Morbidity & Mortality in Aging

Morbidity & Mortality

• Morbidity refers to the presence of illness in older age, while mortality refers to lifespan.
• Compression of morbidity lowers life expectancy but increases the quality of life by minimizing the duration of illness before death.
• Expansion of morbidity increases life expectancy but decreases the quality of life by extending the period of illness before death.

Aging

• Biological aging & senescence involve a cumulative, progressive, and ultimately harmful series of changes that start at reproductive maturity and end in death.
• Primary aging refers to age-related changes independent of disease, like hair turning gray.
• Secondary aging refers to disabilities resulting from disease.

Geriatrics & Epidemiology

• Geriatrics focuses on aging as a medical specialty.
• Gerontology studies aging itself, not specific diseases.
• Epidemiology studies disease frequency and causes.
• Geriatric epidemiology involves studying how diseases affect older people.

Common Diseases in Old Age

• Hypertension (60%), high cholesterol (51%), arthritis (35%), ischemic/coronary heart disease (29%), diabetes (27%), and chronic kidney disease (25%) are the most common conditions.
• Arthritis involves joint inflammation.
• Osteoporosis weakens bone tissue. Falls are a common symptom and can lead to hip fractures requiring advanced care.
• Parkinson's disease is a neurological movement disorder characterized by tremors, slow movement, and micrographia.
• Cancer and cardiovascular disease are leading causes of death.
• Dementia significantly affects memory and thinking.
• Alzheimer's disease is the most frequent dementia type.

Healthcare Spending Trends

• Healthcare costs are continuously rising.
• Medicare spending is increasing faster than inflation.
• The oldest adults (65+) incur the highest healthcare costs.

Medicare

• Medicare eligibility caters to those aged 65 and above or individuals with qualifying disabilities.
• Medicaid serves individuals, families, and children with limited resources.
• Medicare Part A covers hospital costs during inpatient admissions.
• Medicare Part B covers outpatient services, ambulance, testing, and physician-provided care.
• Medicare Part C offers additional private Medicare coverage with potential benefits like dental and hearing care (capped).
• Medicare Part D provides optional prescription drug coverage.
• Medicare is financed through payroll taxes on workers' income.
• Medicare covers about half of older adults' out-of-pocket medical expenses.
• Medigap private insurance policies cover remaining medical bills.
• Medicare does not cover eyeglasses, hearing aids, dental care, long-term non-acute care in nursing homes, assisted living costs, housekeeping, or other fees for maintaining independence.
• Medicare does cover assistive devices like prosthetics and walking aids.

Cost Containment Measures in Medicare

• Prospective payment systems utilize predetermined fixed payments for specific services or diagnoses (Part A).
• Diagnosis-related groups classify patients and determine hospital reimbursement (Part A).
• Resource-Based Relative Value Scale incentivizes prevention and health promotion services over costly procedures (Part B).

Inflation Reduction Act & Medicare (2022)

• Implemented a $2,000 cap on prescription drug costs under Medicare Part D.
• Medicare can now negotiate drug prices.

Housing & Long-Term Care

• Community-based Services provide support in the community like adult day care and home healthcare.
  • Adult day care offers daytime socialization, entertainment, and supervision at a low cost.
  • Home healthcare provides in-home assistance with meals, hygiene, entertainment, and transportation.
• Continuing-care retirement communities (CCRCs) offer age-in-place solutions with various care levels, from independent living to skilled nursing care, within one location.
  • Seniors pay an entrance fee for lifetime care in a CCRC.
• Medicalized services include assisted-living facilities and nursing homes.
  • Assisted-living facilities provide support for daily tasks.
  • Nursing homes provide residential care with varying levels of nursing care.
    • Most nursing homes are for-profit.

Continuum of Care

• Individuals transition from independent living to progressively higher levels of care, ultimately involving skilled nursing care.

Housing Costs

• Nursing homes are the most expensive long-term care options, while adult day care is the cheapest.

Hospice vs. Palliative Care

• Both focus on maximizing quality of life.
• They treat symptoms rather than the underlying disease itself.
• Hospice care is initiated when a terminal diagnosis is made.