Posts Tagged ‘health
Report: Senior Health Care Misses the Mark
Report Details Senior Health Care That Misses The Mark
Quality over quantity. As people get older, their health care goals may shift away from living as long as possible to maintaining a good quality of life. In key areas, however, the medical treatment older people receive often doesn’t reflect this change, according to a new study.
The wide-ranging report from the Dartmouth Atlas Project uses Medicare claims data to examine aging Americans’ health care. Among other things, it identified five key areas where too many older people continue to receive treatments that don’t meet established guidelines or, often, their own goals and preferences.
Two of the five have to do with preventive care that may not benefit seniors: screening for breast and prostate cancer. The other three address care at the end of life: late referral to hospice care, time in the intensive care unit in the last six months of life and placing feeding tubes in patients with dementia.
While the measures themselves are quite different, they each highlight the need for better communication and shared decision-making among patients, their families and their medical providers.
“Where there are harms and benefits and people judge them differently, that’s where the shared decision-making comes in,” said Dr. Julie Bynum, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Despite the simplicity of a mammogram or a blood test to check for prostate cancer, if the screening is positive for cancer, that can set off a cascade of further testing and treatment. Those efforts could cause harm to older patients, whose health may be fragile or who have multiple medical conditions.
In addition, older people may well die from something else before a cancer progresses, said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.
“The single hardest concept for the public to understand is the natural history of finding a cancer through a screening process,” Wender said. “Many people have the sense that had it not been found that cancer would have threatened their life within a couple of years or maybe even a couple of months.”
Experts have cautioned older patients about both tests. The U.S. Preventive Services Task Force, an independent panel that weighs evidence and makes recommendations about prevention services, has concluded that prostate cancer screening isn’t beneficial at any age and said that there’s not enough evidence to know whether women benefit or risk harm by undergoing breast cancer screening after age 74.
Still, the Dartmouth Atlas analysis found that 20 percent of male Medicare beneficiaries age 75 and older got a PSA test to screen for prostate cancer in 2012, and 24 percent of female beneficiaries that age had a mammogram to screen for breast cancer that year.
We Need To Make Decisions Based On The Patient’s Values
Guidelines aside, clinicians and their patients need to discuss the pros and cons of testing and make a decision based on the patient’s values and preferences, experts say.
For example, a 75-year-old woman who is willing to accept that she might actually die of breast cancer within 10 years but wants to avoid the anxiety and harms of treatment, might choose not to be tested.
“I ask people, ‘Do you think you’re going to be around in 10 years? Help me decide’ whether to order a mammogram,” said Bynum, whose work focuses on geriatrics.
As people near the end of their lives, it’s especially important for patients and their family members to discuss their goals and wishes with clinicians. Patients often want to be kept comfortable rather than undergo medical interventions, but physicians and nurses are still trained to do everything possible to prevent death, said Dr. Diane Meier, director of the Center to Advance Palliative Care and professor of geriatrics at Mount Sinai’s Icahn School of Medicine in New York.
The three end-of-life criteria that the Dartmouth researchers cited are areas that geriatrics experts agree are critical but have proven difficult to get providers, health systems and the general public to accept, said Bynum. Late referral to hospice and spending time in a hospital intensive care unit can adversely affect terminal patients’ health, result in higher costs and run counter to their hope for a peaceful death. Feeding tubes in patients with advanced dementia can lead to other complications.
Lost Opportunity: Hospice Comfort Care Services That Are Available For Months Are Not Utilized
The Dartmouth study found that in 2012, 17 percent of Medicare beneficiaries who died were enrolled in hospice only during the last three days of life. Medicare, however, will approve hospice benefits, which generally include comfort care rather than curative treatment, when the physician certifies that someone is expected to live for no more than six months.
The study also found that people spent an average of nearly four days in intensive care during the last six months of life, a figure that is trending upward.
Finally, even though it doesn’t prolong their lives to place feeding tubes in patients with dementia, who naturally lose interest in food and their ability to swallow in the final stages of the disease, 6 percent of Medicare beneficiaries with dementia received them in their last six months of life in 2012.
Communication is key, but the skills that are needed to counsel patients aren’t being taught, said Meier.
“If you unleash an oncologist who does not know how to say, ‘Your cancer has progressed,’ but they know how to say, “I know what we can try,’ that’s why people end up in the ICU and with feeding tubes” at the end of life, she said. “It’s easier than having a difficult conversation.”
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.
Labor of Love
With the Labor Day Holiday approaching this weekend, I really want to take the time to examine what this holiday means. Basically, Labor Day was made an official holiday in 1894 to coincide with the labor movement. Everyone needs an extra day off from the stress of work, but when your job is a caretaker, it’s a different story.
Photo by Gianluca Neri from flickr.com
This Labor Day, I want to encourage caretakers to take the whole day off from the responsibility of taking care of a sick loved one. I understand this is not an easy task to do and it may seem irresponsible, but I feel it is necessary to take a break.
For the most part, caretakers work harder than others. The majority of caretakers have multiple responsibilities that require the same amount of dedication and time. Imagine having the responsibility of a full-time job, children, a spouse as well as taking care of a sick loved one. The amount of stress and exhaustion that falls on the caretaker is tremendous and can cause serious health effects.
Most caretakers push themselves too hard because they feel guilty if they are not giving 100% to all of their responsibilities. The guilt can cause caretakers to not take time off for themselves to relax and rest. Our bodies and minds need rest in order to function correctly. When we push ourselves to the maximum, we can cause harm to our bodies and our relationships can suffer.
Caretakers, take Labor Day off. Ask a friend or relative for help and enjoy the day to relax. Your body and mind will thank you later. If you are alone and do not have anyone to reach out to, look into an adult daycare or a homecare nurse. Do not feel guilty about having a day to yourself. No matter what responsibilities and tasks we have, we are all still human and need a day to ourselves.
Friends or families of caretakers, encourage a day off for them. Volunteer to help and reassure caretakers that they deserve this day to themselves. Showing your support and enthusiasm will help ease the caretaker’s guilt and will give them a peace of mind.
When you’re a caretaker, you are a laborer of love. Your actions and decisions to provide care for a sick loved one all come from the heart. You deserve a day free from responsibilities to re-group and focus on your needs. Relax, rest and remember that having a healthy body, mind and attitude will allow you to be the best caretaker possible.