Tag Archives: geriatrics

New programs aim to give young docs skills to care for aging adults

Photo: Lauren BaggettDr. Ngozi Ifeadi, an internal medicine resident at Athens Regional Medical Center, reviews medication history with a 70-year-old patient at ARMC's Community Care Clinic.

Photo: Lauren BaggettDr. Ngozi Ifeadi, an internal medicine resident at Athens Regional Medical Center, reviews medication history with a 70-year-old patient at ARMC’s Community Care Clinic.

Athens, Ga., is a small city about 75 miles east of Atlanta. Older adults love its low cost of living, community-mindedness and proximity to a major urban area. What they don’t love, however, is the poor access to specialized senior health care.

Nearly 10 percent (11,830) of the city’s 120,000 residents are over age 65, but only three office-based geriatricians practice here. Continue reading

Aging and health: How are we doing?

The Senior Stutters Line Dancers of Valdosta performed a show at Lake Park United Methodist Church on March 1, 2011.

Image by Judy Baxter via flickr.

Did you happen to catch the new report from the CDC  – “The State of Aging and Health in America (PDF)?” This 60-page analysis provides a snapshot of the health and well being of older adults, including care and behaviors that impact premature death and disability, as well as the role of optimal mobility in healthy aging.  

The report points out that two of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66 percent of the country’s health care budget. Americans are living longer – but are they living better?

While most states have met at least some of the Healthy People 2020 goals, many lag behind on others – notably, improving preventive care such as flu and pneumonia vaccines, long-term care services and support,  increasing the number of geriatric care specialists and tackling elder abuse.  Long-term care is headed for a crisis, blogs Betty Ann Bowser on the PBS’s The RundownForbes says the long-term care system is “crumbling.” Continue reading

Seniors missing out on important wellness exams

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.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

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.

Ranking may lead to sources for reporting on aging

Health reporters covering the aging beat might be interested in which hospitals offer the best geriatric services, according to recent rankings published by U.S. News & World Report.

Don’t take the magazine’s word as gospel; its method for rating hospitals has been questioned by many and is by no means the definitive word on the subject.

That said, each of the hospital departments mentioned on the U.S. News list houses experts knowledgeable about aging and health. You might want to put the list in a file so it’s handy when you’re looking for sources to comment on a story you’re covering.

These are the top 25 geriatrics departments, according to the magazine:

1. Mt. Sinai Medical Center, New York
2. Ronald Reagan UCLA Medical Center, Los Angeles
3. Johns Hopkins Hospital, Baltimore
4. Massachusetts General Hospital, Boston
5. Duke University Medical Center, Durham, N.C.
6. Mayo Clinic, Rochester, Minn.
7. Cleveland Clinic, Cleveland
8. New York-Presbyterian University Hospital of Columbia and Cornell
9. UPMC-University of Pittsburgh Medical Center, Pittsburgh
10. Yale-New Haven Hospital, New Haven, Conn.
11. University of Michigan Hospitals and Health Centers, Ann Arbor
12. UCSF Medical Center, San Francisco
13. Johns Hopkins Bayview Medical Center, Baltimore
14. Hospital of the University of Pennsylvania, Philadelphia
15. NYU Langone Medical Center, New York
16. Hospital for Special Surgery, New York
17. Beth Israel Deaconess Medical Center, Boston
18. Rush University Medical Center, Chicago
19. Barnes-Jewish Hospital/Washington University, St. Louis
20. University of Washington Medical Center, Seattle
21. St. Louis University Hospital, St. Louis
22. Brigham and Women’s Hospital, Boston
23. Methodist Hospital, Houston
24. University Hospitals Case Medical Center, Cleveland
25. Indiana University Health, Indianapolis

I’m struck by the absence on this list of hospitals in the South, the Southwest and the interior West. This may have to do with U.S. News‘ methodology, which relies heavily on recommendations from medical specialists. But it’s a bit disconcerting, nonetheless.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Genetic, environmental factors at work in aging process (#ahcj09)

Aging is a biological, psychological and social process, as four researchers explained at Health Journalism 2009. Aging research is important to learn how to slow down the process. At age 50, humans have about 62 years left of their lives, according to Matt Kaeberlein, Ph.D., assistant professor, Department of Pathology, University of Washington (or we might if we learned how to slow down the aging process).

One of the biggest factor of aging is smoking, which affects reproduction, cardiovascular, pulmonary, skin, bone and neoplasia. Genes actually play the biggest role in lifespan. Kaeberlein noted that there is no reason that the human body has to wear out with time, and aging must be “programmed.”

Independent journalist Laura Gater writes about the panel – links to the speakers’ presentations are included.