Top Health Issues for Seniors
By Mary Romelfanger
What are the biggest health issues for seniors in the U.S. these days? While seniors have their own list of their biggest problems —such as gaining too much weight— the view is different for policymakers, strategists and geriatricians who deal with senior issues from a financial and governmental point of view.
The Top Five Health Issues for State Governments
- Medicaid and Money
- Implementation of Affordable Care Act of 2012
- Health insurance exchanges
- Healthcare workforce
- Wellness promotion to save money
Not surprisingly, given the current political and financial climate, the top two healthcare issues from the perspective of those responsible for implementing state-level programs for health services are Medicaid spending and the Affordable Care Act (ACA). ACA is the controversial healthcare reform statute, informally referred to as Obamacare, which President Obama signed into law on March 23, 2010. Even before the implementation of the ACA, states were concerned about escalating Medicaid enrollments and about pressure from healthcare providers for increasing reimbursement in the face of diminishing federal stimulus monies.
Another concern is that, in connection with the ACA, states must establish health insurance exchanges, which are marketplaces where individuals and small businesses can compare policies and premiums, and buy insurance. The Council of State Governments (CSG), (www.csg.org), a nonpartisan organization that brings state leaders together to share ideas, predicts a big impact on state agencies from the efforts required to establish the infrastructure and technologies necessary to create the health insurance exchanges. States may elect to opt out of the requirement to create an exchange, instead allowing the federal government to operate the exchange. But for those states wishing to implement the exchange, they must demonstrate the capacity to do so by January 1, 2013.
Adequate Healthcare Workforce
State governments are also concerned about the healthcare workforce: Will there be enough healthcare workers, and will they be adequately trained? Increased access to health insurance and health services—and the new emphasis on preventive options—raises questions about the ability of primary care practitioners to aid the elderly. The rapid evolution of innovative technologies such as telemedicine and electronic health records has the potential to significantly improve the workforce picture.
The workforce issue is also a prime concern of the prestigious National Academies, composed of the National Academy of Science, National Academy of Engineering, Institute of Medicine and the National Research Council. By 2030, more than 72 million Americans will be 65 or older. On July 10, the Academies issued a press release addressing the probable “inadequacies” of the existing healthcare workforce to meet the burgeoning need of the baby boomer population’s mental health/substance abuse care needs. The release highlighted the Institute of Medicine report “The Mental Health and Substance Use Workforce for Older Adults,” which projects the types and levels of care that boomers will need and makes recommendations for significant education and training for the workforce. (http://www.iom.edu/Reports/2012/The-Mental-Health-and-Substance-Use-Workforce-for-Older-Adults.aspx)
Wellness Programs Inexpensive
Wellness promotion programs are one inexpensive solution that many states are considering to address the remarkably costly issue of chronic illness. According to CSG data, chronic illness accounts for 75 percent of health spending. While many seniors know about the benefits of physical exercise and quitting smoking, research studies show the positive impact of programs such as smoking and obesity reduction, and increased physical activity. Stanford University developed an innovative Chronic Disease Self-Management Program (www.aoa.gov/AoARoot/Press_Room/Enews/enewsletter/archive/2012/eNews_May_W4.pdf) that various states are using to help those with chronic illnesses improve their quality of life. The program is approved by the Administration on Aging, Centers for Disease Control and the National Council on Aging. (www.healthinaging.org/news/fha-e-newsletter/article:07-25-2012-12-00am-summer-2012-e-newsletter).
Geriatricians List Top 10 Health Issues
Geriatricians are medical providers who specialize in care for those 65 and older. As we age, we tend to take our aches, issues and chronic health problems with us as we move to the next year—every year. Dealing with the increasing complexity of maintaining health quality requires special knowledge of the normal and abnormal changes associated with aging, and the specialty practice of geriatrics focuses on quality of life for seniors.
Senior healthcare experts at the University of Rochester Medical Center Division of Geriatrics and Aging (www.urmc.rochester.edu/medicine/geriatrics/patientcare) recently identified the “Top 10 Most Common Health Issues.
- Physical activity and nutrition: Research indicates that in addition to preventing or delaying the onset of some diseases, activity and nutritious food intake may also relieve depression and improve mood.
- Overweight and obesity: There is a strong relationship between excess weight/obesity and death from high blood pressure, diabetes, heart disease, stroke, the occurrence of diseases from osteoarthritis and various types of cancers.
- Tobacco: Tobacco is the greatest preventable cause of illness and premature death in the U.S. Its use is now known as “tobacco dependence disease.”
- Substance abuse: In the older adult population, substance abuse is commonly accidental versus purposeful behavior. Seniors may self-medicate and mix legal medications with alcohol.
- HIV/AIDS: It is reported that between 11 and 15 percent of AIDS cases in the U.S. occur in those over the age of 50, but stereotypes about aging and sexuality keep this a relatively hidden problem.
- Mental health: The most common late-life mental health condition is depression, which left untreated, can lead to suicide. The rate for suicide in elderly white men is higher than for any other age group, including adolescents.
- Injury and violence: The number one cause of injuries in the elderly, falling is also the primary reason for hospital admissions and deaths due to injuries. Each year, one in every three persons over the age of 65 will experience a fall.
- Environmental quality: For economic reasons, many of the nation’s elderly live in neighborhoods and dwellings where they face environmental pollution risks. Financially, many seniors live just over the poverty level.
- Immunization: Influenza and pneumonia continue to be among the top causes of death of older adults, with pneumonia being one of the most serious infections to overcome.
- Access to healthcare: Generally, seniors tend to monitor or seek intervention for health issues less frequently than other age groups. Another aspect of inadequate access to appropriate healthcare is the national shortage of geriatricians.
For more information about the topics addressed in this article, please refer to the referenced websites. You can also visit the Society of Certified Senior Advisors Healthcare Library at www.csa.us/HealthcareLibrary.
Going forward, all of these and other issues will continue to influence the quality of life for seniors served by CSAs. In the coming months, this column will explore these and other health issues in more detail.
Mary Romelfanger, RN, MSN, CS (Gerontology), LNHA, is a clinical specialist with more than 30 years of experience working with the older adult population and healthcare systems throughout the United States and Canada.