LITTLE ROCK — One of the most volatile issues being debated concerning the health-care proposal is what impact it will have on the elderly, particularly because there will be so many of us. (I'm 77.)
Dr. Jeanne Wei, executive director of the University of Arkansas for Medical Science's Donald W. Reynolds Institute on Aging, said recently that in the next 20 years, there will be more 80-year-olds in Arkansas than newborns. We must be prepared to care for them.
Citing the U.S. Census Bureau's 2005-07 American Community Survey, Dr. Wei said an estimated 13.9 percent of Arkansans are 65 years and older, compared with a nationwide average of 12.5 percent. The state ranks ninth in the share of its population that is 65 years and older.
By 2030 it's predicted that there will be 71 million Americans over age 65 (20 percent of the population), which is up from as recently as 2006, when there were only 37 million (12 percent of the population). In 1900, there were only 3 million over age 65.
Dr. Heather Whitson, assistant professor of medicine in Duke University's Division of Geriatrics in Durham, says these sharp increases "have dramatically changed the landscape of medicine." Whitson-we're cousins-has written and spoken extensively on the issue of how to balance increasingly complex health issues facing the elderly.
The "complexity" of the problem, she says, is this: As recently as late in the 20th Century, patients didn't live as long as they would today if they contracted what's called "multiple morbidities"- more than one chronic disease such as diabetes, osteoporosis, heart disease or hypertension-because doctors couldn't manage those conditions as well as they do today.
The good news: Thanks to medicaladvances, the average life expectancy is increasing. The bad news: By surviving longer with one chronic disease, elderly patients are increasingly accumulating multiple chronic conditions, which makes their health-care needs more complicated-and more expensive.
"We've gotten very good at managing chronic conditions so that people can live longer with them," Whitson said during a recent conversation. "As a result, however, almost 67 percent of the Medicare population have at least two chronic conditions and those patients account for about 96 percent of Medicare expenditures."
Referring to a recent article in the Journal of the American Medical Association, Whitson said, "a hypothetical patient was described who had five common conditions-diabetes, hypertension, osteoporosis, osteoarthritis, and chronic bronchitis-the kind of patient that any primary-care doctor would say they see every day."
If the recommended care plan were followed, the patient would be taking 19daily doses of medications plus another weekly medication. If he lacked prescription drug coverage, his medications would cost $4,877 annually. If he had Medicare Part D, which supposedly covers prescription medications to some degree, it would still cost him almost $4,000.
"The patient would almost certainly be given conflicting recommendations by different specialists," Whitson continued. "For example, he is told to take ibuprofen for arthritis but ibuprofen is not recommended as first-line pain medicine in older adults with diabetes."
Also to be considered is that the highest use of resources tends to occur in the last six months of life. "A lot of times, even in the face of medical futility," she said, "there is no one to put on the brakes. Doctors keep ordering tests and procedures. This occurs in part because there is little financial incentive to do otherwise. If a doctor spends 30 minutes performing a procedure on a patient, the reimbursement is about eight times what is reimbursed if the doctor spent those 30 minutes talking to patients abouthow to manage their insulin shots, how to prevent new conditions from developing, how to cut out unnecessary medications, or how to understand and document their end-of-life wishes."
Because these conversations don't take place as often as they should, "many patients receive hundreds of thousands of dollars of intensive treatment during the last days of their lives that they would not have wanted if they had been asked the question."
So what's the answer?
"We need to revise our whole thinking about health care, about how we can provide smarter, better coordinated health care to the population," she replied. "The current system is outdated, fragmented, and too expensive to maintain. So change has to come. The only question, is what will the new system look like? We're a nation of innovators and now is the time to consider all options with an open mind."
Dr. Bill Downs is professor emeritus of mass communications at Ouachita Baptist University in Arkadelphia.
Perspective, Pages 78 on 08/30/2009