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.
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
“What aging is, is the greatest success of public health,” said Ruth Finkelstein, director of the Age-Friendly Initiative of the New York Academy of Medicine.
The City of New York has released a progress report on Age-friendly New York City, a cross-agency, public-private partnership created in 2009 to improve the lives of older New Yorkers. The report highlights progress in several areas including pedestrian safety, parks access and innovative senior centers among others initiatives. New York City is home to 1.3 million older New Yorkers, a number expected to increase by close to 50 percent by 2030. In 2007, the City Council provided funding to the New York Academy of Medicine to begin creating a blueprint to help New York City become a model of an age-friendly city.
The report’s release coincides with the city’s announcement of its recognition as the Best Existing Age-friendly Initiative in the World through a competition sponsored by the International Federation on Aging.
“It’s a fact of life that everyone gets older and we need to make sure our City is prepared to meet the needs of our aging population,” said Department for the Aging Commissioner Lilliam Barrios-Paoli. “Our success is due to the collaborative efforts of our sister City agencies, the New York City Council and the New York Academy of Medicine. Without this uniquely innovative partnership and the grassroots community efforts from local businesses and neighborhood organizations, we would not have been able to build the foundation for what makes New York City a better place to live for our seniors.”
The city’s age-friendly initiatives include:
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.
Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.
The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.
Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.
A new blog post from the Network for Public Health Law presents the dual public health challenges of seniors driving past the time they should be and the hardships posed when seniors need to get around without their cars. The concern is significant. Studies show that seniors are involved in more fatal car accidents than any other driving age group, and many of the accidents are the results of age-related impairments such as declines in vision and cognition abilities, and increased use of medications.
Because state laws vary, the Network offers legislative proposals for states to consider—as well as the pros and cons for each—such as physician reporting on a senior’s eligibility to drive and restricting driving based solely on age.
The Network’s post offers a link to a helpful AARP article with suggestions for transportation alternatives for seniors who may not be able to drive a car of their own. Here are some others from Peter Notarstefano, director of home and community-based services at Leading Age, formerly the American Association of Homes and Services for the Aging.
- Most states have a dial-in service, usually through the area's Agency on Aging or Department of Social Services; most states also have a dial-in service to connect senior Medicaid recipients with a ride to a Medicaid appointment. There may be limitations on times and days.
- Social Service Block grants and Older Americans Act funding through the local area Agency on Aging will provide transportation to grocery shopping and medical appointments for seniors for free or at a low cost.
- Local municipalities at times have transportation programs for older adults. Check here to find out a source of transportation for seniors in your area.
>>Read the post from the Network for Public Health Law.
Weigh In: Does your community have an effective system to help seniors get around without driving their own cars?
Earlier this week, NewPublicHealth reported on the skyrocketing numbers of older adults in the U.S., and with extended healthy years come greater opportunity. Many adults are exploring an “encore career”—a new stage of life and work that combines necessary continued income with new meaning and a chance to create social change.
Today, 200 of the nation’s leading activists in the encore movement from education, business, philanthropy, government, nonprofits and media will come together at the Encore 2011 conference to move this concept forward. NewPublicHealth spoke with Marc Freedman, MBA, CEO and Founder of Civic Ventures, a nonprofit think tank that created Encore.org, about the encore movement.
NewPublicHealth: What is an encore career? What’s happening with encore careers, and why now?
Marc Freedman: We’re hearing more and more about people working longer, and for many people it’s an opportunity to consider a whole new chapter. A significant segment of the population, about 9 million people, have decided to launch a chapter that’s at the intersection of continued income, new meaning and social impact—a kind of practical idealism that we’ve been calling an “encore career.” We’re particularly interested in the decision by so many to focus on trying to help solve the problems of the world, in areas like health, the environment and education.
NPH: Who’s coming to this conference and what’s on tap?
In 1980, there were 720,000 people aged 90 and older in the United States. In 2010, that number climbed to 1.9 million people. But by 2050, the ranks of people 90 and older may reach 9 million, according to a new report, “90+ in the United States: 2006–2008.” The report, from the U.S. Census Bureau, was commissioned by the National Institute on Aging (NIA), and details the demographic, health and economic status of America's oldest adults.
"With the aging boom it is critical to develop demographic data providing as detailed a picture as possible of our oldest population," says NIA Director Richard J. Hodes, MD. "The information on a variety of factors—income, health status, disabilities and living arrangements—will be particularly useful to researchers, planners and policymakers."
Key findings from the report include:
- A majority of the 90-plus population are widowed white women who live alone or in a nursing home.
- Social Security provides almost half of this group's personal income.
- Almost all have health insurance coverage through Medicare and/or Medicaid.
- Most say they have one or more types of disability.
- Women aged 90 years and older outnumber men nearly three to one; 74.1 percent of the total population aged 90 and older in 2006 to 2008 were women.
- Whites represent 88.1 percent of the total 90-and-older population. Blacks make up 7.6 percent, Hispanics 4 percent and Asians 2.2 percent.
NewPublicHealth spoke with Marie Bernard, MD, a noted geriatrician and deputy director of the NIA about how the report can inform current efforts aimed at healthier aging.
NewPublicHealth: What do we know about the health of current seniors?
Dr. Bernard: Their health is better than prior cohorts, but it is a segment of the population who over the course of time can develop health problems. Alzheimer’s disease, for example, increases in prevalence as do other diseases. But those who make it to 100 really seem to be survivors, and you don’t see much in the way of new health issues then.
NPH: What should people do now to increase the chances of a healthy oldest age?