At Hazel’s 65th birthday celebration, her older sister asked whether she’d scheduled her initial “wellness” visit with her primary care physician (PCP). Hazel had enrolled in Medicare but didn’t know anything about this. She jokingly responded, “Why is a ‘wellness’ visit needed for someone of my age and medical condition?!” Hazel’s history included breast cancer, treated successfully at age 57, and type 2 diabetes, diagnosed at age 61.
As you may know, Medicare is the federal health insurance program that serves adults older than 65 and certain younger people with disabilities. People who reach age 65 have an average life expectancy of an additional 19.5 years (20.6 years for females and 18.1 years for males). In 2016, 38% of Americans aged 65 and older had one or no chronic conditions, 47% had two to three chronic health conditions, and 15% had four or more chronic conditions. Chronic medical conditions can lower quality of life and contribute to the leading causes of death among older adults.
Wellness is defined by Merriam-Webster Dictionary as “the quality or state of being in good health, especially as an actively sought goal.” In general terms, “wellness” can apply not only to physical health but also emotional, spiritual, financial, and social health. Physical wellness typically involves a combination of a healthful diet, regular physical activity, preventive health screenings, and managing chronic health conditions. Although the term “wellness” might imply “healthy,” even older adults and/or those with health problems can strive to be as healthy as possible, regardless of their health limitations. Most experts agree it’s never too late to implement small changes to improve health and quality of life.
Medicare Part B medical insurance now covers a “Welcome to Medicare” preventive visit once within the first 12 months of Part B coverage in addition to an annual wellness visit. These visits consist of a review of medical and social history related to health;, height, weight, vision, and blood pressure screening; counseling about preventive services; and an assessment of what other screenings may be needed for each individual. Medicare Part B covers a variety of screening services, including but not limited to diabetes, cancer, CVD, HIV, mammograms, and prostate screening. Wellness visits can be conducted by a physician, nurse practitioner, or physician’s assistant, or other licensed professionals, including RDs, under the direct supervision of a physician. At an initial or annual Medicare wellness visit, health care providers may recommend covered follow-up services such as diabetes self-management training, obesity counseling, and nutrition therapy services for specific conditions such as diabetes or renal disease.
Annual wellness visits can help older adults achieve the goals of the Healthy People 2020 program to improve the health, function, and quality of life of older adults. A healthful lifestyle that includes good nutrition also can help meet those goals. Tips that address the unique needs of older adults are available at ChooseMyPlate.gov, which also provides a general template of a healthful meal. Some older adults may require referrals to programs and services to address food insecurity or medical nutrition therapy services that aren’t covered by Medicare Part B.
Regular physical activity, as an individual’s age and medical condition allows, is another key component of wellness and improved quality of life for older adults. In 2014, only about 12% of people aged 65 and older reported participating in leisure-time aerobic and muscle-strengthening activities that met federal guidelines. The health benefits of regular physical activity for older adults are numerous and include lower risk of all-cause mortality, type 2 diabetes, CVD, certain cancers, dementia, and depression. More details on physical activity recommendations for older adults are available here.
After her initial preventive visit with her PCP, Hazel began to think differently about her age and health status. She began to make wellness a way of life, challenging herself to make improvements in her lifestyle that could be reflected at her routine PCP visits and her annual wellness visit.
Becky Dorner & Associates has a variety of CPE programs that focus on older adults, including “Nutrition Care of the Older Adult” and “Nutrition for the Older Adult.” Both can be accessed at www.beckydorner.com/product-category/courses.
— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition and long term health care. Her company, Becky Dorner & Associates, Inc, is a trusted source of valuable continuing education, nutrition resources, and creative solutions. Visit www.beckydorner.com to sign up for free news and information.