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Health

Here come the Boomers

—Bob Moos, Southwest Public Affairs Officer, Centers for Medicare and Medicaid Services

The first wave of baby boomers will turn 65 next year and become eligible for Medicare. Beginning January 1, about 8,000 boomers a day will join the ranks of the 47 million Americans already benefitting from the nation’s largest health insurance program.

True to form, the generation that has gone through life believing it’s invincible hasn’t given much thought to Medicare. Indeed, research from the National Association of Insurance Commissioners says many boomers are confused about the basics. 

About two-thirds of those surveyed admitted they aren’t familiar with the insurance program’s options. That’s cause for concern. Boomers who don’t understand the fundamentals of Medicare won’t be able to make informed decisions about their health care.

So here’s the short course–Medicare 101, if you will–for the 76 million Americans born between 1946 and 1964.

Medicare comes in four parts. Part A covers hospital stays, skilled nursing care, home health services, and hospice care. You won’t pay a monthly premium for Part A if you or your spouse paid Medicare taxes during your working years.

Part B covers doctor visits, preventive services, outpatient hospital care, and medical equipment. You’ll pay a monthly premium for Part B—$110.50 for new enrollees this year. If your income is higher than $85,000 as an individual or $170,000 as a couple, you’ll pay a higher premium.

You’ll probably also buy a Part D drug plan from one of the private insurance companies in the business. The monthly premium, annual deductible, and other out-of-pocket costs will vary according to the particular plan you choose for your individual prescription needs.

Because Original Medicare usually pays for most, but not all, of a patient’s health care costs, you may consider shopping for additional coverage or for help with the out-of-pocket expenses that Medicare doesn’t pay for.

Under Part C, you can join a Medicare Advantage health plan sold by private insurers. In addition to the services that Original Medicare covers, Medicare Advantage plans usually offer extra benefits, like dental, hearing, and vision care. Most include drug coverage. The plans may also charge a separate monthly premium on top of the Part B premium.

As an alternative to a Medicare Advantage plan, you can supplement your Medicare coverage by buying Medigap insurance. In return for a monthly or quarterly premium, the private policies fill many of the “gaps” for deductibles, copayments, coinsurance, and other charges not picked up by Medicare.

Besides mastering the ABCs and Ds of Medicare, you’ll need to know what to do to get your benefits. That’ll depend on whether you’re already collecting Social Security.

If you’re on Social Security, you’ll be automatically enrolled in Medicare’s Part A and B. About three months before your 65th birthday, you’ll get a Medicare card and letter in the mail, explaining that your monthly Part B premium will be deducted from your Social Security check.

You’ll have the option of declining Part B coverage. But unless you have health care coverage through your or your spouse’s current employer, delaying enrollment in Part B could result in a penalty—in the form of a higher monthly premium—when you do sign up later.

There’s also a penalty for joining a Part D drug plan later.

If you’re not on Social Security when you turn 65, you’ll need to sign up for Medicare yourself. The Social Security Administration, which is responsible for enrolling most people in the health insurance program, says you can start the process about three months before your 65th birthday.

Don’t fret. It’s not hard. There’s a new online application that takes less than 10 minutes to complete. Visit www.socialsecurity.gov, and click on “Retirement/Medicare.” Or, if you don’t want to apply online, you can make an appointment by calling (800) 772-1213.

As I said, this was the short course. For more detailed information about Medicare, get a free copy of the Medicare & You handbook. You can download it at www.medicare.gov, or request a copy by calling Medicare’s toll-free help line at (800) 633-4227.

And, by the way, happy 65th!


The Healthy Geezer

—Fred Cicetti

Q. How serious is a TIA? I heard that they’re really nothing to worry about.

TIA stands for “transient ischemic attack.” A TIA is an interruption in the flow of blood to a part of your brain. Its symptoms are the same as for a stroke. A TIA lasts anywhere from minutes to many hours. It goes away and leaves no apparent permanent effects.

And it is definitely something to worry about.

If you have a TIA, your chances of having a stroke are increased nine times. Treat a TIA like an early warning, and get to your doctor immediately for a checkup.

A stroke, which is also called a “brain attack,” is caused by a blood problem in the brain. An “ischemic stroke” is caused by too little blood in the brain. An “hemorrhagic stroke” is caused by too much blood. About 80 percent of strokes are ischemic strokes; they occur when blood clots or other particles block arteries to your brain. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures.

During a stroke, brain cells are deprived of oxygen and nutrients and begin to die. The earlier a stroke is treated, the better the results.

In the U.S., stroke is the third-leading cause of death, behind heart disease and cancer. It is the leading cause of adult disability. About 700,000 Americans have a stroke each year; about 160,000 of these people die.

The most common stroke symptoms include: sudden numbness, weakness, or paralysis of the face, arm, or leg—usually on one side of the body; trouble talking or understanding; sudden blurred, double, or decreased vision; dizziness, loss of balance, or coordination; a sudden headache with a stiff neck, facial pain, pain between the eyes, vomiting, or altered consciousness; and confusion or problems with memory, spatial orientation, or perception.

The following can increase your risk of a stroke: a family history of stroke or TIA, aging, race (African-Americans are at greater risk), high blood pressure, elevated cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, previous stroke or TIA, heavy alcohol drinking, and uncontrolled stress.

Your doctor has many diagnostic tools for stroke. Among these are: physical exam, blood tests, carotid ultrasonography to check the arteries in your neck, arteriography to view arteries in your brain, a computerized tomography (CT) scan of the neck and brain, and a magnetic resonance imaging (MRI) of the brain, among others.

Treatments are varied and include: therapy with clot-busting and clot-preventative drugs; carotid endarterectomy to remove plaques in the arteries; angioplasty to widen the inside of an artery leading to your brain; catheter embolectomy to remove clots; aneurysm clipping to clamp off a dilation in an artery to keep it from bursting; and aneurysm embolization to seal off a dilation through clotting.


A new order for CPR, spelled C-A-B

The American Heart Association (AHA) is rearranging the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in Circulation: Journal of the American Heart Association.

Recommending that chest compressions be the first step for lay and professional rescuers to revive victims of sudden cardiac arrest, the association said the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-A-B (Compressions-Airway-Breathing).

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose, and breathing into the victim’s mouth and only then giving chest compressions,” said Michael Sayre, M.D., coauthor of the guidelines and chairman of the American Heart Association’s Emergency Cardiovascular Care (ECC) Committee. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away.”

In previous guidelines, the association recommended looking, listening, and feeling for normal breathing before starting CPR. Now, compressions should be started immediately on anyone who is unresponsive and not breathing normally.

All victims in cardiac arrest need chest compressions. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim’s brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.

The change in the CPR sequence applies to adults, children, and infants, but excludes newborns.

Other recommendations, based mainly on research published since the last AHA resuscitation guidelines in 2005:

  • During CPR, rescuers should give chest compressions a little faster, at a rate of at least 100 times a minute.
  • Rescuers should push deeper on the chest, compressing at least two inches in adults and children and 1.5 inches in infants.
  • Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.
  • Rescuers should avoid stopping chest compressions and avoid excessive ventilation.
  • All 9-1-1 centers should assertively provide instructions over the telephone to get chest compressions started when cardiac arrest is suspected.
  • “Sudden cardiac arrest claims hundreds of thousands of lives every year in the United States, and the American Heart Association’s guidelines have been used to train millions of people in lifesaving techniques,” said Ralph Sacco, M.D., president of the American Heart Association. “Despite our success, the research behind the guidelines is telling us that more people need to do CPR to treat victims of sudden cardiac arrest and that the quality of CPR matters, whether it’s given by a professional or nonprofessional rescuer.”

Since 2008, the American Heart Association has recommended that untrained bystanders use Hands-OnlyTM CPR—CPR without breaths—for an adult victim who suddenly collapses. The steps to Hands-OnlyTM CPR are simple: Call 9-1-1, and push hard and fast on the center of the chest until professional help or an automated external defibrillator (AED) arrives.

Key guidelines for health care professionals:

  • Effective teamwork techniques should be learned and practiced regularly.
  • Professional rescuers should use quantitative waveform capnography—the monitoring and measuring of carbon dioxide output—to confirm intubation and monitor CPR quality.
  • Therapeutic hypothermia, or cooling, should be part of an overall interdisciplinary system of care after resuscitation from cardiac arrest.
  • Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity (PEA) or asystole.

Pediatric advanced life support (PALS) guidelines provide new information about resuscitating infants and children with certain congenital heart diseases and pulmonary hypertension and emphasize organizing care around two-minute periods of uninterrupted CPR.

The CPR and ECC guidelines are science-based recommendations for treating cardiovascular emergencies, particularly sudden cardiac arrest in adults, children, infants, and newborns. The American Heart Association established the first resuscitation guidelines in 1966.

The year 2010 marks the 50th anniversary of Kouwenhoven, Jude, and Knickerbocker’s landmark study documenting cardiac arrest survival after chest compressions.

A complete list of authors is on the manuscript.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy. Most manufacturers and other companies also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenue information from pharmaceutical and device corporations is available at www.americanheart.org/corporatefunding.

     

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