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Seniors Newsletter
October 8, 2012
In this Issue
• Use of Medicare Skilled Nursing Benefit Is High at End of Life: Study
• Seniors Who Fell Recently May Fare Worse After Surgery
• Health Tip: Caring for an Older Person's Teeth

Use of Medicare Skilled Nursing Benefit Is High at End of Life: Study

Financial concerns may deter many from using hospice provision, researchers say

TUESDAY, Oct. 2 (HealthDay News) -- Instead of using Medicare's hospice benefits, many elderly Americans are spending their last months of life in a skilled nursing facility paid for through a different provision of the government-funded insurance program for seniors, according to new research.

Although most Medicare beneficiaries took advantage of their benefit for skilled nursing care for rehabilitation or care to prolong their life, scientists at the University of California, San Francisco, found that some dying patients are sent from the hospital to a skilled nursing facility for end-of-life care.

The researchers explained that, unlike the skilled nursing benefit, the hospice benefit forces patients to pay out of pocket for room and board. Although Medicaid, the government insurance program for the poor, would cover room and board, many do not qualify.

"Our finding that Medicare decedents commonly used [skilled nursing facility] care at the end of life suggests a need to better understand who is using the [skilled nursing facility] benefit and whether they are receiving care that matches their goals," the authors wrote. "Unfortunately, financial issues may contribute to why patients near the end of life are using the [skilled nursing facility] benefit and not the hospice benefit."

The research was published online Oct. 1 in the journal Archives of Internal Medicine.

The researchers analyzed data from the U.S. Health and Retirement Study, which is linked to Medicare claims from 1994 to 2007. The study included nearly 5,200 Medicare recipients, who died at an average age of 83.

The study revealed roughly 30 percent of the participants took advantage of the skilled nursing facility benefit in the last six months of their lives. About 9 percent died while enrolled in this benefit.

Use of the skilled nursing facility benefit was greater among patients 85 or older who had at least a high school education, were cancer-free, lived in a nursing home, used home health services and were expected to die soon.

"The hospice benefit is the primary way in which palliative care services are provided in nursing homes. A growing focus is on the development of palliative care in nursing homes alongside the current goals of functional improvement," the authors wrote. "Perhaps having Medicare pay concurrently for [skilled nursing facility] care and hospice services for the same condition could allow earlier incorporation of palliative care for these medically complex patients."

Dr. Peter Boling, of Virginia Commonwealth University in Richmond, said in the news release, however, that about half of the skilled nursing facility users ultimately went home, despite having significant frailty.

"We must all carefully avoid rushing to judgment and imposing end-of-life care protocols when reasonable vitality and quality of life remain, despite chronic illness burden," Boling said.

More information

The Centers for Medicare & Medicaid Services provides more information on skilled nursing care.

Seniors Who Fell Recently May Fare Worse After Surgery

Study found more disability, complications and longer hospital stays for these patients

TUESDAY, Oct. 2 (HealthDay News) -- Older adults who experience a fall within the six months before major surgery have longer hospital stays and higher rates of complications and disability after their surgery, a new study finds.

Researchers looked at 208 patients, average age 74, who had colorectal or heart surgery at a single Veterans Affairs Medical Center. Of those patients, 34 percent had suffered at least one fall in the six months before their operation.

Among patients who had colorectal surgery, more than one complication occurred in 58 percent of those who had a fall and in 27 percent of those who did not fall. Complications included heart, lung and kidney problems, stroke, further surgery, blood clots and infections.

Patients who had a fall also spent nearly three times as many days in the hospital as those who hadn't fallen, the investigators found.

In addition, 59 percent of those who fell within the six months prior to surgery required institutional care after their surgery, compared with 4.2 percent of those who did not fall, the study authors found.

Similar findings were seen in patients who had heart surgery, according to the study presented Monday at an American College of Surgeons conference in Chicago.

"It has been shown in previous studies that a history of falls predicts poor long-term outcomes but we have never looked at immediate pre-op assessment related to post-op outcomes," lead author Dr. Teresa Jones, a surgical resident at the University of Colorado, said in an American College of Surgeons news release. "This is the first time that falls as a stand-alone risk marker have been used for predicting outcomes in older adults," she noted.

"Our goal is to help with preoperative and postoperative planning," Jones explained. "If it's likely that a patient will need to enter a nursing home for several weeks after an operation, the patient and family can evaluate various facilities beforehand to see which one would best address their specific needs. It's important for a patient to be at a place that they've chosen and know what to expect after surgery."

More than one-third of U.S. surgeries are performed on people aged 65 and older, the researchers say, and an increasing number of these patients are in their 80s.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Institute on Aging has more about falls and older adults.

Health Tip: Caring for an Older Person's Teeth

Regular brushing and flossing are key

(HealthDay News) -- As people age and have trouble caring for themselves, they may also struggle to care for their mouths and teeth.

The American Dental Association offers these tips for people who care for seniors:

  • Remind them to brush and floss their teeth daily.
  • If they have trouble brushing or flossing, a dentist or hygienist should be able to offer suggestions.
  • Schedule regular dental checkups.
  • Consider possible denture problems if you notice changes in an older person's eating habits.
  • Don't neglect an older person's dental care, since bacteria from the mouth ultimately can trigger pneumonia.

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