Behavioral and lifestyle factors have a profound impact on health throughout the life span. For example, older adults can help to prevent disease and disability and improve their quality of life through healthy behaviors such as ensuring proper nutrition, exercise, use of preventive health care, and avoiding smoking and alcohol abuse. NIA research on behavioral and social factors in aging encompasses a number of areas, including the effects of behavior and attitude on health, economic implications of aging at both the personal and societal levels, and the demographics of aging.
Does more spending buy better care? Dramatic differences in per-capita Medicare spending exist across U.S. regions. For example, in 1996, average per-capita Medicare spending in Miami was over two and a half times the average in Minneapolis. These regional differences in spending are due neither to differences in the prices of medical services nor to levels of illness or socioeconomic status; rather, they are largely due to the overall quantity or intensity of medical services in high-cost regions. Remarkably little is known, however, about whether the higher spending results in better medical care or better health outcomes.
In a recent study, researchers used a variety of databases and drew on recent advances in research methods to examine the relationship between increased Medicare spending and the content, quality, and outcomes of care. They assigned each of 306 U.S. regions to one of five different quintiles of spending using a measure of overall practice intensity. They then studied nearly one million Medicare enrollees who had been hospitalized in the mid 1990s for a heart attack, hip fracture, or new diagnosis of colorectal cancer, as well as a representative sample of the elderly, and found:
- Patients in the highest spending regions received about 60 percent more medical care than similar patients in the conservative regions, and the additional services (and thus higher spending) were largely due to a more inpatient-based and specialist-oriented pattern of practice.
- Residents of higher spending regions did not receive more major surgery.
- Access to basic health care services was slightly worse in high-spending regions.
- Quality of care was no better in the higher spending regions; for example, although mammography was performed equally across regions of different spending levels, other preventive services such as flu and pneumococcal immunizations and pap smears were performed less frequently in the highest spending regions.
- Finally, health outcomes were no better in higher spending regions: For example, during five years of follow-up mortality rates after adjustment for health status were two to five percent higher in the regions that provided more care.
These findings suggest that the quality and outcomes of care for Medicare enrollees are at least as good, and perhaps better, in lower-spending regions of the United States.
Health, life expectancy, and health care spending among the elderly. Life expectancy among the elderly has been improving for decades, and some economists have speculated that increasing longevity could be associated with higher healthcare costs. To determine whether this is true, investigators developed a model incorporating life expectancy, health status, and annual healthcare expenditures and found that a person with no functional limitations at age 70 could expect to live an additional 14.3 years and accumulate health expenditures of $136,000 (measured in 1998 dollars). Average expenditures per year increased with worsening health status, from about $4,600 per year for persons reporting no limitations to about $45,400 for institutionalized persons. These findings suggest that increased longevity is not in and of itself associated with higher healthcare costs, and that health promotion efforts, such as those encouraging smoking cessation and exercise, will not only result in better health and longer life for the elderly, but may also result in decreased costs for the healthcare system.
Does assistive technology substitute for personal assistance among the disabled elderly? Total expenditures in the United States for home care services amounted to more than $32 billion in 1999 and are expected to triple by 2010. However, researchers recently found that individuals who used assistive devices (such as canes, walkers, or wheelchairs), although more disabled, also received fewer hours of personal help per week than people who did not use such devices, indicating that assistive technologies can substitute to some degree for personal assistance. This suggests that compared to the financial costs of employing a paid personal assistant, use of assistive technology could amount to cost savings to both individuals and insurers.
Use of internet for healthcare information. Use of the Internet and e-mail for healthcare information has attracted considerable attention as a means to improve healthcare delivery. In fact, results from a recent national Internet-based survey of users ages 21 and older indicate that although Internet use is prevalent, it has not replaced traditional face-to-face contact between patient and provider. Specifically:
- Approximately 40 percent of respondents reported using the Internet to look for advice or information about health or healthcare.
- Six percent of respondents reported using email to contact their healthcare provider.
- One-third of respondents reported that the use of the Internet affected their healthcare decisions; however, despite these reports, the authors found few impacts of Internet usage on healthcare utilization or practices.
- Few individuals used the Internet to obtain prescription drugs.
- Individuals in worse health and with less education were more likely to use the Internet to contact others with similar health problems.
- Among individuals with more chronic healthcare conditions, Internet users gained a greater understanding of their condition from on-line health information.
- Few respondents changed their healthcare regime or made substantive decisions based on Internet information.
To respond to the unique needs of Internet users over 60, the NIH launched NIHSeniorHealth.gov on October 23, 2003. Developed by the NIA and the National Library of Medicine, this web site is easy for older adults to read, understand, remember, and navigate. For example, the site features large print and short, easy-to-read segments of information repeated in a variety of formats – such as open-captioned videos and short quizzes – to increase the likelihood it will be remembered. Consistent page layout and prompts help users move from one place to another on the site without feeling lost or overwhelmed. The site will also have a function that will allow users the option of reading the text or listening to it as it is read to them.
The risk of many diseases increases with age, so the site sponsors are focusing on health topics or specific diseases that are of particular interest to older people, including Alzheimer’s disease, Alzheimer’s disease caregiving, arthritis, balance problems, breast cancer, colorectal cancer, exercise for older adults, hearing loss, lung cancer, and prostate cancer. In coming months, topics will include complementary and alternative medicine, diabetes, falls, shingles, vision changes, and others. Each topic provides general background information, quizzes, frequently asked questions (FAQs), open-captioned video clips, transcripts for the videos, and photos and illustrations with captions. Since its launch, the site has averaged over 17,000 page requests per day.
NIHSeniorHealth.gov is expected to serve as a model for web designers seeking to make sites accessible for older adults. The NIA and NLM have also developed a booklet, Making Your Web Site Senior Friendly: A Checklist, which gives guidelines that can be used to update any web site with cognitive aspects of aging in mind.