Recent Articles on Aging

Rachel Elliott, Sumit Majumdar, Muriel Gillick, and Stephen Soumerai, "Medicare Drug Benefit: Benefits and Consequences for the Poor and the Disabled," New England Journal of Medicine 2005; 353:2739-41.

The new Medicare Part D will improve access to medications for millions of Americans. One subgroup of beneficiaries, however, may inadvertently be made worse off: the 7.2 million people enrolled in both Medicaid (because they are poor) and Medicare (because they are elderly or disabled). These beneficiaries, known as the dually eligible, already receive drug benefits through state-run Medicaid programs; but as of 2006, they will be required to enroll in Medicare Part D.

Moving the dually eligible recipients of drug benefits to new federal programs raises several concerns: these beneficiaries may have problems making the transition and negotiating the . . . [Full Text of this Article]

Muriel Gillick, "Advance Care Planning," New England Journal of Medicine 2004; 350: 7-8.

One hundred years ago, the odds that a visit to the doctor would result in a measurable improvement in a patient's condition were slim. But the mere fact that modern physicians are far more likely to be able to influence the course of illness in a particular way does not mean that patients necessarily want them to do so. Patients who are near the end of life often prefer treatment that is focused exclusively on comfort; frail elderly patients may choose to trade longevity for quality of life. Although patients have long been able to refuse burdensome treatment, the U.S. . . . [Full Text of this Article]

Muriel Gillick, "Medicare Coverage for Technological Innovations: Time for New Criteria?" New England Journal of Medicine 2004. 350: 2199-2203.

While Congress was publicly debating a prescription-drug benefit for older patients last year, the Medicare program quietly announced plans to provide coverage for three invasive, high-cost procedures that potentially could affect its 41 million enrollees. The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, opted to pay for lung-volume-reduction surgery, implantable cardioverter-defibrillators, and left ventricular assist devices in selected patients. Although the numbers are speculative, collectively, these three interventions could ultimately affect more than 200,000 people a year at a projected cost of $1.3 billion to $11.4 billion, or from 3 percent to more than 20 percent of . . . [Full Text of this Article]

Muriel Gillick, "Terminal Sedation: An Acceptable Exit Strategy?" Annals of Internal Medicine 2004; 141:206-7.

Muriel Gillick, "Re-thinking the Role of Tube Feeding in Patients with Advanced Dementia," New England Journal of Medicine 2000; 342: 206-210.

A byproduct of the aging of the population has been a dramatic rise in the rate of Alzheimer's disease and other types of dementia. A conservative estimate is that there are currently 4 million people in the United States with dementia.1 In the final stage of dementia, patients are typically unable to walk or to feed themselves, they are incontinent and aphasic, and they have lost the capacity to have relationships with other people. Family members or other surrogate decision makers must make difficult and often painful decisions about limiting care.2 Should they authorize surgery, hospitalization, intravenous medication? . . . [Full Text of this Article]