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Preventive Healthcare for Older Adults

Preventive Healthcare for Older Adults. Framing the Issue. USPSTF charge. Conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications)

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Preventive Healthcare for Older Adults

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  1. Preventive Healthcare for Older Adults Framing the Issue

  2. USPSTF charge • Conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) • Develops recommendations for primary care clinicians and health systems. • Usual Model: Folic Acid Supplementation in Pregnancy • Single population • Women of Childbearing Age • Single intervention • Folic Acid supplementation • Single outcome • Neural Tube Defects

  3. Challenges in Applying Model to the Very Old • Many geriatric disorders have multiple risk factors, interventions, and expected outcomes; • Older adults are not often represented in clinical trials and are more heterogenous than younger adults; and • Important outcomes may not be measured and reported in ways conducive to evidence synthesis and interpretation.

  4. Intervention* (alone or in combination) Multifactorial Assessment and Management Risk Evaluation of ages 65+ years Fall-related fractures and serious injuries; Quality of Life; Mortality; Disability Single clinical treatment (with or without screening) Falls High-risk subpopulation 4 2,2a Clinical Education/ Behavioral Counseling 3 Home Hazard Modification 2b Adverse effects of interventions Exercise/ Physical Therapy Other positive outcomes of interventions Falls Analytic Framework 1,1a

  5. Ideal Analytic Framework

  6. Challenges: Nontraditional Outcomes • Years of Life gained may not be as important as • Independent life or maintenance of function • Quality of life, etc • Caregiver outcomes • Ability to plan by knowing that a patient is dementing • Timing of outcomes • For syndromes, often can’t reverse the underlying progression of disease (frailty, dementia) but can improve for a period of time • How short a period of time is clinically significant • Can outcomes be measured too far out and miss significant short term gains? • Eg, Hospitalizations at 24 months after a fall intervention? • When to stop screening?

  7. Payment Challenge: Uncovered Preventive Services • Medicare will now pay for USPSTF Grade A and B recommendations (MIPPA) • BUT many preventive services have strong evidence showing their benefit, but are not paid for by Medicare • are unlikely to be able to meet the stringent criteria for USPSTF recommendation- that SCREENING will improve outcomes more than waiting for the disorder to be manifest • Glasses • Hearing Aids • Dentures • What needs to be done to obtain coverage for these preventive services?

  8. Elizabeth Eckstrom: Synthesizing the Evidence • Marcel Salive: Medicare coverage of Preventive Services

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