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Elderly Report Key Primary Care Services Missed


 

In a poll of senior citizens released April 23, a majority reported that their physicians were not offering recommended evidence-based services such as asking about recent falls or seeking to verify medications being taken.

The poll of 1,028 Americans aged 65 years and older, conducted by Lake Research Partners for the John A. Hartford Foundation, took place in late February and early March and has a margin of error of plus or minus 3.1 percentage points. Among other questions, the respondents were asked if their physicians had offered seven basic services that are typical of good geriatric care, Chris Langston, Ph.D., a program director at the foundation, said in a press briefing.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Chris Langston said.

The vast majority of those surveyed – 93% – said that they saw their primary care physician regularly. Among the respondents, 82% had one to nine physician visits annually, with half reporting three to nine visits per year. Ninety-six percent said they were completely or somewhat satisfied with their care.

And yet, only 7% of respondents said they’d received all seven services generally considered to be good care. Just over half had received none or only one.

In addition to assessing the risk for falling and reviewing medications, seniors were asked whether their physicians told them how to avoid falling, screened them for depression, provided referrals to community-based health resources, discussed their ability to perform routine daily activities such as shopping, and determined whether they needed help with personal tasks such as showering.

The results of the poll are "extremely interesting and confirmatory of other work looking at doctors’ actual practice," said Dr. Rosanne Leipzig, a professor of geriatrics and palliative medicine at Mount Sinai School of Medicine, New York.

Of particular concern, she said, was the finding that a third of those surveyed said that a physician had not sat down with them to review all their medications and supplements. A huge number of adverse events result from medication errors and misadventures, especially among older patients. These "data are very compelling in identifying a problem that is real," she said in the briefing.

About a third of patients said their physicians had asked them in the last year whether they’d had a fall, or if they were having any depression or other mood issue. A fifth or less said they had been asked if they had problems with activities of daily living, or that their physicians had referred them to nonmedical help in the community. Only 19% said their doctors had discussed fall prevention with them in the past year.

"Older people are not getting the care they really need that would help them live longer, more independently, and with a higher quality of life," Dr. Langston said.

When the data were broken out by various age cohorts, the results were not much different, even for older, and, theoretically, more frail people over age 80, said Tresa Undem of Lake Research Partners, a research firm. For instance, 75% of those over 80 said fall prevention had not been discussed in the last year.

Many seniors were not aware that they were eligible for an annual Medicare wellness visit, in which the physician discusses various aspects of care and offers many of the seven services. It is entirely free for the beneficiary and pays four to five times the regular Medicare physician office rate. Fifty-four percent of seniors said they had not heard of it and 72% said they had not received such a visit in the previous year.

Seniors might be confused about the benefit, however, as Medicare shows higher uptake rates than reflected in the poll, said Ms. Undem.

The poll also asked the seniors if they thought they would receive better care if physicians and nurses had more training in geriatrics. Two-thirds said yes. Most also supported a requirement for geriatrics training in nursing and medical school.

Dr. Leipzig noted that it’s difficult to convince physicians to go into geriatrics. Only about 300 physicians train in the field each year. She said that other physicians should receive specialty instruction in geriatrics to help alleviate the shortage.

But given the time intensity of caring for older Americans – and the low level of reimbursement – it will be an uphill battle, she said. The typical $45 office visit fee "doesn’t even come close to allowing someone to make a living," she said.

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