Options For Elder Care

Health Care Reform Needed for Older Adults on Medicare in 2010

Both the House and Senate passed far-reaching health care reform bills last year, but the election of Massachusetts Republican senator Scott Brown this week makes it more difficult—but not impossible—to pass final legislation that reconciles the differences between the House and Senate bills. There are a number of procedural options for passing a health reform bill that has the support of a majority in both the House and the Senate and that President Obama would sign. What should not be an option is giving up on health care reform.
Older adults and people with disabilities in particular will lose if the Medicare improvements in health reform are not implemented.
People with Medicare now face a gap, or “doughnut hole,” in their drug coverage, when their benefits stop and they must pay the full price for their drugs in addition to the premiums for drug coverage. In 2010, people must spend nearly $4,000 out of pocket to get out of the gap; most never get out and many split pills or stop taking their medicine instead. If we give up on health reform, that coverage gap will grow to more than $7,000 by 2019. Senate leaders and President Obama have promised that the final bill will include a phase-out of the coverage gap by 2019, which is already part of the House health reform bill.
Medicare provides coverage for the treatment of illness and injury, but it falls short in providing affordable coverage of preventive care. Both the House and Senate bills eliminate deductibles and coinsurance for preventive benefits, and the Senate bill would provide 100 percent coverage for an annual health assessment.
One in five people with Medicare who are discharged from the hospital are readmitted within 30 days. Preventable readmissions cost Medicare $12 billion every year. Both the House and Senate bills provide incentives to hospitals to improve care after discharge and for specialists and primary care doctors to improve the coordination of care.
People with Medicare aren’t the biggest losers if Congress gives up on health reform. Over 20,000 people in the U.S. die each year because they lack health insurance, according to the Urban Institute. There are now 50 million people with no health insurance in our country. If we give up on health reform, that number will grow to 54 million in ten years, according to the Congressional Budget Office. Both the House and Senate bills would cover more than 90 percent of U.S. residents.
People who can’t get health benefits through their jobs, or who lose their insurance when they lose their jobs, can now be denied coverage if they have a pre-existing condition. Both the House and Senate bills would make this practice illegal. If we give up on health reform, insurance companies will be able to continue to deny coverage to the people who need it most—those with illnesses needing treatment.
These are the essential elements of health reform: covering the uninsured, prohibiting unfair insurance company practices and improving Medicare. We can’t give up now. We have too much to lose.

One in Three People Over 70 Have Memory Impairment

Duke University Medical Center

 

 

    
                                                                         

New study illustrates that nearly every family will be faced with the challenges of caring for a family member with some form of memory impairment.

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More than a third of people over age 70 have some form of memory loss, according to a national study by a team of researchers at Duke University Medical Center, the University of Michigan, the University of Iowa, the University of Southern California and the RAND Corporation. The group performed the first population-based study to determine the number of people who have some form of cognitive impairment, with and without dementia.

 

While an estimated 3.4 million Americans have dementia, defined as a loss of the ability to function independently, the researchers estimate that another 5.4 million over age 70 have memory loss that disrupts their regular routine but is not severe enough to affect their ability to complete the activities of daily living (ADLs).

 

"These findings illustrate that nearly every family will be faced with the challenges of caring for a family member with some form of memory impairment," said Brenda Plassman, Ph.D., associate research professor of psychiatry at Duke and the study's lead author. "Among the people aged 71-79, a sizeable number had cognitive impairment. This is an age at which most people expect to have many productive years ahead."

 

The frequency of memory loss without dementia increased with advancing age and with fewer years of education—similar to the trends seen in dementia.

 

Plassman explained that throughout the course of the study, individuals with cognitive impairment without dementia progressed to dementia at a rate of about 12 percent per year. On average, the mortality rate for the study group was 8 percent annually, but varied across the subtypes of cognitive impairment without dementia. Said Plassman, “While the overall rate of progression to dementia is in line with findings from other studies, the surprising finding here is that some subtypes of cognitive impairment without dementia progressed to dementia at much higher rates, around 20 percent, within one year."

 

Chronic Illnesses Named as Cause

 

Nearly a quarter of those with memory loss without dementia also had a chronic medical condition, such as diabetes or heart disease, that appeared to be the cause of the cognitive impairment. The researchers speculate that this group is one of the most underdiagnosed subtypes of cognitive impairment because doctors are likely focusing on the primary health issue.

 

"Given how common cognitive impairment without dementia is, physicians should be alert to this problem as they evaluate and treat the patient for other medical problems," said Robert B. Wallace, M.D., the study's senior author from the University of Iowa. "This may have significant ramifications because it means that patients may not be able to accurately portray their symptoms and may not retain important information about their treatment."

 

The data, published in the Annals of Internal Medicine, is from the Aging, Demographics and Memory Study, which is part of the larger Health and Retirement Study conducted by the University of Michigan Institute for Social Research and funded by the National Institute on Aging.

 

"As the population ages and works longer, understanding the extent of cognitive impairment in the older population is critically important," notes Richard Suzman, Ph.D., director of the NIA's Behavioral and Social Research Program. "Research is now beginning to suggest that interventions—such as controlling hypertension and diabetes or perhaps cognitive training—might help maintain or improve mental abilities with age. As such interventions are tested and widely applied, we should be able to track their impact through this type of research."

 

"With such a sizable number of Americans with some form of cognitive impairment, many of whom will get dementia, it's imperative to increase research funding that could lead to breakthroughs in Alzheimer's diagnosis, prevention and treatment," said William Thies, Ph.D., vice president of Medical and Scientific Relations for the Alzheimer's Association.

 

Co-authors on the study include Kenneth M. Langa, Gwenith C. Fisher, Steven C. Heeringa, David R. Weir, Mary Beth Ofstedal, James R. Burke, Michael D. Hurd, Guy C. Potter, Willard L. Rodgers, David C. Steffens, John McArdle and Robert J. Willis.