Four areas of unnecessary senior healthcare

The number of seniors in the United States is projected to nearly double over the next 34 years-from 43 million in 2012 to nearly 84 million by 2050. During that time period, the number of seniors 85 and older is expected to jump from nearly 6 million to 19 million.

“Our Parents, Ourselves: Health Care for an Aging Population,” a report issued by the Dartmouth Atlas Project, a program of The Dartmouth Institute for Health Policy and Clinical Practice, also reveals that the number of seniors in Medicare private health plans such as Medicare Advantage increased from 6.4 million beneficiaries in 1999 to nearly 12 million in 2011-and that number continues to rise.

Because seniors are likely to experience frequent, complex interactions across many providers in the healthcare system, often there’s no single healthcare provider coordinating all of their care, according to the report, which was released in early 2016.

In addition, the American Geriatrics Society’s Choosing Wisely guidelines, which were released in 2013 and updated in 2015, provide geriatrics-specific recommendations to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The campaign advances a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

Here are four areas of elderly care-highlighted in the report and guidelines-that healthcare systems and health plans should be aware of to ensure that elderly patients aren’t receiving unnecessary care.

1. Prostate cancer screenings for men 75 years and older

BynumControversy has long swirled around the use of the prostate-specific antigen (PSA) test for men between the ages of 55 and 69 years-largely because of conflicting results. The Dartmouth Atlas Project report reveals that for men aged 70 years and older, there’s a consensus among the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society, and the American Urological Association against the PSA.

Despite this consensus, the national average rate of PSA screening for Medicare beneficiaries 75 years and older was nearly 20% in 2012. There’s a range across the country, with a low of approximately 10% in Casper, Wyoming, to a high of 30% in Miami.

On the face of it, this is just a blood test, says Julie Bynum, MD, MPH, associate professor at the Geisel School of Medicine at Dartmouth College and The Dartmouth Institute for Health Policy and Clinical Practice. The problem is that the blood test sets off a cascade of events. A positive result to the test could lead to a biopsy, and before you know it, the senior could get on an aggressive treatment path. The problem is that it’s hard to pull back once you get on that treatment path, says Bynum.

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