Category Archives: Older Adults
Deaths and injuries from falls in people older than age 65 have doubled in the last decade. Last year, 24,000 older people died after a fall and more than two million sustained severe injuries—which can often lead to permanent disability. To find ways to prevent those falls and the injuries, deaths and costs that come with them, earlier this year the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute (PCORI) joined forces on the Falls Injuries Prevention Partnership, which will fund clinical trials at ten U.S. centers over the next five years.
The trials include some implementation of proven fall prevention strategies at the ten research sites. NIH researchers say a key goal is to help change physician behavior about fall prevention, because recent education efforts through conventional medical education channels and other methods have not been very effective.
“With this trial, we will be able to evaluate interventions on a comprehensive and very large scale,” said Richard J. Hodes, MD, director of the National Institute on Aging, which is a division of NIH. “This study will focus on people at increased risk for injuries from falls, the specific care plans that should be implemented—including interventions tailored to individual patients—and how physicians and others in health care and in the community can be involved.”
Each person in the trial will be assessed for their risk of falling, and receive either the current standard of care—information about preventing falls—or individualized care plans first shared with the trial participant’s primary care physician for review, modification and approval. They will include proven fall risk reduction interventions that can be implemented by the research team, physicians and other health care providers, caregivers and community-based organizations.
The trial directors hope to enroll 6,000 adults age 75 and older who have one or more risk factors for falls. The first year of the study is a pilot phase; if the go-ahead is given by NIH and PCORI to proceed with the study after that, enrollment for the full trial will start in June 2015, with participants followed for up to three years. The main goals of the trial are reductions in serious injuries from falls.
“With active input from patients and other stakeholders from the very beginning of this study, we think we can have a major impact, changing practice to make a real difference in the lives of older people,” says PCORI Executive Director Joe Selby, MD, MPH.
The ten trial sites and regions they serve are:
- Essentia Health, Duluth, Minnesota (Midwest)
- HealthCare Partners, Torrance, California (Southern California)
- Johns Hopkins Medicine, Baltimore (Mid-Atlantic)
- Mount Sinai Health System, New York City (Northeast)
- Partners HealthCare, Waltham, Massachusetts (Northeast)
- Reliant Medical Group, Worcester, Massachusetts (Northeast)
- University of Iowa Health Alliance, Iowa City (Midwest)
- University of Pittsburgh Medical Center (Mid-Atlantic)
- University of Texas Medical Branch, Galveston Health (Southwest)
- University of Michigan, Ann Arbor (Midwest)
Data management and analysis will be coordinated by the Yale School of Public Health.
This week, NewPublicHealth will run a series on new and creative public health campaigns that aim to improve the health of communities across the country through the use of public service announcements, infographics and more. Stay tuned to learn more about a new campaign each day.
As the country turns increasingly gray, more and more adults are experiencing the stresses and strains of caring for aging family members. It has long been a silent struggle for many of the nation’s 42 million unpaid caregivers, but the full impact of family caregiving is starting to come out from the shadows thanks to a major ongoing campaign from the AARP and the Ad Council first launched in 2012. Through a series of ads for television, radio, print media and digital venues, the campaign aims to raise awareness of the ripple effects of family caregiving and to steer overwhelmed families toward resources that may ease the pressure.
The public service advertisements (PSAs) depict the sense of isolation, responsibility and frustration family caregivers often feel as they tend to their loved ones—providing reassurance that they are not alone with these challenges. The ads also highlight a community of experts set up by the AARP to help caregivers take better care of themselves while caring for others and to encourage caregivers to access online tools or call a toll-free hotline (877-333-5885). The website includes resources on planning for long-term care (legally, financially and in other ways) and advice on dealing with emotional issues such as grief and loss.
Nearly 30 percent of caregivers report feeling sad or depressed, and 33 percent isolate themselves by avoiding people or social situations, according to a 2013 AARP report, Caregivers: Life Changes and Coping Strategies. Moreover, 38 percent of those caring for a loved one say they sleep less since they became caregivers, and 44 percent admit they try to squelch their feelings. An earlier survey by the AARP and the Ad Council, involving 500 caregivers between the ages of 40 and 60, revealed that 31 percent describe their caregiving tasks as extremely or very difficult; 21 percent say they don’t feel like they have the support they need; and 26 percent don’t feel confident about knowing where to turn to find support and information for unpaid caregivers.
“Only those who care for others know what it’s really like to care for others—that’s why we created a community where caregivers can connect with experts and others facing similar challenges,” said AARP CEO Barry Rand. “We hope this campaign will help the millions of family caregivers in the U.S. feel heard and supported, in turn, helping them better care for themselves and for the ones they love.”
As an offshoot of the Caregiver Assistance PSAs, the AARP and Ad Council also launched the “Thanks Project”, a digital opportunity for family members and friends to publicly acknowledge and appreciate how much they value the contributions from the caregivers in their lives. The idea is that a note of thanks can mean a lot to caregivers.
>>Bonus link: Read a NewPublicHealth interview with Gail Sheehy, author of “Passages in Caregiving: Turning Chaos into Confidence.”
A Hospital Helps Revitalize the Community Outside Its Walls: Q&A with George Kleb and Christine Madigan
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of more than 40 organizations, including 36 non-profit health systems that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One Stakeholder Health member is the Bon Secours Baltimore Health System in Maryland, whose Community Works initiative helps improve the lives of the people in one of the poorest neighborhoods in the city. Bon Secours Baltimore is part of a national health system founded by the Sisters of the Order of Bon Secours.
Bon Secours engaged the community before embarking on projects and have created programs aimed at improving the community’s health through services that include the hospital, community clinics and visiting nurse programs, as well as housing, GED and financial literacy programs and revitalization programs.
The ambitious housing program will ultimately provide more than 1,000 units of affordable housing in the streets just around the hospital.
Bon Secours’ partner in its housing program is Enterprise Community Partners Inc., which builds affordable housing throughout the United States. NewPublicHealth recently visited the Bon Secours housing and services sites in Baltimore and spoke with George Kleb, executive director Bon Secours Health System, and Christine Madigan, senior vice president of development at Enterprise Homes.
NewPublicHealth: When did the housing program begin?
George Kleb: Bon Secours here in Baltimore has been developing and operating housing since 1988. We started by developing a couple of senior buildings through a U.S. Department of Housing and Urban Development (HUD) program. Both buildings had been schools that were part of the surplus capacity in Baltimore. The HUD program serves people who are elderly, disabled, or very low income. There was a clear need and so we pursued that, and that was the start of our reach into housing. Then in the ‘90s we began work on housing really in line with a neighborhood revitalization strategy attached to our presence in the neighborhood of Southwest Baltimore. There was an area of West Baltimore Street, which is the street the hospital is on, that had become largely vacant. Two-thirds of the units in the three blocks leading up to the hospital were empty and we acquired 31 of those buildings and started a project we now call Bon Secours Apartments. We renovated three-story Victorian row homes into affordable apartments, and that’s when we started working with Enterprise. That’s a relationship that goes back to the mid-1990s.
Higher Education Linked to Better Obesity Rates for Women in Poorer Areas
Higher education is a key factor that helps protect women in economically disadvantaged areas from obesity, according to a new study in the American Journal of Health Promotion. “It is possible that education is a marker of an individual’s access to health information, capacity to assimilate health-related messages, and ability to retain knowledge-related assets, such as nutrition knowledge,” wrote the study’s authors. Previous studies have shown that women living in area with fewer economic resources have higher body mass index (BMI) than other women. The results indicate that both low education and personal income should be addressed by obesity prevention initiatives. Read more on obesity.
Regular Exercise May Help Decrease Depression
Increases in exercise may be linked to decreases in depression, according to a new review of existing research by The Cochrane Library. The researchers found people with depression who also exercised saw a “moderate” reduction in their symptoms when compared to people who did instead used relaxation techniques or received no treatment. Antidepressant medications and psychotherapy are the most common treatments for depression, which affects about 10 percent of Americans, according to the U.S. Centers for Disease Control and Prevention. More research is needed to better understand the relationship between exercise and depression symptoms. Still, Madhukar Trivedi, MD, a professor of psychiatry at the UT Southwestern Medical Center in Dallas, who was not a part of the study, said one of the keys is making sure patients stick with the exercise regimen. "Once people are prescribed exercise or they choose exercise, the big challenge is to make the exercise real," he said. "If the recommendation from the treating clinician is that you should be exercising with some frequency and intensity…it's important that the patient follow that regimen week after week.” Read more on mental health.
Predominantly Black Nursing Homes Deliver Lower Levels of Care, Perform Worse Financially
Nursing homes that are predominantly populated by black residents deliver overall poorer care and are less successful financially than homes with few or not minority residents, according to a new study in Health Services Research. The study looked at issues such as the ratio of nursing staff to patients, success in preventing pressure ulcers, help with walking, help with getting out of bed, prevention of urinary tract infections, the incidence of medication errors and citations by governmental agencies. However, the study noted that black and white patients living in the same facilities received equal treatments, meaning the disparity is not due to any biases of health care workers. One factor leading to the disparity could be the fact that older black Americans are more likely to rely on Medicaid, which means lower reimbursement rates. Still, Latarsha Chisholm, assistant professor at the University of Central Florida and study author, believes something more must be at play. "It isn't only the financial performance [of nursing homes] that affects performance," she said. "There has to be something else affecting quality. I want to understand what management practices promote improved care in nursing homes with high proportions of minorities that don't have disparities in care.” Read more on health disparities.
The final plenary session at this year’s NACCHO Annual included a talk by Christopher Murray, MD, DPhil, director of the Institute for Health Metrics and Evaluation at the University of Washington on how data is used to measure health, evaluate interventions and find ways to maximize health system impact. Dr. Murray was a lead author on three pivotal studies published last week that used data to assess the state of health in the United States compared with 34 other countries and county level data on diet and exercise. One of the key findings is that Americans are living longer, but not necessarily better—half of healthy life years are now lost to disability instead of mortality; and dietary risks are the leading cause of U.S. disease burden.
NewPublicHealth spoke with Dr. Murray about the study findings, their impact and upcoming research that can add to the data public health needs to improve the health of all Americans.
NewPublicHealth: Tell us about the three studies that were published this week using the Institute’s research.
Dr. Murray: The study in JAMA [Journal of the American Medical Association] is an analysis of a comprehensive look at the health of the United States in comparison to the 34 OECD [Organisation for Economic Co-operation and Development] countries. The study looks at both causes of death and premature mortality through over 290 different diseases and puts them all together in a comprehensive analysis of what the contributors are to lost healthy life. That study also looks at the contribution to patterns of health in the U.S., from major environmental, behavioral, and metabolic risk factors. In each of those categories, there are important findings:
- The U.S. spends the most on healthcare but has pretty mediocre outcomes and ranks about 27th for life expectancy among its peer countries.
- For many large, important causes of premature death, the U.S. does pretty poorly. And we also see a big shift towards more and more individuals having major disability—from mental disorders, substance abuse, and bone and joint disease.
- On the risk factor front, the big surprise is that diet is the leading risk factor in the U.S. It is bigger than tobacco, which is second and then followed by obesity, high blood pressure, high blood sugar, and physical inactivity. Diet in this study is made up of 14 subcomponents, each analyzed separately and then put together.
CNN: President Will Call for Wider Gun Control
CNN is reporting that when President Obama releases his list of gun control proposals later today, they will include a ban on assault weapons, restrictions on high-capacity ammunition magazines, stronger background checks for people purchasing guns and increased funding for U.S. mental health services and school safety efforts. Read more on violence.
DOT Proposes Minimum Sound Rules for Hybrid, Electric Cars
The U.S. Department of Transportation (DOT) is proposing minimum sound standards for electric and hybrid cars to help make pedestrians and bicyclists more aware of the cars when the vehicles are approaching.
According to DOT, electric and hybrid vehicles do not rely on traditional gas or diesel-powered engines at low speeds, making them much quieter and more difficult to hear when they approach people walking or biking. DOT estimates that the proposals could result in 2,800 fewer pedestrian and cyclist injuries over the life of each model year of hybrid cars, trucks and vans and low speed vehicles, compared to vehicles without sound.
New sounds for the cars created by car manufacturers would need to be detectable under a wide range of street noises and other ambient background sounds when the vehicle is traveling under 18 miles per hour. A sixty day comment period on the new proposals begins today. Read more on safety.
New NIH-Supported Alzheimer's Studies to Focus on Prevention and Innovative Treatments
With a goal of effectively treating and preventing new cases of Alzheimer’s disease by 2025, the National Institutes of Health (NIH) has announced funding for four major studies: drug and exercise interventions for people in the early stages of the disease, a new drug to reduce agitation in people with the disease, and a new approach to faster testing of drugs in clinical trials. Read more on aging.
Half of HIV Patients on Meds Skip Treatment When Drinking
A new study in the Journal of General Internal Medicine finds that about half of HIV patients taking antiretroviral medications stop taking the drugs when they drink alcohol, in part due to a mistaken fear that mixing the two is toxic. "I think it's pretty well demonstrated that alcohol use is tied to poor adherence, and I think most people think it's because they're impaired in some way or they forget... whereas here it shows they're (often) intentionally missing their medications," said Catherine Grodensky, a researcher at the Center for AIDS Research at the University of North Carolina, according to Reuters. In addition to not actually treating the disease, failure to take HIV drugs continuously can also lead to drug resistance. Read more on HIV/AIDS.
Youth Deaths from Diabetes Down Significantly Over Past Several Decades
Child and teen deaths related to diabetes have dropped by 61 percent in the last 40 years, according to the U.S. Centers for Disease Control and Prevention. Potential contributing factors to the impressive decline include improved care and treatment, as well as increased awareness of symptoms that helps doctors treat the disease sooner. However, the rate increased for youth ages 10-19 between 1984 and 2009, which researchers say will require further study to explain. "Physicians need to emphasize diabetes awareness, lifestyle modification, psychological issues, and use of insulin pumps in young diabetic patients," said Spyros Mezitis, MD, an endocrinologist at Lenox Hill Hospital in New York City, who was not involved with the study. Read more on diabetes.
Study: Regular Exercise Cuts the Risk of Dementia
The risk of dementia in old age is lower for people who exercise regularly, according to a new study in the journal Stroke. Researchers looked at approximately 600 people in their 60s and 70s, finding exercise cut the risk by about 40 percent and demonstrating the importance of at least 30 minutes of exercise three times a week. "The health of the body and brain are indelibly linked, and caring well for the one benefits the other,” said David Katz, MD, director of the Yale University Prevention Research Center. “One may think that exercise is mostly about conditioning muscles, but this study suggests it is just as important for preserving a well-functioning mind." Read more on older adults.
Sunday’s start to the American Public Health Association annual meeting included keynote speakers superbly equipped to address the meeting’s theme of "Prevention and Wellness Across the Lifespan." Author, journalist and lecturer Gail Sheehy, spoke about the lessons learned from her book, “Passages in Caregiving: Turning Chaos into Confidence.”
NewPublicHealth spoke with Sheehy a few days before the meeting.
NewPublicHealth: How well do you think people have learned that in order to avoid some of the disability of aging, that prevention and wellness at earlier ages are so critical?
Gail Sheehy: I think the message of prevention of disease and cultivation of wellness has become widespread in our society. And the more we see people in our everyday life, running and walking and looking fit, the more the message comes through: “Hey, I would like to look like that when I am 65 and older.” So I think it is spreading, but still usually men are reactive rather than proactive about cultivating better health as they get older.
I did a survey for the American Bar Association a few years ago and we found that men 45 to 55 had a much higher degree of anxiety and poorer health than the men 55 to 65. Why? Because some of the men had a body alert in their forties—a minor heart attack, a very high cholesterol count, prostate cancer—and once they had the physical evidence that their body needed help and protection, they had begun being very proactive in taking care of their health and so they were healthier.
But it would be better if better health was not dependent on a body alert.
NPH: And what works for the women?
CDC: U.S. Cholesterol Levels Improved Since the 1980s
The total cholesterol and “bad” LDL cholesterol levels of an average U.S. adult have been steadily improving over the past two decades, according to a new study in the Journal of the American Medical Association. High cholesterol is often a precursor to heart disease. Probable explanations for the overall improvement in public health include improvements in diet since the late 1980s, according to Reuters. "It's important and significant, the reduction that we see here, but it's not unbelievable," said Goodarz Danaei, MD, from the Harvard School of Public Health in Boston, who was not a part of the study carried out by researchers at the U.S. Centers for Disease Control and Prevention. "I don't think we needed a huge change in diet... to produce this change." Read more on heart health.
Older Heart Attack Survivors Often Fail to Take Prescription Meds
Older heart attack survivors often do not follow through with their prescription medications meant to decrease the likelihood of another attack, according to a new study in the Journal of the American Geriatrics Society. Researchers at the University of Maryland analyzed the long-term use of medications most often given to people post-heart attacks: statins, ACE inhibitors/angiotensin receptor blockers, beta-blockers and the blood thinner clopidogrel. Ilene Zuckerman, professor and chair of the department of pharmaceutical health services research at the University of Maryland School of Pharmacy, said proper use of the drugs can result in a “long-term beneficial effect” on patient health. Read more on older adults.
Study: Alcohol a Bigger Cause of Early Death than Smoking
Alcohol abuse decreases life spans even more than smoking, according to a new study in the journal Alcoholism: Clinical & Experimental Research. Researchers followed the health of approximately 4,000 people over a 14-year period. Alcohol-dependent women were nearly 5 times as likely as those who were not to die prematurely; the rates was almost double for men. "This paper confirms the well-known association between alcoholism and premature death," said James Garbutt, MD, professor of psychiatry at the University of North Carolina. "It also supports the evidence that women are more likely to have more severe health problems from alcohol than men—'sicker quicker.'" Garbutt was not a part of the study. Read more on alcohol.
AHA Identifies Most-Effective Public Health Strategies
American Heart Association researchers have examined more than 1,000 scientific studies to determine 43 of the most effective public health prevention strategies. They include school and workplace interventions; economic incentives to improve access to healthy food; direct mandates and restrictions related to nutrition; local environment efforts; and media and education campaigns. The findings were published in Circulation, an American Heart Association journal. “Policy-makers should now gather together and say, ‘These are the things that work—let’s implement many right away, and the rest as soon as possible,’” said Dariush Mozaffarian, MD, DrPH, chair of the statement writing group. Read more on heart health.
Poor Dental Health May Be Factor in Dementia
A new study in the Journal of the American Geriatrics Society shows a link between poor dental health and a greater risk of dementia. The study looked at the number of natural teeth, dentures worn, the number of visits to a dentist and other general oral health habits of 5,486 adults with the median age of 81 between the years of 1992 and 2010. The link was especially significant in men. A 2011 report from the Institute of Medicine of the National Academies, Improving Access to Oral Health Care for Vulnerable and Underserved Populations, stressed the importance of providing good oral health care to vulnerable and underserved populations. Read more on aging.
New Federal Report on the Health, Economic Status of Older Americans
While today’s older Americans are healthier and living longer than those of past generations, increased financial obligations and the rising obesity rate are still major considerations, according to Older Americans 2012: Key Indicators of Well-Being, a new report from the National Institutes of Health. The report looks at 37 key indicators to determine which areas are—and are not—improving for older Americans. By 1930 there will be approximately 72 million Americans age 65 and older, according to the Federal Interagency Forum on Aging-Related Statistics. Read more on older adults.
NYU Study Finds Antibiotic Use in Very Young May Increase Childhood Weight
Infants who received antibiotics before the age of 6 months are more likely to be overweight, according to a new study of more than 10,000 children. The study was published August 21 in the International Journal of Obesity and conducted by the NYU School of Medicine and the NYU Wagner School of Public Service. The researchers were careful to note that the study merely showed a correlation—not causation—and that more study is needed. “We typically consider obesity an epidemic grounded in unhealthy diet and exercise, yet increasingly studies suggest it’s more complicated,” said Leonardo Trasande, MD, MPP, an associate professor of pediatrics and environmental medicine at the NYU School of Medicine. “Microbes in our intestines may play critical roles in how we absorb calories, and exposure to antibiotics, especially early in life, may kill off healthy bacteria that influence how we absorb nutrients into our bodies, and would otherwise keep us lean.” Read more on infant health.