- Who Consumes the Most Healthcare?
- What Happened to Advance Directives?
- Rethinking Aging
- War on Alzheimer's: False Hope?
- Death by Medicine
- Copyright Questions
- Web Sites to See
- Books of Interest
- Coming Events
WHO CONSUMES THE MOST HEALTHCARE?
From Occupy Wall Street, we've heard a lot about the 99% versus the 1%. What if we did the same analysis for health care expenditures? Who are the 1% top consumers of healthcare money:
"They are older patients with cancer, diabetes, heart disease and other serious chronic conditions. Many have multiple health problems, and their relatives might not be helping with their care. Most have private insurance, are white and female."
That's a picture of the costliest 1% of patients in America and the news is that caring for the 1% cost takes more than 20% of all healthcare spending in the US. What about the healthy people? It turns out that the least costly half of all patients consume only 3% of total health spending, this according to recent data from the U.S. Agency for Healthcare Research and Quality.
It's a very different picture from the stereotype of "rationing health care" on grounds of age, which assumes, wrongly, that's it's the "oldest old" who are driving health care expenditures.
Importantly, the Affordable Care Act makes a number of contributions toward better management of chronic disease and rational restraint of costs in the system.
For more detailed analysis of the trends here, visit: http://www.ama-assn.org/amednews/2012/03/05/gvsa0305.htm
WHAT HAPPENED TO ADVANCE DIRECTIVES?
A recent survey in California showed that more than three quarters of the adults do not have advance directives. Still worse, less than 40% of those surveyed had even heard of the term "advance directive," while three-quarters knew about hospice.
What about family communication, the cornerstone of end-of-life planning? The survey suggested that only 8% of patients had ever been asked about end-of-life treatment wishes by a doctor. But the picture was better for elders and their families. Patients 65 and older were the most likely to have discussed end-of-life wishes with a loved one: 71% reported having done so.
For more on the California survey, visit: http://www.ama-assn.org/amednews/2012/02/27/prsb0227.htm
For details, see "Final Chapter: Californians' Attitudes and Experiences with Death and Dying," available at: http://www.chcf.org/publications/2012/02/final-chapter-death-dying
"You can be healthy well beyond 60, but you’ll be different than you were when you were 20. You’ll have different posture, wrinkles and a lot of other changes that are less obvious but age appropriate. We have to be very, very careful about calling any difference from when we were younger an illness or a disease. And we have to be even more careful about telling people that we have things we can do to ‘fix’ these differences, but this happens all the time. That’s the medicalization of aging."
From an interview with Norton Hadler, M.D., author of RETHINKING AGING: Growing Old and Living Well in an Overtreated Society, at:
WAR ON ALZHEIMERS—FALSE HOPE?
The Obama Administration, with great fanfare, has declared a major assault on Alzheimer's Disease, with big expenditures planned for new research. I could not help but reminded of my conversation with Newt Gingrich when he spoke at an AARP Member Event and expressed highest confidence that we could beat Alzheimer's within a few years with an sustained research effort. When I questioned him privately afterward his confidence was undimmed.
The Obama Administration evidently agrees with that confidence, aiming at a cure for Alzheimer's by 2025. But
some experts say the 2025 deadline is unrealistic: "No one set a deadline for the 'War on cancer' or in the fight against HIV/AIDS. We make progress and we keep fighting. The same should be true for Alzheimer's," said Dr. Sam Gandy, an Alzheimer's researcher at Mount Sinai School of Medicine.
He added: "In my mind, that provides the unfortunate sense that we will have 'failed' if we don't have a cure by 2025."
It was President Richard Nixon who declared that a "war" on cancer in 1971 when he signed the National Cancer Act. The idea was to dedicate the same kinds of funds and resources to cancer as had been spent on splitting the atom. It's a familiar American idea: "Give us the tools and we'll do the job," goes the old saying.
Dr. Gandy was skeptical: "If we had, today, already in hand, the funding, recruitment and the perfect drug, the trial would still take 15 to 20 years," Gandy said.
On the topic of hope and dementia, see "Caregivers Press for Experimental Alzheimer’s Drug" at: http://www.npr.org/2012/02/14/146875971/cancer-drugs-offers-hope-for-alzheimers-treatment
DEATH BY MEDICINE
Halloween is a long ways off, but if you want a horror story don't miss "The Cost of Dying: It's Hard to Reject Care Even as Costs Soar" by Lisa Krieger at: http://www.mercurynews.com/cost-of-dying/ci_19898736
We often hear scare stories about so-called "rationing" of health care, but we don't hear enough about over-treatment and its costs, both human and financial. For more on Krieger's dismal tale read "The Trial of 'Death by Medicine': An Interview with Lisa Krieger" by ethicist Daniel Callahan at: http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5730&blogi#ixzz1mkg16YeU
Not scared yet? Here's another horror story:
"Augustus Monroe figured he'd drop dead long before he'd need a nursing home. A decade later, his son considers the weighty financial and emotional costs that come with a parent's immortality."
So begins a cautionary tale about what financial planners call "longevity risk." Read the full article, "The Long Goodbye," at: http://www.atlantamagazine.com/features/Story.aspx?ID=1629702
From "Stemming the tide of overtreatment in U.S. healthcare" at: http://www.reuters.com/article/2012/02/16/us-overtreatment-idUSTRE81F0UF20120216
A generation of clinicians has used the Mini Mental Status Examination (MMSE) as a handy tool for diagnosing signs of dementia. But recent legal restrictions on the MMSE have put the test out of reach for many professionals. This legal quandary present clinicians with difficult choices: increase practice costs and complexity, run the risk copyright infringement, or give up decades of practical experience while hoping to validate a new cognitive assessment tool. These dilemmas of patient care deserve wider discussion. For more insight on the questions, read "Copyright and Open Access at the Bedside" and visit: http://www.nejm.org/doi/full/10.1056/NEJMp1110652
WEB SITES TO SEE
ADVANCE DIRECTIVES. Can Advance Directives reduce end-of-life costs? For some answers, visit: http://www.geripal.org/2011/10/advance-directives-reduce-end-of life.html?utm_source=feedburner&utm_
THE NEW OLD AGE. Paula Span’s blog is always worth reading, at: http://newoldage.blogs.nytimes.com/author/paula-span/
INTEGRATIVE MEDICINE. For an approach to holistic healthcare and bioethics, look at: http://www.parkridgecenter.org/Page534.html
BOOKS OF INTEREST
BEING WITH DYING: Cultivating Compassion and Fearlessness in the Presence of Death, by Joan Halifax (Shambala, 2009).
THE TRIPLE HELIX: The Soul of Bioethics, by Lisa Bellantoni (Palgrave Macmillan, 2011).
AGING TOGETHER: Dementia, Friendship, and Flourishing Communities, by Susan McFadden and John T. McFadden (Johns Hopkins University Press, 2011).
HOPE & DEMENTIA: "Sources of Hope & Continuing Self-Identity" (Apr. 19, 2012, Burlington, Ontario). The 2012 McMaster Spring Workshop (1 - 4 PM) features Stephen Post, Director of the Center for Medical Humanities, Compassionate Care & Bioethics at Stony Brook University, who explores the role of hope and the importance of continuing self-identify of a person who is profoundly affected by cognitive loss such as Alzheimer‘s Disease. For information and registration visit: http://www.aging.mcmaster.ca/documents/2012%20Spring%20workshop.pdf
WORLD CONGRESS: 11th World Congress of Bioethics International Association of Bioethics (June 26-29, 2012,
Rotterdam, The Netherlands). For details, visit: http://bioethicsrotterdam.com/
ENHANCEMENT: "Human Enhancement: Moral, Religious and Ethical Aspects from a European Perspective" (Apr. 25-27, 2012, Brussels). For more information, visit: http://www.europarl.europa.eu/meetdocs/2009_2014/documents/stoa/dv/07db_worksh_
PALLIATIVE CARE: "An Emerging Policy Agenda for Palliative Care" (May 4, 2012, Valhalla, NY). Center for Long-term Care Research and Policy at New York Medical College. For additional information please contact Kenneth Knapp at Kenneth_knapp@nymc.edu
This electronic newsletter, edited by Harry (Rick) Moody, is published by HealthCare Chaplaincy and co-sponsored by the Office of Academic Affairs at AARP.
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