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By Ronald "Skip" Durning, M.D.
Almost every day healthcare issues are featured in the media. The cost of prescription drugs, Medicare’s financial problems, diabetes, cancer, stroke, heart disease and heart surgery, arthritis and joint replacement surgery are just a few. There are many powerful treatments and approaches to these and many other important medical problems, but the treatments are often expensive, sometimes beyond the reach of even carefully managed budgets. The good news is that many of the most important health problems we face can be helped, or even avoided, by measures within our control. Following are three areas that every senior can, and should, think about to address health, wellness, cost and control.
Every new day offers the opportunity and the need to make choices. Choices about lifestyle, eating, exercise, and stress management influence us fundamentally and shape our genetic makeup into the people we are. I believe each of us can impact our own health and wellness. Our lifestyle choices, our understanding about the medicines we use, and our willingness to confront and plan for our eventual death contribute to our physical state, the cost to ourselves and to society, and our control over our personal destiny. I don’t have all the answers. In fact, each of us will generate a different answer based on our abilities, philosophy, and willingness to engage in the process.
The cost of medications, especially prescription medications, is a major challenge to patients, doctors, pharmacists, third party payers (Medicare, Medicaid, managed care plans for example), and even the pharmaceutical industry. At a time when the science of medicine and pharmacy offers an increasingly wide and powerful array of treatments and the promise of better medical outcomes for many patients, the ability to afford these treatments is increasingly limited. The behavior of the pharmaceutical companies, the insurance industry’s role, and the government’s policies are beyond the scope of this brief article. Our own behavior and choices are my focus.
Many seniors take many medicines. Even though the cost of the medicines threatens to break their budgets, many seniors don’t understand the purpose, or even the names, of the medicines taken. Because several different prescribing providers may be involved, it is possible that multiple medications of the same type are prescribed. Side effects, adverse drug reactions, drug to drug and drug to food interactions—the risk goes up with each additional medication. Some medications should be taken indefinitely, but a periodic review may identify drugs that may be stopped safely. Some medicines can address more than one problem. For example, there is a generically available drug that treats hypertension, raises HDL-cholesterol (the good kind), and can help men with some kinds of prostate symptoms. So what can each of us do about such a complicated subject?
Bring all medications, the actual bottles of pills, to medical appointments. The provider can explain what each drug is treating and consider whether any medications can be safely discontinued. How and when each medication is taken can be reviewed. Often the patient is doing something different from the way the provider intended. The provider will avoid prescribing certain medications if he or she knows what has already been prescribed. Taking the right medications the right way is expensive, but helpful. Taking unnecessary medications, or the wrong medicine, generates expense and, possibly, harm.
All medications have the potential to cause problems, they all cost something, and I prefer to avoid prescribing medications when possible. Lifestyle choices can address, even obviate, many medical problems. And the cost of good lifestyle choices is usually minimal. The balance of work and play, our use of substances like tobacco and alcohol, our diets, our exercise and activity patterns are, in my opinion, even more important than the amazing medications and surgical treatments available. The choices we make can impact cardiovascular disease, obesity, arthritis, diabetes, depression, and many other common and potentially devastating conditions. Each of us can help control the cost of our own healthcare by investing in ourselves, by making good choices. Physicians and other providers can give advice, but each of us must take responsibility for our health practices. Each senior must take responsibility and invest in him or herself. There is almost no cost, and the potential for a great return on the investment.
No matter how much we invest in ourselves, no matter how healthy our choices, eventually biology takes over. In the normal course of events each of us grows, matures, ages, and dies. We are all going to die. In Miyamoto Musashi’s “A Book of Five Rings” he writes that the secret of the warrior is to know death. Knowing that this life of ours is finite shapes how we choose to live. Our experience and our sense of spirituality influence our choices and impact our health and wellness.
Thinking about our eventual death helps us understand what choices we can make to influence our care and to ease the burden on our loved ones. If staying alive for every possible second is the goal, then a person will choose to receive every possible therapy and treatment available. For some of us, however, the quality of our time is more important than the quantity. We might inform our loved ones and physicians (using “Advanced Directives”) that being kept “alive” with mechanical ventilation or receiving nutrition through tubes with no realistic expectation of return to independent life is not our choice. Rather, when faced with the end of our time on earth, we might choose to be comfortable, surrounded by the people who mean the most to us, who give our life value and meaning. Each of us has the opportunity, and I believe the responsibility, to think about and make these important choices. Planning ahead can take some of the fear and pain out of the process.
Many seniors feel their lives are dictated by health problems, medications, Medicare, physicians, and well-meaning children. I believe each senior has the opportunity to gain, or regain, some measure of control by investing in him or herself. Each senior can choose how to live, so choose wisely.
Dr Ronald Durning started in the practice of internal medicine. He now concentrates his work in Geriatric care as a partner in Adams Internists, P.C. He has a special interest in Hospice and palliative care and is the Medical Director of The VNA and Hospice of Northern Berkshire.