It can be hard to quantify the problem of elder abuse. Experts believe that many cases go unreported. And Wednesday morning, their belief was confirmed by two new government studies.

The research, conducted and published by the Office of Inspector General of the U.S. Department of Health and Human Services, finds that in many cases of abuse or neglect severe enough to require medical attention, the incidents have not been reported to enforcement agencies, though that’s required by law.

One of the studies focuses solely on the possible abuse of nursing home residents who end up in emergency rooms. The report looks at claims sent to Medicare in 2016 for treatment of head injuries, body bruises, bed sores and other diagnoses that might indicate physical abuse, sexual abuse or severe neglect.

Gloria Jarmon, deputy inspector general for audit services, says her team found that nursing homes failed to report nearly 1 in 5 of these potential cases to the state inspection agencies charged with investigating them.

“Some of the cases we saw, a person is treated in an emergency room [and] they’re sent back to the same facility where they were potentially abused and neglected,” Jarmon says.

But the failure to record and follow up on possible cases of elder abuse is not just the fault of the nursing homes. Jarmon says that in five states where nursing home inspectors did investigate and substantiate cases of abuse, “97 percent of those had not been reported to local law enforcement as required.”

State inspectors of nursing homes who participated in the study appeared to be confused about when they were required to refer cases to law enforcement, Jarmon notes. One state agency said that it only contacted the police for what it called “the most serious abuse cases.”

Elder abuse occurs in many settings — not just nursing homes. The second study looked at Medicare claims for the treatment of potential abuse or neglect of older adults, regardless of where it took place. The data was collected on incidents occurring between January of 2015 and June of 2017.

The federal auditors projected that, of more than 30,000 potential cases, health care providers failed to report nearly a third of the incidents to law enforcement or Adult Protective Services, even though the law requires them make such reports.

“It’s very important that the first person who notices this potential abuse and neglect reports it, because then they can begin the investigative process to determine if abuse or neglect occurred,” says Jarmon. “And if it’s not reported, it can’t be tracked.”

The HHS report says that Medicare could do a better job of analyzing the data it has on hand. It recommends that the Centers for Medicare and Medicaid Services, which oversees the health care program for older Americans, should periodically examine claims for treatment, looking for diagnoses that suggest possible abuse or neglect, as well as where and when those cases occur.

“You have to be able to get the data to see how bad the problem is,” says Jarmon, “so that “everybody who can take action has it.”

However, the Centers for Medicare and Medicaid Services, which pays for much of the health care for seniors, and provides guidance on the reporting required of health care workers and health care facilities, has rejected most of the reports’ recommendations.

CMS declined NPR’s request for an interview, but in a written response, it argues that it can take up to a year for Medicare claims to be filed. So analyzing such claims, CMS says, would “not be [a] timely enough” way to identify and respond to cases of elder abuse and neglect.

The inspector general’s report counters that the vast majority of Medicare claims are filed within a month, not a year. And Gloria Jarmon says that just letting state agencies and health care providers know that they’re being tracked, could reduce the problem of elder abuse.

Let’s block ads! (Why?)

The U.S. Preventive Services Task Force has a new recommendation aimed at preventing HIV infections and AIDS. The influential panel’s guidance says people at high risk of being infected with HIV should be offered preventive antiretroviral medications — taken in a daily pill.

There’s lots of evidence that preexposure prophylaxis — also known as PrEP — is effective. The Food and Drug Administration-approved pill Truvada contains two antiretroviral medicines (tenofovir and emtricitabine).

The Centers for Disease Control and Prevention cites evidence that PrEP can reduce the risk of HIV infection by up to 92% in people who are at high risk and who take the drug consistently.

The CDC recommended PrEP several years ago and calls it “a powerful HIV prevention tool,” but so far uptake of PrEP has been slow.

“Currently, less than 10% of individuals with an indication for PrEP are receiving this medication,” write Hyman Scott and Paul Volberding in an editorial published Tuesday alongside the new recommendation in the medical journal JAMA. Both authors are physicians and researchers at the University of California, San Francisco who have been involved in HIV research.

“The gap between indication and use is most pronounced among black and Latino men who have sex with men,” Volberding and Scott write.

And the new recommendation “should serve to promote policies to expand PrEP access to those at risk,” they conclude.

People at high risk of HIV infection include those who inject drugs and those who have sex without condoms when they don’t know the HIV status of their high-risk partner.

Many insurers already pay for Truvada, but the task force’s recommendation could be influential in expanding coverage of the drug, whose list price runs $21,360 a year.

“The cost of the medication is absolutely a barrier for a lot of people in the U.S.,” Scott said in an interview. “We have patients who go to the pharmacy and are told they have to pay $1,300 or $1,600 for their month’s supply of Truvada.”

Many at-risk people can get the drug at a reduced cost or at no cost, depending on their insurance. “We try to educate patients to let them know there are many programs to help offset the costs,” Scott says.

“We’ve done a good job in medicine at being able to treat HIV, in the sense it’s now become a chronic disease for most people … but we still have a problem with new HIV infections,” says John Epling, a physician and professor of family and community medicine at Virginia Tech and a member of the U.S. Preventive Services Task Force. The goal is to prevent these infections.

More than 38,000 new HIV cases were diagnosed in the U.S. in 2017, according to the CDC. “So, we need for primary care clinicians to engage in offering PrEP to their high-risk patients,” Epling says.

The task force’s recommendation is published with a new review of the evidence, including an analysis of multiple studies evaluating the safety and effectiveness of PrEP.

The studies found that most side effects, including gastrointestinal complaints and some nausea, were mild and reversible. Another side effect in some people taking Truvada is elevated creatinine, a measure of kidney function, so patients on the drug are monitored periodically.

The review finds that the therapy significantly reduces the risk of acquiring HIV infection compared with a placebo, although effectiveness drops when people fail to take the pill daily.

“PrEP is highly effective at preventing HIV acquisition,” Epling says, “if it’s taken every single day and condoms are used.”

Let’s block ads! (Why?)