"Clinical Preventive Services for Older Adults" By Allen Weiss, MD, MBA, President and CEO

Clinical Preventive Services for Older Adults
July 15th, 2011 -  Supporting the health needs of older Americans has been a major goal of our country since the passage of the landmark Medicare Act in 1965. The recent addition of the Patient Protection and Affordable Care Act which has been law for about a year now, recognizes the critical role of preventive services to improve the unique social, economic, quality of life and health needs for those over 65 years old, representing more than a third of patients discharged from the NCH Healthcare System.

We can and should do better—both as a nation and locally—by preventing illnesses and keeping our fellow citizens from becoming patients. The U. S. Preventive Services Task Force has recommended eight specific health related activities that have been shown by evidenced-based medicine to make a significant difference, when followed, in the health of an individual and a community. In fact, Medicare is so supportive that the current rules for these preventive services have eliminated out-of-pocket costs. The new law entitles Medicare beneficiaries to a free annual wellness visit that includes these recommended preventive services.

The services are sectioned into three categories—vaccinations, screenings, and counseling.
  • Influenza vaccination is recommended each fall for everyone age six months and older. About 85% of deaths and 63% of hospitalizations are attributed to influenza in those 65 and older. Vaccination significantly reduces hospitalization and death due to flu, yet over 30% of Americans do not get flu shots!

  • Pneumococcal vaccination is recommended every five years for those over 65. This improves survival and decreases pneumonia complications and length of stay when hospitalized, but again, more than a third of Americans have never received this vaccination.

  • Breast cancer screening is vital for women age 50 to 74. Almost half of all new cases and nearly two-thirds of deaths from breast cancer occur in women 65 years of age and older. Close to 17% of women in this age group have not received a mammogram within the past two years. Women over 75 are less at risk for breast disease.

  • Colorectal cancer screening for the over 65 population. Two thirds of new cases of colorectal cancer are diagnosed in people aged 65 and older, and sadly, 36% of adults reported never having been screened. Early detection makes this disease so treatable!

  • Diabetes screening. This condition is our newest epidemic as we have become the fattest nation in the history of civilization. With the discovery of insulin in 1929, the genetic basis for diabetes is now imbedded in our gene pool; diabetics who previously would not have survived to reproduce now live to old age when cared for appropriately. About a third of the population is at risk yet 31% have never been screened.

  • Lipid disorder screening, namely checking for cholesterol and triglycerides, is a major area for potential improvement. Elevated fats in the blood cause heart disease and stroke—the two major causes of premature death and serious disability. Ninety-five percent of adults claim to have been screened during the past five years. We need to do better with our diets and exercise; knowing you have a problem is only the beginning of a solution—doing something about it is mandatory!

  • Osteoporosis screening is so important. This condition is known as the silent thief for stealing calcium from bones resulting in up to 50% of women and 30% of men having a fracture during their lives. A hip fracture in a frail elderly patient is associated with a 50% chance of dying within the next year. Statistics on the number of people screened range from a third to over a half of all people over 65 years old and is dependent on many factors, such as insurance coverage and social, racial, ethnic, and economic factors.

  • Smoking cessation counseling is also under-performed during yearly exams; up to 30% of smokers report never having been offered help to stop smoking. An estimated $73 billion is spent each year on treatment for smoking related medical conditions, according to a public health report in 1998. That number is, undoubtedly, much higher now. It has been said that if the 20% of Americans who smoke now were to quit, we could reduce medical spending by 20%. This savings alone would balance the budget.
According to a consolidated report by the Centers for Disease Control, The Administration on Aging, The Centers for Medicare and Medicaid, and the Agency for Healthcare Research and Quality, if these services were widely followed, a community like southwest Florida could have over 3,000 people live significantly longer and better lives, without any increase in healthcare costs. While over 90% of Medicare beneficiaries visit a physician at least once a year, most do not receive all of the above recommendations.
While eliminating out-of- pocket costs is a good start, people need to be more self-motivated in order to improve their own health. The major gaps in prevention that exist today can and should be closed so we can continue to thrive as a nation in a globally competitive world. We must all be part of the solution.

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.