But a male relative\u2019s results weren\u2019t so good. The words \u201cvery severe coronary calcification\u201d and \u201chigh risk\u201d leapt alarmingly from his report. That made me wonder, why didn\u2019t we know this earlier \u2013 my bone density, my relative\u2019s calcified arteries – so steps could have been taken 10 years ago to slow the progress? <\/p>\n
Sometimes the lack of obvious symptoms is the problem. Diseases like cancer can take years to show up. But increasingly, one of the issues is lack of time – both for the patient and the GP. <\/p>\n
The days of a leisurely chat with the local doctor who has treated the same family for two generations, and sometimes three, are all but gone. Now it\u2019s a two-week wait for an appointment at some practices, a consultation with a doctor who you might never have met, and just 15 minutes to get a flu jab, blood pressure checked and prescriptions renewed while other patients queue up in the waiting room. <\/p>\n
It\u2019s an issue that troubles Hamilton GP Prabani Wood, who says her main hope for a future generation of Kiwis is that they can once again establish a relationship with one doctor and benefit from preventive medicine so that they live long and healthy lives. <\/p>\n
Wood, who is the medical director of The Royal College of General Practitioners, says there is a wealth of international data that shows when general practice is well supported, there is less of a financial burden on the public health system. <\/p>\n
\u201cPeople live longer, [they are] healthier and they\u2019re happier with good general practice and that means good continuity of care,\u201d she says. However, good quality care is getting harder for practices to achieve because it is harder to find GPs, she says. <\/p>\n
\u201cThat general ability to do preventative health is reduced when we\u2019re at capacity because you\u2019re often dealing with people who are sick and have waited a while to be seen so they\u2019re even sicker by the time they get to see you.\u201d <\/p>\n
That means Kiwis, as they age, will increasingly need to take responsibility to keep up health checks. To their credit, many older Kiwis are making efforts to keep fit, determinedly turning their aching backs on walking frames and stairlifts. They\u2019re running, walking, swimming and cycling their way to old age, joining gyms, running half and full marathons, hiking the Great Walks, and skiing and mountain biking well into their 70s and beyond. <\/p>\n
Older Kiwis are increasingly determined to keep themselves active. Photo \/ 123rf<\/p>\n
But maintaining that rude good health is dependent on there not being a silent killer lurking because health checks are missed. One of the Breast Cancer Foundation\u2019s most alarming stats is that 30% of women eligible for a free mammogram every two years, between the ages of 45 and 69 (gradually increasing to 74 in the next few years), don\u2019t have it done. <\/p>\n
The Herald asked a selection of medical experts what tests and checks ageing New Zealanders should have done to make sure they stay healthy, or detect disease early.<\/p>\n
The role of the GP <\/p>\n
Annual health checks are recommended from the age of 40 to 45 which include blood pressure, weight, discussions about skin cancer risks and smoking, and relevant blood tests to check for diabetes and cholesterol levels, depending on family history. <\/p>\n
Your GP should also remind you about regular checks like cervical smears, breast screening, heart disease risk assessment, immunisations such as \u2018flu jabs, and, where relevant, why exercise is a good idea but smoking is not. <\/p>\n
From age 45, a free booster vaccine for tetanus, diphtheria, and whooping cough (pertussis) is recommended, plus an annual flu vaccine and a Covid-19 booster. <\/p>\n
At age 65, it\u2019s time for a shingles vaccine, which is free for 12 months after your 65th birthday. After that, the vaccine will cost patients between $600 and $900. <\/p>\n
A booster for tetanus, diphtheria, and whooping cough is also recommended if it has been more than 10 years since your last tetanus-containing vaccine. <\/p>\n
Wood says in an ideal world GPs \u201cwalk alongside\u201d their patients, get to know them and build trusting relationships, as well as looking after them when they are unwell. <\/p>\n
\u201cThat\u2019s our aim, our hope. But it\u2019s getting harder.\u201d <\/p>\n
Years of under-resourcing in the primary health sector mean preventative health measures have become more difficult. <\/p>\n
\u201cIt\u2019s really, really important though.\u201d <\/p>\n
Wood wants to see skin checks funded publicly. <\/p>\n
\u201cHow much could we save in terms of money down the line for having to treat people for melanoma if there was a way of funding skin checks both in the public system and privately?\u201d <\/p>\n
Those with medical insurance often still have to pay for general skin checks and preventative mole mapping, although treatment is often covered for suspicious lesions or excisions. <\/p>\n
Skin checks range from $165 up to $450 for a full-body mole map, depending on how comprehensive the procedure is. <\/p>\n
General skin checks and mole mapping are invariably not covered by private medical insurance or available in the public sector. Photo \/ 123rf<\/p>\n
Southern Cross Health Insurance covers the assessment and treatment of suspicious or cancerous lesions. Routine skin checks or mole mapping are not covered when there are no signs of disease. <\/p>\n
Regan Savage, the company\u2019s chief sales and marketing officer, says broad screening can lead to over\u2011diagnosis and over\u2011treatment, including the removal of harmless lesions that would never cause health issues, exposing people to unnecessary procedures without clear benefit.<\/p>\n
The CT calcium score test is useful, Wood says, but points out the test is not as accurate for women, and in particular South Asian women who have a much higher rate of heart disease and diabetes than Europeans. <\/p>\n
Look after your bones <\/p>\n
Your skeleton, the only one you\u2019re ever going to have, needs looking after from a young age. We build up peak bone mass up to our 30s but by the time we hit 40, it\u2019s going the other way. <\/p>\n
One of the biggest risks to ageing bones is fragility fractures – caused by falls from a standing height. They are both debilitating and an increasing burden on hospitals as the population ages. By 2075, nearly half of the country\u2019s population will be aged 50 and older. <\/p>\n
Fragility fractures account for 191,000 hospital bed stays annually, the equivalent of a 521-bed hospital (larger than Wellington Regional Hospital) being fully occupied for a year by fracture patients. <\/p>\n
Although osteoporosis is more common in post-menopausal women, men suffer from it too. <\/p>\n
Of the 16,000 hospitalised or treated for 17,140 fractures last year, 24% were men. Worldwide data shows that a third of hip fractures occur in men and that they have a higher mortality rate as a result than women. <\/p>\n
Bone-density scans are recommended for women aged 65 and over, and for men aged 75 and over. The scans cost between $150 and $300 if not covered through the public health system, or health insurance. <\/p>\n
ACC currently pays out around $360 million a year for fragility fractures, a figure estimated to double to $720m within the next 10 years. Recognising that the trend needs to be slowed, ACC partnered with Osteoporosis New Zealand four years ago to set up more than 20 fracture liaison clinics throughout the country. <\/p>\n
Older Kiwis who have a first fragility fracture are likely to have a second, more serious fall, often breaking a hip. Less than 50% of hip-fracture patients will walk unaided again.<\/p>\n
The role of the clinics is to stop that second fall occurring through osteoporosis treatment, and lifestyle improvements, including strength and balance classes. <\/p>\n
Strength and balance exercises help prevent falls that lead to debilitating fragility fractures, including broken hips. Photo \/ 123rf <\/p>\n
Adjunct Professor Paul Mitchell, who is also a strategic adviser to Osteoporosis New Zealand, is optimistic about New Zealanders\u2019 skeletal futures, pointing out bone health is now manageable with safe and inexpensive medicines that have come off patent. He has worked for the past 25 years, here and overseas, to establish fracture liaison clinics and says early results in New Zealand are encouraging with the number of Kiwis presenting with a second fracture starting to drop. <\/p>\n
Analysis commissioned by ACC showed that 17,700 hospital beds would be freed up annually by the fifth year of the liaison clinics\u2019 operation. <\/p>\n
However, because of New Zealand\u2019s ageing population, the number of initial fractures is still rising. Tackling that issue will be the next part of the project, Mitchell says, by working with GPs, oncologists and other specialists to target high-risk groups. (Osteoporosis New Zealand has a \u201cTake the test\u201d button on its website to help people assess their risk). <\/p>\n
The Breast Cancer Foundation wants the free mammogram screening age to drop to 40. Photo \/ 123RF<\/p>\n
The Big C <\/p>\n
The advice on cancer is don\u2019t ignore symptoms. The earlier you raise them with your GP the more likely the cancer can be treated. <\/p>\n
Bowel cancer, the second-highest cause of cancer death in New Zealand behind lung cancer, can be detected early with the help of free bowel cancer screening kits which are sent to Kiwis aged 58 to 74 years every two years. And yet hundreds either don\u2019t bother to do the test, or make an error which makes the test defunct. <\/p>\n
Oncology experts say once a colonoscopy is advised, those need to be kept up every three to five years depending on the results. Other checks include prostate, five-yearly vaginal swab tests for cervical cancer, and breast cancer checks including mammograms. <\/p>\n
The Breast Cancer Foundation wants the free mammogram screening age to drop to 40 (around 400 women under the age of 45 are diagnosed with breast cancer annually). As things stand, women under the age of 45 without health insurance will need to pay privately for mammograms, unless they are referred to the public health system because of a suspected breast issue. <\/p>\n
Breast cancer can occur in the time between two-yearly mammograms, and in older women in their 70s and 80s who no longer qualify for a free test. <\/p>\n
The foundation\u2019s head of nursing and community outreach, Natalie James, recommends women carry out a monthly breast self-check, looking and feeling for changes in the breasts and armpits, and checking with a doctor if there are concerns. <\/p>\n
Women with a genetic risk or very dense breast tissue should have a mammogram every year. <\/p>\n
If paying privately, James advises comparing prices with at least two radiology groups. A standard 2D mammogram costs between $200 and $300; a more sophisticated 3D mammogram costs between $350 and $400. (After a first breast cancer, mammograms are funded annually for five years). <\/p>\n
Retired medical oncologist Dr Vernon Harvey, who treated thousands of cancer patients during his 50-year career, says patients should take advice from cancer specialists and stick with the medical plan. <\/p>\n
\u201c[Treatments] are not perfect but they\u2019re getting better all the time.\u201d<\/p>\n
Taking vitamins and using alternative medicine is unlikely to prevent people from getting cancer, or treating it effectively, he says. <\/p>\n
Tremendous advances in immunotherapy treatments have been made in recent years after decades of trials. <\/p>\n
\u201cWe now understand much better about how the immune system works and how it can be controlled, and how the cancer can block certain immune systems from working. We now know how to unblock that and that\u2019s why they\u2019re much more effective.\u201d <\/p>\n
However some immunotherapy treatments are unavailable in New Zealand because of their enormous cost. <\/p>\n
Women\u2019s health <\/p>\n
Many women sail through perimenopause and menopause with few symptoms but others suffer greatly. Dr Emma Jackson, the vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) says talk to your GP and ask for a health check. Symptoms can usually be treated, she says. <\/p>\n
Hormonal changes increase the risk of cardiovascular disease so checks should include blood pressure and blood tests for cholesterol, as well as discussion about nutrition, diet and exercise. <\/p>\n
\u201cWe strongly encourage women to talk to their GP about any menopause symptoms that are impacting them. These can usually be treated.<\/p>\n
\u201cRANZCOG would like to see this sort of preventative health care that focuses on women\u2019s changing needs through their life stages, funded so that it is accessible to all women.\u201d <\/p>\n
She urged women to keep up with screening programmes, like breast screening, HPV testing and bowel screening. <\/p>\n
Keeping your heart happy <\/p>\n
Cardiologist and medical director of the Heart Foundation, Dr Gerry Devlin, advises a heart health check for men over the age of 45 and women aged 55 and over (15 years earlier is recommended for M\u0101ori and Pacific people). That includes a blood pressure check, blood tests for cholesterol and a diabetic check, and a chat about the dangers of smoking and the benefit of exercise. That helps the doctor assess the patient\u2019s risk of having a cardiac problem within the next five to 10 years. <\/p>\n
But Devlin points out risk assessments are based on population equations which means some people\u2019s risk may be underestimated, others overestimated. That\u2019s where individual tests like the CT Calcium score can help personalise the risk assessment. However the test is not readily available in public hospitals because of the lack of CT scanners. <\/p>\n
\u201cSo for most people in our country that\u2019s not an option currently.\u201d <\/p>\n
He acknowledges that regular health checks can slip in GP practices that are struggling to cope. <\/p>\n
\u201cA lot of our primary care model, I believe, is currently crisis management. You go in with a problem and they\u2019ve got to look after that problem. So being proactive is much more challenging in our health system.\u201d <\/p>\n
Even so, he says, people need to be proactive about heart checks, particularly if they have a family history or are experiencing symptoms like chest discomfort, breathlessness, or a heartbeat that doesn\u2019t feel right. <\/p>\n
Devlin doesn\u2019t think Kiwis get better care going privately, because the same specialists work in both the public and private sectors. <\/p>\n
\u201cBut you get more timely care [going private]. That\u2019s the reality of our health system currently.\u201d <\/p>\n
He\u2019s worked for many years both privately and in the public health service. <\/p>\n
\u201cIt\u2019s as stretched as I\u2019ve ever seen it, you know, and that\u2019s up and down the length and breadth of our country.\u201d <\/p>\n
Jane Phare is a senior journalist based in Auckland. <\/p>\n