How old is too old to practice medicine? That’s a question without a definitive answer, but one of concern to health systems, patients and clinicians.
Normal age-related physical or cognitive issues don’t mean physicians or nurses should stop practicing by a certain age, but according to this new tip sheet from reporter Cheryl Clark, many doctors are seeing patients, and even performing delicate surgical procedures well into their 80s … or even 90s. On the one hand, these doctors may be the only ones available in rural or lower-income areas; they’re helping alleviate the workforce shortage. On the other hand, there’s concern they could they be putting some patients, or themselves, at risk. Continue reading
Some low-income seniors who qualify for both Medicare and Medicaid — the dual eligibles — have the chance to age in place in their communities thanks to Medicaid’s coverage of long term services and supports (LTSS). This is especially important for older adults who are juggling multiple chronic conditions and may require help with activities of daily living, like bathing, dressing, or eating.
This is a population at high risk for needing expensive institutional care, and is not the preferred site of care for most people. Community-based LTSS avoids institutionalizing many older adults and is a more cost-effective solution to the growing aging population. Continue reading
Why do so many older adults complain about poor sleep? It turns out that physiological changes, coupled with increased prevalence of chronic conditions, multiple medications, and changes in overall sleep patterns can make getting a good night’s sleep pretty difficult for many people.
Sleep problems in older adults are often undiagnosed or untreated simply because many people believe they’re a normal part of aging or that nothing can be done to help. However, diagnosing and treating any underlying medical disorders can dramatically improve sleep.
Seniors need about 6.5 to 7.5 hours of sleep – about the same or a little less than their younger selves, however, the quality of that sleep is not as good. As we age, we spend less time in non-REM sleep, which is when the deepest sleep occurs. Research on the sleep habits of older adults show it also takes older adults more time to fall asleep and to stay asleep. Continue reading
The U.S. Preventive Services Task Force issued recommendations on Tuesday on the value of routine cognitive screening for older adults, concluding “the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment.”
The task force said there was inadequate direct evidence on the benefits, and that several drug therapies and non-pharmacologic interventions have a “small effect” on the short term cognitive function measures in patients with mild to moderate dementia. They said the extent of clinically relevant benefit is uncertain. This is the same conclusion reached in previous assessments of the clinical benefit of cognitive screening.
They did find evidence that interventions targeted to caregivers have a small effect on caregiver burden and depression, but the scope of clinical relevance is still uncertain. This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 and have no signs or symptoms of cognitive impairment. Early detection and diagnosis of dementia through the assessment of patient-, family-, or physician-recognized signs and symptoms, some of which may be subtle, are not considered screening and are not the focus of this recommendation. Continue reading
Unless you have just emerged from winter hibernation it’s hard to miss the increasingly grim projections about of Alzheimer’s disease and dementia. The latest comes from a RAND study, published in the April 4 New England Journal of Medicine. Researchers predict that the costs of caring for those with dementia will double by 2040, as more baby boomers age into the target population. A team led by Michael Hurd of the Center for the Study of Aging, at RAND, concluded “our estimate places dementia among the diseases that are the most costly to society.”
Researchers estimated that some 4.1 million older adults will develop dementia by 2040; a lower figure than that of the Alzheimer’s Association, who included people with less severe cognitive problems in their forecast. Data from two major studies, the Health and Retirement Study (HRS) a nationally representative longitudinal survey of adults 51+, and Aging, Demographics, and Memory Study (ADAMS), a nationally representative study of dementia, were analyzed. Co-morbid conditions such as diabetes were controlled for, providing a truer portrait of dementia-related costs. Continue reading