Our Parents, Ourselves
Dartmouth Atlas Project Issues National Report Card on Health Care for U.S. Aging Population
Members of the “sandwich” generation can attest to how much time their aging parents spend inside the health care system, because they often accompany them on their succession of visits to the doctor’s office, lab or hospital. According to a new report by The Dartmouth Institute’s Dartmouth Atlas Project, aging patients spend nearly a month of the year in contact with the health care system.
In the report, “Our Parents, Ourselves: Health Care for an Aging Population,” it’s noted that Medicare beneficiaries in East Long Island and Manhattan, New York, spent 24.9 and 24.6 days, respectively, in contact with the health care system, while patients in Marquette, Michigan, and Lebanon, New Hampshire, only spent 10.3 and 10.2 days, respectively.
For patients with multiple chronic conditions and dementia, the amount of time spent in contact with the health care system was even higher. Across the 306 hospital referral regions the report looked at, patients in Manhattan and East Long Island, New York, tied for the highest rate of contact days among patients with two or more chronic conditions, at 46.2 days, and patients in East Long Island also had the highest rate of contact days among patients with dementia, at 44.9 days.
“It is striking how much of an older adult’s life is occupied by health care, especially those with multiple chronic conditions or dementia,” says Dartmouth Institute researcher Julie Bynum, the report’s lead author. “In 2012, the average Medicare beneficiary was in contact with the health care system on 17 days — meaning in an inpatient setting or having a clinician visit, procedure, imaging study, or lab tests in an outpatient setting — and 33 days if they had two or more chronic conditions.”
“Our Parents, Ourselves: Health Care for an Aging Population,” also serves as a national report card that shows where the United States is making progress in patient-centered care and where improvements need to be made for older adults, a population predicted to surge from 43.1 million in 2012 to 83.7 million by 2050.
The report cited five areas were in which improvement is still needed: screening for prostate cancer, screening for breast cancer, late referral to hospice, feeding tube placement in patients with dementia, and the number of days spent in intensive care during the last six months of life.
The US Preventive Services Task Force (USPSTF) has recommended against PSA screening for men over 75 for several years, but in 2012 recommended against all PSA screening regardless of age. This is based on evidence that the benefits of PSA-based screening for prostate cancer do not outweigh the harms. Despite this recommendation, the national average rate of PSA screening among men ages 75 and older was 19.5 percent, and regional discrepancies were significant, from 9.9 percent in Casper, Wyo., to 30 percent in Miami, Fla.
The four areas in which health care for older populations has improved in recent years are: decreased use of high-risk medications, increased testing for diabetes, a reduction in preventable hospital admissions, and reduced 30-day readmissions.
The percentage of Medicare beneficiaries who filled at least one prescription for a high-risk medication decreased between 2006 and 2012, from 32.2% of beneficiaries to 18.4%, a decline of almost 43%. The report also notes that while use of high-risk medications decreased in every hospital referral region, rates of use of these drugs continued to vary significantly across the country. About 10% of Medicare beneficiaries filled a prescription for a high-risk medication in Rochester, Minnesota (9.8%), Sioux Falls, South Dakota (10.5%), and Mason City, Iowa (10.8%), while rates of high-risk medication use approached 30% in three Louisiana regions: Monroe (29.1%), Alexandria (28.9%), and Baton Rouge (27.5%).
“Our bodies change as we age, and our priorities change, too, as the number of years ahead are fewer than the years behind us,” Bynum said. “The information in this report is a good starting point for patients and their caregivers to begin a conversation with their doctor about certain aspects of their care.”