Only 7% of seniors get key preventive services
■ Medication safety, fall prevention and mental illness are among the items getting short shrift in many physician offices.
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The vast majority of elderly patients are not being screened for mood disorders, problems with falls or performance of daily activities such as housework, says a poll of more than 1,000 adults 65 and older released in April.
In the nationwide survey, patients responded to specific questions about the last year of care they received, such as whether their physician asked if they had fallen or were sad, anxious or depressed.
Only 7% of the surveyed seniors said they received each of the key preventive services identified by geriatric experts, including an annual medication review and referral to nonmedical services such as support groups and exercise programs. The survey was conducted in late February and early March for the John A. Hartford Foundation, a New York City nonprofit that works to improve the well-being of seniors and supports expanded geriatric training for physicians and other health professionals.
The need for these screening services is great, experts say. About 100,000 seniors a year are hospitalized for adverse drug events, said a Nov. 24, 2011, study in The New England Journal of Medicine. One in three seniors falls each year, but less than half tell their doctors about it, according to the Centers for Disease Control and Prevention. The agency says falls are the leading cause of injury death in the elderly, killing about 20,000 seniors annually and injuring 2.2 million. And the National Alliance on Mental Illness reports that depression affects about 6.5 million seniors, about one in five older patients. (See correction)
“You don't have to do these preventive services every year, but you have to be able to,” said Christopher Langston, PhD, the foundation's program director. “Particularly for primary care providers, we all know they are greatly overburdened, but the answer is not to skip doing these important things but to try to develop systems and capacities to let you develop and implement this.”
Few use Medicare wellness benefit
To address this long-standing problem, in January 2011, Medicare began paying about $150 to physicians for an annual wellness visit that comes at no out-of-pocket cost to seniors enrolled in the plan. The visit is not a physical, but it is intended to give doctors and patients a dedicated chunk of time to cover questions about immunizations, problems in daily life and other preventive-care items. Yet only 32% of the seniors polled had heard about the Medicare wellness visit, and only 17% were sure they took advantage of it.
The survey findings are no surprise to Sharon A. Brangman, MD, chair of the American Geriatrics Society's board of directors.
“As a whole, the medical profession doesn't look at geriatrics as having a set of skills very different from taking care of other adults,” said Dr. Brangman, chief of geriatrics at the State University of New York's Upstate Medical University in Syracuse, N.Y. “Just as we know that an 8-year-old is not just a little adult, we know that an 80-year-old is not the same as other adults. There's a special skill to taking care of older adults, and there are low-tech, low-cost things that can have an impact on their quality of life and can help them maintain their independence.”
For example, many drugs that are fine for younger adults to take are dangerous or ineffective in the elderly. In April, the American Geriatrics Society updated its list of potentially inappropriate medications for seniors.
Too many physicians lack training in how to attend to seniors' special medical needs, said Rosanne M. Leipzig, MD, professor of geriatrics at the Mount Sinai School of Medicine in New York. She is researching how to help nongeriatricians improve the quality of care they provide to older patients.
“One piece of the problem has to do with lack of knowledge of the importance of these sorts of problems for the quality of life of older people,” Dr. Leipzig said. “In training, we focus very much on diseases and organs, and not on symptom-alleviation and preserving function.”