las trabajadoras de cuidado en el hogar a la ley laboral, dándoles derecho al salario mínimo, al pago de hora y media por las horas extra, y a que se les pagara el tiempo de traslado entre un cliente y otro.

Después de que las demandas de la industria no lograran revertir la medida en los tribunales, “todo se estabilizó y estuvo en vigor sin problemas durante una década”, explicó Scales.

Sin embargo, cada año trabajadoras de cuidado en el hogar presentaban cientos de denuncias por incumplimiento. En el 87% de los casos, el Departamento de Trabajo encontró violaciones a la ley laboral, según un informe de 2020 de la Oficina de Responsabilidad del Gobierno.

Desde 2013, las agencias que emplean personal de atención en el hogar debieron pagar unos $158 millones en salarios atrasados, según cálculos de PHI.

Repentinamente, en julio de 2025, el Departamento de Trabajo anunció que volvería a las regulaciones de 1975 y anularía la norma de 2013, argumentando que había tenido “efectos negativos en la práctica” y dificultado el acceso al cuidado para las personas.

Las agencias que emplean a la mayoría de las trabajadoras, financiadas principalmente a través de Medicaid, coincidieron en esa postura. “Muchas nunca obtuvieron ningún beneficio con esto”, señaló Damon Terzaghi, vicepresidente de la National Alliance for Care at Home.

“Los estados hicieron muchos cambios para, básicamente, desligarse de toda responsabilidad”, comentó. Un informe federal de 2020, por ejemplo, comprobó que 16 estados habían puesto un tope de 40 horas semanales a la atención en el hogar cubierta por Medicaid, para evitar así tener que pagar horas extra.

La alianza, que calcula que el número de agencias y empresas afectadas se redujo en un 30% desde 2013, respaldó la anulación de la norma.

Por el contrario, Scales, que espera que el Congreso actúe, calificó la medida como “un retroceso impactante”.

En lo que sí hay consenso es en que Estados Unidos nunca se ha comprometido realmente a financiar de manera adecuada el cuidado a largo plazo en el hogar. Con la legislación aprobada en julio —que abre la puerta a un recorte de $914.000 millones a Medicaid durante la próxima década—, resulta poco probable que esa situación cambie en el corto plazo.

El “arbitraje” de IA en Medicare

Además de eliminar políticas relacionadas con el cuidado de las personas mayores, la administración Trump ha establecido un programa piloto que introduce un elemento nuevo en Medicare tradicional: la autorización previa, utilizando inteligencia artificial.

Presentado como una medida a favor del contribuyente, Medicare lo llama WISeR, por sus siglas en inglés: Wasteful and Inappropriate Service Reduction (Reducción de Servicios Innecesarios e Inapropiados).

La autorización previa, mediante la cual las aseguradoras privadas revisan los tratamientos propuestos antes de aprobar su pago, es común en los planes de Medicare Advantage, a pesar de las objeciones de pacientes, médicos y organizaciones de salud. En cambio, casi no se ha aplicado en el Medicare tradicional.

Así y todo WISeR está comenzando a implementarse en seis estados (Arizona, New Jersey, Ohio, Oklahoma, Texas y Washington) como parte de un programa piloto de seis años, para evaluar si la revisión a cargo de empresas tecnológicas puede reducir costos y mejorar la eficiencia, sin afectar —y hasta tal vez mejorar— la calidad de la atención.

Inicialmente, WISeR se enfocará en 17 productos y servicios que, según los CMS, “históricamente han tenido mayor riesgo de desperdicio, fraude y abuso”. La lista incluye artroscopía de rodilla para artritis, dispositivos de estimulación nerviosa para varias afecciones y tratamientos para la disfunción eréctil.

El programa piloto excluye los servicios de emergencia, la atención hospitalaria o tratamientos cuyo retraso represente “un riesgo considerable”. Los rechazos basados en algoritmos deberán ser revisados por “un profesional clínico humano con la licencia correspondiente”.

Las empresas tecnológicas recibirán “una parte de los gastos que se eviten”. “Esto introduce lo peor de Medicare Advantage en Medicare tradicional”, dijo David Lipschutz, codirector del Center for Medicare Advocacy.

Las seis empresas que aprueban o rechazan tratamientos “tienen un interés financiero en los resultados”, dijo, y por lo tanto “un incentivo para negar los cuidados”.

Además, el Centro de Innovación de CMS, que supervisa el programa piloto, podría, en teoría, eludir el Congreso y extender la autorización previa a más servicios médicos en más estados.

La agencia no respondió preguntas sobre qué tipo de profesionales humanos revisarían las respuestas negativas, salvo que tendrían “experiencia relevante” y que las empresas tecnológicas serían “sancionadas financieramente por rechazos inapropiados, altas tasas de apelación o bajo desempeño”.

El programa prevé una “evaluación independiente, financiada con fondos federales” y la publicación de informes públicos anuales.

Legisladores demócratas presentaron proyectos de ley en ambas cámaras del Congreso para revocar WISeR. “Deberíamos reducir la burocracia en Medicare, no crear nuevos obstáculos que pongan en duda el criterio de los profesionales de la salud”, dijo la representante Suzan DelBene, del estado de Washington, una de las impulsoras de la iniciativa.

Por ahora, sin embargo, WISeR ya está en marcha y recibe solicitudes de autorización previa a través de sus portales electrónicos.

“The New Old Age” es una producción realizada en colaboración con The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).