Seniors

The above headline is from an interesting article in a Canadian publication the “Financial Post” and was written by Diane Francis, a journalist who took an outside look at the US healthcare system and compared it to the Canadian system. Ms. Francis’s views add some interesting insights into the healthcare system in the US and the discussion, or lack thereof, related to this issue.

In the article, Ms. Francis starts off by comparing the two systems and concludes, “Canadians are lucky on this one. We may have line-ups and our newspapers may occasionally publish horror stories about someone left in a gurney for hours outside an emergency room. But the U.S. system is the worst-executed in the world and its private sector interests have convinced the government to insure the riskiest people namely veterans, indigents and seniors while leaving the gravy to private-sector insurers.”

The article notes that the US government provides insurance for almost half of the Americans who are insured. But that half are the highest risk portion of the population that will incur the most expenses. The article also suggests that there are two types of medical systems in the US. One system is for the well-off with insurance where medical costs are passed off to those paying for the insurance. The article suggests that the second medical system “takes care of the old, disabled, impoverished or militarily wounded.”

In her article Diane Francis also comments on the human side of the US healthcare and notes, “It’s hard to imagine the human suffering that has resulted from this situation. Canadians don’t have the anxiety about healthcare that underlies American existence. People there don’t leave jobs, don’t start new ones or businesses because they fear losing insurance benefits.”

The article lists a series of facts about the US health care system that helped Ms Francis come to her conclusions. These facts are:

The United States is spending 15.3% of its Gross National Product (GNP) on medicine and that doesn’t include the cost of litigation over medical bills.

There are 49 million people without any insurance. The same number are inadequately insured.

Despite that shortfall, the U.S. spends about $5,700 per capita compared with Canada’s $2,900 and has worse results in areas such as lifespan or infant mortality.

Some estimate is that half of the personal bankruptcies in the U.S. are because of high medical bills due to a catastrophic illness.

In a previous article by Ms. Francis earlier in the year, she notes one of the glaring facts about the US healthcare system and states, “Health spending is rising faster than incomes in most developed countries, which raises questions about how these countries will pay for future health care needs. The issue may be particularly acute in the United States, which not only spends much more per capita on health care than any other country, but which also has had one of the fastest growth rates in health spending among developed countries.”

According to a new nationwide US government survey, 38 percent of adults in the United States use some form of what the study called, Complementary and Alternative Medicine (CAM). The survey conducted by the National Center for Complementary and Alternative Medicine of the National Institutes of Health (NIH) was released on December 10, 2008. In older adults ages 60 to 69 the percentage is slightly higher with 41% using some form of CAM procedure.

Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine (NCCAM), part of the NIH, defines CAM by saying, “CAM covers a wide range of therapies and practices not currently considered part of conventional medicine. Thus, its important to be well informed if you are considering using any.”

Of those non-medical procedures considered “CAM”, one of the most used and most accepted is chiropractic. Although not entirely accurate by chiropractic standards, the National Institutes of Health senior website explains chiropractic by saying, “The goal of chiropractic medicine is to help the body heal by correcting its alignment. Doctors of chiropractic, who are also called chiropractors or chiropractic physicians, use a type of hands-on therapy called manipulation, or adjustment, as their main type of procedure. Adjustments are done to increase the range and quality of motion in the area being treated.”

Dr. Robert Braile, a chiropractor in Georgia and past President and Chairman of the Board of the International Chiropractors Association notes that chiropractic usage continues to be on the increase. He states, “We are in an economy where times are tough, and nearly 50 million Americans are without health care insurance. Certainly many of these people are going to look for more affordable ways to deal with their health care concerns. Chiropractic has always represented an affordable and safe alternative to more expensive and risky forms of medical care.”

NCCAM Director Dr. Josephine Briggs noted the reasons why more Americans are turning to non medical forms of healthcare by saying, “The most common reason why people turn to complementary and alternative medicine in our survey results is chronic back pain – far and away, the leading reason to use complementary and alternative medicine,” she says. “Neck pain, joint pain, headache: All these other conditions are also given as common reasons. But chronic back pain is the leading reason, a very common and difficult condition to treat.”

In a December 12, 2009 release by the National Institutes of Health (NIH), they also noted that an increasing number of older Americans are turning to the Internet for health information. They noted that 68 percent of online seniors look for health and medical information when they go on the Web.

According to a February 11, 2004 Associated Press story, health care spending in the United States grew to an estimated $1.7 trillion in 2003. This represents more than $5,800 for every American. The federal Centers for Medicare and Medicaid Services stated that this expenditure represents more than 15% of the gross domestic product of the United States.

The rate of increase of health care spending was 7.8% over the previous year. This figure continues to place healthcare spending increases far ahead of the rest of the US economy. The article continued to note that health care spending, is projected to outpace growth in the rest of the economy for the next 10 years.

The Centers for Medicare and Medicaid Services also estimated that by 2013, annual spending on health is expected to reach $3.4 trillion and be more than 18 percent of gross domestic product. These projections did not include the anticipated increases from the new Medicare prescription drug law, which will offer seniors prescription drug coverage beginning in 2006. However, Centers for Medicare and Medicaid Services officials said they expect a shift in who pays prescription drug bills rather than a significant increase in spending on drugs. It was noted that the increase in spending on prescription drugs will continue to outpace the rest of health care for the next 10 years.

The report published in the January / February 2004 Issue of the Health Affairs, the number one cited health policy journal devoted to publishing original peer-reviewed research and commentary, reported that private health insurance premiums per enrollee grew 10.4 percent in 2003, the third consecutive year of double-digit premium growth.

News of a pilot program to expand chiropractic coverage in Medicare was reported in the April 7, 2005 issue of the Senior Journal. According to the report the Centers for Medicare and Medicaid have announced the start of a two-year demonstration to expand Medicare coverage of chiropractic services in five states. The purpose of this pilot program is to determine the impact on satisfaction, use of services, and costs for Medicare beneficiaries.

The states involved in the pilot program involve areas in Maine, New Mexico, Illinois, Iowa, and Virginia. In the areas of this pilot program, chiropractors are able to offer Medicare Part B patients an expanded array of services that they are allowed to provide by state law to their entire list of patients, but that were not previously paid for by Medicare.

Normally, only chiropractic adjustments are a covered service under Medicare. In the pilot program the services that will also be covered will include diagnostic and therapy services, including extraspinal manipulation or adjustment of a body part other than the spine, x-rays, EMG and nerve conduction studies, clinical lab tests, and certain additional procedures.

The program is designed to last for two years and evaluate the possibility of expanding chiropractic coverage in Medicare across the entire program. Centers for Medicare Services Administrator Mark B. McClellan, M.D., Ph.D noted, “Medicare currently only pays for a limited number of services from doctors of chiropractic, even though chiropractic services may be less costly alternatives to other types of medical care.” He continued, “By expanding chiropractic coverage in this demonstration, we are reducing out-of-pocket costs for seniors who visit chiropractors, and we will learn whether paying chiropractors for delivering these additional services can help improve health outcomes and keep Medicare costs down.”

A story by John Dorschner of Knight Ridder News Service and published in the January 30, 2005 issue of the Miami Herald reported on the huge increase of insurance companies covering, what they termed, “Alternative Medicine”. The story reports that this activity is now a $30 billion industry.

Some insurance programs, such as Vista Healthplan, based in Hollywood, Fla., has even announced a discount program for its members of up to 30 percent to encourage usage of some 30 alternative programs. Steve Russell, a Vista vice president commented on a new program where seniors enrolled in Vista can get a $25 voucher to try alternative care. He noted, “Most of them don’t know about these things. Basically, we’re encouraging them to step over the line.” He continued, “To increase their mobility, their flexibility, to get out and try new things.”

Santiago Leon, a Miami health insurance broker who has studied the field extensively stated, “Complementary medicine is going mainstream quickly. Part of the impulse is therapeutic. Part of it is economic.”

John Dorschner, author of the article noted that chiropractic care may not even be considered alternative anymore. He stated “Chiropractic, once considered alternative, is now considered mainstream, or nearly so. A chiropractor’s adjustment of a back, or a few minutes of massage therapy, when effective, costs a fraction of what back surgery does. Eighty-seven percent of firms offering health insurance now have benefits for chiropractic, according to the Kaiser Family Foundation.”

The above headline comes from the February 17, 2004 Associated Press, and offers seniors hope for a vital life. Researchers at the University of Illinois reported that improving fitness can boost the thinking ability of aging adults. The study published in the online edition of Proceedings of the National Academy of Sciences, showed that adults ages 58 to 78 who began a fitness program, even as simple as brisk walking, saw improvements in how their brains functioned.

In the study 41 adults began an exercise program that gradually increased over three months to a 45-minute walk three times a week. Their brain activity was measured by magnetic resonance imaging. After three months the adults in the exercise program showed increased brain activity and had an 11 percent improvement on tests that measured their decision-making while performing a variety of tasks.

A control group of similar age and health that only did stretching and toning exercises, but not the cardiovascular walking program, had lower brain activity than the other group and only showed a 2 percent improvement in performance. Arthur F. Kramer of the Beckman Institute for Advanced Science and Technology at Illinois explained, “The kinds of tasks that we explored are similar to those encountered in real world situations such as driving a vehicle or any endeavor that requires a person to pay attention despite distractions,”

A research study published in the July 12, 2006 issue of the Journal of the American Medical Association (JAMA), shows that daily activity can have a positive impact on life expectancy in older adults. It was previously known that exercise had a positive effect on life expectancy. This study also shows that those who are active in their daily routine, even non-exercise activities, are also getting positive benefits.

This study, conducted by Todd M. Manini, Ph.D., and his colleagues of the National Institute on Aging, in Bethesda, Md., was designed to determine the association of what the researchers called “free-living activity energy expenditure” and death rates. The study looked at a group of 302 high-functioning, community-dwelling seniors ranging in age from 70 to 82.

In this study the researchers measured energy expenditure over a two week period using sophisticated processes of tracking certain isotopes of hydrogen and oxygen as eliminated from the body as carbon dioxide. This process then determined the amount of energy expenditure and therefore the activity of the individual. The 302 participants were followed on average for just over 6 years. Over this period of time 55 participants (18.2 percent) died. The researchers then compared the activity levels of all participants to see if there was a correlation between death rates and activity levels.

The results showed that after adjusting for other factors, higher levels of activity energy expenditure and physical activity were indeed associated with a lower risk of death. When the researchers categorized activity levels of the participants into three groups they found that risk of death was only 12.1 percent in the group with the highest level of activity energy expenditure. The group in the middle third, relative to activity level, had a 17.6 percent risk of death. However, the group in the bottom third level of activity had a 24.7 percent risk of death. Statistically, this meant that those with the highest level of activity had a 69 percent better chance of survival than those with the lowest activity.

The authors of this study commented, “Our study suggests that any activity energy expenditure in older adults can help lower mortality risks.” They continued, “Efforts to increase or maintain free-living activity energy expenditure will likely improve the health of older adults.” In the study they concluded, “Objectively measured free-living activity energy expenditure was strongly associated with lower risk of mortality in healthy older adults. Simply expending energy through any activity may influence survival in older adults.”

From the University of Buffalo comes an article that raises questions and concerns about the amount of medications taken by senior citizens. Dr. Wayne K. Anderson, Dean of the School of Pharmacy and Pharmaceutical Sciences states, “Different physicians use different drugs to treat different conditions, and some of these drugs interact, in some cases exacerbating the side effects of other drugs that are being taken for other conditions.”

Anderson estimates that senior citizens in the United States age 65 and older take an average of six to eight prescription drugs daily. His response is, “That is probably too many. Proper pharmaceutical therapy management probably could cut in half the number of drugs most senior citizens now are taking so the amount of money they are spending is reduced and the quality of their lives is much improved.”

Anderson also notes that a person taking eight drugs can expect at least one drug interaction that will have a negative effect on his health. Additionally he noted that the American Association of Consultant Pharmacists suggest that 25 percent of admissions to nursing homes result from failed drug regimens, noncompliance by patients, drug interactions, inappropriate medications being prescribed for certain conditions and the lack of good therapeutic monitoring.

Dr. Andersons answer to this problem is “proper pharmaceutical therapy management.” From a chiropractic perspective the answer seems obvious. Healthier seniors will just naturally need less medications. Chiropractic has always focused on removing interference to the functions of the nervous system and therefore allowing people to function better. Millions of senior citizens already know this approach makes sense and works for them.

Several articles appeared in a number of publications over the past month questioning the effectiveness of the flu vaccine for the elderly. One such article in the October 25, 2008 Daily Press from Richmond, Virginia noted that the flu vaccine may not give the benefits that were previously advertised.

The article reports that Lone Simonsen, a researcher from George Washington University believes the skepticism concerning the vaccinations is long overdue. She commented, “If I could have it my way, we would start by going back and looking at the basic premise for flu vaccination of seniors.” In the article Simonsen, a former epidemiologist for the National Institute of Allergy and Infectious Diseases, noted that the flu vaccination rate among U.S. seniors has risen over the past 25 years up to 65 percent in 2007. However, over that same period of time, hospitalizations and deaths caused by flu or pneumonia have declined only marginally in the 65-and-over population.

The article references a study published in the August 2, 2008 scientific Journal, Lancet. In that study researchers looked at the cases of 3,519 patients older than 65 who had been admitted to the hospital with pneumonia either just prior to, or during the 2000-2002 flu season. The results of that study showed that those who had been immunized against flu were no less likely to develop pneumonia requiring hospitalization than those who had not been vaccinated.

A second study published in the June 2008 issue of the American Journal of Respiratory and Critical Care Medicine also reached the same conclusion. The author of that study reported that deaths due to flu in their study showed that 8% had been vaccinated while 15% had not. However, he noted that this difference was not due to the vaccination but rather to what he called the “healthy user effect”. This was described in the article as, “Seniors who get vaccinated against flu tend to be younger, healthier, more active and better able to take care of themselves.”

The conclusion of the study in the Lancet stated, “The effect of influenza vaccination on the risk of pneumonia in elderly people during influenza seasons might be less than previously estimated.” Likewise the conclusion of the study published in the American Journal of Respiratory and Critical Care Medicine stated, “Previous observational studies may have overestimated mortality benefits of influenza vaccination.”

From the Australian scientific journal, Chiropractic & Osteopathy, comes a report dated September 6, 2007 that chronicles how elderly adults in the United States utilize chiropractic care. The study interviewed over four thousand seniors over 70 years of age, and then correlated those interviews to Medicare records. The results of the study were then extrapolated to give a picture of the overall population.

The research, headed by Dr. Fredric D Wolinsky, and Dr. Gary E Rosenthal of the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center reported that on an annual basis about 4.6% of seniors 70 or older see a chiropractor. These seniors are more likely to be in pain and have a means of self transportation to get to the chiropractor’s office.

The report also noted that predominantly, there were unexplainable racial discrepancies noting that, “African Americans and Hispanics are simply much less likely to visit chiropractors than Whites in the United States”. Researchers also reported that those who used chiropractic were much more likely to have arthritis and/or drink alcohol.

The report showed that over the 4 year study about 30% of those seniors who did have chiropractic visits continued to see a chiropractor over at least three of the four years studied. Researchers concluded that these seniors made chiropractic a regular part of their healthcare regime. Conversely, about 48 percent of those who visited a chiropractor did not have any visits in more than one of the four years in the study. They also found that, “among those who had seen a chiropractor, the volume of chiropractic visits was lower for those who lived alone, had lower incomes, and poorer cognitive abilities, while it was greater for the overweight and those with lower body limitations.”