Category Archives: Aging
Recommended Reading: Life Expectancy Gains Threatened When Older Americans Have Multiple Medical Conditions
A new study from the Johns Hopkins Bloomberg School of Public Health finds that nearly four in five older Americans are living with multiple chronic medical conditions. That’s very concerning, say the researchers, because their work shows that the more ailments a person has after retirement age, the shorter their life expectancy. The researchers say the new study is one of the first to look at the burden of multiple chronic conditions on life expectancy among the elderly and may help explain why increases in life expectancy among older Americans are slowing.
“Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States,” said Eva H. DuGoff, PhD, a researcher at the school of public health and the lead author of the new study. “The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy.”
The study found that a 75-year-old American woman with no chronic conditions will live to be an average of 92, but a 75-year-old woman with five chronic conditions will only live to an average age of 87 and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men and white people live longer than black people, based on data from annual U.S. surveys.
On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up. The study is based on an analysis of the records of 1.4 million Medicare enrollees and was published in the journal Medical Care.
Other groups are also beginning to look at this issue. Healthy aging will be this year’s focus of the President’s Initiative of the Association of State and Territorial Health Officers. A year-long focus on healthy aging will begin during the association’s annual conference in September.
Read the full study.
HHS, DOJ Release ‘Roadmap’ to Prevent Elder Abuse
The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) have announced a new Elder Justice Roadmap to enhance elder abuse prevention and prosecution, while also highlighting the issue of elder abuse. An estimated one in 10 Americans over the age of 60 have experienced elder abuse or neglect. The Roadmap includes the DOJ’s development of an interactive, online curriculum to teach legal aid and other civil attorneys to identify and respond to elder abuse, as well as the HHS’ development of a voluntary national adult protective services data system. “Elder abuse is a problem that has gone on too long, but the Roadmap Report released today can change this trajectory by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multi-faceted dimensions of elder abuse and financial exploitation,” said Associate Attorney General Tony West, in a release. “While we have taken some important steps in the right direction, we must do more to prevent elder abuse from occurring in the first place and face it head on when it occurs.” Read more on aging.
Study: Health Care Providers Must Do More to Ensure Pregnant Women Receive the Flu Vaccine
A new study finds that health care providers (HCPs) must do more to ensure pregnant women are vaccinated against influenza. After a review of 45 research papers, researchers determined that HCP influenza vaccine recommendations and on-site services would both help increase the current suboptimal vaccination rate. The study pointed to inadequate knowledge of the risks of influenza; doubts about vaccine safety, efficacy and benefits; and fear of adverse reactions for both the pregnant women and their unborn fetuses as barriers to vaccination. Many of the women in the review were also unaware that their pregnancies placed them at higher risk of complications from influenza. Read more on maternal and infant health.
Study: Younger Pro Pitchers at Higher Risk of Needing ‘Tommy John’ Surgery
Stephen Strasburg. Matt Harvey. Kerry Wood. All were or are hard-throwing Major League Baseball (MLB) pitchers who underwent “Tommy John” surgery early in their careers. Now, a new study from researchers at the American Orthopaedic Society for Sports Medicine indicates that entering the MLB at a younger age increases the risk of needing Tommy John surgery—which is a reconstruction of the ulnar collateral ligament in the elbow—at some point in a career. In a study of 168 pitchers who had Tommy John surgery and 178 age-matched pitchers who did not, approximately 60 percent of those who needed the surgery had it in the first five years of their career. They also had statistically more Major League experience, indicating that arm stress at a younger age heightens the risk of damage. “Having athletic trainers and team physicians closely look at when players’ pitching performance stats start to decrease may allow for steps to be taken before a surgery is needed. Our study also further highlights the need for kids not to overuse their arms early in their pitching careers,” said lead author Robert Keller, MD, of Henry Ford Hospital in Detroit, in a release. Read more on injury prevention.
Widely Used HIV Drug Linked to Higher Suicide Risk
People infected with HIV whose treatment includes the widely used antiretroviral drug efavirenz appear to have double the risk of suicidal thoughts, attempts and completion compared to HIV patients not taking the medication, according to a study by several researchers at the Harvard School of Public Health and the University of North Carolina at Chapel Hill. The study was published in the Annals of Internal Medicine.
“When efavirenz is used as a component of antiretroviral therapy, patients should be monitored carefully for exacerbation of depression or evidence of suicidal thoughts or behavior,” according to the study.
The drug has been previously linked to central nervous system side effects and suicide, but until now a clear link to suicidal thinking, attempted suicide, or completed suicide was not clear. The effects persist for the time patients are on the drug. The researchers recommend that patients with HIV use alternative drugs, if possible, if they are at risk for depression. Read more on HIV.
Nutrition Screenings Should Be Regular Part of Geriatric Health Assessment
Most older adults typically have one or more chronic health conditions that can affect their food intake and should be asked about their food intake during health exams, according to a new study in Nutrition in Clinical Practice. The researchers said that health care providers should also look for signs of malnutrition, such as loss of subcutaneous fat, muscle loss and fluid accumulation. Read more on aging.
Many American Teens Follow Pro-Marijuana Twitter Feeds and Receive Pro-Marijuana Tweets
Hundreds of thousands of American teens are following marijuana-related Twitter accounts and getting pro-marijuana tweets several times each day, according to researchers at the Washington University School of Medicine in St. Louis. The researchers say the tweets are cause for concern because young people are especially responsive to social media influences and because patterns of drug use tend to be established in a person’s late teens and early 20s. The study was published in the Journal of Medical Internet Research and relied on tweets sent and received between May 1 and Dec. 31, 2013, from a single popular pro-marijuana Twitter feed. During the study period, the feed posted an average of 11 pro-marijuana tweets per day. Read more on substance abuse.
AHA to Fund Research Network for the Prevention of Heart Disease, Stroke
With a $15 million grant from the American Heart Association (AHA), four major medical institutions are coming together to form a research network with the goal of preventing heart disease and stroke. The Strategically Focused Prevention Research Network Centers will include investigators at Northwestern University in Chicago, Vanderbilt University in Nashville, the Icahn School of Medicine at Mount Sinai in New York City and the University of Texas-Southwestern Medical Center in Dallas. “Heart attack and stroke can strike suddenly, and frequently without warning. The best way to reduce premature mortality from cardiovascular diseases and stroke is to prevent the development of the risk factors that lead to these conditions,” said AHA President Elliott Antman, MD, professor of medicine at Harvard Medical School and a senior physician in the cardiovascular division of the Brigham and Women’s Hospital in Boston, in a release. “Scientists working in these research centers are helping to discover the mechanisms that will allow all Americans to live healthier lives, helping lead us to a culture of health.” Read more on heart health.
Study: One-Third of U.S. Total Knee Replacements ‘Inappropriate’
Approximately one-third of all total knee replacements in the United States are unnecessary and “inappropriate” under a patient classification system used in Spain, according to a new study in the journal Arthritis & Rheumatology. Researchers said the findings demonstrate a need for the United States to develop similar patient selection criteria so as to limit the unneeded surgeries. There are more than 600,000 total U.S. knee replacements annually—meaning that approximately 200,000 are unnecessary, according to the study—and from 1991 to 2010 the number of Medicare-covered replacements climbed by approximately 162 percent annually. Read more on aging.
Kids’ ADHD Medications Not Linked to Increase Risk of Substance Abuse
While children with attention-deficit/hyperactivity disorder (ADHD) are twice as likely to abuse drugs, the medications prescribed to treat ADHD do not play a role in the increased risk, according to a new study in the journal Pediatrics. In fact, researchers determined that the combination of behavioral techniques and ADHD medications actually lowers the risk of substance abuse. "Obviously, the medications that are used to treat ADHD have the potential for abuse, but the vast majority of children with ADHD do not develop a substance abuse problem," said Michael Duchowny, MD, a pediatric neurologist at Miami Children's Hospital. "More research has to be done to find out why some children are more susceptible than others." Common ADHD medications include amphetamines such as Adderall or Dexedrine, and methylphenidates such as Concerta, Metadate CD or Ritalin. Read more on substance abuse.
CDC: Two U.S. MERS-CoV Cases Did Not Spread Any Further
In May of this year the U.S. Centers for Disease Control and Prevention (CDC) announced two cases of imported Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the United States, with one in Florida and the other in Indiana. Both patients were health care providers who lived and worked in Saudi Arabia. The CDC has now confirmed that in neither case did the disease spread to either members of the patients’ households or health care workers who treated the patients. “The negative results among the contacts that CDC considered at highest risk for MERS-CoV infection are reassuring.” said David Swerdlow, MD, who is leading CDC’s MERS-CoV response. “Today, the risk of MERS-CoV infection in the United States remains low, but it is important that we remain vigilant and quickly identify and respond to any additional importations.” Read more on infectious disease.
FDA Approves the Manufacture of Cell-based Influenza Vaccine
Yesterday the U.S. Food and Drug Administration (FDA) announced approval to manufacture the first cell-based seasonal influenza vaccine in a U.S. facility. The Holly Springs, N.C., facility, which is owned by the Swiss company Novartis, will also be capable of manufacturing vaccines against pandemic influenza viruses. The technology was created in partnership with the Biomedical Advanced Research and Development Authority, part of the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response. According to a statement from Robin Robinson, PhD, ASPR Director and Deputy Assistant Secretary for Preparedness and Response, the cell-based vaccines will be part of multi-use approach that “strengthens everyday systems and increases our resilience in emergencies.” Read more on influenza.
Study Links Air Pollution, Cognitive Decline in Older Adults
One way to help reduce age-related cognitive decline may be to reduce air pollution, according to a new study in The Journals of Gerontology: Series B. Researchers determined that older adults who live in areas with low concentrations of fine particulate matter air pollution—from sources such as vehicle exhaust—made fewer cognitive errors on math and memory tests than did older adults who lived in areas with high pollution levels. “Although finding a link between the air we breathe on a daily basis and our long-term brain health is alarming, the good news is that we have made remarkable progress in the last decade in reducing levels of air pollution across the country, and there are efforts underway to further reduce air pollution,” said study co-author Jennifer Ailshire, of the Center for Biodemography and Population Health and the Andrus Gerontology Center at the University of Southern California in Los Angeles. Read more on aging.
Far too many older people in generally good health find themselves without purpose—which is itself at cross purposes with the natural makeup of humans, according to Linda P. Fried, MD, MPH, an expert on aging and the dean of the Mailman School of Public Health at Columbia University.
“We are a species wired to feel needed, respected, and purposeful,” she wrote in the latest issue of The Atlantic. “The absence of those qualities is actually harmful to our health.”
The new article discusses the current research on the benefits of older people engaging in work that they are good at and enjoy. One example, Experience Corps—which Fried cofounded and which is now hosted by the AARP—seeks to leverage “the investments in one age group in order to benefit many stakeholders.”
Another example is the World Health Organization’s Global Network of Age-Friendly Cities and Communities, which provides a model for developing public-private partnerships. In New York City, the Age-Friendly NYC Commission was established in 2010 in partnership with the New York City Council and The New York Academy of Medicine. The underlying premise, according to Fried, was that the active participation of older residents in all aspects of city life is essential to the growth and health of the city, and that creating the conditions to achieve this is an important investment in public health.
Read the full story from The Atlantic, “Making Aging Positive.”
>>Bonus Link: Read a previous NewPublicHealth post on the Age-Friendly NYC Commission.
NIH Spearheads Private/Public Collaboration to Improve Care for Several Serious Health Conditions, Including Alzheimer’s
The U.S. Department of Health and Human Services (HHS) today released the 2014 update for the National Plan to Address Alzheimer’s Disease, which includes a determination to accelerate efforts to identify the earliest stages of Alzheimer’s disease and to develop and test targets for intervention. That acceleration has new momentum this year with the announcement several weeks ago by the National Institutes of Health (NIH) that it has formed a first-if-its-kind partnership—the Accelerated Medicines Partnership (AMP) with ten pharmaceutical companies and several nonprofit organizations—to help identify and validate new diagnostics and drugs for several diseases that impact tens of millions of Americans and their families. The three other conditions are Type II diabetes, lupus and rheumatoid arthritis.
“Despite the fact that there have been huge revolutions in science from discovery of the double-helical structure of DNA, to recombinant DNA, to all sorts of interesting technological advances...it still takes too long and costs too much and we fail too often in the development of new drugs,” said Kathy Hudson, PHD, deputy director for Science, Outreach and Policy at the NIH, in a conversation with NewPublicHealth.
Hudson said a key development that drove the creation of the AMP is a new center at NIH, the National Center for Advancing Translational Sciences, which she says will work on how to “create new methods and new approaches that will decrease the failure rate and decrease the timeline for delivering new, important medicines to patients’ medicine cabinets.” Hudson said it currently takes about 15 years and more than $1 billion to develop a new drug and the failure rates are quite high at every step because of safety and because of efficacy.
“The new partnership effort is really targeted towards trying to boost the success of the pipeline by improving efficacy. What we’re exploring in this partnership is using a whole bunch of different new approaches and new technologies to try to identify higher quality targets that can enter the drug development pipeline,” said Hudson.
The private sector drug firms will match NIH dollars one-for–one. The other key contribution, according to Hudson, is that “industry scientists and NIH scientists and academic scientists all come at these problems with slightly different perspectives and experience and expertise, and by combining those together we’re really getting a research plan that is distinctive from what any one of us would have generated by ourselves.”
Hudson said another critical issue that is helping the collaboration is the fact that “the ground rules have been so clearly laid out about us working in a precompetitive space, about all of the data being broadly shared not just with the participants but with the entire scientific community.” Even with the collaboration, identifying and testing new compounds will take years. How to commercialize successful products will be part of the ongoing discussions.
>>Bonus Link: Read more about the Accelerated Medicines Partnership
CDC: American Indians, Alaska Natives Have 50 Percent Higher Death Rates than Non-Hispanic Whites
American Indian and Alaska Native (AI/AN) death rates were approximately 50 percent higher than rates among non-Hispanic whites—for both men and women—from 1999 to 2009, according to a new study in the American Journal of Public Health. The study determined that patterns of mortality were strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking and health-harming social determinants. Among the findings:
- Among AI/AN people, cancer is the leading cause of death followed by heart disease. Among other races, it is the opposite.
- Death rates from lung cancer have shown little improvement in AI/AN populations and AI/AN people have the highest prevalence of tobacco use
- Suicide rates were nearly 50 percent higher for AI/AN people
- Death rates from motor vehicle crashes, poisoning and falls were two times higher among AI/AN people
- Death rates were higher among AI/AN infants
“The Indian Health Service is grateful for this important research and encouraged about its potential to help guide efforts to improve health and wellness among American Indians and Alaska Natives,” said Yvette Roubideaux, MD, MPH, acting IHS director, in a release from the U.S. Centers for Disease Control and Prevention. “Having more accurate data along with our understanding of the contributing social factors can lead to more aggressive public health interventions that we know can make a difference.” Read more on health disparities.
FDA Proposes New Program to Help Patients With Unmet Tech Needs
The U.S. Food and Drug Administration (FDA) has proposed a new program designed to help treat or diagnose people with serious conditions, but whose needs aren’t met by current technology. The proposed Expedited Access Premarket Approval Application for Unmet Medical Needs for Life Threatening or Irreversibly Debilitating Diseases or Conditions (“Expedited Access PMA” or “EAP”) program would include earlier and more interactive engagement with FDA staff, with the goal of providing patients with earlier access to safe and effective medical equipment. “The program allows manufacturers to engage early and often with the agency,” said Jeffrey Shuren, MD, director of the FDA’s Center for Devices and Radiological Health. “We expect most devices that enter this program will be in the pre-clinical trial phase.” Read more on technology.
Study Links Internet Use, Lower Depression Rates in Older Americans
Older Americans who spend more time online are also less likely to suffer from depression, according to a new study in The Journals of Gerontology: Series B. Using data on 3,075 retired men and women who didn’t live in nursing homes gathered by the U.S. Health and Retirement Survey, researchers determined that the 30 percent who were Internet users also had a 33 percent lower probability of depression. "The largest impacts on depression were actually for those people who lived alone, so it's really suggesting that it's about connecting with others, eliminating isolation and loneliness," lead study author Shelia Cotton, according to Reuters. Read more on aging.
Study: Mean Devices Approved for Pediatric Use Never Tested on Kids
The majority of medical devices recently approved for pediatric use were never actually tested on kids, but rather only on people ages 18 and older, according to a new study in the journal Pediatrics. Researchers analyzed the clinical data used to get each device approved, finding that 11 of 25 examined devices were not tested on any patient age 21 and younger, and that only four had been tested on patients under the age of 18; three devices were specifically approved for patients under age 18, while the test were approved for people ages 18 to 21. "Children are not simply 'small adults,' and a device found to be safe and effective in adults may have a very different safety and effectiveness profile when used in a pediatric population," said Brigham and Women's Hospital and Harvard Medical School research fellow Thomas J. Hwang, one of the study’s authors, according to Reuters. "Without this data, it is difficult for clinicians and parents to make informed treatment decisions that weigh the risks and benefits of a particular treatment.” Read more on pediatrics.
Kaiser Report Examines Employer-Sponsored Retiree Health Benefits
A new report from the Kaiser Family Foundation on employer-sponsored retiree health benefits for pre-65 and Medicare-eligible retirees finds that the percentage of employers sponsoring retiree health coverage has declined, while employers that offer coverage are redesigning their plans almost annually in response to rising health care costs. The report, Retiree Health Benefits At the Crossroads, also examines the effect of recent legislation on retiree health coverage, such as the Medicare drug benefit and the Affordable Care Act. Read more on aging.
Study: Fewer Blood Transfusions Would Mean Fewer Infections
The increased use of blood transfusions in hospitals also leads to the increased risk of infection, according to a new study in the Journal of the American Medical Association. In a review of 21 randomized control trials, researchers from the University of Michigan School of Public Health determined that for every 38 patients considered for a red blood cell transfusion, the reduction of transfusions would mean one patient did not develop a serious infection, with the elderly undergoing hip and knee surgeries benefiting the most. “The fewer the red blood cell transfusions, the less likely hospitalized patients were to develop infections, “ says lead author Jeffrey M. Rohde, MD, assistant professor of internal medicine in the division of general medicine at the U-M Medical School, in a release. “This is most likely due to the patient’s immune system reacting to donor blood (known as transfusion-associated immunomodulation or TRIM). Transfusions may benefit patients with severe anemia or blood loss; however, for patients with higher red blood cell levels, the risks may outweigh the benefits.” Read more on prevention.
CDC: Reducing High-risk Antibiotic Prescriptions Could Also Reduce Deadly Infections
The most recent Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC) finds that if prescriptions of high-risk antibiotics in hospitals were reduced by just 30 percent, then there could be as many as 26 fewer cases of deadly diarrhea infections with Clostridium difficile. “Improving antibiotic prescribing can save today’s patients from deadly infections and protect lifesaving antibiotics for tomorrow’s patients,” said CDC Director Tom Frieden, MD, MPH. “Health care facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program.” As part of its ongoing efforts to improve antibiotic prescribing, the CDC has release a checklist of seven core elements for hospitals:
- Leadership commitment: Dedicate the necessary human, financial, and IT resources.
- Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
- Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
- Act: Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose, and duration.
- Track: Monitor prescribing and antibiotic resistance patterns.
- Report: Regularly report prescribing and resistance information to clinicians.
- Educate: Offer education about antibiotic resistance and improving prescribing practices.
Read more on infectious diseases.
Poorer Women Most Likely to Be Caught in ‘Vicious’ Caregiving, Financial Well-being Cycle
Low-income women are at increased risk of finding themselves caught in a “vicious cycle” of parental caregiving and financial well-being, according to a new study in The Journals of Gerontology. While women of better financial means can afford additional caregiver assistance and better health care for aging parents, poorer women lack those options. "People who had less household income and less financial resources were more likely to take care of their parents so there is this cycle that they cannot get out of—they are poor, then taking care of parents, then being poor and taking care of their parents—there's this kind of cycle," said lead author Yeonjung Lee, a researcher and professor at the Faculty of Social Work at the University of Calgary in Alberta, Canada, according to Reuters. Read more on aging.
Young Skin Cancer Survivors at Heightened Risk for Other Cancers
Younger skin cancer survivors are at increased risk for additional cancer types later in life, according to a new study in the journal Cancer Epidemiology, Biomarkers & Prevention. A review of data of more than 500,000 people with a history of nonmelanoma skin cancer found that while all age groups were at heightened risk for melanoma and other types of cancers, the increase was especially significant for people under the age of 25, who were 23 times more likely to develop cancer than people who had never had nonmelanoma cancer. The risk was 3.5 times higher for nonmelanoma survivors ages 25-44, 1.74 times higher for those ages 45-59 and 1.32 times higher for those older than 60. The types of cancer they are at risk for include melanoma skin cancer, and cancers of the breast, colon, bladder, liver, lung, brain, prostate, stomach and pancreas. Read more on cancer.