Showing posts with label seniors. Show all posts
Showing posts with label seniors. Show all posts

2 Questions May Reveal Seniors' Impending Decline, Study Says

Inability to climb steps seen as one red flagStudy finds missed diagnoses happen with many

By Robert Preidt

HealthDay Reporter

TUESDAY, Sept. 17 (HealthDay News) -- Mobility is a key indicator of healthy aging, and doctors should screen older patients for signs of physical decline, say the authors of a new review.

For the study, published Sept. 18 in the Journal of the American Medical Association, the researchers analyzed studies published between 1985 and 2012 that examined mobility and aging.

"The review confirmed that increased physical activity and exercise are extremely important for healthy aging," Dr. Cynthia Brown, of the division of gerontology, geriatrics and palliative care at the University of Alabama at Birmingham, said in a university news release.

Mobility problems are often an early sign of impending functional decline in seniors, which can affect their ability to live independently, Brown said.

She recommended that primary care doctors ask all senior patients two questions:

For health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile?Because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?

"Any modification of a task such as climbing 10 steps raises a red flag," Brown said. "Asking the right questions can tell a clinician a great deal about the level of mobility in their older patients."

If patients' answers suggest that they have mobility problems, doctors should take appropriate measures, such as referring patients to physical therapy or prescribing appropriate mobility assistance devices, Brown advised.

"Mobility is one of the cornerstones of healthy aging," she said. "With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently. The major barriers -- lack of physical activity, obesity and smoking -- are all risk factors that can be successfully overcome with appropriate treatment and assistance."


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FAQ: Seniors On Medicare Don’t Need To Apply To The Health Law Marketplaces

FAQ: New Exchanges Not for Seniors on MedicareFAQ: Seniors On Medicare Don’t Need To Apply To The Health Law MarketplacesWebMD News from Kaiser Health News

By Mary Agnes Carey

Nearly 50 million Americans are enrolled in Medicare, the federal health insurance program for the elderly and disabled. The 2010 health care law, known as the Affordable Care Act, will make some changes to the program. Here are some answers to frequently asked questions about Medicare and the health law.

Q: The health law creates something called a health insurance marketplace. What is that and can I apply for coverage on an exchange?

A: There is no need for you to enroll in the health law's exchanges. It's an online marketplace where individuals and small employers without group coverage will be able to shop for insurance coverage. Enrollment begins Oct. 1 for policies that will go into effect on Jan. 1.

Medicare is not part of the health insurance exchanges.   Seniors will still get health coverage through Medicare’s traditional fee-for-service program or Medicare Advantage plans, private health insurance plans that are approved by Medicare. Those who are enrolled in Medicare Part A, which covers hospital care, or the Advantage plans will meet the health law’s mandate for individuals to have insurance.

Q: Does the health care law offer any new benefits for Medicare beneficiaries?

A: Beneficiaries receive more preventative care services – including a yearly "wellness" visit, mammograms, colorectal screening, and more savings on  prescription drug coverage.  By 2020, the law will close the Medicare gap in prescription drug coverage, known as the "doughnut hole." Seniors will still be responsible for 25 percent of their prescription drug costs.

Q: Does the law cut spending on Medicare?

A: Medicare spending will continue to expand as increasing numbers of baby boomers reach 65. However, the law does cut the expected growth of Medicare spending by about $716 billion over the next decade.

Those cuts are made by lowering reimbursements to nursing homes, hospitals, home health agencies and other providers. It also cuts payments to Medicare Advantage plans to bring those payments closer to what Medicare pays for care for beneficiaries enrolled in the traditional fee-for-service plan. Medicare officials stress that the spending changes will not reduce Medicare benefits.

Some worry those cuts could lead to access problems, if providers drop out of the program. In the most recent Medicare Trustees report, Paul Spitalnic, then acting chief actuary for the Centers for Medicare and Medicaid Services, wrote that over the long term, some of the health law's changes would cause Medicare payment rates for home health, hospital and other services to drop below those now paid by the Medicaid program, "which have already led to access problems for Medicaid enrollees."

Q: Does the health law require higher-income Medicare beneficiaries to pay more for their Medicare prescription drug coverage?

A: It does. Currently, Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The health law brought that same sliding-scale approach to beneficiaries' prescription drug coverage in Medicare Part D for those with incomes of more than $85,000 ($170,000 for a couple). Those income thresholds will be frozen through 2019.

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See expert answers to questions about health reform.

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Two questions can reveal mobility problems in seniors

 
The hottest trend in mobility right now is not a smart phone or wireless gadget. The mobility that’s making health headlines is the kind that let us do what we need to do: walk and move. Mobility is essential for getting through the day, whether you need to walk across a room to the bathroom or kitchen, get out of bed or a chair, or walk through a grocery store.

Loss of mobility, which is common among older adults, has profound social, psychological, and physical consequences. “If you’re unable to get out then you can’t go shopping, you can’t go out with your friends to eat dinner or go to the movies, and you become dependent on other people to get you places. So you become a recluse, you stay home, you get depressed. With immobilization comes incontinence, because you can’t get to the bathroom, you can develop urinary infections, skin infections. The list goes on,” says geriatrician Dr. Suzanne Salamon, an instructor at Harvard Medical School.

The cascade of negative effects that comes with immobility can often be prevented or limited, according to a review in today’s JAMA. Researchers from the University of Alabama at Birmingham looked at dozens of mobility studies published over the years. They discovered common factors that lead to loss of mobility, such as older age, low physical activity, obesity, impaired strength and balance, and chronic diseases such as diabetes and arthritis. Less common red flags included symptoms of depression, problems with memory or thinking skills, being female, a recent hospitalization, drinking alcohol or smoking, and having feelings of helplessness. Individuals with one or more of these factors is at risk for immobility.

Given so many things that can lead to immobility, you’d think primary care physicians would be able to spot older adults at risk of losing mobility. But it’s not so simple, says Dr. Salamon. “There are so many other things that doctors have to pay attention to—heart problems and lung problems—that screening for mobility gets pushed to the background. However, it’s one of the most important, because it makes the difference between living at home or living in a facility,” she explains. She also points out that loss of mobility puts you at greater risk for falling, which often results in a hip fracture. “That’s the worst, because within a year 20% of people with hip fractures die from complications. So we try to avoid that at all costs,” says Dr. Salamon.

Checking a person’s mobility is fairly simple. Dr. Salamon likes the Get Up and Go Test, where she asks a person to stand up from sitting in a chair, walk 10 feet, turn around, walk back to the chair, and sit down. “You look at how long that takes and how steady the person is,” she says. Another way is just to watch how quickly people walk. They should walk faster than a yard per second. If you walk that or faster, you’re normal; if you’re slower, you have a gait problem, which increases your chances of falling,” she says.

The University of Alabama researchers suggest asking these two questions:
For health or physical reasons, do you have difficulty climbing up 10 steps or walking one-quarter of a mile?Because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?
The beauty of “test” is that you don’t have to go to a doctor to get an answer. You probably know already if you’re having trouble climbing stairs. And walking one-quarter of a mile? That’s one lap around a medium-sized mall’s upper level. Can you walk around it without difficulty?

If stairs and walking are difficult, it’s an indication that you’re on the road to less travel, and you’ll need to see your doctor. The good news is that your physician can help you address what’s causing the difficulty before it progresses to a loss of mobility. A variety of solutions are available. They can include physical therapy to improve balance and strength training. Occupational therapy can help improve a person’s ability to perform daily living activities and the living environment with tools such as elevated bathroom fixtures and grab bars. Social support can help eliminate mobility barriers such as lack of transportation. Referrals to subspecialists may be needed to treat medical conditions that can lead to immobility. Finally, the use of devices such as canes, walkers, wheelchairs, and scooters can open the door to greater mobility.

There are a few tools you can check out online, including the Get Up and Go test as well as the Performance-Oriented Mobility Assessment. Take the test with a friend or loved one who can help you if needed; don’t try it at home if you’re unsteady on your feet.

Loss of mobility is a real problem, but one that is often preventable or treatable. Take steps now to make sure you can take the steps you need in the years ahead.