Spending to Rise for Aged Nursing Care

Times Staff Writer

The well-chronicled graying of America and the concomitant implications of steadily increasing life spans have begun to lend themselves to startling projections of the rise in spending for nursing home services over the next 25 years.

The latest prediction comes from a study team at the Vanderbilt University School of Medicine, which makes computations of nursing home outlays that will be necessary under the Medicaid (Medi-Cal in California) program in the next 2 1/2 decades. In all, the researchers say, increases in the number of old people--especially those 85 and older--imply a real rise of 280%, after inflation, in what the public-health insurance plan will have to pay for nursing home care.

By the year 2012, the Vanderbilt study concludes, the number of people 85 and over will triple, to 6.9 million. If current rates of long-term nursing home use remain constant at about 20% of that population, it would mean $6.3 billion a year (in 1982 dollars) above Medicaid's current nursing home-care budget.

The Vanderbilt study was based on analysis of nursing home usage rates in five states, which together account for 39% of Medicaid expenditures: California, Georgia, Michigan, New York and Tennessee. In California in 1981, there were an estimated 2.3 million people 65 to 84 and 225,000 85 and over. The 65 to 84 group had little long-term nursing home use--just 2.3% of the population. But among the group over 85, 10.8% of men and 22.2% of women (for an overall total of 18.9% of the entire group, allowing for greater longevity among women) required nursing home care.

"Clearly, the conflict between the demographic fact of the rapidly increasing numbers of the very old, who are at high risk of both having low incomes and requiring nursing home care," the Vanderbilt team reported in the American Journal of Public Health, "and the societal desire to cap public expenditures for health care will be a most important factor in determining public-health policy for the next 25 years."

Women and Smoking

In a step they said took note of rising smoking rates in some age groups of women, leaders of the American Public Health Assn. and 45 other primarily health-related organizations have urged nearly two dozen of the nation's top women's magazines to stop accepting tobacco advertising.

The call was combined with suggestions that the 22 women's magazines make a point of including more anti-smoking reader-service materials in their publications. The suggestions were contained in a letter mailed last week to editors and publishers of the magazines. A press conference was scheduled in New York today to further publicize the drive.

The association urged women's magazines to publish more stories on the health hazards of tobacco, combined with service features on ways women can quit smoking. The association letter also urged the magazines to gradually eliminate cigarette advertising as existing contracts with tobacco companies expire.

The letter sent to the magazines noted that an estimated 44,000 American women will die of lung cancer this year and that lung cancer passed breast cancer as a killer of women in 1985. There was no immediate response from the publications involved. "We hope that what might be a difficult economic deicision will be rendered easier by considering the extremely beneficial influence you could exert on the health of millions of American women," the letter concluded. Resuscitation Policy

It is an almost universal hospital rule that close friends and relatives may not remain in the same room when their friend or loved one has suffered a major heart attack or stroke and is undergoing emergency resuscitation. No hospital in Southern California, for instance, permits relatives and friends to witness resuscitation, hospital officials say.

It is generally thought that friends and relatives might disrupt the often hectic procedure or that they might panic and endanger the patient or medical personnel.

It has also been presumed that observing an unsuccessful resuscitation might do irreversible damage to survivors' mental health.

But now, in a small study at Foote Hospital in Jackson, Mich., doctors who experimented with allowing family members who wished to do so to stay and observe resuscitation say these universal assumptions may not be valid.

The conclusion is based on a study of 47 relatives of severely stricken patients who were permitted to remain in the room where emergency life-saving care was being given.

Forty-four of the relatives said they would participate a second time, and 36 said they believed that though their relative subsequently died, observing the frantic attempt to save his or her life had facilitated the grieving process. Thirty of the subjects said they believed their presence had helped stricken relatives.

As a result, the researchers concluded in the journal Annals of Emergency Medicine: "There appears to be no reason for continuation of policies that exclude family members from the resuscitation room."

Graying of Jogging

As the running boom has appeared to peak and level off, observers of the fitness phenomenon have waited to see what would happen to the demographics of many physically active participation sports. A hint is contained in a survey described in a letter to the journal Lancet.

In it, two Swiss physicians describe differences in the age profile of participants in the 1982 and 1986 runnings of the Morat-Fribourg race--one of Europe's most prominent marathons.

The comparison demonstrates a clear shift upward in the ages of participants--with the greatest number of runners in the 32 to 33 bracket in 1982 but 40 to 41 last year. The doctors' conclusion: Fewer young people are taking up running, and the sport is being perpetuated by an increasingly aged population of enthusiasts.

"Jogging may turn out to be a self-limited epidemic," the Swiss doctors wrote.

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