COLUMN-How seniors can get needed primary care
(The author is a Reuters columnist. The opinions expressed are his own.)
By Mark Miller
CHICAGO May 1(Reuters) - When older patients experience memory loss or confusion, it's not uncommon for doctors to suspect dementia. But for Dr. Roseann Leipzig, her first thought is to check the patient's medications, including over-the-counter meds, to make sure none are causing trouble.
"For example, Benadryl can cause confusion in older people, even in very low dosages" says Leipzig, a professor of geriatrics and palliative medicine at the Mount Sinai School of Medicine in New York City.
In addition to better health, such probes in primary care can save seniors - and the government - money in the long run, but too often, they just don't happen.
Many seniors weren't asked screening questions that geriatric medicine experts view as critical for older patients, according to a survey of more than 1,000 U.S. seniors conducted earlier this year by the John A. Hartford Foundation, a foundation that focuses on health care research and training for older adults.
Only 67 percent said their doctor had reviewed their prescription medications with them in the past 12 months; 37 percent had been asked about their mood or if they were depressed; and less than a third, or just 30 percent were asked if they had experienced a fall.
The survey found that only 7 percent of seniors had been screened by their doctors for seven key issues geriatricians consider key for well-being and health; 76 percent had received fewer than half. The seven areas of screening include a review of medications, depression and problems with falling or conducting daily activities.
Most elderly patients don't realize anything is amiss. The survey found that 69 percent of those questioned were "completely satisfied" with the primary care they received; another 27 percent were "somewhat satisfied."
"That means the patient finds that a visit to the doctor's office is pleasant - the trains run on time, and the staff attends to your concerns," Leipzig says. "It doesn't mean they are following guidelines or practicing the kind of medicine you need as you get older."
Leipzig assisted Hartford with the analysis of the poll and participated in a press briefing for reporters. She is not otherwise affiliated with Hartford.
Eighty percent of Medicare dollars are spent to treat the sickest 20 percent of patients, so anything that can be done to manage chronic care can help moderate the program's long-range costs.
Healthcare is one of the largest areas of out of pocket expense in retirement - $230,000 over a lifetime for a 65-year-old couple, not including nursing home costs, according to Fidelity Investments.
Knowledge can also help keep cash in seniors' pockets. The Affordable Care Act includes measures aimed at improving primary and preventive care - including a free annual wellness visit for Medicare beneficiaries.
It also reimburses doctors at three times the rate of an average office visit. Unfortunately, 68 percent of seniors told Hartford's pollsters they hadn't even heard of the wellness benefit.
Good primary care also can help seniors moderate out-of-pocket spending on acute care down the road.
TAKE ACTIVE ROLE
Medication management is the starting point to taking a more active role, Leipzig says.
Patients should maintain their own list of all medications, dosage, frequency of use, why they are taken and the prescriber.
"You should give that list to every doctor you see, and then make changes on it and keep it updated," she says. "There is no single electronic repository of that information, and medications are key." Be sure to include over-the-counter medications.
Seniors should tell their doctors if they've experienced problems such as depression, falling down or a fear of falling.
"Things can be done about these problems," Leipzig says. "It's important to talk about these things if they're happening to you. If your doctor doesn't know how to help, then ask for a referral to someone who can."
Many seniors find it difficult to take a more assertive role, says Richard Birkel, senior vice president for healthy aging at the National Council on Aging (NCOA).
"The current generation didn't grow up with a tradition where they were expected to take active role," he says. "It's up to you to shape your office visit."
"Have a list of questions and goals in mind," he adds. "You can't just go in and expect your doctor to miraculously scan you and figure out what is going on in your life."
A good starting point is a checklist of good preventive care for older patients maintained by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. The agency offers (link.reuters.com/daw87s) and women (link.reuters.com/faw87s).
NCOA offers free online and in-person workshops across the country that help patients living with chronic diseases learn self-management techniques that can improve health (link.reuters.com/gaw87s).
Developed at Stanford University, the workshops teach patients an array of self-management techniques, including how to deal with pain, fatigue, and stress; talking with doctors and family about health problems; accessing community resources; and making better nutrition and exercise choices. (Editing by Chelsea Emery and Leslie Gevirtz)
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