Getting Better at Getting Older
By Sandy Graham
Coloradans, like other Americans, are living longer on average. But when it comes to quality of life, will those years be comfortable, healthy and active ones?
That question has huge implications for both Colorado's and the nation's economies. National health care spending as a percentage of gross domestic product reached an all-time high of 18.2 percent in 2011. People older than age 65 typically use more health care than younger people, and there is a growing influx of older people as the 79 million member baby boom generation moves into its golden years.
Boomers, born between 1946 and 1964 and who began turning 65 last year, are likely to redefine old age just as they redefined youth and middle age. Boomers are more likely to be active participants in their care, be knowledgeable about health care choices and strive for healthier golden years.
"Especially as we get further into the baby boom's aging, people will realize they will have a reliably longer period of healthier life than ever before," says Christopher A. Langston, PhD, program director at The John A. Hartford Foundation in New York City, which focuses on effective and affordable health care. "My grandfather turned 65 and died. Nowadays, that would be considered quite anomalous."
Boomers and others in the 65-plus age group can thank medical technology, better treatments and improved care for the potential extra years.
Good Riddance, Old Killers
"There have been wonderful advances in medical technology and in other ways of managing health," says Gretchen Alkema, PhD, licensed certified social worker and vice president of policy and communications for The SCAN Foundation of Long Beach, Calif. "It's contributed to a pathway where people are able to live with chronic conditions and difficulties with managing daily activities independently." Acute illnesses such as pneumonia and intestinal diseases that were among 1910's leading causes of death have largely been conquered by antibiotics.
That's not to say the future is completely rosy. As the population grays, there will be increasing demands on health care, especially primary care providers and experts in geriatrics, which is the care of older people. (For more about The Hartford Foundation's work in geriatrics, see story, Aging Population Intensifies Provider Shortage.) Funding for Medicare, the federal health insurance program for people 65 and older, has been uncertain as Congress has debated entitlement programs. As a result, some practitioners won't accept new Medicare patients and question whether reimbursement covers their costs.
The obesity epidemic also is worrisome since being overweight or obese brings higher risks of conditions including diabetes, heart disease, arthritis or cancer. Nationally, about a quarter of people older than age 65 are obese. In Colorado, it's about 19 percent, according to the Centers for Disease Control and Prevention.
And while there is more emphasis on managing people's chronic conditions for better quality of life and lower costs of care, chronic diseases are epidemic among older people. A 2006 national survey by the U.S. Agency for Healthcare Research and Quality found that 90.7 percent of people 65 years and older had one chronic condition (such as arthritis, diabetes or heart disease) and 73 percent had two or more.
"Chronic disease does not mean we lose ability to do things or that we feel bad," says Langston. "The challenge here is how should we support aging with health care and how do we get that right."
Making Medicare Pay Off
Donald Murphy, MD, co-principal of Senior Care of Colorado/IPC, a metro-area geriatric practice that treats about 15,000 Coloradans 65 years and older, is teaching other physicians that caring for Medicare patients can benefit the bottom line. With funding from the Colorado Health Foundation, the Alzheimer's Association's Colorado Chapter works with Senior Care to instruct doctors in coding and documentation, focusing on complex medical conditions such as dementia.
Providers "have been very open and welcoming to our input," says Murphy, who serves on the Board of the Colorado Health Foundation. However, with so many other pressing changes facing busy medical professionals these days – such as converting to electronic medical records – it's hard to reach as many practitioners as Murphy would like with his message.
He praises the state's health care system for high-quality senior care. "We don't have an ideal system of caring for our seniors, but we're doing a good job," Murphy says. To meet the demands of the aging population and shrinking physician base, he predicts there will be even greater use of nonphysician providers such as physician assistants and nurse practitioners.
While seniors' physical health issues and the capacity of the health care system to handle them are important matters, mental and dental health demand attention, too – especially for lower-income older people who don't always have the financial resources to access care.
The Colorado General Assembly authorized $3 million for dental care for older people with household incomes 135 percent of the federal poverty level (FPL) or lower. (The FPL is $11,170 for a single person and $23,050 for a family of four.) Eileen Doherty, the executive director of the Colorado Gerontological Society, welcomes the funding, noting poor dental health is linked to several chronic conditions including heart disease. The society runs a Denver dental program for the Area Agency on Aging that has a 750-person waiting list, she says. Medicare does not cover routine dental services.
Older people also suffer from mental health issues at rates higher than the general population. The U.S. Administration on Aging estimates that 20 percent of people age 55 and older suffer from mental disorders. The suicide rate for people age 65 and older is 14.22 per 100,000 compared with 11.1 for the general population.
"One of the saddest things we find is a lot of depression," Doherty says. "Some of it is situational and some evolves into clinical depression." Some depression stems from losses older people face – homes, mobility, loved ones or friends, she adds. Some is a side effect of medications. (See box below.)
Chopping Wood, Cleaning House
A frail elder may need more than mental, dental and physical health care. Through 16 Area Agencies on Aging statewide, the Colorado State Unit on Aging provides services such as transportation for shopping and doctor appointments, meal delivery, caregiver support and home chores such as snow removal. Often, it's enough to keep an older person living at home rather than in an institution, says Todd Coffey, the unit's manager.
"This does give [older people] the ability to maintain their independence," he says.
People 60 and older are eligible for the Unit on Aging's services regardless of income, although the unit tries to target the neediest citizens, Coffey says. About 20 percent of recipients live in poverty while statewide, the poverty rate for people 60 years and older is about 8 percent.
Coffey expects to see the baby boom generation's impact on his unit's services in about 10 years when boomers begin to move toward the average age of beneficiaries, which is 78. But there are already waiting lists for services in some parts of the state. In Denver, for example, 200 to 300 people are waiting for meal delivery. In rural areas, transportation services are difficult because of the distances between towns.
As with other life stages, disparities exist in health and health care among older people. Generally, minorities and low-income people have shorter life expectancies and higher mortality rates, in part because they have less access to health care, healthy foods, exercise opportunities and health education.
Aging often presents challenges, whether situational, physical or mental, but there is no set point at which they present themselves.
"The world is not going to come crashing down the day you turn 65," Doherty says. "However, there are things that happen. At some point, you become widowed. You may experience exacerbations of chronic illness that send you to the doctor more often. You may need nursing home care, short term or longer."
She estimates there is a stretch at the end of life, generally two to three years long, when health worsens to the point of impairing daily living. With an average life span of 77 or 78 years, "you're still looking at 75 years of good health and being able to do many of the things you've always done," she says.
Despite some stiffening knees or compromised breathing, the leading edge of the boomers and those who have preceded them into later years are largely handling health challenges well – living longer and better.
"'Better' is obviously a subjective term, but I do think we're living better as well as longer," says Murphy. "We're not guaranteeing people will have stress-free golden years. Few people are very ecstatic about getting another 10 years older. But I see people who adjust to aging and impairments quite gracefully."
|What the ACA Means to Medicare
First, the Affordable Care Act (ACA) maintains benefits and allows older people to keep their providers, contrary to some claims.
The ACA offers recipients annual wellness exams and certain preventive services, such as flu shots and bone mass tests, without deductibles or copays.
The "donut hole" – the nickname for the coverage gap in Medicare Part D drug coverage – is gradually closing although recipients will still have copays. Those reaching the donut hole now get a 50 percent discount on covered brand-name drugs.
The ACA also contains provisions to reduce Medicare waste and fraud, and to slow growth in Medicare expenses, extending the life of the Medicare fund.
|Rx for the Drug Dilemma
People typically use more prescription drugs as they get older, which can pose financial problems or troubling side effects.
The average person 65 years or older filled 31.1 prescriptions yearly compared with 11.3 per person 19 to 64 years old in 2010, according to a Kaiser Family Foundation study. A 2005 AARP survey of older people found that 87 percent of those polled took prescription drugs daily – on average, four different drugs a day!
Not only can prescription drugs exert financial stress on older people who live on fixed incomes, they can cause adverse effects such as dizziness, falls, confusion or depression. Often a person sees multiple providers who prescribe medications without knowing what that person is already taking. It can baffle a senior who may not ask questions or understand medical explanations.
Experts suggest that an older person sit down with a primary care provider once each year to review all prescribed medications from all providers – as well as over-the-counter drugs and supplements – to ensure there are no potentially hazardous conflicts and that the person understands why and how each drug should be taken.
The federal Affordable Care Act has enhanced Medicare's medication management program for people with complex health needs and multiple prescription drugs. Eligible people can get free annual medication reviews by a pharmacist, by phone or face to face. Part D carriers can tell an individual if he or she qualifies.
King Soopers and City Market pharmacists "are capable and willing to provide a complete review" of medications, says Marla F. Frawner, RPh, pharmacy merchandiser. People should schedule a review and submit a full list of medications ahead of time. If people are not covered by Part D, there is a charge.
|Aging and Health by the Numbers
- Life expectancy in the United States increased from 49 years in 1900 to 78.7 in 2012. Colorado's life expectancy is 79.9.
- At 65 years old, a woman has on average another 20.3 years of life; a man has 17.6 years ahead.
- By 2050, 20 percent of the population will be 65 or older – 88.5 million people, more than double the 38 million in that age group in 2008.
- The number of Americans who will suffer functional disability due to arthritis, stroke, diabetes, coronary artery disease, cancer or cognitive impairment is expected to increase by at least 300 percent by 2049.
- In 2007, two-thirds of Medicare spending was for people with five or more chronic conditions.
Sources: Various federal agencies including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, and Medicare