Health care is ‘overwhelmingly complex’ for older adults, experts say: ‘Ever-increasing hurdle’
Adults tend to need more medical care as they age, but coordinating that care can be stressful and strenuous for seniors.
Getting in-person care and treatment can require "substantial time, effort and cost" for older adults and their partners or caregivers, according to a new study from Brigham and Women’s Hospital in Boston.
Led by Ishani Ganguli, an associate professor of medicine at Harvard Medical School, researchers looked at data from 6,619 adults aged 65 and older, who responded to the 2019 Medicare Current Beneficiary Survey data, to get an idea of the number of days spent receiving medical care.
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During that year, the older adults had an average of 17.3 "ambulatory contact days," which consisted of visits to a primary care doctor or specialty doctor — or a test, imaging procedure or treatment.
They had an average of 20.7 total contact days, which also included days spent in a hospital, emergency department, skilled-nursing facility or hospice facility.
Around 11% of the adults had 50 or more total contact days.
"Some of this may be very beneficial and valuable for people, and some of it may be less essential," Ganguli of Harvard Medical School told KFF Health News.
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"We don’t talk enough about what we’re asking older adults to do and whether that’s realistic."
Woven into all of those medical touchpoints are different guidelines for medical conditions, financial incentives offered to doctors and the need for specialized care, Ganguli noted.
"It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests," she also said.
For patients with multiple health issues, there are even more appointments to juggle.
"The good news is that we know so much more and can do so much more for people with various conditions," Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care, told KFF Health News.
"The bad news is the system has gotten overwhelmingly complex."
Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, was not involved in the research but agreed that medical complexity for seniors is a "huge problem" in the U.S.
"The medical system is overburdened coming out of the pandemic, and there is a shortage of both doctors and nurses," he told Fox News Digital.
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Meanwhile, the health care needs of the country’s elderly are increasing, especially with technological advances in helping to manage chronic illness, Siegel noted.
"At the same time, the extensiveness of Medicare coverage is shrinking, along with providers who can work with it," the doctor added.
"And the barriers to getting needed procedures and treatments are increasing, along with out-of-pocket costs."
Dr. Shana Johnson, a physical medicine and rehabilitation physician in Scottsdale, Arizona, said the complexity of navigating the U.S. health care system is an "ever-increasing hurdle" to obtaining medical care.
"Every step of the health care system is laden with complexity — from scheduling an appointment with a provider that accepts your insurance, to filling a prescription that you can afford, to discerning which medical tests you actually need," she told Fox News Digital.
Johnson was not involved in the new study.
In her new role as an independent health care system consultant, Johnson works to help patients navigate this complexity.
"An increasing number of people are reaching out for help navigating the system and finding the right care," she said.
A patient recently contacted Johnson for help after her primary care doctor’s failed attempts to refer her to a rheumatologist.
"First, her doctor sent her to the university medical center," she said. "They denied the referral because their appointment slots were reserved for high-complexity cases, and her case was deemed not difficult enough."
A second referral was placed to a private rheumatology practice, but they declined because they didn’t accept Medicaid insurance.
"Fewer private practices accept Medicaid because of the low reimbursement rates," Johnson noted.
At this point, the patient contacted Johnson for help in getting connected to care.
"After speaking with her, I suspected she had fibromyalgia, and this expanded the number of specialists who could help her," she said.
Johnson referred the patient to a pain clinic in a large hospital system — but the clinic denied the referral because it was too busy with opioid patients and could not accept outside referrals.
Also, the patient’s doctor did not work for the hospital system.
"Next, I tried the general physical medicine and rehabilitation clinic," Johnson said. "They said no because she was a better fit for the pain clinic that declined to see her."
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At this point, the patient had waited five months, in pain, trying to get a diagnosis — and treatment hadn't even started.
Johnson noted, "This patient's struggles are not unique — they are the usual."
When faced with the "treatment burden" that comes with making appointments, finding transportation, following up with insurance companies, incorporating doctors’ recommendations and managing medical costs, many seniors may opt to forgo care altogether, according to Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota.
In a 2020 research paper, Montori revealed that around 40% of patients with chronic conditions "considered their treatment burden [to be] unsustainable."
At highest risk are the older adults who are managing multiple medical conditions and those who have "low levels of education" or are "economically insecure and socially isolated," as reported by KFF.
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The rise of digital technologies in the health care system can add another layer of difficulty for older adults, experts agreed.
"It’s harder and harder for patients to gain access to clinicians who can problem-solve with them and answer questions," Montori told KFF.
Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School, shared with KFF Health News her tips for making care more accessible for older adults.
First, she recommended giving feedback to doctors if a treatment plan doesn’t seem sustainable.
"Be sure to discuss your health priorities and trade-offs —what you might gain and what you might lose by forgoing certain tests or treatments," she told KFF.
It’s also important to discuss which medical interactions are essential and which can be skipped, Rogers said.
Based on these discussions, doctors might be able to make adjustments to treatment plans or prescriptions.
Some medical centers may have social workers or "patient navigators" on staff to help seniors coordinate and consolidate appointments, and arrange transportation if necessary.
Rogers also stressed the need for seniors to ask questions to ensure they understand their doctors’ directions.
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"I would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease, but also for the time I’ll spend getting care?’" Ganguli of Harvard told KFF.
"If they don’t have an answer, ask if they can come up with an estimate."