THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
In a world riddled with uncertainties of varying degrees, one thing is sure: it is impossible to get younger. Each passing second and minute and hour takes a biological toll on every cell that exists in the body, and this toll eventually culminates in the body giving up in the ultimate way – aka, death.
But let’s not start this discussion with gloomy profoundness. The point I am driving at is that we will all age and an unfortunate consequence of this is that our bodies will weaken. This is why a 30-year-old body is not on the same level of physical and mental health as an 80-year-old body.
If you read the headline before reading, you may be wondering exactly what the relationship is. Well, a study has found that seniors dedicate the equivalent of three weeks every year to accessing healthcare outside their homes. In this context, seniors refer to adults above 65. The whole preamble I gave was to establish that it is indeed normal for adults to require more healthcare attention. It’s just biology. The older you get, the weaker you get, and the more you need external attention to keep the body moving.
It seems an obvious inference that older people will spend more time in the hospital. Also, it seems pretty straightforward to expect that the time you spend in the hospital is a valuable representation of the state of your health. Given those assumptions, you may then find it surprising that very little research has been devoted to estimating how long adults actually spend in hospitals and how it relates to health.
Consider it. We always wonder why some people are healthier than others in their older years. There are many possible answers to this, including their lifestyle, diet, occupation, their previous experiences, and, of course, their access to quality healthcare. Of these markers, access to quality healthcare is held in high regard among seniors. This is because even living healthy at a certain age is not nearly enough to guarantee that you will be healthy.
However, access to healthcare is not the easiest to measure. Therefore, we are often forced to make gross generalizations, especially on the basis of race, location, economic status, education, and the like. These generalizations have been more widely researched and, while relevant in some cases, have their flaws. One way, though, that can be used to correlate access to quality healthcare is the time spent in hospitals. This is what a recent study has considered, and I am here to break it down for you.
According to the study, which considered 6619 older adults, there was an average of 21 total healthcare contact days in the year. By total contact days, the study refers to both ambulatory and institutional contact. Yeah, yeah, I’d explain.
Ambulatory contact days refer to days with primary care visits, specialty care visits, tests, imaging, procedures, or treatments. On the other hand, institutional contact days refer to the other times spent in an emergency room, hospital, skilled nursing facility or hospice. Of the total contact days, 17 days were for ambulatory services, while the other four were for institutional visits.
From surface viewing, this finding does not mean much, except maybe to generate an interesting “hmm, I did not know that” for most people. It starts to make more sense, though, when you consider the factors that allowed for more contact days. These factors are some of the familiar ones when considering inequality in healthcare access generally. They include age, race, ethnicity, gender, income, education, location, and conditions faced.
More specifically, the study states that factors associated with more ambulatory contact days include “younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and care-seeking behaviors (for example, “go to the doctor…as soon as (I)…feel bad).”
By implication, Black and Hispanic people, as well as lower-income adults and the less educated, are associated with fewer ambulatory contact days. This can then be correlated to reduced access to quality healthcare. These groups also dominate on mortality rate charts and statistics. This further emphasizes why healthcare access inequity is a systemic problem and one that should be viewed from an urgent lens.
However, beyond stamping what we already knew, the study also found that there is an undue burden placed by non-clinical factors on many patients when it comes to healthcare contact days. For instance, half of the test and imaging days were not on the same day as office visits. In other words, patients had to spend longer in hospitals for non-clinical reasons. Considering the age of these individuals, hospitals and healthcare providers should consider how they can reduce the stress on patients to the barest minimum.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist; Board certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ; House Call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://pubmed.ncbi.nlm.nih.gov/38252944/
- https://www.ajmc.com/view/older-adults-in-traditional-medicare-spend-weeks-per-year-on-health-care-contact-days
- https://www.hcplive.com/view/older-adults-spend-3-weeks-the-year-receiving-out-of-home-healthcare
