In last week’s blog post, we introduced you to three core truths in healthcare. This week, we’re diving deeper into Truth #1: The chronic conditions that used to kill us no longer do.
In the event you don’t feel like reading a lengthy blog post, I can sum this one up with one sentence: What used to kill us no longer does; and that’s a problem.
If you’re still reading, allow me to explain further below.
The Longer Version
When Social Security was enacted in 1935, the average life expectancy was 61 years old and the average retirement age was 65. Today, Americans are living up to 78.6 years on average according to the most recent report from the Centers for Disease Control and Prevention.
This change can be largely attributed to improvements in education, safety, medicine and overall quality-of-life. Said simply, what used to kill our grand- or great-grandparents in their 40’s or 50’s can be treated and managed long-term today.
Senior adults living with chronic conditions like heart failure, certain cancers, COPD, kidney and bladder failure, and adult onset diabetes, have an ever-increasing supply of prescription medicines, medical interventions, physicians and alternative therapies to address their medical needs. But our wealth of medical solutions has created an entirely new set of problems.
Consider the following…
- On average, older adults spend 17 days a year in a healthcare setting such as a clinic, lab or hospital. Patients with multiple conditions or dementia may spend nearly 34 days a year in a healthcare setting. (Source: Dartmouth)
- For over 40% of older adults, a specialist is the predominant provider of care (the provider they see most often).
- More than 33% of all prescription drugs used in the United States are taken by elderly patients. The ambulatory elderly fill between 9 to 13 prescriptions per year and the average nursing home patient takes seven medications. Medical professionals refer to this as ‘polypharmacy.’
- More than 15% of hospitalizations involving elderly patients are caused by or related to adverse drug reactions and the increased risk associated with polypharmacy.
The Devil is in the Details
As we live longer and access the healthcare system more frequently, we place increasing demand on an already over-burdened system. For senior adults who may be receiving medication from multiple prescribers and bouncing between a hospital, skilled nursing or home setting, there is virtually no continuity or coordination of care.
Don’t believe me? Here are a few examples from my recent memory…
- During an ER visit, the patient (on over 20 medications) didn’t bring a medication list. The hospital’s EHR had no record of the patient’s medications despite the fact that the patient’s primary care physician had seen the patient twice in the last four months and shared an electronic record with the hospital.
- A frail, older woman who had been hospitalized over 15 times in the previous six months was sent home after a seven-day stay in a skilled nursing facility for intensive at-home physical therapy with no in-home care or support in place.
- A 90-year-old who was prone to falls was prescribed a blood pressure medication by a cardiologist which was contraindicated in older adults due to side effects including dizziness and other risk factors associated with falls. The patient’s primary care physician did not know of the new prescription but when contacted, agreed immediately that it should be discontinued.
Unfortunately, I could go on and on and on…
After all, treating an 85-year-old with the same medical interventions a 55-year-old would receive is not only ridiculously short-sighted but, in many cases, harmful to the senior adult. I’ve yet to meet a working healthcare professional that would disagree with that.
Politicians, pharmaceutical companies, insurance companies and fear mongers call this type of thinking… ‘rationing of care.’ At CarePods, we call it common sense care.
As we work with prospective clients, we encourage them to think differently about how they access and use the system. I usually offer the following advice:
- Set quality-of-life not just quantity-of-life goals. How do you want to spend most of your time? What’s most important to you as you age? Share those goals with your family – well-intended adult children often pressure their parents into procedures or treatments they wouldn’t choose on their own. They’ve making decisions based on their reality and experience; not yours.
- Maintain an updated medication list at all times. Take it with you to doctor’s appointments and to the hospital if needed. Include the name of the medication, how often you take it, when you take it, who prescribed it, and what you’re taking it for.
- Maintain an ongoing relationship with at least one physician. Primary care physicians only spend an average of 15 minutes with their patients each visit; specialists spend even less time. Just like everyone else, clinicians get to know you and your baseline better over time. Be forthcoming and consistent in your appointments.
- Respect your emotional and mental health needs, not just your physical care needs. Medical problems resulting from isolation and depression in older adults have skyrocketed in recent years. Consider speaking with a therapist regularly or hiring someone to visit you occasionally at home.
There is no ‘right’ way to access or use the healthcare system; there is only what’s right for you. I hope that by thinking critically about not just your health conditions or problems, but more broadly, about how you want to preserve and maintain your quality-of-life long-term, you can navigate the system more effectively as you age.
Next week, we’ll explore the healthcare provider’s role in our care and how our healthcare payment systems drive action (or inaction) on our behalf.
Until next time,