Did you know: in 2010, 46% of fee-for-service Medicare spending went to those 14% of beneficiaries who had six or more chronic conditions. (See Fig 3.2 of the 2012 Medicare Chronic Conditions Chartbook.)
You might think those are unusually sick seniors. But when I practiced primary care internal medicine, I saw people with 6+ conditions all the time. As you can imagine, they tend to see doctors a lot. (That data is in Figure 2.4 of the chartbook.)
It’s actually not that hard to end up with several chronic conditions by age 65: a history of smoking and being overweight in middle age will easily bring on 6+ chronic conditions later in life. And many of those seniors don’t look that sick or disabled.
But they struggle with their symptoms, and they especially can struggle with an overwhelming amount of “self-healthcare” to manage.
If there’s anyone who would benefit from digital health technology, it’s them. They need help with their health. Their primary care providers need help helping them. Their adult children are worrying. Oh and, we want to help them in order to minimize ED visits and hospitalizations, which are distressing for seniors and expensive for all of us.
Unfortunately, over the past three years I’ve found very little that seems usable and useful for these seniors with multiple chronic conditions.
So as part of my upcoming ebook about better digital health for seniors, I’ve written a little story. It illustrates the situation of Joan, an older woman struggling with multiple conditions. I’ve even included her medication list.
As you read this, consider the following:
- If you’ve developed or are using a digital health app or service: do you think it will work for Joan?
- More importantly: what do you think would be most beneficial to Joan right now, to help her with her health?
Joan’s Health Story (According to Joan)
She didn’t always have health problems. She had a career and raised her kids and earned a good pension that supports her now that she’s retired. She lost her husband to a heart attack years ago, but she’d be doing fine on her own if she didn’t have to keep going to the doctor all the time.Maybe she hadn’t taken the best care of herself, but who knew the difference? Everyone smoked. And she quit five years ago anyway. She’s maybe a little overweight, all right, but you try having three kids and see if you stay slim.
He said something about her kidney function last time, too. She can’t remember what it was. He didn’t seem like he was that concerned, so she won’t worry about it just yet.
She tries to take her pills when she should, although she slips up more when she’s feeling depressed.
She has seven prescription pills and two inhalers, plus she takes vitamins and calcium. When her knees hurt – which is almost all the time these days – she takes over-the-counter painkillers. She likes the PM versions; they help her sleep. One of them is bad for the kidneys, but she can never remember which one. It’s either the Advil or the Tylenol. Who can keep track?
On top of all that, she’s supposed to keep a strict diet for the diabetes and check her blood sugar every day. But the doctor hardly ever looks at her glucose logs anyway, and it hurts, sticking yourself every day like that. And she’s tired. She’s alone now, and she hurts all the time.
They want her to exercise too, to lose weight. But it’s so hard with her arthritis, and she’s too tired to do much of anything. She often gets short of breath even when she’s not running around, from the COPD. Or is that her atrial fibrillation? One of them, anyway.
The doctor said she should try checking her pulse when she feels short of breath but who wants to check a pulse when you can’t breathe? She just wants to sit down and rest until she feels better. She doesn’t even know how to take her pulse, anyway. Sure, you put your fingers on your wrist, fine, and then you count. But for how long? She doesn’t even wear a watch – how’s she supposed to keep time?
Between the doctor’s visits and the shortness of breath and the arthritis pain, it’s gotten so hard to do the things she wants to do. She can barely see her friends or do anything fun. She just hurts all the time. Susie, her daughter, is worried she’s depressed. She doesn’t really think so. She’s not sad or anything like that. She just doesn’t want to do much. She just wants the pain to go away.
She fell down the other day. She’s not sure why. She just felt light-headed, stumbled, and fell down in her living room. It took her a while to get back up, and Susie was mad at her. “Mom, you need to tell the doctor. It can be dangerous for you to fall at your age.”
“I did tell the doctor. She says to check my blood pressure next time and let her know if it happens again.”
Susie didn’t like that. She kept saying how Joan needs to take care of herself, before all the health conditions get worse. Susie’s a good girl but she doesn’t understand. She’s raising her own kids. Joan remembers what that was like. Sure, you’re tired all the time, but your body still works. You can still run around after them. You can still remember the ballet recitals and the doctor’s appointments and the way they like their sandwich made. Suzie just doesn’t understand, that’s all.
It’s hard being older with health problems. The doctors give you so much stuff to do and remember, but you can’t remember everything. You can’t run around getting things done. No one seems to realize that.