Large majorities of older Americans experience gaps in their primary care

Large majorities of older Americans experience significant and troubling gaps in their primary care, according to a new national survey, "How Does It Feel? The Older Adult Health Care Experience," released today by the John A. Hartford Foundation.    

The poll focuses exclusively on Americans age 65 and older and assesses whether, in the past 12 months, patients received seven important medical services to support healthy aging, including:

• an annual medication review,
• a falls risk assessment and history,
• depression screening,
• referral to community-based health resources, and
• discussion of their ability to perform routine daily tasks and activities without help.

This type of low-cost, low-tech geriatric care can manage and lower patients' risk of a number of preventable health problems that erode quality of life, increase health care costs, cause disability, and even kill. Yet only a tiny number (7%) of older adults surveyed received all seven recommended services, all critical elements of a standard geriatric assessment. Fifty-two percent report receiving none or only one, and a large majority (76%) received fewer than half.

For a complete list of findings from the poll, please visit http://www.jhartfound.org/learning-center/hartford-poll-2012/.

"Preserving people's ability to do the things that are important to them is the gold standard of geriatric care," said Rosanne Leipzig, MD, PhD, Professor of Geriatrics and Palliative Medicine at the Mount Sinai School of Medicine. "Helping people learn how to avoid falling, screening for depression, and closely tracking their medications can affect older patients' quality of life just as much as any test we order or prescription we write," Dr. Leipzig added.

"We feel this survey highlights why expert geriatric care is needed," said Christopher Langston, PhD, Program Director of the John A. Hartford Foundation, which commissioned the poll. "One of the central truths of geriatrics is that older adults are not just older 40 year olds, any more than children are just small 40 year olds. Older people need different care, and when they don't receive these kinds of evidence-based interventions, as many don't, the result is a lot of preventable disability and suffering."

Medicare's Annual Wellness Visit: The benefit nobody knows

Since January 2011, Medicare has offered a benefit specifically designed to promote these healthy aging interventions, the Annual Wellness Visit (AWV), which is free for patients (no co-pays or deductibles) and pays doctors nearly three times as much as an average office visit. Unfortunately, 68 percent of older adults surveyed had not heard of the benefit or were not sure if they had heard of it. Only 17 percent said that they had received their Annual Wellness Visit. (In fact, the self-reported number may be overstated, as Medicare's records suggest that uptake is only 6.5 percent.)

"The Annual Wellness Visit represents a wonderful chance for doctors and patients to work together to make these proven preventive services an important part of their care plan," said Christopher Langston of the Hartford Foundation. "We urge all older people and their health care providers to take advantage of it and to have these important conversations."

Strong support for geriatrics education

Older adults in the survey also expressed strong support (93%) for requiring all medical and nursing students to take classes and training in caring for older people (which most are not presently required to do). Sixty-seven percent also said they believed they would "get better care" if their doctors, nurses, social workers, and other health professionals had more geriatrics training.

"We couldn't agree more," said Chris Langston of the Hartford Foundation. "One of the goals of the Hartford Foundation's grantmaking is to ensure that everyone who cares for older adults, specialists and non-specialists alike, receives the training required to understand and meet their unique health needs."

Other poll findings: low rates of intervention on depression, falls

Depression screening is one of the most important yet overlooked services for older adults that the poll examines. Depression is a killer of older adults, who are at greater risk of suicide than any other age group, and is known to exacerbate other conditions and increase the cost of care. Yet when asked whether a doctor or health care provider had asked about "your mood, such as whether you are sad, anxious, or depressed," 62 percent said no.

Falling is another highly preventable problem with serious consequences for older adults. Falls cause more injury and injury-related death in older people than any other event and cause 90 percent of all hip fractures, which greatly increase odds of nursing home placement. Peer-reviewed evidence has shown that older people can cut their risk of falling by about 30 percent by addressing key risk factors. Yet even among those at elevated risk, such as people over age 80 or people taking multiple medications, the Hartford poll reveals a widespread lack of intervention. Seventy-five percent of adults 80+ said their doctor had not discussed how to avoid falling, as did 71 percent of people taking 5+ medications.