Many different groups of people are subject to stereotypes. Positive stereotypes (e.g., "older and wiser") may provide a benefit to the relevant groups. However, negative stereotypes of aging and of disability continue to persist and, in some cases, remain socially acceptable. Research has shown that when exposed to negative images of aging, older persons demonstrate poor physical and cognitive performance and function, while those who are exposed to positive images of aging (or who have positive self-perceptions of aging) demonstrate better performance and function. Furthermore, an individual's expectations about and perceptions of aging can predict future health outcomes. To better understand how stereotypes affect older adults and individuals with disabilities, the National Academies of Sciences, Engineering, and Medicine, with support from AARP, convened a public workshop on October 10, 2017. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Who Is Worthy of Choice? 3 Exploring the State of the Knowledge on Stereotypes and Their Impact 4 Disrupting Stereotypes in Practice 5 Disrupting Negative Stereotypes in the Media 6 Disrupting Negative Stereotypes in Design 7 Closing Remarks References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers and Moderators

Individuals with disabilities, chronic conditions, and functional impairments need a range of services and supports to keep living independently. However, there often is not a strong link between medical care provided in the home and the necessary social services and supports for independent living. Home health agencies and others are rising to the challenges of meeting the needs and demands of these populations to stay at home by exploring alternative models of care and payment approaches, the best use of their workforces, and technologies that can enhance independent living. All of these challenges and opportunities lead to the consideration of how home health care fits into the future health care system overall. On September 30 and October 1, 2014, the Institute of Medicine and the National Research Council convened a public workshop on the future of home health care. The workshop brought together a spectrum of public and private stakeholders and thought leaders to improve understanding of the current role of Medicare home health care in supporting aging in place and in helping high-risk, chronically ill, and disabled Americans receive health care in their communities. Through presentations and discussion, participants explored the evolving role of Medicare home health care in caring for Americans in the future, including how to integrate Medicare home health care into new models for the delivery of care and the future health care marketplace. The workshop also considered the key policy reforms and investments in workforces, technologies, and research needed to leverage the value of home health care to support older Americans, and research priorities that can help clarify the value of home health care. This summary captures important points raised by the individual speakers and workshop participants. Table of Contents Front Matter 1 Introduction 2 Home Health Care: Today and Tomorrow 3 Toward Personal Health: Going Home and Beyond 4 Key Issues and Trends 5 The Home Health Care Workforce 6 Models of Care and Approaches to Payment 7 Innovations in Technology 8 Making Connections 9 Reflections and Reactions References Appendix A: Workshop Agenda Appendix B: Speaker and Moderator Biographical Sketches

Combined with the more traditional employer occupational safety and health protection activities are newer employment-based programs to promote better health through helping workers quit smoking, lose weight, reduce stress, or exercise more regularly. In support of these efforts, some employers have made changes in their policies and facilities to support physical activity and healthier eating, and some employers connect with community resources for health education, health fairs, and other services. This diverse array of activities most typically has been planned, managed, and assessed - to the extent they exist in the workplace at all - by different, often uncoordinated departments within the business entity. Some employers have reconceptualized their safety, prevention, and promotion initiatives and attempted to bring them together into a coherent whole. The National Institute for Occupational Safety and Health (NIOSH) has supported this integration, defining Total Worker Health as "a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being." In May 2014, with support from NIOSH, the Institute of Medicine organized a workshop on Total Worker Health. Rather than a review of published literature, this workshop sought input from a wide variety of on-the-ground stakeholders regarding their experiences with integrating occupational safety and health protection with health promotion in the workplace. Promising and Best Practices in Total Worker Health is the summary of the discussions and presentations of the event. This report identifies prevalent and best practices in programs that integrate occupational safety and health protection with health promotion in small, medium, and large workplaces; employer and employee associations; academia; government agencies; and other stakeholder groups. Table of Contents Front Matter 1 Introduction 2 Total Worker Health in the Real World 3 The Value in Pursuing Total Worker Health 4 Total Worker Health in Large Businesses 5 Total Worker Health for Small- and Medium-Sized Businesses 6 Reactors Panel and Discussion References Appendix A: Workshop Agenda Appendix B: Speaker and Moderator Biographical Sketches

Every year, significant amounts of expensive drugs are discarded. This is due in part to the growing number of prescription drugs that are administered in variable doses (rather than fixed or flat doses) based on a patient's weight or body size. Strict regulations and guidance generally prohibit or severely restrict the acceptable time frame for sharing medication from single-dose vials among patients, and so the unused amount will typically be discarded. Due to the current system for producing, administering, and paying for drugs in the United States, significant - but indeterminate - amounts of expensive prescription drugs are discarded each year. At the request of the Centers for Medicare & Medicaid Services, Medications in Single Dose Vials: Implications of Discarded Drugs explores the federal health care costs, safety, and quality concerns associated with discarded drugs that result from the weight-based dosing of medicines contained in single-dose vials. Table of Contents Front Matter Summary 1 Introduction 2 Single-Dose Vials of Weight-Based Drugs 3 Scope of Discarded Drugs from Single-Dose Vials 4 Efforts to Reduce Discarded Weight-Based Drugs 5 Discarded Weight-Based Drugs in Single-Dose Vials 6 Prescription for Reducing Discarded Drugs Appendix A: Glossary Appendix B: Supplemental Figures and Tables from Commissioned Analyses Appendix C: Stakeholder Input Appendix D: Biographical Information Appendix E: Disclosure of Unavoidable Conflicts of Interest

As part of the overall disability determination process, the Social Security Administration uses a step-by-step approach to understand how severe an individual's condition is and whether it meets program criteria for disability. The use of various types of biomarkers has been suggested as a way to strengthen the amount and quality of objective evidence available to the review process. At the request of the Social Security Administration, the National Academies of Sciences, Engineering, and Medicine's Board on Health Care Services organized a virtual workshop on July 21, 2020, titled The State of the Science of the Use of Biomarkers to Establish the Presence and Severity of Impairments. Workshop discussions focused on the current and potential uses for biomarkers; explored legal and ethical implications associated with biomarker use in clinical decision making; and considered the possible uses of nongenetic biomarkers as tools for the diagnosis or prognosis of the severity of specific physical and mental impairments. This publication summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Understanding Biomarker Use and Its Potential for Determining Health and Function 3 State of the Science for Specific Impairments 4 Legal and Ethical Implications 5 Final Thoughts References Appendix A: Statement of Task Appendix B: Workshop Agenda Appendix C: Biographical Sketches of Workshop Speakers and Planning Committee Members

Being able to communicate is a cornerstone of healthy aging. People need to make themselves understood and to understand others to remain cognitively and socially engaged with families, friends, and other individuals. When they are unable to communicate, people with hearing impairments can become socially isolated, and social isolation can be an important driver of morbidity and mortality in older adults. Despite the critical importance of communication, many older adults have hearing loss that interferes with their social interactions and enjoyment of life. People may turn up the volume on their televisions or stereos, miss words in a conversation, go to fewer public places where it is difficult to hear, or worry about missing an alarm or notification. In other cases, hearing loss is much more severe, and people may retreat into a hard-to-reach shell. Yet fewer than one in seven older Americans with hearing loss use hearing aids, despite rapidly advancing technologies and innovative approaches to hearing health care. In addition, there may not be an adequate number of professionals trained to address the growing need for hearing health care for older adults. Further, Medicare does not cover routine hearing exams, hearing aids, or exams for fitting hearing aids, which can be prohibitively expensive for many older adults. Hearing Loss and Healthy Aging is the summary of a workshop convened by the Forum on Aging, Disability, and Independence in January 2014 on age-related hearing loss. Researchers, advocates, policy makers, entrepreneurs, regulators, and others discussed this pressing social and public health issue. This report examines the ways in which age-related hearing loss affects healthy aging, and how the spectrum of public and private stakeholders can work together to address hearing loss in older adults as a public health issue.

Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults is the summary of a workshop convened in June 2013 by the Forum on Aging, Disability, and Independence of the Institute of Medicine and the National Research Council to examine the financing of long-term services and supports for working-age individuals with disabilities and among individuals who are developing disabilities as they age. The workshop covered both older adults who acquire disabilities and younger adults with disabilities who may acquire additional impairments as they age, the target population of the Forum's work. The challenges associated with financing long-term services and supports for people with disabilities impacts all age groups. While there are important differences between the characteristics of programs developed for different age groups, and specific populations may have different needs, this workshop addressed the financing sources for long-term services and supports in general, noting specific differences as appropriate. The financing of long-term services and supports has become a major issue in the United States. These are the services and supports that individuals with disabilities, chronic conditions, and functional impairments need in order to live independently, such as assistance with eating, bathing, and dressing. Long-term services and supports do not include the medical or nursing services required to manage health conditions that may be responsible for a disabling condition. At least 11 million adults ages 18 and over receive long-term services and supports. Only a little more than half of them - 57 percent - are ages 65 or older. One study found that about 6 percent of people turning 65 in 2005 could expect to have expenses of more than $100,000 for long-term services and supports. Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults discusses the scope and trends of current sources of financing for long-term services and supports for working-age individuals with disabilities and older adults aging into disability, including income supports and personal savings. This report considers the role of families, business, and government in financing long-term services and supports and discusses implications of and opportunities for current and innovative approaches. Table of Contents Front Matter 1 Introduction and Themes of the Workshop 2 The Challenge 3 The Role of Individuals and Families 4 The Role of Government 5 The Role of the Private Sector 6 Reflections on the Workshop References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches

The Institute of Medicine (IOM) and the National Research Council (NRC) have had prominent roles in discussions of aging, disability, and technology for decades. In 1978, Aging and Medical Education (IOM, 1978) raised national awareness of the challenges to physicians posed by the aging of the U.S. population. Thirty years later, Retooling for an Aging America highlighted concerns for the entire health care workforce in view of the aging of the population, including the role of technology in caring for older populations. The 1988 report The Aging Population in the 21st Century examined social, economic, and demographic changes among older adults, as well as many health-related topics: health promotion and disease prevention; quality of life; health care system financing and use; and the quality of care- especially long-term care. In 1991, the landmark report Disability in America laid out a national agenda to prevent disability and improve the lives of people with disabling conditions. The 1997 report Enabling America: Assessing the Role of Rehabilitation Science and Engineering examined the knowledge base of rehabilitation science and engineering and proposed ways to translate scientific findings into interventions that produce better health. And the 2007 report The Future of Disability in America examined progress made since the earlier reports and looked at continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. All these reports were produced by committees appointed in accordance with guidelines of the National Academies and met multiples times to compile and review evidence, reach consensus on conclusions and recommendations, draft a report of the committee, and then modify that draft report in response to comments from outside reviewers. The IOM and NRC have also held several workshops related to aging, disability, and technology and published summary reports, such as Technology for Adaptive Aging and Grand Challenges of Our Aging Society. The IOM and NRC also convene groups that take a different approach to issues of pressing national and international importance. Often known as forums or roundtables, these groups meet regularly to foster dialogue and confront issues of mutual interest and concern among a broad range of stakeholders. They can convene workshops, initiate cooperative projects among members, commission independently authored articles, and generate ideas for independent consensus studies. In 2012 the IOM and NRC joined together to establish the Forum on Aging, Disability, and Independence to provide a neutral venue for broad-ranging discussions among the many stakeholders involved with aging and disability. The goals of the forum are to highlight areas in which the coordination of the aging and disability networks is strong, examine the challenges involved in aligning the aging and disability networks, explore new approaches for resolving problem areas, elevate the visibility and broaden the perspectives of stakeholders, and set the stage for future policy actions. Forum sponsors and members include federal agencies, health professional associations, private sector businesses, academics, and consumers. Fostering Independence, Participation, and Healthy Aging Through Technology summarizes this workshop. Table of Contents Front Matter 1 Introduction and Themes of the Workshop 2 The Promise of Technology 3 Technologies to Promote Activities of Daily Living and Independence 4 Technologies to Promote Community Integration and Participation Through Community Design 5 Technologies to Promote Community Integration and Participation Through Social Connectedness 6 Health Management and Promotion 7 Reflections on the Presentations References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers.
Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others.
The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

The past several decades have been a time of rapid globalization in the development, manufacture, marketing, and distribution of medical products and technologies. Increasingly, research on the safety and effectiveness of new drugs is being conducted in countries with little experience in regulation of medical product development. Demand has been increasing for globally harmonized, science-based standards for the development and evaluation of the safety, quality, and efficacy of medical products. Consistency of such standards could improve the efficiency and clarity of the drug development and evaluation process and, ultimately, promote and enhance product quality and the public health. To explore the need and prospects for greater international regulatory harmonization for drug development, the IOM Forum on Drug Discovery, Development, and Translation hosted a workshop on February 13-14, 2013. Discussions at the workshop helped identify principles, potential approaches, and strategies to advance the development or evolution of more harmonized regulatory standards. This document summarizes the workshop. Table of Contents Front Matter 1 Introduction 2 Principles and Definitional Considerations 3 Overview of the Current Global Regulatory Landscape 4 Areas of Need for Harmonized Standards and Barriers to Progress in Addressing the Gaps 5 Characteristics of Harmonized Regulations and Regulatory Structures 6 Finding Solutions: Options and Systemic Approaches 7 Tactics and Strategies for a Way Forward References Appendix A: Workshop Agenda Appendix B: Participant Biographies