Category Archives: Health

Another Straw in the Wind

Here’s another straw in the wind suggesting that the times are becoming unfriendly to seniors.

House Republicans have unveiled preliminary outlines of their health care reform agenda, with the intention of moving forward with major changes in coming weeks. Changes to Medicaid are a high priority, and Republicans are considering either (1) giving states a fixed amount for each person enrolled in Medicaid or (2) giving states block grants to carry out the Medicaid program as each state sees fit.

Either choice could be a serious problem for the 4.6 million seniors with limited incomes who have dual eligibility for both Medicare and Medicaid. Medicare pays for their hospitalizations and physician services, but Medicaid is vital to these seniors for coverage of nursing facility care, prescription drugs, eyeglasses, and hearing aids.

The cost of skilled care in a nursing home or assisted living facility is a great worry for seniors and their families. Many simply do not have the resources to pay for either. Others have some resources, but not enough to pay for long term care. Typically, a senior in this situation who falls ill may be sent to a rehab facility after a hospital stay for the 100 days that Medicare allows, and then have to stay on or move to another facility at their own expense. With the average cost of a nursing home at $6,235 per month, and assisted living at $3,500, it doesn’t take long for even middle class seniors to deplete whatever savings they may have.

But the saving grace today is that once their resources are depleted, seniors can enroll in Medicaid. They are allowed to keep their house, if they have one, and they don’t have to bankrupt their children to pay for their care. Medicaid will take care of them.

If Congress limits the Medicaid amount available per person, or limits the states to block grants, Medicaid may no longer be able to meet its promise to care for seniors. According to the New York Times, “About 60 percent of the costs of traditional Medicaid come from providing nursing home care and other types of care for the elderly and those with disabilities.” With the percentage that high, seniors are almost certain to be hit by any reduction in Medicaid resources.

Seniors are worried about what the Republican Congress might eventually do to Medicare, and rightly so. But for the moment, Congress and the President don’t seem ready to take on that popular program. They may never be ready. Nonetheless, seniors should be alert to the dangers the Medicaid program faces. They could be hurt by these changes, and their children could be hurt as well.

 

 

PPIs and Dementia: A Link?

I’ve been bothered by this article in Scientific American, which argues that regular use of proton pump inhibitors (PPIs), is associated with a number of health problems, including dementia, heart disease, and kidney disease. PPIs are used to combat gastroesophageal reflux disease (GERD), and are very widely prescribed among seniors. I take generic omeprazole myself, but PPIs also include Nexium, Prevacid, and Prilosec.

I’m not sure I could get through the night without my omeprazole, but I sure would like to avoid dementia. Particularly bothersome is the inability of scientists so far to identify any causal pathway that might explain why people taking PPIs tend to have higher rates of dementia. Perhaps it’s that lower levels of stomach acid due to PPI use inhibit the absorption of vitamin B12, needed for brain health. I’m already taking a B12 supplement, so maybe I’m OK. Or maybe not.

Another theory is that seniors tend to take many drugs — a phenomenon known as
“polypharmacy” — and that this in itself has been shown to be associated with memory loss. So the problem might not be PPIs in particular.  Some suggest that people practicing polypharmacy are likely to be people who see physicians regularly, increasing their chances of being diagnosed with something or other, including dementia. Maybe that’s the problem.

Anyway, I’m planning do discuss the PPI issue with my own physician, next time I’m in.

 

The Importance of Primary Care

This New Yorker article by Atul Gowande emphasizes how important it is — and how life-extending — to have a strong and lasting relationship with your primary care physician. Incremental care at the primary level can do more to promote health and well-being than heroic surgeries and other interventions by specialists after a problem has been neglected.

Unfortunately, the incentives in our health care system work against primary care. Surgeons and specialists earn twice as much as primary care physicians, discouraging medical students from pursuing primary care or elder care careers. Meanwhile,  deductibles and co-pays can discourage people from making regular doctor visits. Looming changes to the Affordable Care Act and Medicare may make the situation worse.

As usual with Gowande, the article is extremely well written, and chock full of interesting medical anecdotes.

On Electroshock Therapy and Being Really Old

The January 1 New York Times had a couple of articles of interest to seniors.

One was about electroshock therapy to relieve depression. According to the article, electroshock  today is nothing like what you remember from One Flew Over the Cuckoo’s Nest, and in fact can be very helpful for the depressed. Kitty and Michael Dukakis (aged 80 and 83) are advocates because of all the treatment has done for her. The late Carrie Fisher reported positive experiences with the treatment, as has Dick Cavett.

The Times also published the latest in its series on how several of the “oldest old” in New York City are faring. Every day is a blessing, we often hear, and certainly these nonagenarians are still leading lives full of meaning and joy. But great age, the series underscores, brings great challenges.

Some Good News for Home Caregivers

We have several friends who at some point in their lives have become at-home caregivers for a parent, spouse, or other loved one. NPR has just broadcast a story on the dilemmas such caregivers face. One item of good news — thirty-three states now have legislation requiring hospitals to give caregivers training and instructions before a loved one is sent home from the hospital.

Hospitals have an incentive to do this anyway because of the Hospital Readmission Reduction Program created by the Affordable Care Act. They can be dinged by Medicare if too many patients have to be re-admitted after being sent home. Whether this program survives the Republican drive to repeal the Affordable Care Act remains to be seen.

Another bit of good news is that under Medicare, physicians can prescribe skilled nursing care at home. The visiting nurses provide care and treatment, as well as additional training for the home caregiver. This brochure lays out the terms and conditions Medicare’s home health care program. (Like Obamacare, Medicare may soon be on the chopping block.)

The NPR story made me recall some of the thinking that went into our decision to downsize and move to a more urban area. In our new home in Reston, Virginia, we’ll have access to several agencies providing home health care, should that become necessary one day. By downsizing to a single home, rather than the Finger Lakes house and the Reston condo we used to have, we’ll also be in a better position to afford an assisted living facility should we we come to the point at which home health care is no longer possible. There are several such facilities in and around Reston, and more are on the way.

Useful Links

The Washington Post does a good job of reporting on issues of interest to seniors. One recent article reported that rates of dementia seem to be declining and speculated on the reasons. It’s nice to have some good news!

This article on atrial fibrillation is also interesting. Since I had my episode on July 4, I’ve learned in talking with others that this problem is quite common — and difficult to learn to live with. My only problem with the article is that it makes no mention of helpful medications. Beta blockers and calcium channel blockers can restore and maintain a normal heart rhythm for many sufferers. They are working for me, so far.

 

Immunotherapy Series in the New York Times

The New York Times has been running a highly informative series on the progress of immunotherapy in treating cancer.

I don’t know about you, but I’m always tempted to ignore articles about cancer. If I ignore it, perhaps it will ignore me.

But this is not a common sense approach. I’ve known too many seniors, close friends and relatives, who have waged epic struggles against the disease. I could well be affected too, as might loved ones. Common sense suggests that I should be as well informed as possible.

Anyway, the news about cancer is a lot better today, and a lot easier to read about, than it was just a short time ago thanks to the gains in immunotherapy. That’s why the recent New York Times series on the subject is so helpful.

The times laid out the fundamentals on Sunday with What is Immunotherapy? The Basics on These Cancer Treatments.  On Monday, the paper followed up with detailed personal stories, focusing on checkpoint inhibitors — drugs that empower the body’s immune system. On Tuesday, the Times turned to cell therapy, the other major line of approach to immunotherapy.

Immunotherapy doesn’t always achieve remission, and remissions may not last forever, but remarkable progress has been made. That’s worth reading about.