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MEDICAL CARE, MEDICARE, AND MEDICATIONS

Chapter 14

Outline

Chronic and acute health conditions

Chronic health conditions

Hypertension

Arthritis

Heart disease

Cancer

Type 2 diabetes

Other chronic health conditions

Medicare: Parts A, B, C, and D

Medications and managing prescription drugs

Chronic and Acute Medical Conditions

Over time, there has been a major shift in leading causes of death for all age groups from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses

Acute conditions: usually limited duration, often require a hospital stay

Chronic conditions: long-term/permanent, often require personal or rehabilitative care

Leading Chronic Conditions in Older Adults

Older Americans 2012: Key Indicators of Well-Being

Hypertension/High Blood Pressure

Can damage blood vessels, brain, eyes, kidneys

Leading cause of stroke

Usually no symptoms, so blood pressure checks are important

Can be controlled with lifestyle changes, medication, or both

Arthritis

A disease that can attack joints in any part of thev body, causing pain and stiffness

3 types: osteoarthritis, rheumatoid arthritis, gout

Goals of treatment: minimize joint damage, manage pain, maintain function to preserve a good quality of life

Keys to living with arthritis: sufficient rest; range-of-motion, strengthening, and aerobic exercise; healthy, well-balanced diet; protecting and easing pain around joints; using assistive devices; medications

Heart Disease

Most common type is coronary artery disease (CAD), which can cause heart attacks, angina, arrhythmias, heart failure

Risk factors: high cholesterol, hypertension, diabetes, cigarette smoking, being overweight, poor diet, physical inactivity, alcohol use

Modifying these behaviors is critical for both preventing and controlling heart disease

Cancer

Cancer, in which abnormal cells continually divide and invade other tissues, is not just one disease

Some causes are known (cigarette smoking, environmental toxins, radiation, excessive alcohol intake), others are not

The most common types in older adults are breast, cervical, colorectal, and prostate

The number of new cancer cases, and many cancer deaths, could be prevented with early screening

Advances in early detection and treatment have resulted in people living many years after diagnosis

Type 2 Diabetes

Results from difficulties in insulin production or action, or both

Can lead to serious complications, such as blindness, kidney damage, cardiovascular disease, lower limb amputations, and premature death

Controlling blood glucose, blood pressure, and blood lipids can lower the occurrence of complications

Losing weight, eating healthy foods, and increasing physical activity can delay or prevent the onset of diabetes

Other Chronic Health Conditions

Osteoporosis: disease resulting in low bone mass; increased risk for fractures, falls; adaptations: calcium and vitamin D supplements, home modifications, exercises to improve balance

Eye diseases: macular degeneration, glaucoma, retinopathy; treatments can minimize vision loss or slow progression

Sleep disorders: insomnia, circadian rhythm disorders, sleep apnea, leg movements; treatments vary depending on causes

Medicare

Health insurance program for people age 65+, enacted in 1965

Certain people younger than age 65 can qualify, including those who have disabilities

Helps with costs of health care; does not cover all medical expenses nor most long-term care

4 parts:

Part A: Hospital insurance

Part B: Medical insurance

Part C: Medicare Advantage

Part D: Prescription drug coverage

Medicare Part A: Hospital Insurance

Inpatient hospital care

Inpatient stays in skilled nursing facilities

Home health services

Hospice care services

No monthly premium

Covered by payroll taxes of 1.45% of wages, paid by employee, matched by employer

Medicare Part B: Medical Insurance

Medical services: physicians, ambulance

Outpatient care

Clinical laboratory services: X-rays, urine and blood tests, etc.

Some mental health and preventive services

Monthly premium: $104.90 for annual incomes of $85,000 or less (those with higher incomes pay more, e.g., $146.90 for incomes of $85,000 to $107,000)

Annual deductible: $147 in 2013

Co-pays for some services (usually 20%)

Medicare Part C: Medicare Advantage

Private companies contract with Medicare to deliver Part A and Part B benefits, and other coverage if they so choose

Most are HMOs or PPOs

Premiums are determined by the chosen plan

Medicare Part D: Prescription Drug Coverage

Part D, voluntary prescription drug benefit, added to Medicare in Medicare Modernization Act in December 2003

Helps cover cost of prescription drugs

Seniors enroll when they first become eligible, usually age 65

All plans must meet certain minimum requirements

Open enrollment period: October 15 to December 7

Medications and Managing Prescription Drugs

28% of seniors take 5 or more prescription drugs per week

Taking multiple medications (polypharmacy) can increase the risk of harmful drug reactions

Aging affects the way medication is absorbed and used by the body

It is estimated that 30% of hospital admissions of older adults may be due to adverse drug reactions

Programs for medication management are widely available