The Quality Gap in Care for Older Adults with Multiple Complex Health Problems,Benefits of a Computerized Exercise “Coach” for Seniors,How High Out-of-Pocket Healthcare Expenses Affect Medicare Beneficiaries Are Focus of Studies at Scientific Meeting
May 3rd, 2012
Three groundbreaking studies—illuminating the quality gap that older adults with complex health problems face; a high-tech way to encourage seniors to exercise; and how Medicare’s out-of-pocket costs may worsen existing inequalities in well-being at the end of life—will be presented at the American Geriatrics Society’s 2012 Annual Scientific Meeting. The meeting, which runs from May 3-5, in Seattle Washington, is the premier educational event in geriatrics, covering the latest in clinical care, research in aging, and innovative models of care. The three papers, judged the best among 706 submissions, will be presented during the meeting’s Plenary Paper Session.
Quality Gap in Care for Older Adults with Multiple Complex Health Problems
Studies have found that older adults with greater numbers of health problems appear to receive higher quality care than those with fewer health problems. Investigating what might account for this, researchers recently examined whether the quality of elder healthcare might vary depending on how many general health problems, on the one hand, and how many “geriatric syndromes,” on the other, that older patients have. General medical conditions include such disorders as coronary heart disease, diabetes, hypertension, and heart failure. Geriatric syndromes include particularly complex disorders such as dementia, malnutrition, incontinence, osteoporosis, and falls. The authors of the study, Geriatric Versus General Medical Conditions Have Opposite Effects on Overall Quality of Ambulatory Care, followed nearly 650 adults, all older than 75, for 13 months. Most of the adults had both geriatric conditions and general medical conditions.
The study’s lead author, Lillian Min, MD, of the University of Michigan Medical School, and co-authors, used 65 process-of-care quality indicators to evaluate the quality of care the adults received. They then examined the relationship between care quality and the number of both general and geriatric syndromes the adults had. While greater numbers of general medical conditions appeared to be associated with higher quality of care, each additional geriatriccondition was detrimental to care quality, the researchers report.
“We found that primary care practices have more difficulty providing high-quality care to patients with multiple geriatric morbidity burden, perhaps defining a new way to think about why some older patients are more complex than others,” Dr. Min notes. “Burden of general medical conditions is important in predicting death, but this traditional way of capturing co-morbidity is inadequate for identifying poor care process in outpatient care. Future quality improvement efforts must target those who need it most – those with multiple geriatric conditions.”
Benefits of Computerized Exercise “Coach” for Seniors
While physical activity offers a wide range of health benefits, many older adults are sedentary, note Boston University School of Medicine’s Michael Paasche-Orlow, MD, and co-authors of the study,Efficacy of a Computer-based Intervention to Promote Walking in Older Adults. To determine whether “Steps-to-Health” – an innovative computer- animated “virtual coach” – would encourage older people to walk regularly, Dr. Paasche-Orlow and co-authors conducted a randomized, controlled trial, enrolling 263 older adults with an average age of 71. All participants were given a pedometer, and the 132 randomly assigned to the intervention group received a portable computer and virtual coach program for the two-month active phase of the trial. After the active phase ended, the researchers followed participants for another 10 months. Older adults who used “Steps-to-Health” walked more than those in the control group – an average of 4,037 steps per day, compared with 3,533 steps – the researchers report.
Participants using the electronic coach also walked more than controls during the 10-month maintenance period following the trial, though the difference was not statistically significant. Participants in the “Intervention Groups were very satisfied with the program,” the authors write. “But effective methods for maintenance of behavior change are needed.”
Medicare Beneficiaries Face High Risk of Out-of-Pocket Health Expenses
One of the goals of the Medicare program is to reduce the risks of financial catastrophe that high out-of-pocket healthcare-related expenditures can pose for older adults, note the authors of Out-of-Pocket Spending in the Last Five Years of Life. High out-of-pocket expenses have the potential to adversely affect both beneficiaries and their spouses prior to the former’s death, and to continue to adversely affect the latter afterward, by significantly reducing the surviving spouse’s financial resources.
In addition, high out-of-pocket costs may create significant inequality in care at the end of life, with those with limited financial resources having fewer care options, explains lead author Amy S. Kelley, MD, of Mount Sinai School of Medicine in New York City, and co-authors. In the first study of its kind, the researchers analyzed information – including medical histories and reported household wealth—about more than 3,200 Medicare beneficiaries who died between 2002 and 2008.
The researchers calculated each beneficiary’s out-of-pocket spending for insurance, nursing home care, and other health-related expenses over the five years preceding each beneficiary’s death. Median out-of-pocket expenditures over the five-years were roughly $23,000 for individuals and more than $39,000 for married couples. All told, one in three beneficiaries accrued expenditures exceeding his or her non-housing assets, with spending on long-term care a dominant contributor. In addition, average spending varied considerably by cause of death, ranging from roughly $31,000 among those with gastrointestinal disease to over $66,000 among those with Alzheimer’s disease.
“Despite nearly universal insurance coverage under Medicare, older adults face considerable financial risk from out-of-pocket expenditures in the last five year of life” Dr. Kelley reports. In addition, “large disease-related differences further complicate efforts to plan for health-related expenses late in life.”
About the American Geriatrics Society
The American Geriatrics Society (AGS) is a not-for-profit organization of nearly 6,000 health professionals devoted to improving the health, independence and quality of life of all older people. The Society provides leadership to healthcare professionals, policy makers and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy.
For more information pleae contact Jillian Lubarsky at (347) 491-9309 orjlubarsky@americangeriatrics.org.
