Short Takes On News & Events

Poll: Doctors Fall Short In Helping Many Seniors

By Judith Graham

April 24th, 2012, 6:11 AM

Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation.

Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year.

Falls cause over 2 million injuries in people age 65 and older annually, but more than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs, the Hartford poll found.

Similarly, depression can cause people to become socially isolated, suicidal, or stop taking care of themselves, but 62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.

The results, which cover a period of 12 months, speak to doctors’ and nurses’ lack of training in geriatric medicine.  Providers need to recognize that “care of an 80 year old differs from that of a 50 year old,” said Dr. Rosanne Leipzig, professor of geriatrics at the Mount Sinai School of Medicine in New York. But too often, this doesn’t happen.

Seven interventions examined in the Hartford study are part of Medicare’s annual wellness visit, which became a no-cost benefit available to all seniors in the government health program in January 2011.  Yet 54 percent of older people surveyed by the foundation had never heard of the Medicare wellness visit while another 14 percent weren’t sure if they had.

Only 2.3 million seniors out of a total 35 million with traditional Medicare coverage took advantage of wellness visits last year, according to government data.  Medicare pays doctors about three times their ordinary office visit rate for asking about older adults’ ability to function, evaluating their mood, recommending preventive services, and connecting them with community resources during wellness visits.

“These are low tech, low cost interventions that are easy to do and that can have a huge impact on an older person’s medical care and their quality of life and function.  But too many providers and older adults don’t realize they’re important,” said Dr. Sharon Brangman, chairwoman of the board of directors of the American Geriatrics Society and professor of medicine at SUNY Upstate Medical University.

Christopher Langston, program director at the Hartford Foundation, said older adults should schedule a Medicare wellness visit and talk to their doctors about recommended preventive care.  The Rand Corp. has found that only 30 percent of older adults get care supported by medical evidence, compared to 55 percent of the general population, he noted.

Still, despite gaps in care uncovered, 97 percent of respondents reported being satisfied with their primary care providers.

The mission of the Hartford Foundation is to improve the health of older adults.  Its survey, released Tuesday, asked 1,028 people age 65 and older between February 29 and March 3 about their experiences with care. The study was conducted online by Lake Research Partners and had a margin of error of +/- 3.1 percentage points.

16 Responses to “Poll: Doctors Fall Short In Helping Many Seniors”

  1. Dan says:

    Who cares? Certainly not Republicans!

  2. Rebecca says:

    Oh, we recognize the problem, all right. But good luck getting all of the recommended care into a 10-15 minute visit, which is all that patients usually get. (One study found that doing all of the recommended interventions in primary care for one patient would put a doctor 7-8 hours behind.) If Medicare would reimburse better for so-called cognitive interventions, it might be a different story.

  3. Dan says:

    “If Medicare would reimburse better for so-called cognitive interventions, it might be a different story.”

    Who pays?

  4. A number of issues are at play. First, financing – definitely need better reimbursement for geriatric docs – maybe cut specialist pay in this zero-sum, no-new-taxes world? Second, older persons need education on how to interact and bring these issues up. Third, physicians need to make better use of health educators who could do much of this. Like most of health care, blame doesn’t work, education may, money will.

  5. Barbara Bryant says:

    Excerpt: “Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year.”
    This is especially true of elderly patients who have multiple conditions and are seen by multiple providers. Too often, one physician will not tell another what (s)he has prescribed for the patient and, as a result, patients may be taking medications that aren’t meant to be taken simultaneously–with sometimes disasterous results. Primary care providers claim they don’t have time or resources to track or manage all aspects of a patient’s care when delivered by multiple providers and some doctors don’t take the time to keep their colleagues in the loop. I’ve seen patients mentally or physically debilitated by the large number of conflicting meds they’ve taken. Better patient care coordination among each patient’s providers is key to safety and effective care.

  6. Kathy Callaghan says:

    I feel grateful to live in Vermont where we have an excellent health care system and very caring docs. My Medicare-covered mother received excellent care until her death at age 89. I realize that is not the case all over the country, and it is sad.

  7. oncdoc says:

    THIS IS A TERRIBLE DISCRACE !!!
    The United States clearly needs better doctors to care for our Seniors!
    Here is my plan:
    1

  8. oncdoc says:

    Here is my plan:
    1 Pay them less
    2 Work them more
    3 More paperwork, rules ,regs etc
    4 More threats, complaints and lawsuits
    5 More “Quality” measures
    6 Don’t forget patient satisfaction surveys!

    We have tried this for over a decade and it’s not working

  9. W Khalifa says:

    Doctors need to be rated like restaurants on Yelp. Get rid of the “bad” ones.

  10. oncdoc says:

    Yes, I agree; bad Drs should no longer be allowed to see old people with big bags full of meds who are falling down all the time. Save those pts for the really good docs!

  11. W Khalifa says:

    Sounds like you are one of those “bad” doctors.

  12. Dan says:

    America has the best health care system and the most advanced medical care money can buy!

  13. Ella says:

    Long before healthcare costs were so high, reimbursements were reduced, and insurance paid for nearly everything, my primary care physician spent no more than 20 minutes on my physical. I was 45 – 55 years of age at the time and lived in one of the most affluent suburbs in the US. Don’t blame Republicans for what has gone on for years. Uninteresting cases don’t generate revenue because there are few extras to bill for. The cost of running a medical practice is high so patient volume and billing for an array of tests becomes a way of life. Now that I am 65, I hardly expect to get more time or attention.

    Please note that I am a highly education professional who works at the headquarters of a healthcare system. What I have learned in recent years is that the model of production, adopted from manufacturing, runs hospitals and physician offices. To keep the finances in the black, improvements are of the liner (first curve) variety. In fact, only second curve approaches that re-examine the roles, knowledge and innovative collaboration of all stakeholders (yes, patients, physicians, nurses, technicians and back office staff) will move this moribund system into a newly invigorated life.

  14. W Khalifa says:

    Sounds like you need to adopt some of the not-for-profit health care systems being implemented. The real stakeholders (shareholders) will have less influence then…

  15. Jack says:

    Doctors should partner with their neighborhood pharmacists who can help ensure patients understand their medications and keep taking them. Never could figure out why there isn’t a better connection between these two healthcare providers.

  16. W Khalifa says:

    That would be Kaiser, Jack…

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