As health care reporters, we come across this truth time and again: insurance coverage doesn’t guarantee high quality medical care.
The latest evidence comes from a survey of 1,028 seniors (age 65 and older) by The John A. Hartford Foundation, whose mission is improving the health of older adults. (Editor’s note: The John A. Hartford Foundation is one of the supporters of AHCJ’s core curriculum on Aging.)
It found that a measly 7 percent of older adults surveyed received seven highly recommended services, including a yearly review of all their medications, screening for depression or other mood disorders, a history and assessment of their risk of falling, evaluation of their ability to perform daily activities of living and care for themselves and referral to resources in the community.
All of these services are covered by Medicare through the program’s new annual wellness visit – a benefit to all beneficiaries on traditional Medicare as of January 2012 – and all are endorsed by geriatric experts. Yet 52 percent of older adults who participated in the Hartford survey said they had received none or one of the interventions.
“Healthcare isn’t very well adapted to the special needs of older people,” said Christopher Langston, program director at the Hartford Foundation, introducing the findings at a press conference last week. Most physicians have little if any training in geriatrics and simply apply knowledge of young adults or middle aged adults to seniors, others said.
That’s misguided, since older adults’ changing bodies – different sleep patterns, alterations in metabolism, changes in muscle strength and nutritional requirements, and more – require special attention and special interventions.
Yet, with a few exceptions, medical schools don’t incorporate geriatric training into their curriculums. And Medicare doesn’t adequately reimburse doctors who treat large numbers of older patients, who tend to require more time and attention because of their complex needs and, often, multiple illnesses.
Rosemary Leipzig, M.D., professor of geriatrics at Mount Sinai School of Medicine in New York City, said it was “really concerning” that one-third of older people surveyed said doctors hadn’t reviewed all their prescriptions and over-the-counter medications, vitamins and supplements over the past year.
Thirty percent of seniors who participated in the survey reported taking five or more prescription medications; another 33 percent were taking up to four medications.
Well-documented harms occur when older adults swallow too many pills with possible adverse side effects, but these can be prevented up to 40 percent of the time with proper oversight, Leipzig said. The American Geriatrics Society recently published an updated list of medications that can be dangerous for seniors. (The society’s standards for potentially inappropriate medication use in older adults are known as the Beers criteria.)
Another troubling gap in care arises from doctors’ and nurses’ failure to ask older patients whether they have fallen recently or advise them about how to minimize the risk of falls, as I wrote in a blog post about the Hartford survey. Dan Kadlec also highlighted the issue in his blog post for Time Moneyland, quoting the Hartford Foundation:
“Falls cause more injury and injury-related death in older people than any other event and cause 90% of all hip fractures, which greatly increase odds of nursing home placement. … Evidence has shown that older people can cut their risk of falling by about 30% by addressing key risk factors.”
For health care reporters, I think the take-home message is that doctors who care for older adults in the community are not doing all they could for this population. There are several reasons why this is so. A lack of knowledge about Medicare, inadequate training in geriatric care, harried practices and reimbursement pressures are high on the list.
Also, for their part, older adults don’t really know what kind of care they should be getting, what to ask for from their doctors, and what benefits are available to them under Medicare. (Fifty-four percent of seniors polled by the Lake Research Partners for the Hartford Foundation said they’d never heard of Medicare’s annual wellness visit.)
This seems a ripe area for coverage by reporters committed to educating older adults about the components of high quality care and Medicare.