The AWV is a discovery tool which helps people live better and happier lives. Below are a few stories about patients whose lives are better as a result of a discovery during the AWV.
Martha, age 76, was using a cane and having difficulty walking. When asked about her cane use, Mary replied “I started about 3 or 4 months ago. I was having a hard time keeping my balance. I just don’t have the strength I used to.” Why didn’t she come in? Mary said “I didn’t want to be a bother. I didn’t think anything could be done. That I would just had to live with it” After a quick review of her medications to rule them out as the cause, Mary was referred to physical therapy. She eventually became strong enough to stop using her cane. In addition, she was referred to a fall prevention class offered free of charge at a local senior center which Mary said was very helpful.
According to the CDC, one in three adults aged 65 and older falls each year. Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently, and increase their risk of early death. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.
Annual Depression Screen
Sandra, age 69, had very high results for depression. She wasn’t suicidal but she was heavily weighed down by a sense of sadness and disinterest. No one would have known. Depressed patients don’t usually pick up the phone to say “I need to see the doctor. I’m sad”. The practice arranged for Sandra to speak with counselor specializing in senior depression the next day. They also gave her a prescription and scheduled a follow up visit for the next week. Sandra continued counseling for a few months, started walking, and made some other changes in her life. She showed no sign of depression at her next annual depression screen.
Healthcare providers may mistake an older adult’s symptoms of depression as just a natural reaction to illness or the life changes that occur as we age. Regular screening helps identify individual who need help.
Sam, age 70, was obese. He had been for a long time along with several chronic conditions – high blood pressure, diabetes, and cardiovascular disease. As part of Sam’s personalized prevention plan, he was scheduled to come back and meet with the doctor for obesity counseling (Intensive Behavioral Therapy). Since there was no co-pay Sam agreed to give it a try, but just once. During those 15 minutes they had a productive interaction that engaged Sam. Together they decided on a short term goal for Sam. The doctor provided helpful information and suggestions. Sam was then scheduled for a follow up session the next week. Sam built on the small success he experienced that week. He continued to lose weight, gain strength, and increase his endurance. Four months later, Sam told the staff, “I can’t believe it. I’m wearing normal shoes and my feet don’t hurt. I can walk almost 2 miles now.” But the best outcome was when Sam was able to stop taking insulin. He was also able to reduce the dosage of his blood pressure medication. “Having this one-on-one time where we only talk about how to get healthier has been amazing. I was tired of hearing how sick I was”, said Sam.
More than one-third of adults over 60 (35.4%) are obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.
Exercise & social connections
“I hate exercise”. Those were the first words out of Harold’s mouth, when he was presented with his personalized prevention plan. Luckily the AWV team member wasn’t daunted by this brisk 68-year-old. She said, “I totally understand. I hate exercise too. That’s why it’s important to find something you like that doesn’t feel like exercise. That’s the secret. Even a little bit of activity will help you.” Harold didn’t say anything but she could sense he was listening. “Have you ever tried going to the senior center? Their classes are very social and I think they laugh more than they exercise. You never know, you might make some friends.” Still no answer. “The Y has classes just for seniors or maybe you might find swimming or water aerobics fun. Think fun – don’t think exercise”. Harold rolled his eyes. A few months later Harold was in the office for a bad cough. He said to the staff, “Tell that gal that they do laugh a lot at the senior center and I have made some friends. I even go walking most mornings with my neighbor.”
The benefits of regular moderate exercise are numerous. In addition to its role in weight control, it can improve a patient’s ability to do daily activities and prevent falls. It strengthens bones and muscles and improves mental health and mood. It can also reduce the risk of cardiovascular disease, type 2 diabetes, metabolic syndrome and some cancers. Studies indicate that strong social ties is one of the biggest predictors for better health, happiness, and longevity.
Thomas, age 72, was healthy. His weight was normal. He ate well and felt good. However, he was determined to be at risk for diabetes during his AWV because of his family history. His blood test showed he as slightly diabetic. This came as a bit of a shock to Thomas. He wasn’t like his overweight relatives. With the help he gained from two Medicare preventive services – Diabetes Self-Management Training and Medical Nutrition Therapy, Thomas is controlling his diabetes through diet and exercise. His lifestyle changes weren’t big but the impact on preventing diabetes complications was huge.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.
When you tell older seniors you want to do a simple cognitive screen with them, you can see the small flash of fear in their eyes. Karen, age 80, failed the cognitive impairment screen portion of the AWV which indicated the need for additional diagnostic testing. She was undecided about the testing. She wasn’t sure she wanted to know. Her memory wasn’t causing her any problems at the moment and even if she found that there was a problem, what could she do about it? Karen did decide to be tested. She found she had very mild impairment and that there were things she could do to improve her brain/cognitive health.
According to the CDC, half of the people who meet the diagnostic criteria for dementia have not received a diagnosis from a physician. Early detection and diagnosis are essential to providing the best medical care and outcomes for people at any stage of the disease. Even without a way to cure or slow the progression of dementia, including Alzheimer’s disease, an early formal diagnosis offers the best opportunities for intervention and better outcomes. With a diagnosis in hand, individuals and their caregivers can access available treatments, build a care team, and better manage coexisting chronic conditions.
These are just a few patients that have been helped through the AWV, but there are still so many patients who are not getting the help they need. According to Medicare, less than 18% of the 57 million Medicare patients received their AWV in 2016. That means over 47 million patients missed out on this powerful discovery tool and the opportunity to improve the quality of their lives.