Abstract
When one considers the health care landscape in the United States, it is difficult to ignore the driving influence of chronic disease on utilization and costs. Indeed, as 2012 data from the Center for Medicare and Medicaid Services demonstrate, 68% of Medicare beneficiaries with multiple chronic conditions account for 93% of all Medicare expenditures (Centers for Medicare and Medicaid Services [CMS], 2012). Chronic diseases, which occur gradually but progress in insidious fashion, pose significant challenges to the people with these conditions and those who care for them (Stone & Benson, 2012). Chronic diseases are prevalent among older persons; 65% of U.S. men and 72% of U.S. women above the age of 65 had two or more chronic illnesses in 2010 (Ward & Schiller, 2013).
Into this challenging but vital context come several Journal of Applied Gerontology articles that describe advances in how chronic diseases and their associated functional limitations are screened, assessed, and managed. Mingo, McIlvane, Haley, and Luong (2015) examine the family care context of older persons with osteoarthritis (OA), and whether racial differences exist in emotions, illness beliefs, and willingness to help a hypothetical family member with OA. African American participants demonstrated more willingness to help a family member with OA and appeared more positive about the prognosis of OA in a hypothetical family member. These intriguing results suggest the importance of cultural values when determining how families initiate and assume care provision of older relatives with a chronic illness. Another study in this issue attempts to disentangle the empirical association between prostate cancer risk and education in older adults. Utilizing almost two decades of data, a large, representative sample derived from the Wisconsin Longitudinal Study (N = 5,218), and Monte Carlo simulation techniques, Pudrovska and Anishkin (2015) found that higher utilization of prostate cancer screening and lower mortality post-diagnosis were the driving factors explaining why higher educated men had higher rates of prostate cancer. This study is timely, given the ongoing debate about the value of prostate cancer screening in the United States. Building on this examination of screening, Lundquist and Ready (2015) offer a very interesting overview on whether public health strategies successfully used in promoting breast cancer screening could inform the early detection of Alzheimer’s disease. Implicit in this discussion is that earlier screening and detection can lead to improved treatment of Alzheimer’s disease (a position that has some, but not yet robust, evidence in support of it). Nonetheless, the article by Lundquist and Ready raise some intriguing ideas related to public health approaches regarding the detection of Alzheimer’s disease.
The article by Clark, Stump, Tu, and Miller (2015) examines whether risk prediction of older adults’ activities of daily living (ADLs) limitations, a classic measure of disability that is often a result of chronic impairment, is improved through the use of cognition measures or gait speed when compared with traditional interview-based strategies. Relying on a large, representative sample of 8,095 older adults from the 2006 Health and Retirement Survey, Clark et al. interestingly did not show improved validity using cognitive measures or gait speed when compared with interview-based approaches. The findings remind us that although “objective” measures of function or other conditions are often touted as optimal, in some instances self-report or interview approaches yield similarly valid results. Further extending this issue’s focus on screening but offering a clinical application, Tisnado, Moore, Levin, and Rosen (2015) developed and piloted a decision-making aid for health care providers when recommending mammography screening for older women. Following the engagement of multiple stakeholders and a literature review, Tisnado et al. report that 2/3 of geriatricians felt that the decision aid would have facilitated a recommendation for mammography screening in instances when a clinical decision was not immediately clear. The introduction of this decision aid could help fill an important gap in clinical geriatric practice.
In using empirical survey data to inform subsequent in-depth, qualitative data collection, Schoenberg, Tarasenko, Bardach, and Fleming (2015) examine the intersection between multi-morbidity and an increased likelihood of colorectal cancer screening among Appalachian residents aged 50 to 76. Themes emerging from nine focus groups (six consisting of providers and three of patients) suggested that multi-morbidity increased providers’ and patients’ vigilance for health complications, and the more frequent contact with health care providers due to these issues resulted in preventive actions such as colorectal screenings. The study by Schoenberg and colleagues highlights how the use of sequential, multiple methods can yield greater explanatory insight as to why certain empirical associations occur. To round out this issue, Fisken, Keogh, Waters, and Hing (2015) examined facilitators of and barriers to aqua-based exercise for older adults with and without OA in a series of focus groups. Pain reduction was perceived as a benefit of aqua-based exercise for those with OA, whereas those without OA tended to focus on health and fitness benefits. Instructors were also perceived as important in acting as both barriers and facilitators to engaging in aqua-based exercise.
The articles in this issue of the Journal of Applied Gerontology offer intriguing findings that help us better understand how chronic diseases among older adults are understood, identified, and managed. Coupled with the book review by Anderson (2015), the articles in this issue of the Journal of Applied Gerontology have provided intriguing contributions to how we understand and address chronic conditions among older adults.