Preventing illness and injury: Is it ever too late to adopt a healthy lifestyle?

One in every five people in the United States (U.S.) is over 65, according to the U.S. Census Bureau. As of 2020, this adds up to 56.4 million people. Although older patients are not as afraid of dying as much as they are afraid of losing their independence, it is hypothesized that one fall leading to a trip to the ER portends a higher risk (up to 21 percent) of mortality within one year.

Often, elderly patients don’t have the reserves to change their delicate routines. Appropriate nutrition and regular exercise become a challenge to those with chronic health conditions. Isolation, depression and lack of social cohesion can all contribute to rapid decline as well. Expensive medications and their untoward side effects also contribute to the conundrum of elderhood.

As our over 65 population will reach 20% of U.S. citizens by the year 2030, our country would be well-served to find better ways to help our aging population stay healthy for as long as possible. Our efforts should be directed at preserving health and independence while aging at home. There are Medicare-approved platforms, such as Embrace Prevention Care, that compensate health care providers for their efforts to follow elderly health issues in the home while reducing unnecessary trips to the hospital emergency department (ED).

Prevention is a key to aging healthfully—but is it “too late” to focus on prevention with patients who are over age 65?

Is it ever too late to change?

In “Outlive,” author Peter Attia, MD, suggests that education, awareness and preventive health practices need to start years before symptoms arise, whereas Medicine 3.0, a proactive curriculum, teaches a preventive strategy that starts at 40. This approach covers more when it comes to preventing the ravages, both physically and financially, of what he calls the “Four Horsemen” of health decline: diabetes mellitus, heart disease, cancer and dementia (p. 10 and p. 41).

Unfortunately, medical schools are still often teaching traditional medicine 2.0—the “find it and fix it” model of symptoms present, a diagnosis is made and treatment is prescribed, often employing expensive testing, medications and surgery. Early in most medical careers, we attempt to diagnose illness and injury correctly. Later, we learn to select the most appropriate treatment plan. Subsequently, as expertise and experience mold our judgement, our mission turns to prevention.

It is estimated that the U.S. spends more on health care than all other countries. Roughly $35,300 is spent in the last 12 months of life alone, with over 60% of elderly U.S. patients dying in acute care hospitals. Could these numbers be reduced by prevention strategies? I would say yes, though it takes changing the behaviors of both physicians and patients alike.

Prevention

In “Younger Next Year for Women,” authors Chris Crowley and Henry S. Lodge, MD, contend that while many patients will live long past age 65, a big difference in their levels of health is their amount of activity.

Similar to financial contributions to a retirement account, you are far behind if you start at age 65. However, while most doctors encourage their patients to start exercising and staying active when they are young, it’s never too late to start—becoming/staying active beyond age 65 can still help prevent or delay health issues and can help keep the muscles strong so a break during a fall is less likely and less damaging.

Consistently moving for 30 minutes a day, five days a week, can help with strength, balance and stamina. Doing so promotes emotional wellbeing, enhances cognitive function and reduces heart disease, diabetes and some forms of cancer. As always, restful sleep and a proper, balanced diet with an emphasis on hydration and protein will contribute to these benefits.

It is imperative that we as physicians reform our approach to delivering medical care and encourage our patients to focus on the areas that they individually need more help in.

Strategies to connect people to a primary care physician, promote healthy behaviors and create safe environments are key to reducing hospital visits and subsequent admissions. Medication observance, fall prevention exercises and cognitive activities have all been shown to help with this as well.

Taking care of the older population         

Currently, the many caregivers for elder patients have become a crowded room, with some patients having various medical experts within their circle—all with input that may or may not be compatible with the established goals of health quality versus lifespan quantity. Often there is little practicality when juggling care team input from many different sources, especially when dealing with an elderly aging demographic. In “Elderhood,” by Louise Aronson, MD, a defined, committed younger family member is recommended as an integral part of the care team as well.

Osteopathic physicians are uniquely positioned to promulgate health prevention strategies. As one of the fastest-growing areas of health care, DOs make up more than 11% of practicing physicians, a number that is rapidly increasing. Through our growing numbers, health care promotion and disease prevention can take on a new philosophy, with the use of A.T. Still, DO, MD’s, principle of a person being a unit of body, mind and spirit.

Where to look for help with elderly patients

One example of innovation in geriatric medicine is Embrace Prevention Care (EPC), a scalable prevention platform to amplify the voice of elderly patients’ doctors with frequent nurse practitioner calls that help change behaviors and implement a care plan to reduce ER visits and initial hospital stays. Elderly patients with chronic medical conditions are contacted monthly by a nurse practitioner and provide virtual preventive care reminders, attempting to continuously change behaviors of exercise, nutrition, medication adherence and social cohesion. Geriatric pharmacists, medical social workers and psychologists are also available as needed.

Another example, Chronic Care Management, a provision of Medicare, can help reduce the need for unnecessary trips to the hospital by availing patients to monthly virtual health reminders and encouraging feedback.  Monthly reviews by nurse practitioners, pharmacists and social cohesion experts are beneficial as well. New Medicare codes allow for reimbursements to the health care team, including the overworked primary care physician.

The conventional construct for health care for the aging elderly is inadequate, too expensive and often too late. Many members of the team do not know what they do not know. Early prevention can limit pain, suffering and financial burdens. Coordinated prevention strategies for the elderly with chronic health conditions can be embraced by changes in behavior for both patients and caregivers alike.

Starting late is still better than never—any small change an elderly patient can make will likely have a positive benefit.

Related reading:

The DO Book Club, Jan. 2024: ‘Outlive: The Science and Art of Longevity’

Listening to our patients: The sounds of an emergency department