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MATURE MARKET HEADLINES POSTED 8/21/98
Retirement Policies Bankrupting SocietyAll the new medical technology may be helping the elderly stay healthy, but the price tag is making the economy sick. According to Stanford health economist Victor Fuchs, health care for the elderly could consume 10 percent of the nation's gross domestic product by 2020 if present trends continue, Fuchs says. That is more than double the share the elderly consumed on health care in 1995, which means that Americans will have less money to spend on other goods and services.Age-specific expenditures have been rising, so that the health care costs of the average 73-year-old, for example, today are considerably higher than they were for the average 73-year-old 20 years ago. Even though some new treatments for ailments cost less than older ones, the total costs of sustaining health for a year are increasing for the elderly. New medical technology is the primary reason Americans over 65 are spending more on health care. Newer methods of diagnosis and treatments with new drugs or surgical procedures have improved the general health of older people and lengthened their lives, especially those of men, he said. People are not working longer, however, and so there are more years of retirement (and health care) to finance. The number of years that men at age 65 could be expected not to work after retiring rose from 11.7 in 1975 to 13.7 in 1995. Women also showed an increase in the number of years they are not working for pay after retiring from 17.3 in 1975 to 17.8 in 1995, he said. For most people, health care becomes a bigger share of the budget with age, Fuchs said. National data indicate that health care expenses are three times as great for the average person over age 65 as for those who are younger than 65, and persons 85 and older spend nearly three times as much on health services and drugs as people age 65 to 74. Fuchs suggests that policymakers encourage people to work longer and save more income to finance longer retirements and greater health care expenses. If no policies change, health care will consume the greater amount of tax dollars within a few years. About 63 percent of the health care cost for those 65 and older is borne by taxpayers primarily younger workers who pay payroll taxes for Medicare and Medicaid. Will this growing disparity between young and old eventually lead to an intergenerational conflict? Only time will tell. But the reality of ever-limited resources is becoming more apparent to more Americans every day. Expect this increased awareness to create more pressure for a solution. Expect the mounting pressure for a solution to drive an unprecedented appetite for retirement planning services. See related articles in the AgeVenture archives. "New Retirement Age Won't Fix Social Security" "Social Security Takes Stock of Wall Street" "Gerontologists Seek Longevity Prescription" AgeVenture News Service, www.demko.com BACK TO TOP Heaven's Waiting Room Studies End-of-LifeThe same advances in healthcare technology that prolong an elder's life also prolong their dying process. A process that, in some cases, can make the final days a hell-on-earth for elders, their families, and their caregivers. The whens, whats, whys, and hows of eldercare have become perplexing issues.What might be considered a reasonable effort to prolong life? What is a reasonable effort to ensure death with dignity? How does one decide to shift caregiver effort from prolonging life to allowing death? What are the patient's rights? What are the caregiver's obligations? Perhaps it's no surprise that Florida, the state with the highest concentration of elders, has chosen to tackle these weighty issues. The Florida legislature recently empowered Florida State University's Pepper Institute to move forward on issues relative to the end-of-life. "The goal of the (Florida's new End-of-Life) panel," says Pepper Institute Director Melissa Hardy, "is to raise issues related to the dying process in a very public way." To address these and other issues such as living wills, Florida legislators outlined five areas for the panel to study:
"The lifelong relationship between patient and doctor has become much less common in today's transient market. Health care has become less personal and more corporate," she said. As a result, said Hardy, doctors, patients and their families often do not discuss death and the dying process and the patient's particular desires, which complicates end-of-life care. "This social censorship prevents most of us from talking about, witnessing or participating in the dying process," she said. In order for a person's end-of-life decisions to be respected and carried out, Hardy said, people should think of it in the same terms as retirement. "In this way, people will become more aggressive in protecting their health care interests," she said. Another important change has been the shift from dying in the home to dying in the hospital where pain can be better alleviated. Because of this, terminal patients may think they have to choose between dying at home in pain among loved ones, or in a sterile environment such as a hospital without pain in the company of strangers. "This shouldn't be a zero-sum game. You shouldn't have to give up pain management just to die in familiar surroundings," she said. Whatever recommendations the Florida State University panel generates, there is no doubt the rest of the nation will welcome their perspectives. That's because, in many respects, Florida is considered a snapshot of what the nation's older population will look like in the next century. See related articles in the AgeVenture archives. "Nursing Homes Ignore Many Elders in Pain" "AGS Launches Pain Management Guidelines" "Abuse Raises Elder's Death Risk 300%" AgeVenture News Service, www.demko.com BACK TO TOP End-of-Life Decisions Made In A Heart BeatHas technology given us the "good life" ... or, has it made our lives so fast and complicated that often we don't know which way is up? Remember that old saying, "there's nothing certain about life except death and taxes"? Well, scratch the "death" part. Welcome to the 90's. Life's become so complicated in America's high-tech society that you can't even die unless someone gives you permission. Here's yet another study that underscores the complexity of our social world.About one in four doctors of patients with advanced congestive heart failure misjudge their patients’ wishes about being resuscitated should they go into cardiac arrest. So says a recent study of congestive heart patients reported by the American Heart Association. This is a very big deal because more than 4.9 million Americans suffer from congestive heart failure, and the condition is newly diagnosed in about 400,000 individuals each year. Heart failure is the only major cardiovascular condition that is increasing in its incidence and prevalence, accounting for almost 6 million hospital days with total direct and indirect costs of $20.2 billion per year and hospital and nursing home costs near $14.5 billion each year. The study, published in "Circulation: Journal of the American Heart Association", also says that some patients may change their minds about whether they want their doctors to "pull the plug." Unlike people with terminal cancer whose condition steadily declines, individuals with severe congestive heart failure may have episodes of feeling relatively well between times when they feel as if they’re at death's door, according to Harlan M. Krumholz, M.D., lead author of the study and associate professor at Yale School of Medicine. "There were times for some patients in the hospital when they felt like they didn't want to go on, that if their heart stopped this was the time their life should end," says Krumholz. "Then there were times after being discharged when they were feeling better and felt that if their heart stopped their condition was fair enough that they would want to be revived. "It is a particularly challenging aspect of heart failure that the condition fluctuates. People’s feelings can change, and their preferences about resuscitation can change." Researchers found that many patients changed their minds about being resuscitated. Among 600 patients questioned two months after their initial response, 19 percent had different viewpoints. In the study’s survey of do-not-resuscitate (DNR) preferences among 936 individuals hospitalized for severe heart failure, nearly one-quarter said they did not wish to receive artificial respiration. Patients who asked not to be resuscitated tended to be older, have a higher income and thought they were sicker and less able to function than those who did not request DNR, according to researchers. At any rate, physicians misjudged their patients’ preferences for 24 percent of the individuals. "The patients need to be their own best advocates," says Krumholz. "They need to understand that it is ultimately their responsibility to take control over the end of their lives." "Physicians seemed to think that many patients wanted what they would prefer themselves. That approach does not always work," says Krumholz. "There is a need to improve patient-doctor communication about the topic, even though it is often difficult to discuss." In a related study, covered by AgeVenture News Service earlier this year, embarrassment was identified as another factor that can hurt the doctor-patient relationship. In that study of patient-physician communication issues, conducted by Louis Harris for Pharmacia & Upjohn, many patients were found to suffer needlessly due to embarrassment about health problems. Twenty-five percent of patients surveyed in that Harris Poll admitted there had been times when they wanted to talk to a doctor about a health problem but were reluctant to do so because of embarrassment. In fact, embarrassment far out-paced other doctor-avoidance factors such as thinking one's symptoms are unimportant (11%), fear of bad news (8%), not wanting to waste the doctor's time (8%), and fear of treatment (7%). See related articles in the AgeVenture archives. "Strengthening Doctor-Patient Relationships" "Patients Want Doctor To Share Bad News" "Heart Risks Doubled In Depressed Males" "Hospital Stay Longer For Female Heart Patient" AgeVenture News Service, www.demko.com BACK TO TOP Science Helps Boomers Battle Premature AgingDespite all the warning about the damaging effects of sun exposure, including premature aging and skin cancer, sun worshipping baby boomers are still saying, "burn baby burn". "In our culture, tanning represents youth, sex appeal and beauty. It represents having a good time, enjoying the good life. However, the risks for skin cancer remain, and people should take precautions to protect themselves from the sun, said Dr. Jim C. Chow, associate director of dermatology and dermatologic surgery at the University of South Carolina's School of Medicine."There are different forms of sun damage to the skin," Chow said. "From a dermatological standpoint, there is no such thing as a safe tan. A tan is a sign of injury. It is the skin's response to an overdose of ultraviolet light." Initially, sun damage shows up in the form of a sunburn, causing redness, peeling and occasional blistering. But years of tanning or being outside without adequate sun protection will result in wrinkles, blemishes and sun spots and will cause the skin to lose its elasticity. One in six Americans will develop skin cancer in their lifetimes, and more than 1 million new cases of skin cancer will be diagnosed this year. Malignant melanoma -- the deadly form of skin cancer -- is the eighth most common cancer in the United States. Just two decades ago, malignant melanoma was the 20th most common cancer. "... in spite of the public health messages encouraging people to stay out of the sun," says Dr. Chow, "we are (still) seeing a higher incidence of sun-related injury to the skin through this increased exposure." Nevertheless, the desire to have younger, more beautiful skin is on the rise, particularly among baby boomers, many of whom spent years in the sun before the dangers of tanning were taken seriously. It is possible, says Chow, to reverse the signs of aging caused by sun exposure. Several new products and procedures are available to rejuvenate appearance:
See related articles in the AgeVenture archives. "Aging? Boomers Say "Hell No, We Won't Go" "Age-Phobic Americans Just Dying to Stop Aging" AgeVenture News Service, www.demko.com BACK TO TOP New Technology Dominates Healthcare's FutureIn a new article published in Medical Care Research and Review (September 1998 issue), researchers from the University of Michigan's School of Public Health outline three obstacles policy-makers may encounter as they consider new laws and other measures designed to curb the cost of health care. The article examines the role of medical technology as the root of spiraling health care costs."The reason why health care costs are higher now than they have been in the past is because of new medical technology. It's not increased waste, it's not fraud, it's not increased law suits, it's not the fact that people on average are older---all of that may contribute, but the predominant factor relates to the development and utilization of new medical techniques, of which there are an enormous number," said U-M public health economist Michael E. Chernew, who is first author of the article. Chernew and colleagues examine existing evidence that assesses the relationship between health care costs and medical technology. The article, "Managed Care, Medical Technology, and Health Care Cost Growth: A Review of the Evidence," also examines the role managed care may play in constraining health care costs by controlling medical technology. Although some existing studies show that managed care has reduced the rate of health care costs growth in some markets, in general, the rate of growth of health care costs have exceeded sustainable levels. If managed care does not control health care cost growth, then some other force will, Chernew said. He and the co-authors of the article discuss three paths policy makers may consider:
See related articles in the AgeVenture archives. "New Health Care Mandates Devastating" "New Medicare+ Choice Health Options" "Facist Healthcare In The West" AgeVenture News Service, www.demko.com BACK TO TOP |