Navigating health complications of aging is challenging for adults, patients, and caregivers due to many factors related to interacting with healthcare systems and physicians. While caregivers and patients want the easiest path to receiving good care, healthcare systems and physicians are governed by policies and procedures that complicate providing care.
Studies confirm that about
50% of people 55 and older have 4 or 5 health conditions. Health prevention and navigating health conditions are essential for living your best life, whether you are in good health today or have several health conditions to manage.
Learn tips to navigate care when health conditions stack up and feel overwhelming. Due to the limitations of the healthcare system, caregivers and patients benefit from learning to coordinate care. In this article, learn the factors to be aware of with healthcare systems and providers to manage health conditions and avoid preventable care issues.
The Health and Retirement Study
If you enjoy research, a valuable source of information is the
Health and Retirement Study and the 4000 papers, articles, and studies created from data in this study. The Health and Retirement study surveys people in America, is managed by the University of Michigan, and is funded by the National Institute on Aging (NIA U01AG009740) and the Social Security Administration.
The study features information about common health conditions, health insurance, healthcare expenses, retirement plans, participant employment status and work history, family, housing, and other measures to support
navigating health complications of aging.
Let’s look at the most common health conditions you or a loved one can learn to navigate. Becoming aware of these conditions early in life can help you avoid a diagnosis that can be with you for a lifetime.
Many of these ongoing conditions can result in daily difficulties. It is important to learn about the conditions and their consequences because they can pose complications in daily life related to one’s ability to work, enjoy retirement, and feel good enough to enjoy life.
Module 8 of Pamela’s online program, Caring for Aging Parents, focuses on tips to manage relationships with healthcare providers.
Navigating Health Complications of Aging
Having this knowledge can help you prevent and manage your health conditions so they do not negatively impact your life’s dreams. The most common health conditions are:
- Heart disease
- Congestive heart failure
- Diabetes
- Arthritis
- COPD/Asthma
- Cancer
Add to these a diagnosis of dementia or Alzheimer’s disease, which in many cases occurs at the same time.
Dementia is general memory loss that can be related to any one of the health conditions I mentioned. Many times, dementia results from circulatory disorders, which include heart disease and diabetes that can result in a stroke. Dementia is also associated with neurological diseases like Parkinson’s, Huntington’s, multiple sclerosis, or ALS. Alzheimer’s disease is a subset of dementia.
Two other conditions common in older adults are falls and incontinence, which the healthcare system likes to call geriatric syndromes. If you or an aging parent has several chronic diseases, you are more likely to experience frequent falls and incontinence.
In this case, the best plan you can make to navigate health conditions is to have a primary care physician and specialists to help you manage conditions for which your primary care physician lacks experience and expertise.
Identifying the Benefits and Risks of Specialty Care
The overall risk caregivers and patients must know to be aware of and plan for navigating health complications of aging is to know that each doctor or specialist works in their specialty or pays attention to the one condition causing the most problems at a moment in time. This can be similar to taking your car to a mechanic who identifies one specific problem for repair, even though ten other minor repairs could be done.
For example, a cardiologist manages heart disease, an endocrinologist manages diabetes, a rheumatologist manages arthritis, a pulmonologist manages breathing issues like COPD or asthma, and an oncologist manages cancer.
The benefits of specialists can outweigh the risks if you are a patient or a caregiver committed to coordinating your care needs between multiple physicians. Specialists identify and treat conditions that primary care physicians may be aware of but lack the expertise to treat.
Compare this idea to completing your income taxes and then consulting a CPA who identifies missed deductions that save you a lot of money. General knowledge can be good enough until you begin navigating health complications of aging and need a specialist.
When navigating multiple conditions, specialists lack the expertise of other specialists. So, for example, a cardiologist may know nothing about dementia treated by a geriatrician or neurologist, arthritis treated by a rheumatologist, or a hip condition treated by an orthopedist. This is when specialists should consult with other specialists or refer a patient to another specialist for treatment recommendations.
The risk for patients and their caregivers is that any one condition can interact with or cause another condition. Similar to one medication interacting with a medication prescribed by a different physician. In this case speaking with your pharmacist about medication interactions can be very helpful.
The
side effects of medications can be significant for older adults. As a patient or a caregiver, you should know the diagnosis and the reason for being prescribed medications, along with their potential side effects.
Physicians treating conditions are limited by health insurance plans, technological gaps, and treatment and billing policies. Most doctors work within the constraints of a very complicated healthcare system – which is why caregivers and patients must be proactive in managing health conditions.
Understanding the Effects of Health Conditions
While one health condition may not seem significant, as other conditions are diagnosed, it is important to think about the short—and long-term risks of ongoing treatment to navigate the health complications of aging.
These statistics that might surprise you are from
AHRQ, the Agency for Healthcare Research and Quality. Persons with multiple health conditions result in:
- 64% of all doctor visits
- 70% of hospitalization stays
- 83% of prescription costs
- 71% of all healthcare spending
- 93% of Medicare costs
While many chronic conditions are not immediately linked to death rates,
the conditions are linked to physical disabilities and difficulties performing daily activities.So, the result for caregivers and loved ones with multiple conditions includes more frequent hospital admissions and potential institutionalization—which means living in a nursing home.
Gaps in care coordination between primary care physicians and specialists, if not managed by patients and caregivers, can result in:
- Harmful medication interactions
- Confusing recommendations from physicians
- Duplicate or overlapping lab tests
- More frequent hospitalizations
- Higher patient costs
Research confirms that smoking increases the risk of developing multiple conditions such as heart disease, diabetes, dementia, and depression.
So, as a caregiver, a person who needs care, and a healthy person, it is critical to know that doctors and healthcare systems face challenges in managing multiple conditions. The methods by which their performance is measured and by which they are paid do not yet support whole-person care, which CMS (Centers for Medicare and Medicaid) recognizes as a need.
Story-Telling: Primary and Specialty Care Gap
This story relates to a missed opportunity for care coordination of an older woman living in an assisted living community who fell and broke a hip.
If you have a loved one who has broken a hip, you may know that there are several treatment options: replacing an entire hip, placing a pin called hip pinning, or no treatment. Each of these has different rehabilitation options.
In this case, the orthopedic surgeon was unfamiliar with dementia and did not consult with a geriatrician or a specialist in dementia care before performing surgery.
Instead of treating the hip fracture with a full hip replacement, he placed a pin. This treatment option meant the female patient was ordered not to stand or walk for 6-8 weeks.
The result? The woman with the dementia diagnosis could not regain the strength to stand between parallel bars in the physical therapy gym or advance one foot in front of the other. She forgot how to walk and could not re-learn this skill, regardless of the efforts of physical therapists and her caregivers.
The surgeon, who believed he was performing the best treatment, placed his patient in a permanent wheelchair-bound status. Becoming immobile and physically weak meant she could not stand from her bed to transfer to a wheelchair.
She became bed-bound and required the use of a Hoyer lift to move in and out of bed to a wheelchair. Eventually, she acquired pressure ulcers—also called bedsores-from sitting in the same position and died because she could not heal from the skin breakdown that resulted in a serious infection.
This was an unnecessary situation that could have benefitted from consultation with a team of physicians who looked at the woman’s health conditions in their entirety rather than the narrow scope of a hip fracture. If you have loved ones in the hospital in a similar situation, be persistent in requesting an evaluation and treatment recommendations from the right specialists.
Fragmented Care Risks
This woman’s story is one example of disconnected healthcare treatment. Many physicians and specialists may lack the time or experience to consider treatment recommendations and interactions with their patients’ other diagnoses.
Health plans and their guidelines influence treatment plans. Plans often group people of a certain age into certain categories, which can limit treatment options. Limiting treatment options reduces health plan costs. For example, a total hip replacement is more expensive than treating a hip fracture with a
hip pinning.
Physician bias and health plan limitations exist across many factors. This means that if you are healthier than most of your peers, doctors looking at your information on paper may ignore your health status and not recommend a treatment that could help because your age categorizes you as old and feeble.
Electronic Health Records
Another gap in healthcare provision is electronic health systems. While some health systems and medical practices share patient records, many do not and refuse to do so. This is called
information blocking.
Information blocking makes it impossible for doctors to view the full picture of a patient’s healthcare needs and diagnoses electronically.
Collecting and sharing medical records and information becomes your responsibility if you want coordinated care between physicians. Being computer savvy and learning to access your online healthcare records is critical to receiving good care.
In addition to the gaps between primary care and specialty care physicians and hospital care, called acute care, a gap exists in post-acute (after hospitalization) care.
Health records at nursing homes, assisted living communities, home health, hospices, pharmacies, and medical equipment companies may not be shared. If providers do not relay critical information, this lack of electronic medical record sharing can unintentionally harm patients.
The Necessity of Patient and Caregiver Care Coordination
If you have ever struggled to get the care you need and have been frustrated about why one doctor or healthcare facility does not have medical information, the reason may be the information gap between federal and state healthcare policy, rules, and regulations.
Instead of feeling like another patient record number in a huge healthcare system, it’s important to learn how care systems work so that
you can take action to coordinate care.
Let’s look at another example of the steps to coordinate care after a hospitalization:
- Ensure you are aware of any medication changes and why the medications have been changed.
- Make a follow-up appointment with a loved one’s primary care physician as soon as possible after the hospitalization.
- If any type of home medical equipment or physical therapy was ordered, request copies of the orders so you have the names of the companies who should follow up. It’s easy for these orders to become lost or delayed because of incorrect medical coding or missing documentation.
As a patient and a caregiver, it is important to understand medical conditions, medications, and follow-up care to avoid a return to the hospital. This means being clear about what it will take, in terms of effort, time, and treatments, for a loved one to return to their previous level of abilities when they feel healthy.
Age and the number of health conditions can significantly impact recovery from illnesses or surgery. The time for a full recovery can be weeks or months. For this and the reasons mentioned in this article, learning to navigate the health complications of aging is the path to enjoying a good life and stable health and well-being.
Looking For Help Caring for Elderly Parents? Find the Information, Including Step-by-Step Processes, in Pamela’s Online Program.
©2024 Pamela D. Wilson All Rights Reserved