Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.

“A cardiologist puts someone on good, evidence-based medications for his heart,” said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “An endocrinologist does the same for his bones.” And let’s say the patient, like many older adults, also uses an over-the-counter reflux drug and takes a daily aspirin or a zinc supplement and fish oil capsules. Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults. Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported in November that 39 percent of those over age 65 now use five or more medications — a 70 percent increase in polypharmacy over 12 years. Lots of factors probably contributed, including the introduction of Medicare Part D drug coverage in 2006 and treatment guidelines that (controversially) call for greater use of statins. But older people don’t take just prescription drugs. An article published in JAMA Internal Medicine, using a longitudinal national survey of people 62 to 85, may have revealed the fuller picture. More than a third were taking at least five prescription medications, and almost two-thirds were using dietary supplements, including herbs and vitamins. Nearly 40 percent took over-the-counter drugs.

For the article from the New York Times, click here.

The Obama administration tightened rules for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors. For consumers the most visible change may eventually be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years. But the sweeping regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how UnitedHealthcare, Aetna and other large contractors who administer care for some of the most vulnerable patients do business.

For the article from Kaiser Health News, click here.

A staggering share of veterans who served in Iraq and Afghanistan have been returning home with mental illnesses brought on by their time overseas. But as hundreds of thousands struggle with post-traumatic stress disorder, many are going without the help they need, which is prompting several states to step in. State officials say they are trying to bridge what they see as gaps in services provided by the U.S. Department of Veteran Affairs, whose medical centers have been plagued by mismanagement, often face lengthy backlogs and can be located far from rural communities. If veterans with PTSD aren’t treated while their wounds are still raw, it will end up costing not only the veterans and their families, but society, according to state lawmakers and mental health workers. Veterans with PTSD are more likely to be depressed, drink heavily or use drugs, and many have trouble working and maintaining relationships — problems that cost billions of dollars in lost productivity. Starting this year, Texas will give money to nonprofits and private programs that provide treatment to veterans with PTSD and their families. New Hampshire has been training community mental health staff since last summer on how to find veterans and treat their PTSD. And New York is expanding a program that connects service members and veterans with mental health needs in small settings or in activities such as yoga and tai chi. Although state and local governments have long relied on the VA, states have an obligation to veterans, and they need to do more, said Kathryn Power, a regional administrator for the Substance Abuse and Mental Health Services Administration. The agency encourages local governments at a minimum to train mental health center staff about military culture, and make sure they know how to help veterans and their families.

For the article from Pew Charitable Trusts, click here.

Owners of assisted-living facilities are lobbying Massachusetts lawmakers for authority to provide several highly sought medical services — a campaign that is sparking concern among patient advocates and dividing the industry. Unlike nursing homes, which provide round-the-clock medical care by nurses, assisted-living centers are designed and regulated in Massachusetts as private apartments that offer assistance with daily activities, such as bathing, cooking, dressing, and managing medications. Such facilities are home to roughly 14,000 residents in Massachusetts. Proposed legislation would allow assisted-living facilities to provide limited medical services that include injections, catheter replacement, applying medication and sterile dressing for wounds and skin problems, and administering oxygen to patients with serious ailments.

For the article from the Boston Globe, click here.