(The author is a Reuters columnist. The opinions expressed are
By Mark Miller
CHICAGO May 1When 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
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
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
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
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)