We were surprised just a few days ago by a news story on National Public Radio revealing a disturbing statistic: barely one in every seven seniors is getting routine, regular screening for cognitive impairment. This is in spite of the fact that almost every primary care physician surveyed – and a huge majority of patients – think such regular screening is worthwhile.
Screening for Dementia is Just Not Happening
You can read the NPR story here. It’s titled, “Alzheimer’s Screenings Often Left Out Of Seniors’ Wellness Exams,” and it’s based on the just-released Alzheimer’s Facts and Figures report for 2019 from the Alzheimer’s Association. This definitive 90-page document is the statistical gold standard for facts, figures and trends related to the prevalence, detection, treatment and cost of this most-dreaded disease. This year the Association included a special report on how well the U.S. is doing in early detection of cognitive impairment by primary care physicians. The answer: we’re doing a pretty poor job of regular screening. “Despite seniors’ and [primary care physicians’] widespread awareness of the benefits of early detection and widely held beliefs that regular cognitive assessments are important, just half of seniors are being assessed, and only one in seven is receiving regular assessments,” says the report.
The National Public Radio news story put this failure to screen seniors into perspective. “Primary care doctors are really good at checking seniors’ cholesterol levels and blood pressure,” said the radio report done by Jon Hamilton, “but often fail to use tests that could detect dementia. Fewer than half of primary care doctors surveyed say they routinely test patients 65 and older for problems with memory and thinking.” Hamilton quoted the Alzheimer’s Association finding that just 16 percent of older patients surveyed say they receive regular cognitive assessments during routine health checkups. This meager percentage stands in sharp contrast to the 90-plus percent of seniors who receive regular blood pressure screening and the 83 percent who say their cholesterol is routinely tested.
“This cognitive assessment should be part of every senior’s annual wellness visit,” Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association, told NPR. “But we’re seeing that it’s simply not happening.”
Screening for Dementia Involves a Few Minutes of Questions
According to the news story, the type of cognitive assessment recommended by the Alzheimer’s Association “typically takes a few minutes and may include questioning the patient or the patient’s family, observing the patient’s interactions or using short verbal or written tests.” Medicare has included a cognitive evaluation as a required part of annual wellness visits. “Yet,” says NPR, “because doctors often skip the evaluation, many seniors are diagnosed only when they are severely impaired.” This means that the diagnosis of the disease comes too late for the patient to become involved in a clinical trial – an important part of researching for an Alzheimer’s cure – and often too late to make necessary plans and adjustments for themselves and their families in a more orderly manner.
One of the great ironies in the news report about failure to provide routine cognitive screening is that practically everyone – physicians as well as patients – seems to agree that it’s important. “The report found that 82 percent of seniors think it’s important to have their thinking and memory checked out regularly,” says NPR, and well over 90 percent of primary care physicians concur. But many doctors hesitate to bring up the topic of cognitive testing with their older patients, according to the Alzheimer’s Association. Physicians are waiting for their senior patients to initiate the conversation, but seniors rarely do that, for a variety of reasons: they’re afraid of bad news, or they think there’s no value in early detection since there’s no cure.
Screening for Dementia: Patients Often Ignore Results
Even if the cognitive screening reveals a problem, follow-up is proving challenging, says NPR. “It can be hard to get seniors who have a cognitive problem to see a specialist and get the right sort of care and counseling,” one expert said. “At least half the time, patients refuse to act on the results of a cognitive assessment.” Doctors say they need to play a much more active role in getting patients to take their case to a specialist, just as they would if a problem showed up on a mammogram, prostate screening, or blood pressure test. But if the screening isn’t being performed in the first place, the question of follow-up seems somewhat academic.
Still, not every medical provider is on board with the value of routine tests for dementia. NPR reports that the U.S. Preventive Services Task Force says “the current evidence on cognitive screening is insufficient to assess whether it does more harm or good.” Other primary care physicians say that testing is unnecessary and time-consuming. As one official with Kaiser Permanente told NPR, “Primary doctors who know their patients well don’t need formal tests to detect cognitive problems. We will notice a change within a few minutes of walking in the exam room.” Her fear is that it’s “hard to justify spending valuable time during a patient’s visit to do a cognitive assessment” because it takes away time that would be better spent on other types of screening, such as tests for heart disease or diabetes.
Is It Time to Change Physicians?
Whether you decide to get screened for cognitive decline or not, this last comment provides one more bit of evidence that, as a senior, your best choice for a primary care physician is a geriatrician. These board-certified geriatric physicians are trained in the particular physiological and emotional needs of older adults, and they’ll take the right amount of time to listen, observe, test and diagnose. We urge you to say good-bye to cookie-cutter medicine and instead to call AgingOptions this week and let us provide you with a list of geriatricians in your area.
If you’re getting serious about planning for your retirement future, we hope you’ll accept the invitation from Rajiv Nagaich of AgingOptions to join him soon at a free event called a LifePlanning Seminar. Rajiv will show you an exciting model for comprehensive retirement planning in which health care, financial security, legal protection, housing choices and family communication are all woven together into one powerful and seamless blueprint. Come discover how to build the retirement of your dreams! You’ll find a calendar of upcoming seminars on our Live Events page – then simply register for the date and time that works for you.
There’s no “hidden secret” to proper retirement planning – it’s available to you today from the professionals at AgingOptions. Age on!
(originally reported at www.npr.org)
