{"id":7752,"date":"2024-08-13T10:28:21","date_gmt":"2024-08-13T14:28:21","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=7752"},"modified":"2024-08-13T10:28:21","modified_gmt":"2024-08-13T14:28:21","slug":"the-burden-of-getting-medical-care-can-exhaust-older-patients","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2024\/08\/the-burden-of-getting-medical-care-can-exhaust-older-patients\/","title":{"rendered":"The Burden of Getting Medical Care Can Exhaust Older Patients"},"content":{"rendered":"

For this article, journalist Judith Graham interviewed doctors about how time-consuming and difficult it can be for older patients to get the health care they need. When you add up the time they spend on everything from medical tests and doctor visits to juggling appointments and dealing with insurance companies, it comes to about three weeks a year for most. Graham has some suggestions for how to lighten that burden. <\/span><\/i>KFF Health News<\/span><\/a> posted her article on March 27, 2024. It also ran on the <\/span><\/i>Washington Post<\/span><\/a>. <\/span>Funding from the Silver Century Foundation helps <\/span><\/i>KFF Health News<\/span> develop articles (like this one) on longevity and related health and social issues.<\/span><\/i> <\/span><\/p>\n

Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.<\/span><\/p>\n

Pain shot through her left knee and ankle. After summoning her husband on her phone, with difficulty she made it back to the house.<\/span><\/p>\n

And then began the run-around that so many people face when they interact with America\u2019s uncoordinated health care system.<\/span><\/p>\n

Gilliam\u2019s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her, \u201cI don\u2019t do ankles.\u201d<\/span><\/p>\n

He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience\u2019s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, MA. But the hospital didn\u2019t have the doctor\u2019s order when she called for an appointment. It came through only after several more calls.<\/span><\/p>\n

Coordinating the care she needs to recover, including physical therapy, became a part-time job for Gilliam. (Therapists work on only one body part per session, so she has needed separate visits for her knee and for her ankle several times a week.)<\/span><\/p>\n

\u201cThe burden of arranging everything I need\u2014it\u2019s huge,\u201d Gilliam told me. \u201cIt leaves you with such a sense of mental and physical exhaustion.\u201d<\/span><\/p>\n

The toll the American health care system extracts is, in some respects, the price of extraordinary progress in medicine. But it\u2019s also evidence of the poor fit between older adults\u2019 capacities and the health care system\u2019s demands.<\/span><\/p>\n

\u201cThe good news is we know so much more and can do so much more for people with various conditions,\u201d said Thomas H. Lee, MD, chief medical officer at Press Ganey, a consulting firm that tracks patients\u2019 experiences with health care. \u201cThe bad news is the system has gotten overwhelmingly complex.\u201d<\/span><\/p>\n

We don\u2019t talk enough about what we\u2019re asking older adults to do and whether that\u2019s realistic.<\/b><\/p>\n

\u2014 Ishani Ganguli, MD<\/b><\/p><\/blockquote>\n

That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care, and specialization among clinicians, said Ishani Ganguli, MD, an associate professor of medicine at Harvard Medical School.<\/span><\/p>\n

\u201cIt\u2019s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,\u201d she said. If someone has multiple medical problems\u2014say, heart disease, diabetes, and glaucoma\u2014interactions with the health care system multiply.<\/span><\/p>\n

Ganguli is the author of a <\/span>new study<\/span><\/a> showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the COVID pandemic disrupted care patterns. If any services were received, that counted as a day of health care contact.)<\/span><\/p>\n

That study found that slightly more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care\u2014at least 50 days a year.<\/span><\/p>\n

\u201cSome of this may be very beneficial and valuable for people, and some of it may be less essential,\u201d Ganguli said. \u201cWe don\u2019t talk enough about what we\u2019re asking older adults to do and whether that\u2019s realistic.\u201d<\/span><\/p>\n

Victor Montori, MD, a professor of medicine at the Mayo Clinic in Rochester, MN, has for many years raised an alarm about the \u201ctreatment burden\u201d that patients experience. In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills, monitoring health at home and following recommendations such as dietary changes.<\/span><\/p>\n

More and more medical practices use online patient portals and digital phone systems that frustrate older patients, who find them hard to navigate. <\/b><\/p><\/blockquote>\n

Four years ago\u2014in a paper titled <\/span>\u201cIs My Patient Overwhelmed?\u201d<\/span><\/a>\u2014Montori and several colleagues found that 40 percent of patients with chronic conditions such as asthma, diabetes and neurological disorders \u201cconsidered their treatment burden unsustainable.\u201d<\/span><\/p>\n

When this happens, people stop following medical advice and report having a poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple medical conditions and low levels of education who are economically insecure and socially isolated.<\/span><\/p>\n

Older patients\u2019 difficulties are compounded by medical practices\u2019 increased use of digital phone systems and electronic patient portals\u2014both frustrating for many seniors to navigate\u2014and the time pressures afflicting physicians. \u201cIt\u2019s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions,\u201d Montori said.<\/span><\/p>\n

Meanwhile, clinicians rarely ask patients about their capacity to perform the work they\u2019re being asked to do. \u201cWe often have little sense of the complexity of our patients\u2019 lives and even less insight into how the treatments we provide (to reach goal-directed guidelines) fit within the web of our patients\u2019 daily experiences,\u201d several physicians wrote in a <\/span>2022 paper<\/span><\/a> on reducing treatment burden.<\/span><\/p>\n

Consider what Jean Hartnett, 53, of Omaha, NE, and her eight siblings went through after their 88-year-old mother had a stroke in February 2021 while shopping at Walmart.<\/span><\/p>\n

At the time, the older woman was looking after Hartnett\u2019s father, who had kidney disease and needed help with daily activities such as showering and going to the bathroom.<\/span><\/p>\n

During the year after the stroke, both of Hartnett\u2019s parents\u2014fiercely independent farmers who lived in Hubbard, NE,\u2014suffered setbacks, and medical crises became common. When a physician changed her mom\u2019s or dad\u2019s plan of care, new medications, supplies and medical equipment had to be procured, and new rounds of occupational, physical and speech therapy arranged.<\/span><\/p>\n

Neither parent could be left alone if the other needed medical attention.<\/span><\/p>\n

\u201cIt wasn\u2019t unusual for me to be bringing one parent home from the hospital or doctor\u2019s visit and passing the ambulance or a family member on the highway taking the other one in,\u201d Hartnett explained. \u201cAn incredible amount of coordination needed to happen.\u201d<\/span><\/p>\n

Hartnett moved in with her parents during the last six weeks of her father\u2019s life, after doctors decided he was too weak to undertake dialysis. He passed away in March 2022. Her mother died months later in July.<\/span><\/p>\n

Ask which of the things you\u2019re being asked to do is most important and which might be expendable.<\/b><\/p><\/blockquote>\n

So, what can older adults and family caregivers do to ease the burdens of health care?<\/span><\/p>\n

To start, be candid with your doctor if you think a treatment plan isn\u2019t feasible and explain why you feel that way, said Elizabeth Rogers, MD, an assistant professor of internal medicine at the University of Minnesota Medical School. <\/span><\/p>\n

\u201cBe sure to discuss your health priorities and trade-offs: what you might gain and what you might lose by forgoing certain tests or treatments,\u201d she said. Ask which interventions are most important in terms of keeping you healthy, and which might be expendable.<\/span><\/p>\n

Doctors can adjust your treatment plan, discontinue medications that aren\u2019t yielding significant benefits and arrange virtual visits if you can manage the technological requirements. (Many older adults can\u2019t.)<\/span><\/p>\n

Ask if a social worker or a patient navigator can help you arrange multiple appointments and tests on the same day to minimize the burden of going to and from medical centers. These professionals can also help you connect with community resources, such as transportation services, that might be of help. (Most medical centers have staff of this kind, but physician practices do not.)<\/span><\/p>\n

If you don\u2019t understand how to do what your doctor wants you to do, ask questions: What will this involve on my part? How much time will this take? What kind of resources will I need to do this? And ask for written materials, such as self-management plans for asthma or diabetes, that can help you understand what\u2019s expected.<\/span><\/p>\n

\u201cI would ask a clinician, \u2018If I chose this treatment option, what does that mean not only for my cancer or heart disease but also for the time I\u2019ll spend getting care?\u2019\u201d said Ganguli of Harvard. \u201cIf they don\u2019t have an answer, ask if they can come up with an estimate.\u201d<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Susanne Gilliam, 67, was walking down her driveway to get the mail in January when she slipped and fell on a patch of black ice.<\/span><\/p>\n

Read more The Burden of Getting Medical Care Can Exhaust Older Patients<\/span> ›<\/span><\/a><\/div>\n

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