Interim Charge by Liam M. Fry, MD, FACP, CMD
Senate Health and Human Services
Interim Charge on Healthy Aging
Feb. 18, 2016
Good afternoon, chair and members of the committee. I want to thank you for the opportunity to testify on the interim charge related to healthy aging. I am Liam Fry, MD, CMD, FACP, a physician practicing internal medicine in Austin, with a focus on geriatric medicine. I am board certified in internal medicine, geriatrics, and hospice and palliative care. I am here on behalf of the Texas Medical Association, representing more than 48,000 physicians and medical students. I appreciate the opportunity to share our comments on this charge regarding the effects of aging, healthy lifestyles, chronic diseases, the effect of public and community health, and the importance of access to care.
Within 15 years, one in five Texans will be age 60 or older. Many people likely imagine these older Texans as living with chronic conditions and diseases that erode their health and their social and economic lifestyle. While a significant proportion of Texans aged 65 and older have one or more chronic diseases, today, even many people aged 50 to 65 are already living with chronic conditions such as arthritis, cancer, diabetes, or cardiovascular disease.
We commonly identify these as diseases of aging — but they do not have to be a part of normal aging. The longest study of human aging  reinforces our understanding that normal aging does not have to include costly, disabling diseases that limit a person’s lifestyle. As we age, our body grows less capable of maintaining energy levels, retaining all of our cognitive abilities, and even resisting disease. But this decline begins in our 30s and 40s, when we still can adopt healthy lifestyle practices that will help us resist or prevent many disabling and costly diseases later in life.
While our health is largely influenced by genetics, we physicians advise our patients that a healthy lifestyle is essential to healthy aging. A healthy lifestyle includes healthy eating with a focus on certain nutrients (such as calcium and vitamin D) while avoiding some substances (sodium, sugars, certain fats); regular physical activity (to reduce muscle loss and maintain physical balance for fall prevention); monitoring of behavioral health (alcohol and substance use, depression, and adequate sleep); regular testing and health screenings (weight, blood pressure, glucose, cholesterol, cancers, vision, and dental); and vaccinations (influenza, pneumococcal, and zoster) to prevent or delay onset of disease.
But the preventive and clinical care we offer our patients in the medical home is most effective when it is complemented with a strong public and community health system. This integration of medicine and population health presents the best opportunity to reduce and mitigate the chronic conditions and disabilities associated with aging. For this to work, we need your continued support so that state and local agencies have the ability and resources to provide services and programming. Some of the key functions of public health and proposed programming to support healthy aging include:
- Public health monitoring and surveillance of chronic diseases and working with communities to assess the prevalence of risk factors (such obesity, overweight, physical activity, and substance use), along with physician and provider access to these data;
- Training, surveillance, and initiatives aimed at preventing the spread of infectious diseases in long-term care facilities, including antibiotic stewardship;
- Monitoring and surveillance of injuries to expand and support evidence-based injury prevention programs;
- Evidence-based community/local population-based programming such as the Texas Department of State Health Services’ potentially preventable hospitalization program;
- Education of the public health workforce to enhance awareness of aging and evidence-based clinical guidelines for the aging population, and of prevention programming including home-centered services that support independence;
- Preparedness planning to support the aging population in the event of a disaster or infectious disease emergency; and
- Assessing how to address gaps in and strengthen our statewide child and adult vaccination programs, emphasizing strong policies to support vaccination of caregivers and health care workers in health facilities.
Public health workers and the medical community need to have timely, high-quality data on the health status of Texans and the threats to their health. Public health monitoring and surveillance, vaccination, and an informed public and health care workforce are crucial for us to assist our patients in adopting healthy behaviors and reducing their risk for disabling and costly chronic conditions.
Yet much of the positive effect of these steps means little if these patients cannot access doctors’ care when they need it. Many of these patients are the frailest of the frail and the oldest in our communities, so-called “dual-eligible” patients. They are eligible for Medicaid assistance, and their age or chronic condition qualifies them for Medicare. Physicians caring for these patients continue to face the challenge of less payment than in prior years, so increasingly doctors are being forced out of providing their care. As a result too many of these vulnerable patients have no medical care at all. Unless action is taken to reverse this trend, it will continue in the coming years as the population grows. Therefore we urge the state to make dual-eligible patients’ care a funding priority as deliberations begin on the next budgets later this year.
While our aging population is growing exponentially, these Texans’ future does not need to include chronic health conditions. We can do more to promote healthy aging, but we need to start to work now to promote healthy communities and environments to support a culture of healthy aging.
 U.S. Department of Health and Human Services, National Institute on Aging, Baltimore Longitudinal Study of Aging.
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