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Many Older Adults Are Burdened by Demands of Healthcare System

Nearly four in ten older adults say that managing their healthcare needs is difficult for them or their families, that medical appointments or tests get delayed or don’t get done, or that all of the requirements of their healthcare are too much to handle. This is according to Johns Hopkins Bloomberg School of Public Health research published in the October issue of the Journal of General Internal Medicine.

“Medical providers must be aware that when they ask older adults to take a new medication or suggest they see another doctor that this is happening in a broader context of treatment,” said study author Jennifer L. Wolff, PhD, an associate professor in the Department of Health Policy and Management at the Bloomberg School. “High-quality care is not only about a single disease or visit, but rather the overall treatment plan across multiple providers. If we look at each visit in a vacuum, the health of these older adults could really suffer.”

While Wolff and her Hopkins co-author Cynthia M. Boyd, MD, MPH, found a high level of what they call “treatment burden,” they also found that the vast majority of older adults surveyed prefer to play an active role in making decisions about their healthcare either in conjunction with their doctors (85 percent) or their family or close friends (96 percent). The strong degree of interest in participating in decisions was a surprising finding given that previous surveys using smaller samples or comparisons by age group have shown that those over 65 prefer to take a more passive role in healthcare decision making. Two-thirds of older adults said they were managing their own healthcare independently. Those who delegate the management of healthcare activities to others tend to be older and sicker than those who manage their own care, the researchers found.

For the research, Wolff and Boyd examined the results of the 2012 National Health and Aging Trends Study, a nationally representative survey of 2,040 Medicare patients age 65 or older. Participants were asked a series of questions to understand the roles they play-and wish to play-in their own healthcare.

Older adults are among the heaviest users of health services, and their care is often not well coordinated among their various physicians. This can be problematic for a variety of reasons including the high prevalence of cognitive and physical decline that can impair the ability of older patients to make sense of the many demands their doctors may place upon them. Doctors are not typically trained or have not traditionally been reimbursed by Medicare for taking extra time to work with patients and families to ensure that they are getting what they need out of their healthcare experience.

The system also isn’t always welcoming of friends’ or family’s involvement in medical decision making, Wolff said, mainly because of concerns over privacy and practical considerations.

“What we have found is there isn’t a one-size-fits-all approach to caring for adults,” she said. “The healthcare system is complex and it is important to understand and incorporate individual patient preferences and perspectives about care. We need to ask these patients not only about their urgent health needs but their overall goals and experiences with care.”

This article was adapted from information provided by the Johns Hopkins Bloomberg School of Public Health.

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