Tag Archives: wellness

Aging and health: How are we doing?

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

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

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), is a freelance journalist based in Denver and former topic leader on aging for AHCJ. She haswritten for the New York Times, Kaiser Health News, the Washington Post, the Journal of the American Medical Association, STAT News, the Chicago Tribune, and other publications.

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.

Value-based plans use disincentives, not denials

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Michelle Andrews at Kaiser Health News is exploring value-based health insurance plans, a growing field that bases its reimbursement rates on how effective it believes certain treatments are. Under these models, for example, things like cholesterol-lowering drugs and help with weight management are provided free, while things like MRIs and back surgery come with hundreds of dollars in added penalties. In other words, instead of denying treatments of dubious efficacy, they keep them available but ask the patient to shoulder more of the burden.

The principle behind it is a familiar one.

A landmark 1982 study showed that as out-of-pocket costs rise, consumers spend less on health care services. But they scrimp not just on care that’s ineffective or unnecessary but also on care that they need, treatment that’s highly effective at addressing their condition.

To help us understand the system, Andrews profiles a recent large-scale implementation in Oregon. She focuses on the disincentives, or “sticks.”

In October, 155,000 Oregon public education employees and their dependents began to experience this stick approach. Their plans already offer carrots: free preventive care and low-cost or free generic drugs for chronic conditions. But starting in October members will be charged an extra $500 if they get services that the state Educators Benefit Board has determined are overused or “preference sensitive” to patient choice, including spinal surgery, knee and shoulder arthroscopy, hip and knee replacement and upper endoscopy exams. Patients will pay an extra $100 for advanced imaging tests and sleep studies.

People are willing to compromise, says Marge Ginsburg, executive director of the Center for Healthcare Decisions, a Sacramento-based nonprofit that studies how consumers make health care choices. They’re open to “the idea that yes, it’s still available to you, but it’s going to cost you more,” she says.

Outright denials, on the other hand, don’t sit so well. “People are really unhappy if you draw a line in the sand.”

Health series tries to reach those often left out

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Kate Dailey of Newsweek has teamed up with Public Radio International for a 10-part series, “DIY Checkup: Taking Control of Our Health.” The project looks at “what people can do to live better, no matter their genetics, history, or economic status.”

Dailey, in a blog post about the series, recognizes that some of the standard pieces of advice, such as going to the gym for exercise or eating fresh fruits and vegetables, are not relevant for significant parts of the population. People who work on their feet all day and people who live in food deserts are not getting the messages in a way that make them relevant to their lives.

As Dailey says, “the language that doctors and journalists often use to talk about personal health often leaves many people out.”

Part one of the series lists things people can do to significantly improve their health. Listen to part one: