Economic issues in the care of the elderly cancer patient.

ODAY’S nursing, medical, and lay literature regarding the elderly universally addresses the monumental concern about the health of our graying America. Over the next 50 years, the number of elderly individuals in the U.S. will double,’ and one out of every five will be 65 years or older.2 With this group emerging as the most rapidly expanding segment of our population, the health care of these individuals has become a major national concern. During the last several years dramatic changes have occurred in policies affecting health care for the elderly. Programs of health care and benefits have been developed and/or expanded at significant expenditure of federal monies. When a large proportion of public funds is allocated to one segment of the population, a “red flag” is waved; various sectors of society then attempt to influence or implement health policies that favor their interests. When the issue is health care these groups include (1) the consumer, who is concerned about the rising cost of deductibles, premiums, and outof-pocket payments; (2) the third-party payers including Medicare, Medicaid, Blue Cross, commercial insurances, and health maintenance organizations (HMOs) who are concerned about increasing numbers and costs of reimbursable charges; (3) the legislators, who are trying to control the health expenditure of the Gross National Product (GNP); (4) the health care providers, who want to stay in business but at the same time maintain a competitive quality of patient care; and (5) the big businesses who want to control their expenditures of health insurance premiums. 3 As the largest group of health care providers, nurses, too, face the dual challenge of providing care that is competitive, cost effective, and yet of a quality compatible with our professional standards. Care for the elderly is no exception. With 50% of all cancers occurring after age 65, the practice of oncology nursing will be predominantly involved with the elderly population4 As the greater proportion of our population approaches old age, those nurses specializing in oncology may need to subspecialize into geriatric oncology. Just as nursing interventions differ depending on the patient’s treatment modality and stage of illness, nursing practice will need to focus on distinct age categories. The obvious parallel is the current subspecialty of pediatric oncology. In developing effective strategies for patient care, the nurses must consider the impact of the individual’s formative years. Piaget labels these years the formal operation per&L5 It begins in adolescence and spans the ages of 12 to 18 years. During this time, youths1 become capable of thinking, conceptualizing, and hypothesizing.5 These years are significant in developing philosophies on life and/or cultural expectations. To emphasize this concept, consider the following: In 1987 you meet a patient who is 63 years of age. What historical event, life crisis, or medical discovery occurred during the patient’s formative years, or in the 193Os? Answer: At that time the Great Depression occurred. Individuals were not encouraged to ask questions regarding health care symptoms. Physicians were seen as rather saintly individuals and the diagnosis of cancer was fatal. (Keep in mind that chemotherapy was only introduced as a treatment modality in the late 1940s.) Therefore, in providing care for individuals 60 or older who are diagnosed with cancer, we must be cognizant of their perceptions of cancer as a hopeless disease, of the health care system as mysterious and frightening, and of money matters being a serious and worrisome issue. McCaffrey6 reported that misconceptions about cancer increase with subsequent decades of life. To intervene effectively and efficiently, oncology nurses must dispel the myths or misconceptions about cancer, emphasizing that today’s medical advancement has improved the cure rate of cancer to 50%.’ Nurses must also encourage patient/families to ask questions about their illness, serving as a patient advocate when necessary. Finally, and perhaps most importantly, nurses must feel comfortable in allowing patient and family to discuss their financial