PERSONAL HEALTH : Pushing 65? : Wellness Programs Promote Diet, Exercise and Safety in Effort to Reduce Common Old-Age Maladies and Health-Care Costs
When the Bush Administration releases a highly anticipated plan later this year to deal with mounting health-care costs, don’t be surprised if Uncle Sam asks you to do your part.
This might be especially true if you’re 65 or older.
Hints from Washington indicate that the government will emphasize disease prevention and health promotion among the elderly--self-directed activities such as dieting, exercising, quitting smoking and observing safety measures--as key strategies in reducing health-care spending.
Although the idea of losing 15 pounds or taking up aerobics for the good of the nation may seem silly, health experts insist it isn’t merely government hype.
In one of the first studies to correlate health habits with health costs among the elderly, California researchers have shown that health improvements among retirees at high risk for medical problems saved $4,588 per person, per year.
Other studies show that elderly people can significantly reduce illness and injuries and improve strength and stamina through preventive health, or wellness, programs.
An estimated 80% of chronic health problems common in old age can be avoided or postponed, says Dr. Evan Hadley of the National Institute on Aging.
“The scientific evidence shows it’s not too late,” Hadley says. “There have been some pilot studies with very encouraging evidence. We are also impressed with a dramatic change in public attitudes about exercise and aging.”
Among the recent findings:
Reducing the risk of osteoporosis through weight-bearing exercise.
Reducing the risk of heart attack, stroke and other circulatory diseases through smoking cessation. Stopping won’t stop lung disease but can slow the progression of disease and help retain lung function, studies reveal.
Improving mobility, flexibility and muscle strength through exercise.
Reducing injuries and illness through treatment for alcohol abuse, which, studies show, can be successfully treated at any age.
But, Hadley said, health experts have only recently begun to ask if conditions such as physical frailty and poor balance can be corrected. And some of the early studies have been surprising.
In a recent study reported in the Journal of the American Medical Assn., researchers showed that a strength-training program for nursing home residents with an average age of 90 dramatically increased their mobility and muscle strength.
“What that showed was that in only eight weeks of strength training there were dramatic improvements in the strength of leg muscles of very frail older people,” Hadley says. “That was not just a curiosity. In fact, people in that study were able to walk better and, in several cases, disposed of walking aids.”
The NIA is sponsoring a $2.9-million clinical trial at eight research centers this year to further explore the advantages of exercise and physical conditioning in reducing frailty. The study, “Frailty and Injuries: Cooperative Studies of Intervention Techniques,” will examine whether elderly people involved in Tai Chi, aerobics and strength training are stronger.
“One of the benefits we hope to see is a reduction in health-care needs and costs,” Hadley says.
For example, weight-bearing exercise may help reduce hip fractures, a common problem among the aged that results from poor bone and muscle strength. Hip fractures account for $7 billion in health-care costs per year, Hadley says.
But, he says, “we need to know what the full range of benefits is so we can tell people realistically what they can expect.”
Employers and government health agencies will also want to know just how much money can be saved through prevention programs, experts says.
“We pay enormously for health care in the United States--11% to 12% of our Gross National Product--and yet our longevity statistics are awful compared to most other developed countries,” says J. Paul Leigh, the San Jose State University health economist who co-wrote the new California study on financial savings from prevention programs. That’s because, Leigh says, “these other countries are more aggressive in spending on prevention.”
Leigh’s one-year study followed 1,588 retired Bank of America employees in a prevention program called Healthtrac offered by Blue Shield of California. The retirees were instructed in ways to improve their health through dieting, exercise, smoking and alcohol reduction, and use of seat belts.
Participants received periodic education, feedback and assessment. Health-care costs for the group were later compared to those for a control group.
The study, also written by Stanford University medical researcher James Fries, will help policy-makers looking for innovative ways to cut health costs, Leigh says.
“Employers see the bottom figure, and they want to know, right now, how they can reduce medical costs,” he says. “In this way, I think the public has been leading the medical profession in prevention.”
Employers are also being encouraged by the government to find new ways to trim health-care costs.
A Department of Health and Human Services task force created to design a plan to reduce spending has indicated that personal responsibility for good health will be a high priority. In addition, the government is now requiring employers to maintain special reserves for retiree health benefits.
Without changes, health-care costs will price many pension and retiree health plans out of existence, Leigh says. Group medical insurance is increasing about 20% each year. And, as a group, the elderly generate the greatest health-care costs.
According to a report in Personnel Journal, 39% of the nation’s companies plan this year to change retiree health benefits, such as requiring larger contributions from working employees, cutting back retiree benefits, or increasing deductibles, co-payments and premiums.
Another study found that companies still paying the full cost of medical insurance for retirees over 65 dropped from 73% six years ago to 52% this year.
But many employers want to retain their retiree health benefits as part of an attractive pension program. Those companies are looking hard at prevention programs.
“It’s forcing us to make choices,” says Clark E. Kerr, vice president of government relations at Bank of American in San Francisco. “(We can) trim the benefits that we offer our retirees or (transfer) more expense onto retirees or try to help retirees to become healthier and use fewer services. Those are our choices.”
But experts feel more studies are needed to show which prevention activities result in the biggest savings. In the Healthtrac study, for example, smoking one fewer pack of cigarettes each day yielded more than $2,300 in annual health-care savings while adding 100 minutes of exercise a week resulted in $134 per year in savings.
Despite financial savings and the prospect of feeling better, experts also have no firm answers on how motivated people will be to change their health habits. Slightly more than 50% of Bank of America employees offered Healthtrac chose to participate. The dropout rate was relatively low.
Many seniors might be held back by the myth that they cannot improve their health after a certain age, says Carole Lewis, an expert on prevention programs for the elderly for the American Physical Therapy Assn. and the author of a book on such programs.
Lewis says many elderly people believe that poor health is an inevitable consequence of old age.
“It’s so sad when my patients say to me ‘I’m 80 years old. What do you expect?’ I tell them arthritis is not normal. It’s a problem. There’s something you can do about it,” she says.
CUTTING HEALTH-CARE COSTS
A study of California retirees has found that weight reduction, exercise, increased seat belt use and a substantial reduction in smoking and excessive drinking can cut yearly health-care costs by up to $4,588 per person. The savings for six months (in hospital days, doctors visits and sick days) are as follows: $1,158 Cigarette smoking reduction from one pack a day to none. $502 Alcohol reduction from more than two drinks a day to less than two. $260 Seat belt use increase from 50% use to 100% use. $257 Body mass decline of .005. $117 Exercise increase of 100 minutes a week. Total: $2,294 ($4,588 per year) Source: Blue Shield of California.
