Aging & Public Health
From the Editor
Welcome to the spring 2008 newsletter of the Gerontological Health Section of APHA. This issue has its usual complement of announcements, news from the Section, and reports from the field but differs in presenting a set of reports around a common topic. This issue’s topic is palliative care and aging. We have a number of reports on palliative care collected by Mary Beth Morrissey (Fordham University) and Michael Gerardo (Ohio University). You will see more of this topical focus in future issues, as we earmark each issue to focus on an area of research and practice of interest to the Section. Please let me know if you would like to take the lead on soliciting contributions for a topic.
I am impressed by the diversity of areas we cover. This issue has information on qualitative research, podiatry, Alzheimer’s care guidelines, needs assessments for geriatric services, exercise and arthritis, and minority aging.
Please continue to send your news and announcements to me as we gear up for the next newsletter, which will appear in early fall.
Greetings for a restful and productive summer,
Steven M. Albert, PhD, MSPH
Professor and Associate Chair
Department of Behavioral & Community Health Sciences
Graduate School of Public Health
University of Pittsburgh
A211 Crabtree, 130 DeSoto St.
Pittsburgh, PA 15261
(412) 383-5846 (FAX)
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John W. Rowe Speaks at the Heller School to Celebrate Brandeis University/Hebrew SeniorLife Educational Collaboration
On May 6, the Heller School for Social Policy and Management at Brandeis University hosted a celebration to kick off the new educational partnership between the school and Hebrew SeniorLife, one of the nation’s premier nonprofit senior housing and services organizations.
John W. Rowe, MD, professor in the Department of Health Policy and Management at the Columbia University Mailman School of Public Health and author of Successful Aging, gave a keynote address to commemorate the partnership and discuss the “Opportunities and Challenges of an Aging Society.” In his talk, Dr. Rowe urged the audience to consider the changes that will take place as our nation becomes an aging society and challenged listeners to reflect on how we will adapt as the nation's population ages.
Heller School Dean Stuart Altman and Hebrew SeniorLife CEO Len Fishman offered opening remarks and highlighted the role that the new partnership will serve in meeting the need for new leaders in the field of aging. Through a concentration in aging in Heller's MBA and MPP degree programs, the partnership combines management and policy training with hands-on experience at Hebrew SeniorLife’s multi-site facilities.
Incoming Heller School Dean Lisa Lynch moderated a discussion panel following the keynote address that included Michael Festa, Massachusetts secretary of Elder Affairs, Len Fishman and Alan Solomont, CEO of Solomont Bailis Ventures. Speakers and panelists participated in a discussion regarding ways to maintain work and community engagement for older adults as well as ways to involve all generations in preparing for and making decisions about the direction of our aging society.
For more information on the concentration in aging at the Heller School or the Brandeis/Hebrew SeniorLife Educational Collaboration, please visit www.heller.brandeis.edu or contact Dr. Sarita Bhalotra, chair of the concentration in aging, at email@example.com .
Student Research Awards
The Retirement Research Foundation has awarded APHA $60,000 to support 10 additional years (2008-2017) of Student Research Awards. The Student Awards are made in collaboration with the Gerontological Health Section. Lawrence G. Branch, a founding member of GHS, initiated student research recognition in 1993. In 1997 the Retirement Research Foundation granted APHA $30,000 for an initial 10 years (1998-2007) to support both a doctoral and a master's and bachelor's level Student Research Award. Over the past 10 years, 46 APHA GHS student members were either awarded $750 for Winner as a doctoral student award recipient, $500 for Winner as a master's or bachelor's award recipient, or $100 for Honorable Mention. Award recipients have made substantial contributions to the health and well being of older adults through scholarly research and publication, training of new scholars in the field of aging and public health, and professional activities.
Providing the means to attract, reward and retain outstanding students is vital for APHA and GHS to remain a national voice in the public health policy arena. Recognizing outstanding scholarship is necessary for the country to maintain an educated and motivated public health work force. The Retirement Research Foundation sponsored Student Research Award Program has made, and will continue to make, a substantial commitment to improving the health and well being of older adults.
Retirement Research Foundation Student Award Recipients
Glenn V. Ostir, Bsc, BA
Lucinda L. Bryant, PhD, MSMA, MBA
Nina T. Harawa, PhD, MPH
Ardith R. Brunt, PhD, RD
Jennifer Weuve, MPH
Robin Taylor Wilson, PhD, MA
Beth Hui Han, PhD, MPH, MD
Sherry H, Weitzen, PhD
Chiu-Chin Huang, PhD, NHA
Aram Dobalian, JD, PhD, MPH
Bonnie Davies Yeiser, MA
Linfeng Xu, MD, MHA
Amanda J. Boening, PharmD
Denys T. Lau, PhD
Heather M. Brandt, PhD, MSPH
Kisten Corazzini Gomez, PhD
Margie Rauch, MHS
R. Tamara Hodlewsky, MA
Elizabeth D. Moxey
Francis C. Yahia-Levy, MS, MPH, CHES, CPT
Patricia Heyn, PhD
Daniela Friedman, PhD, MSc
Michelle Gilles, MS
Stephanie L. Jones, PhD, MPH
Yael Harris, PhD, MHS
Amir Qaseem, MD, PhD, MHA
Susanne D. Dragun, PhD
Yoko Kawamura, MPH
Erika M. Symonette, MS
Laura E. Burleson, MPH
Katherine H. Leith, PhD, LMSW
Martha Conkling Tromp, MSPH and members of the evaluation team,
Department of Health Policy and Management, Texas A&M University
Alyson A. Falwell, MPH
Christopher B. Rosnick, PhD
John D. Prochaska, MPH
Karen Ertel, MPH
Katherine Anderson, PhD, MS
Nancy Lynn, MSPH
Monica L.W. Pecha, BS
Rohini G. Khorana
Yu Kang, MPA
Linda K. Ko
Kwan Ho Kenneth Chui
Shayna Rich, MA, BA
Highlights of Retirement Research Foundation Award Recipients
Susan C. Miller, PhD, MBA
Susan C. Miller is an associate professor of community health (research), Department of Community Health and Center for Gerontology & Health Care Research, Brown University School of Medicine. She is the chair-elect of the Gerontological Health Section. In 1997, Dr. Miller received Honorable Mention for the Retirement Research Foundation Doctoral Student Award, presenting research on a Retirement Research Foundation-funded study related to hospice care in nursing homes. Her research was published in the Journal of Palliative Medicine:
Miller, SC, Mor, V, Coppola K, Teno, J, Laliberte L, Petrisek, AC. (1998). The Medicare Hospice Benefit’s influence on dying in nursing homes, Journal of Palliative Medicine, 1(4):367-376.
Dr. Miller also made several presentations related to this work. Dr. Miller’s research focuses on end-of-life care, issues of quality of care, as well as health disparities among older adults.
As chair-elect of the Gerontological Health Section, Dr. Miller is working with the Section’s leadership and members to continue to ensure public health issues relevant to health care access and quality for older adults and their caregivers are prominent on APHA’s agenda. Her background as an administrator, educator, researcher, and, more recently, as the Gerontological Health Section’s representative on APHA’s Action Board, has provided her with the knowledge and skills needed to motivate and lead Section members in their efforts to increase the Section’s influence in the wider policy arena. In relation to these efforts and to her research interests, Dr. Miller is working to develop closer liaisons between the Gerontological Health Section and palliative care membership organizations in order to more effectively promote the provision of high-quality, well-coordinated long-term care and support to persons with life limiting illnesses and their caregivers.
Lucinda L. Bryant PhD (Health & Behavioral Science,) MSHA, MBA
Lucinda L. Bryant is an assistant professor, Department of Preventive Medicine & Biometrics, University of Colorado at Denver and Health Sciences Center. Dr. Bryant’s professional career in healthy aging “officially” began with the recognition and encouragement she received from members of the Gerontological Health Section as a finalist for the Retirement Research Foundation Doctoral Student Award in 1998. As a finalist for the Award, when Dr. Bryant had just completed her PhD, she received encouragement from Dr. Branch to publish the part of her dissertation work contained in her competition paper.
Bryant, L.L., Beck, A., Fairclough, D.L. (2000). Factors that contribute to positive perceived health in an older population. Journal of Aging and Health, 12:169-192.
Her connections with the Gerontological Health Section, and, more broadly, aging interests and research, have continued through ensuing annual meetings and collaborations with Section members. Dr. Bryant has a passion for community-based research and support for older adults in communities, especially those at special risk socio-economically, ethnically and geographically. She has been principal investigator for Colorado’s Prevention Research Centers’ Healthy Aging Research Network (HAN) member center for the past six years, working closely with public health and aging colleagues locally and nationally. The HAN conducts community-based research into areas that include physical activity, cognitive health, depression and social engagement, the physical and built environment, and nutrition. Within the HAN, as co-leader of the HAN Research Dissemination and Practice Group, Dr. Bryant focuses especially on dissemination of the results of healthy aging research, in partnership with national- and state-level aging service and public health providers. As a current Gerontological Health Section Section Councilor, Dr. Bryant seeks to encourage the development, dissemination, and evaluation of community-sensitive evidence-based programs to promote health in older adults.
Dr. Bryant has continued to develop an interest in healthy aging, trying to understand the factors that encourage and impede healthy aging and to translate and transfer the evidence into community programs and policies. The support of the Gerontological Health Section’s Retirement Research Foundation Doctoral Student Award and Dr. Branch provided a tremendous boost.
Daniela B. Friedman, MSc, PhD
Daniela B. Friedman is an assistant professor in the Department of Health Promotion, Education, and Behavior of the Arnold School of Public Health at the University of South Carolina. In November 2002, she received the Retirement Research Foundation Master's Student Research Award for her graduate research entitled “Cancer Coverage in North American Seniors' Publications.” [Abstract available at: http://apha.confex.com/apha/130am/techprogram/paper_34955.htm]. Based on this research, Dr. Friedman published two articles as first author in the Journal of Cancer Education:
Friedman, D.B., & Hoffman-Goetz, L. (2003). Sources of cancer information for seniors: A focus group report. Journal of Cancer Education, 18(4), 215-222.
Friedman, D.B., & Hoffman-Goetz, L. (2003). Cancer coverage in North American publications targeting seniors. Journal of Cancer Education, 18(1), 43-47.
Being recognized for this research as a graduate student encouraged Dr. Friedman to pursue a doctoral degree in gerontology at the University of Waterloo (Waterloo, Canada). She continued her work on communication and aging with a research focus on older adults’ understanding of cancer prevention information and on the content and difficulty level of Web-based cancer messages being communicated to older adults. Dr. Friedman’s research program as faculty at USC continues to focus on health communications and health literacy research. Currently she is a co-investigator on a CDC-funded Special Interest Project entitled “Prevention Research to Promote and Protect Brain Health.” The goals of this qualitative research are to obtain information about how diverse audiences understand and think about cognitive health. Dr. Friedman is also principal investigator on a USC grant examining functional health literacy skills and understanding of prostate cancer prevention among older African American men, and exploring the value of a more expansive framework of health literacy for use with under-served minority populations.
Tool for Public Health
I don’t know if you’ve seen this, but it’s a great tool to talk about public health! Please share!
Tricia Todd, MPH
Health Careers Center, University of Minnesota
2-565 Moos Tower MMC 502
420 Delaware St SE
Minneapolis, MN 55455
Task Force on Community Preventive Services Seeks Experts
CDC's Task Force on Community Preventive Services, which develops The Community Guide, seeks experts to participate in review groups that assess the literature with respect to taks for recommendations. This provides an opportunity for individuals with relevant expertise to participate in helping shape recommendations as to the efficacy of interventions. For more information, please contact Natalie Raynor at (202) 777-2433.
ASA Announces New Board Officers
San Francisco, April 14, 2008 — The American Society on Aging announced today that Cynthia Stuen, PhD/DSW, has started a two-year term as chair of the association’s national board of directors.
“It is a privilege to be the new chair of ASA’s board at this exciting time as the baby boomers start entering their 60s,” Dr. Stuen said. “With the largest generation in U.S. history moving toward retirement age at the same time that longevity is increasing, ASA has a vital opportunity to bring together the leaders in this field so that all older adults may live to their fullest potential with dignity.”
Dr. Stuen is senior vice president for policy and professional affairs at Lighthouse International, New York City. She has worked in the field of aging for more than 35 years and has been active in ASA since it changed from the Western Gerontological Society to become the American Society on Aging in 1985. She has served in the leadership of the association as: a board member; as chair of ASA’s Network on Environments, Services and Technology constituent group; and on several committees and task forces. In addition, she chaired the search committee in 2006-2007 for ASA’s new president and CEO. She received the ASA Leadership Award in 2005.
Dr. Stuen’s publications, presentations and research cover topics of age-related sensory loss, access to environments for older adults with impaired vision, and contributions older adults and their family and friends can make to program planning and service delivery. She served as a guest editor for the spring 2003 issue of ASA’s quarterly journal, Generations, which focused on aging and the senses.
Dr. Stuen has been at Lighthouse International, a leader in vision health care, for 21 years. In 2005, Dr. Stuen served as a delegate to the White House Conference on Aging. She is active in several professional organizations, has published extensively and is a frequent speaker for both professional and consumer audiences. She holds a doctorate from the Columbia University School of Social Work, a master’s degree from the School of Social Service Administration at the University of Chicago and a bachelor’s degree from Valparaiso University.
Other ASA board officers recently elected include Chair-elect John Feather, president and CEO of American Society of Consultant Pharmacists; and Treasurer Jed Johnson, assistant vice president of the Easter Seals headquarters.
Founded in 1954, the American Society on Aging is a professional association that develops leadership, knowledge and skills to address the challenges and opportunities of a diverse aging society. With more than 10,000 members, subscribers and partners, ASA is the largest association for professionals working in the field of aging. Based in San Francisco, the association currently employs more than 30 staff and has an operating budget of more than $4.1 million. For more information, visit www.asaging.org.
L.A. COUNTY SENIORS HAVE SPOKEN!
Results of First-Ever Older Adults Survey are Released
LOS ANGELES COUNTY — Los Angeles County and the City of Los Angeles have released the results of a groundbreaking survey regarding the identified needs of older adults in Los Angeles County. The Los Angeles region is home to nearly one-third of California’s seniors. The first of its kind, L.A. County Seniors Count! Survey of the Older Adult Population, is the result of a countywide needs assessment survey, generating responses from 16,500 culturally diverse residents age 60 and over.
This was a joint effort of the Los Angeles County Community and Senior Services Department, Los Angeles City Department of Aging and the Los Angeles County Commission on Aging. L.A. Seniors Count! Survey of the Older Adult Population” report was recently presented at the National Council on Aging and American Society on Aging Joint Conference, the nation’s largest conference on aging.
“This is the first time that Area Agencies on Aging have jointly surveyed seniors directly,” said Cynthia Banks, director of the Community and Senior Services Department. “Prior surveys have been based mostly on information gathered from secondary sources and not seniors themselves. This research does not rely on an expert’s vision, but on the opinions of the people who live in the county.”
The report identifies 21 key findings, highlighting the areas of greatest concern for the respondents.
Key Findings Include:
*inadequate or no dental insurance.
*inadequate prescription drug coverage.
*interest in physical exercise, health promotion and disease prevention.
*interest in safety information or had safety issues.
*inadequate information about productive activities.
“The findings revealed that health issues make up the greatest area of need,” said Laura Trejo, general manager, Los Angeles City Department of Aging. “Many of the respondents lack adequate health and dental insurance and expressed difficulty in accessing preventive health services. We also found that we cannot talk too broadly about the needs of county seniors. Residents with different backgrounds and in different geographical areas often reported different needs.”
To gain a clearer understanding of the current needs of seniors, the Los Angeles County Community and Senior Services Department, Los Angeles City Department of Aging and the Los Angeles County Commission on Aging collaborated on a large-scale needs assessment survey of county residents age 60 and over.
The four-page survey contained a total of 40 questions covering seven categories: health, productive activity, information assistance, daily activities, housing, transportation and caregiving. Approximately 100,000 surveys were distributed throughout the county and were completed by nearly 16,500 men and women.
The needs assessment survey process included:
~A partnership of three local agencies.
~Distribution of approximately 100,000 copies of the survey to Los Angeles City and County senior and community centers, libraries, polling places, churches and synagogues, in-home supportive services, home-delivered meals routes.
~The provision of a Web-based opportunity for completion of the survey in English and Spanish.
~The distribution of the survey in English, Spanish, Korean, Chinese, Tagalog, Armenian and Japanese.
~A national search for senior needs assessment survey reports
~A literature review of Gerontology studies
~Support from Kaiser Foundation, California Community Foundation, the Los Angeles County Commission on Aging and CVS Pharmacy.
The needs assessment has identified opportunities for L.A. County to prevent or delay dependence by creating systems and services that allow older adults to sustain self-sufficiency.
“The report provides the county and the city with information that is invaluable for both planning programs and advocacy,” said Commission Past President Bernard Weintraub, and former chair of the Los Angeles County Commission on Aging Needs Assessment Committee. “We are eager to share it with others who can use the results to help seniors lead healthy and productive lives for as long as possible.”
To Obtain Copies of the Report
Copies of “L.A. County Seniors Count! Survey of the Older Adult population” are available at http://css.lacounty.gov and www.lacity.org/DOA, or you may call Patricia Senette-Holt at (213) 738-2065.
Nancy Alfred Persily
It is with sadness that we note the death of Nancy Alfred Persily. Nancy was a founding member of the Gerontological Health Section and began her membership in APHA in 1968. Nancy devoted her career to ensuring quality of life for older populations through improving direct services, conducting research, mentoring health professionals and developing educational programs. Nancy earned her undergraduate degree from Cornell and her MPH from Yale. She served on the faculties of several universities including the University of Miami, George Washington University, and the University of Albany, School of Public Health where she was assistant provost and associate dean for academic affairs. In addition to her work in academe, Nancy was active in consulting, owning her own successful business as well as serving as vice president at Lewin Associates.
As an active participant in health services research, Nancy improved our understanding of health care systems and care of older persons. For example, her work on enrollment and disenrollment of older persons in Florida Medicare HMOs contributed to our understanding of how organization of payment influences quality of care, as well as the health behaviors of elders. Her expertise in designing and improving hospital services for older persons and her deep understanding of community based-services and their interface with acute care were illustrated in a book co-edited with Steve Brody entitled "Hospitals and the Aged: The New Old Market," as well as three other books spanning academic and health professional audiences. She has served as a mentor to health professionals in Israel, several South American countries and other areas around the world.
Nancy was an innovative educator and developed several new academic programs for leading universities, including undergraduate public health programs at both G.W. and Albany, each with attention to gerontologically relevant content across the curriculum.
Nancy was a tireless advocate for older persons and for public health education. She was the founder of the GHS Key Award, and will be sorely missed by all of us who worked with her toward common goals.
Terrie Fox Wetle, PhD
Associate Dean of Medicine for Public Health
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Stand By Me: Palliative Care Concepts and Approaches
Pain & Symptom Management: A Multidimensional Perspective
Terry Altilio, LCSW
Social Work Coordinator
Beth Israel Medical Center
“Harm occurs when the amount of hurt or suffering is greater than necessary to achieve the intended benefit. Here lies the basic ethical challenge to caregivers; since pain seems harmful to patients and caregivers are categorically committed to preventing harm...not using all the available means of relieving pain must be justified.” Walco, Cassity, Schechter, (1994)
Pain and symptom management whether along the continuum of illness or at end of life is a shared responsibility of the health care team. The ethical mandate to relieve suffering emanates from the principles of justice, beneficence and nonmaleficence; principles that inform the work of all of us who interface with patients and families.
Pain is undertreated in the most vulnerable of our populations such as the elderly, children and minority populations, and this tragic reality invites participation as both advocates and clinicians.
Of particular concern is the prevalence of pain in older adults which ranges from 25-83 percent in the community and from 45-83 percent in long term care facilities. The undertreatment of pain in long term care has been clearly established by the work of Joan Teno and her team and others. For example, a review of data from 50 states revealed that 15 percent of residents were in daily pain, 41 percent of the residents in pain were still in pain 60 – 180 days later, 3.7 % were assessed to have excruciating pain and 42 percent continued to have unrelieved pain (Teno et al., 2001; Teno et al., 2004). This is the tragedy that is at the basis of an ethical and moral mandate to manage pain with competence and vigilance.
Pain when viewed as a multidimensional construct includes the physical nature of pain and extends beyond to culture, spirituality, cognitive, emotional, financial, social and family impacts and response. Multidimensional exploration of pain is not a denial of physical pain but rather an expression of interest, caring and concern for the total person. Medical management is accompanied by efforts to understand beliefs, thoughts, behaviors and feelings that may contribute to pain, suffering and distress.
The International Association for the Study of Pain has defined pain as unpleasant sensory & emotional experience associated with actual or potential tissue damage or described in terms of such damage. As a subjective experience, the person’s report of pain becomes central to the beginning assessment. This process becomes more complex and requires learnable skills in settings where patients are cognitively impaired, demented, and psychiatrically ill or speak a primary language that is different than the health care provider.
Assessment and treatment of pain assumes knowledge of symptoms, etiology and potential treatments and explores the individual experience of the patient and the family. While pain is a universal experience, the presence of pain in life threatening illness invites an assessment that considers impact on mood, function and quality of life. Pain can be infused with cultural and spiritual beliefs. Some have been taught by their family and culture to bear with pain stoically while others are raised to express pain with dramatic, emotional behaviors. Some believe that pain is a punishment from God, while others may view the presence of pain as redemptive and therefore may initially be reluctant to accept treatments that are offered.
The response of family members to the pain experience is important to explore as patients and their families are intertwined and the suffering that ensues from unmanaged pain extends beyond the life of the patient to the family and ultimately infuses bereavement and the legacy that evolves around the death of the patient. The consequences of pain, whether in life-threatening illness or chronic conditions such as arthritis, ripples outward as a person’s mood, function and quality of life impacts the lives of family members as roles and responsibilities shift and relationships are affected. This reciprocal relationship is often observed in the assessment of pain by family and caregivers who may overestimate or underestimate the level of pain because their perceptions are filtered through their own emotions, fears and suffering. This is a part of the multidimensional understanding of pain that is essential to quality care at end of life and appropriate care planning.
Medical management of pain is a primary focus as ameliorating overwhelming pain is a prerequisite to any multidimensional assessment. Pain assessment may include clinical interviews, tools and scales that can both partialize the experience and inform and prioritize interventions. The language and metaphors chosen to explain and describe pain can provide a narrative through which the meaning and significance of pain is expressed. The patient’s perception and information is validated, and input from family and health care professions may be sought to complement and enrich the clinical understanding of the pain and its impact.
Comprehensive management of pain and other symptoms combines expert medical management with interventions that focus on reducing anxiety and distress and, when indicated, treating depression. If left untreated, these psychological aspects can exacerbate the patient and families’ experience of pain and the quality of their time together. Understanding the impact of pain on mood, function, sleep, appetite and family relationships creates opportunities for focused interventions that extend beyond medical management to a holistic approach that respects the unique person and family.
Teno, J., Weitzen, S., Wetle, T. & Mor. V. (2001). Persistent pain in nursing home residents. Journal of the American Medical Association, 285(16), 2081.
Teno, J., Kabunoto, G., Wetle, T., Roy, J. & Mor, V. (2004). Daily pain that was excruciating at some time in the previous week: Prevalence, characteristics, and outcomes in nursing home residents. Journal of the American Geriatric Society, 52(5), 762-767.
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Why I Love Palliative Care
STAND BY ME: PALLIATIVE CARE CONCEPTS AND APPROACHES
Why I Love Palliative Care
Joseph Sacco, MD, ABFM, ABHPM
Director, Palliative Medicine Consultation Service
Bronx Lebanon Hospital Center
When I tell people I practice palliative care, their usual reaction – after asking “What’s that?” – is, “That must be hard,” or “I could never do that.” Then they mention an uncle, an aunt or a parent who died from cancer, or a stroke, or chronic lung disease, and how hard it was for everyone, and, with a wistful shake of the head, move the conversation toward other subjects.
I nod to convey my sympathy. “Yeah,” I say, “It’s hard. It really is. But I love it. I enjoy it more than anything else I have ever done in the practice of medicine. And I’ve done just about everything. Clinic, ER, inpatient, outpatient, the ICU. Everything except operate on people. And I love it.”
This, inevitably, is met with incredulity, or at least surprise. “But don’t you deal with dying people?,” the medical and non-medical ask. “Isn’t it sad?” When I recently suggested a “road trip” to Calvary Hospital in the Bronx to visit a patient, saying how nice the place was, how they had a drink cart with wine and sherry and even let the patients’ pets visit, a surgical PA who overheard the comment wrinkled his nose like I had suggested visiting a garbage dump. “A road trip to Calvary?” he asked, rolling his eyes. “Calvary? Well, I guess if you like that kind of thing.”
The statistics are clear. Dying is managed poorly in the United States, with study after study showing doctors and other medical providers ill-prepared to handle the suffering associated with the end of life, especially pain, and referrals to palliative care and hospice programs lagging far behind need. And not only symptom management, for pain, nausea and vomiting, delirium, anxiety, and other unpleasant symptoms, but also psychosocial needs. Doctors are unaware of their patients’ preferences for cardiac resuscitation, they do not complete heath care proxies, they do not discuss ventilator dependence, long term care preferences or hospice. Patients – and families – the trajectory of illness long apparent to anyone with even a modicum of medical training and experience, find themselves suddenly confronted by a crisis that was inevitable, wholly unprepared to decide what to do. The palliative care team at my hospital finds itself in the ER, the ICU, and the wards counseling patients and families astonished to learn what they didn’t know about the ultimate outcomes of illness, aghast that they didn’t know more, and grateful, not just for the relief of pain, but at finally understanding what was going on all along.
I came to the practice of palliative care after more than 20 years of practicing hard core medicine with the sickest of the sick in the South Bronx: poor black and Hispanic people who rarely presented for care with cancer less than stage three, with HIV that had long ago morphed into frank AIDS, breathless, febrile, emaciated, drug addicted, mentally ill, miserable. In the '80s and '90s, on a single 40-bed medical ward, 70 or more patients a month died from HIV alone. And many, alone. But it wasn’t until a well-meaning oncologist suggested that a dying cancer patient’s doctors would “go down fighting,” that I moved full time to palliative care.
Now, instead of grinding out 10 or f15 patients in an afternoon in clinic or seeking to be head of the first of the hospital’s units to bring average length of stay to below three days, I pull a chair to people’s bedsides and schmooze about life, illness and death. I talk politics and morphine, “code status” and grandchildren, ventilators and movies. I give patients and families my beeper and cell phone number and tell them I am available “24-7.” They thank me profusely, visibly relieved, but they rarely call. Just having access is enough, the ability to actually reach a doctor so far off the beaten trail of conventional medicine as to elicit wonderment. And the team relieves a lot of pain. The SUPPORT study showed that pain at the end of life was unrelieved in 1995, and we find it still unrelieved in 2008. How easy is it, I ask the residents, to give someone a dollop of morphine, and how gratifying to see the grimaces melt as the pain fades? Where else in the practice of medicine can we see results more immediate and kind? Yes, we are surrounded by death. Yes, it is sad and hard. But death, I must regrettably confess, is not something that keeps us awake at night. Not after thousands. What keeps us awake at night is dying poorly managed, a death in pain, a death prolonged far beyond the limits of reason because that is the kind of death that pays hospitals the most. Abandoned elderly, collecting bedsores in nursing homes across the nation, literally a commodity, warehoused by the perverse, if well-intentioned, reimbursement structure of Medicare and Medicaid that makes them so profitable.
Now, the practice of medicine is about the medicine itself, for medicine is among the most powerful forces for good in existence, but also about the relationship, about the person and the unique preferences on which medicine will have its ultimate result. It is about the CAT scan and the subject of the CAT scan. It is about Mr. Miller, in Calvary, and his wife, Wanda, and “Al” from the corner, who I often find asleep in a chair at Mr. Miller’s bedside. I’ve known Mr. Miller since he was diagnosed with lung cancer, and I will be his doctor until he dies. It’s about Hector, post operative from colon cancer and praying that he is cured, and his daughter, who text messages me updates on his condition, as well as off-color jokes. It’s about the baby with three sets of chromosomes instead of two, whose mom will repeatedly bring him back to the hospital until he dies. I will be there every time.
When I tell people I love palliative care, this is why. Palliative care is about dying, but it is far more about relationship; being a friend of patients who also happens to be a doctor. It is about making medicine, finally, about what it should be about.
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Diversity and Aging: Hospice and Palliative Care
Hospice and palliative care programs across the country provide a tremendous service to those requiring palliation of burdensome symptoms and to those in the terminal stages of their disease trajectories. These services, which are provided by a multidisciplinary team of physicians, nurses, social workers, spiritual care personnel, bereavement counselors and volunteers, have shown to improve the care of persons in need of pain and symptom management and psychosocial support – be they continuing with curative therapy or nearing the end of life. Historically, persons of underrepresented racial and ethnic groups have underutilized these services; however, recent data suggests that the gap in utilization of hospice and palliative care is closing.1
Despite increased utilization, racial differences continue to exist in the perceptions of the quality of care provided to patients that may benefit from palliative care and other support services. African American cancer patients have reported more problems with coordination of care and psychosocial care as well as more severe symptomatology than patients of other ethnic groups.2,3 Furthermore, studies have shown that there are differences in treatment patterns, pain management, and the use of hospice care between African American women and women in other ethnic groups.4 These differences also exist in the perception of the quality of care patients receive at the end of life. In research conducted by Welch et al, bereaved family members of African American decedents were found to have more concerns with the care provided to their loved one during the dying process than bereaved family members of white decedents. They were more likely to report absent or problematic physician communication, concerns with being informed, and concerns with family support. Bereaved family members of African American decedents were also less likely to rate the care they received as excellent or very good.5
One of the goals of my research has been to examine racial and ethnic disparities associated with the access to hospice and palliative care. In an attempt to understand historically documented underutilization of hospice by members of the African American community, I, with assistance from my mentor Dr. Joan Teno, conducted a secondary analysis of a national mortality follow-back survey. The respondents of this survey were bereaved family members of persons who died in the year 2000. In this study, we found that almost 70 percent of African American decedents did not receive hospice services, and of those, slightly more than half (54 percent) were not informed about hospice as an option for care at the end of life.6
An additional goal of my research has been to carry forward the work conducted by Welch and colleagues by examining disparities in perceptions of the quality of care received while on hospice. This was done by conducting a secondary analysis of the 2005 Family Evaulation of Hospice Care survey (FEHC). The FEHC is a 61-item questionnaire that surveys family members about care provided to the decedent by the hospice. Hospices submit their data to the National Hospice and Palliative Care Organization (NHPCO), where results are tabulated.7 Our study revealed that though bereaved family members’ perceptions of the quality of care they receive improve with hospice enrollment, opportunities for improvement remain. Family members of African Americans were more likely than white family members to report concerns with unmet needs for pain, lack of provision of emotional support, and being informed of their loved one’s condition. Additionally, they continued to be less likely to rate the care they received as excellent.8 These findings suggest that though the disparity in access to care may be closing, the disparities associated with perceptions of the quality of care provided persist. Now that these racial differences have been identified, future research should include identification of individual, organizational and market-level factors that contribute to these disparities and the creation of multifaceted interventions to reverse the disparities in perception of hospice care quality that have been identified.
Ramona Rhodes MD, MPH
Assistant Professor, Center for Gerontology and Health Care Research
Brown University, Division of Geriatric Medicine
Rhode Island Hospital
1. NHPCO’s Facts and Figures: Hospice Care in America, November 2007 Edition. The National Hospice and Palliative Care Orgnaization. http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-figures_Nov2007.pdf. (Accessed June 3, 2008).
2. Rao D, Debb S, Blitz D et al. Racial/Ethnic Differences in the Health-Related Quality of Life of Cancer Patients. Journal of Pain and Symptom Management. 2008; 24.
3. Ayanian JZ, Zaslavsky AM, Guadagnoli E, et al. Patients' Perceptions of Quality of Care for Colorectal Cancer by Race, Ethnicity, and Language. Journal of Clinical Oncology. 2005; 23:6576-6586.
4. Payne R, Medina E, Hampton JW. Quality of Life Concerns in Patients with Breast Cancer: Evidence for Disparity of Outcomes and Experiences in Pain Management and Palliative Care Among African-American Women. Cancer. 2003;97 (1 suppl):311-317.
5. Welch LC, Teno JM, Mor V. End-of-life care in black and white: Race matter for medical care of dying patients and their families. Journal of the American Geriatrics Society. 2005;53:1145-1153.
6. Rhodes RL, Teno JM, Welch LC. Access to Hospice for African Americans: Are They Informed about the Option of Hospice? Journal of Palliative Medicine. 2006;9:268-272.
7. Connor SR, Teno J, Spence C et al. Family Evaluation of Hospice Care: Results from Voluntary Submission of Data Via Website. Journal of Pain and Symptom Management. 2005;30:9-17
8. Rhodes RL, Teno JM, Connor SR. African American Bereaved Family Members’ Perceptions of the Quality of Hospice Care: Lessened Disparities, but Opportunities to Improve Remain. Journal of Pain and Symptom Management. 2007;34:472-479
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Diversity and Aging: Quality of Care
A major focus among public health scientists and public policy advocates centers on the quality of care provided across all health care settings. The Institute of Medicine defines quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”1. The morbidity and mortality associated with having a chronic disease may be prevented if the quality of care related to preventive care practices were implemented at the provider, facility and federal level2,3. A recent Centers for Disease Control and Prevention statement outlines those quality indicators which, when implemented, may improve health status4. Such measures include behavior and lifestyle modification and early screening to detect the presence of chronic illness.
There is, however, a paucity of research describing the quality of care offered to a growing, diverse older adult population. This is surprising given the tremendous ethnic and racial demographic changes projected by the Census 2000. African Americans, Hispanics, and Asian Americans comprised 8.4 percent, 12 percent and 7.7 percent (respectively) of the older adult population in the year 2000. By the year 2050 African Americans, Hispanics and Asian Americans will comprise 16.1 percent, 20 percent, and 15 percent (respectively) of the older adult population5. In order to proactively reduce any differences in the quality of care offered to racial and ethnic elders, researchers, health care providers and public policy advocates alike must address the various factors that influence poor quality of care.
One such quality indicator is blood pressure screening. Blood pressure screening in the primary care setting is intended to identify disease, and when hypertension is diagnosed, blood pressure screening is used to evaluate response to therapy. The U.S. Preventive Services Task Force recommends (Grade A) regular blood pressure screening to detect those at high risk of developing hypertension. The evidence suggests that poor health outcomes such as heart disease and stroke can be significantly reduced if high blood pressure is well-controlled even among the very old 6.
Investigators at the Department of Geriatric Medicine and Gerontology at Ohio University have recently undertaken an examination of data from the National Ambulatory Medical Care Survey to address disparities in quality of care among the diverse older U.S. population in the primary setting. The survey is an ideal database for such an endeavor since this national survey collects information related to the use of ambulatory medical care services in the United States and as of 1989 has been collected annually by the CDC.
Our initial findings suggest that non-Hispanic black and Hispanic elders, when compared to non-Hispanic white elders, are more likely to receive blood pressure measurement after adjustment for selected patient, provider and facility characteristics. One potential explanation is that physicians who tend to care for older racial and ethnic minorities may be more vigilant with blood pressure screening because they are aware of the increased incidence and prevalence of hypertension among minority populations. These observed differences in blood pressure measurement persisted among a subset of non-hypertensive elders. An interesting finding is that among the subset of hypertensive older adults, there were no differences in blood pressure measurement between the racial and ethnic groups. Perhaps once diagnosed with hypertension, health care providers are more likely to equally address blood pressure measurement as a necessary guide to treatment response.
Our initial research efforts suggest that there are ethnic/racial differences in the quality of care received by older adults, as indicated by differences in blood pressure measurement. This difference appears to occur only among those without diagnosed illness. Identifying whether these differences are attributable to physician practice or patient preference may help untangle the web of multiple causes leading to disparate care. We welcome any suggestions or comments. Please feel free to e-mail your thoughts or concerns to firstname.lastname@example.org.
1. Institute of Medicine: The National Academy of Sciences. http://www.iom.edu. Accessed June 5, 2008.
2. Matson Koffman DM, Lanza A, Campbell KP. A purchaser’s guide to clinical preventive services: a tool to improve health care coverage for prevention. Prev Chronic Dis 2008;5(2). http://www.cdc.gov/pcd/issues/2008/apr/07_0220.htm. Accessed June 6, 2008.
3. Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109:3244-3255.
4. Centers for Disease Control and Prevention. http://cdc.gov/aging. Accessed June 3, 2008.
5. Angel J., Hogan D., Population Aging and Diversity in a New Era. Chapter 1: 1-12. Closing the Gap: Improving the Health of Minority Elders in the New Millennium.
6. Leatherman S., McCarthy D., Quality of Health Care for Medicare Beneficiaries: A Chartbook, 2005. New York, NY: The Commonwealth Fund.
Renee’ Walker, MS, Research Assistant in Minority Aging University of Buffalo and Ohio University, College of Osteopathic Medicine
Michael P. Gerardo, DO, MPH, Assistant ProfessorDepartment of Geriatric Medicine and GerontologyOhio University, College of Osteopathic Medicine
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Public Health and Podiatric Medicine Principles and Practices
"Public Health and Podiatric Medicine - Principles and Practices" is the second edition of out text initially published in 1987. The publisher is APHA Press. It is the only text to focus on the health and public policy issues relating to podiatric medicine and foot health. There are several chapters that provide a focus on aging and maintaining mobility in older patients -- major factors that relate to the quality of life and the ability to live independently and to live life to the end of life. Issues include Medicare, long-term care, health education and promotion, assessment and chronic disease issues including diabetes mellitus, peripheral arterial disease, and arthritis as examples.
"Foot Health Training Guide for Long-Term Care Personnel" is an education guide published by Health Professions Press. It has been developed to permit those who provide daily care to patients in long-term care programs to raise their index of suspicion to recognize foot problems, provide an initial assessment, suggest and recommend the need for consultation and care. Included are the special needs of older diabetics, fall prevention, pressure ulcer considerations, and most importantly, an assessment protocol that provides a standard index to document foot health issues.
Arthur E. Helfand, DPM
9 Hansen Court
Narberth PA 19072-1712
FAX: (610) 667-9183
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Fit and Strong
Fit and Strong!: An evidence-based exercise/behavior change program for older adults with lower-extremity osteoarthritis
Arthritis is the number-one cause of disability among the growing population of older adults in the United States. In particular, lower extremity joint impairment among older adults with osteoarthritis (OA) is a known risk factor for future disability and institutionalization (Guralnik, et al. 1995; Dunlop, et al. 1997; Jette, et al. 1999). Arthritis currently affects 20 million persons aged 65 and over in the United Sates. and is projected to increase to affect approximately 40 million by 2030 (Centers for Disease Control and Prevention, 2006). Older adults who have OA in their lower extremity, weight-bearing joints tend to limit movement of these joints because of pain. This limitation of movement leads to the development of a sedentary lifestyle, which is associated with significantly reduced aerobic capacity and muscle strength (Minor et al. 1989; Semble et al. 1990). Thus, as older adults with lower extremity OA progressively limit their activity over time, they become unable to climb stairs, get in and out of a car, and perform other tasks of daily living that require the involvement of lower extremity, weight-bearing joints and that are necessary for independent functioning in the community. Although several exercise interventions have been tested with persons with OA, few have been designed to specifically reinforce long-term adherence to a regular multiple component program of physical activity designed for this high risk group.
To address this urgent public health problem, we developed Fit and Strong! Fit and Strong! is the first program of which we are aware to combine flexibility/balance, aerobic walking, and strength training with health education for disease management and sustained behavior change among older adults with OA (Hughes et al., 2004). The program meets for 90 minutes, three times a week for eight weeks. The first 60 minutes are devoted to physical activity, which incorporates flexibility/balance exercises, fitness walking and low impact aerobics, and lower extremity strength training. The last 30 minutes are devoted to group discussion/problem-solving to enhance disease management and self-efficacy for adherence to physical activity over time.
Efficacy Trial. We originally tested the impact of Fit and Strong! using a randomized trial with 215 older adults with lower extremity OA in Chicago. The trial was funded by the National Institute on Aging as part of our Edward R. Roybal Center. We assessed outcomes at two months (the end of the formal program) and also examined the maintenance of program effects at six months and 12 months. Relative to the control group, Fit and Strong! participants experienced statistically significant improvements in self-efficacy for exercise, exercise adherence, and lower extremity stiffness at two months (Hughes et al., 2004). These benefits were maintained at six months, at which time participants also experienced a significant increase in self-efficacy for adherence to exercise over time, a significant decrease in lower extremity joint pain, and a marginally significant increase in self-efficacy for arthritis pain management. At 12 months, significant treatment group effects were maintained on self-efficacy for exercise and exercise adherence that were accompanied by marginally significant reductions in lower extremity stiffness and pain (Hughes et al., 2006). No adverse health effects were seen.
Although the formal program ends at two months, effect sizes for self-efficacy for exercise and for exercise adherence at six and 12 months in the treatment group were large, at 0.798 and 0.713, and 0.905 and 0.669, respectively. Furthermore, treatment group participants maintained a 55.6 percent increase in participation in physical activity relative to their baseline levels at 12 months. This rate is approximately double the rate observed among control group members at 12 months. These findings indicate that this low-cost, eight-week intervention demonstrated substantial efficacy as a health promotion intervention and is ready to be replicated broadly.
Effectiveness Trial. We are currently testing different ways of reinforcing long term maintenance to the multiple physical activity components included in Fit and Strong! at five senior centers run by the Chicago Department on Aging through an R01 from NIA. All participants enroll in the eight-week Fit and Strong! program and are assigned to two different post Fit and Strong! maintenance strategies: negotiated vs. mainstreamed, with and without follow-up telephone reinforcement. Participant evaluations from new enrollees in the program show that 73 percent described their overall reaction to Fit and Strong! as ‘excellent’, 99 percent agreed that they had benefited from it, and 98 percent agreed that they would recommend the program to friends and family members.
The original efficacy trial of Fit and Strong! used licensed physical therapists to develop and test an exercise program that was safe for older adults with lower extremity OA. Since the program components demonstrated safety and efficacy during that trial, during our current R01 we transitioned to a model using certified exercise instructors in order to reduce program costs and disseminate the program broadly as a cost-effective health promotion intervention for older adults with OA. Evaluations from more than 400 participants in the follow-up R01 described above have ranked the program as equally effective under both physical therapist and certified exercise instructors, and no adverse events have occurred, indicating that the program is ready for wide-scale adoption.
Awards. Fit and Strong! was selected by the Healthcare and Aging Network (HAN) of the American Society on Aging, in collaboration with Pfizer Inc., as one of only six recipients of the 2008 Healthcare and Aging Awards. The review committee for the Health Care and Aging Award found Fit and Strong! to be innovative with a significant impact on community. The committee strongly believes that the field and practice of health care and health promotion is advanced by sharing Fit and Strong! with others in the field. The Fit and Strong! team received the Award at the American Society on Aging-National Council on Aging Joint Conference in Washington, D.C., in March 2008.
In 2006, Fit and Strong! also received an honorable mention for the Archstone Award in Program Innovation from the Gerontological Health Section.
Translation and Dissemination. Fit and Strong! is currently being replicated in Chicago, North Carolina and West Virginia. It is ready for broad, community-based diffusion to persons who can benefit from it. We have recently obtained funding from the Centers for Disease Control and Prevention under their new initiative, “Improving Public Health Practice Through Translation (R18)” to examine the effectiveness of partnering with existing Area Agencies on Aging (AAAs) in two states (Illinois and North Carolina) to translate and diffuse the program to providers within two AAA catchment areas per state. Our translation work is using Glasgow’s Re-Aim model and Greene et al.’s work on evaluation (Glasgow, Vogt and Bowles, 1999; Green and Glasgow, 2006) to identify facilitators and barriers to the reach, effectiveness, adoption, implementation and maintenance of Fit and Strong!. We will train a T-Trainer and Master Trainers and will work with them to train certified exercise instructors to conduct Fit and Strong at providers in four AAA catchment areas (target numbers = one T trainer, two master trainers, 30 sites, 30 certified instructors and a minimum of 1,200 participants). The study will use mixed qualitative and quantitative methods to examine barriers and facilitators to the reach, effectiveness, adoption, implementation and maintenance of Fit and Strong! Study funds are also being used to develop a Fit and Strong! Web site (www.fitandstrong.org) and an interactive, Web-based support hotline, to finalize training materials, to support the cost of the trainings and to provide financial incentives for participation among the first sites that sign up to participate.
Collaboration with the National Arthritis Foundation. We are also simultaneously working closely with the National Arthritis Foundation to translate and disseminate Fit and Strong! in four additional states through their local chapters beginning in Fall 2008. These locations include southern and northern New England, Michigan, Kansas and Northern California.
We anticipate that all of these activities will advance the development of Fit and Strong! as a high-quality, turnkey, evidence-based program, while advancing our understanding of factors that facilitate the adoption, implementation, and maintenance of effective physical activity programs for older adults.
CDC. (2006). Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation, MMWR, U.S. 2003-2005, 55, 1089-1092.
Dunlop, D. D., Hughes, S. L., Manheim, L. M. (1997). Disabilities in Activities of Daily Living, Patterns of Change and a Hierarchy of Disability. American Journal of Public Health, 87, 378-383.
Glasgow, R.E., Vogt, T.M., Boles, S.M. (1999). Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework. American Journal of Public Health, 89,1322-1327.
Green, L.W., Glasgow, R.E. (2006). Evaluating the Relevance, Generalization, and Applicability of the Research: Issues in External Research and Translation Methodology. Evaluation and the Health Professions, 29, 126-153.
Guralnik, J. M., Ferrucci, L. Simonsick, E.M., Salive, M.E., Wallace, R.B. (1995). Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability. New England Journal of Medicine, 332, 556-561.
Hughes, S. L., Seymour, R. B., Campbell, R., Pollak, N., Huber, G., Sharma, L. (2004). Impact of the Fit and Strong Intervention on Older Adults with Osteoarthritis. The Gerontologist, 44, 217-228.
Hughes, S.L., Seymour, R.B., Campbell, R.T., Huber, G., Pollak, N., Sharma, L., Desai, P. (2006). Long-Term Impact of Fit and Strong! On Older Adults with Osteoarthritis. The Gerontologist, 46(6), 801-814.
Jette, A.M., Lachman, M., Giorgetti, M.M., Assmann, S.F., Harris, B.A., Levenson, C., Wernick, M., Krebs, D. (1999). Exercise--It's Never Too Late: The Strong-for-Life Program, American Journal of Public Health, 89, 66-72.
Minor, M.A., Hewett, J. E., Weber, R.R., Anderson, S.K., Kay, D.R. (1989). Efficacy of Physical Conditioning Exercise in Patients with Rheumatoid Arthritis and Osteoarthritis. Arthritis and Rheumatism, 32, 1396-1405.
Semble, E. L., Loeser, R. F., Wise, C.M. (1990). Therapeutic Exercise for Rheumatoid Arthritis and Osteoarthritis. Seminars in Arthritis and Rheumatism, 20, 32-40.
For more information, please contact:
Susan L. Hughes, DSW
Professor, Community Health Sciences
School of Public Health
Co-Director, Center for Research on Health and Aging Institute for Health Research and Policy
1747 W. Roosevelt Rd., Room 558, M/C 275 Chicago, IL 60608
Ph: (312) 996-1473 Fax: (312) 413-9835
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New Project to Promote Signing of Health Care Proxies
Christina Staudt, PhD
President, Westchester End-of-Life Coalition
Barbara Robb, MA
Special Project Coordinator, Westchester End-of-Life Coalition
This spring the Westchester End-of-Life Coalition (WEL Coalition) launched a new county-wide project to promote the signing of Health Care Proxy forms. The effort, part of the Everybody Needs A Proxy campaign, culminated on April 16 to coincide with National Healthcare Decisions Day (NHDD).
The new initiative was executed in collaboration with the Westchester Library System. In advance of NHDD day, the WEL Coalition prepared packages of New York State Health Care Proxy forms, wallet-sized proxy forms and one-page fact sheets about the importance of health care proxies. These were distributed by the Westchester Library System to all of the County’s 42 public libraries. A total of 2,250 Health Care Proxy forms in English and 450 in Spanish were sent out, along with posters and fliers announcing NHDD on April 16 and the new library initiative.
Westchester County residents were encouraged to come to their local libraries on April 16 to obtain proxy materials and information by way of several venues. E-blasts were sent to targeted organizations and groups. Information regarding NHDD was provided to the Westchester County Department of Senior Programs and Services for distribution to senior centers. Fliers about the event were posted in local communities by volunteers and members of the WEL Coalition and handed out at the Conference, Stand by Me: Palliative Care Concept and Approaches, held on April 4. A local publicist was hired to disseminate information about the event to Westchester papers and radio stations. An hour-long interview with WEL Coalition Board Members was also aired on a local radio station.
At 29 of the County’s 42 libraries, those who came for their proxy information on April 16 were greeted by trained volunteers who assisted as needed for three hours in each place. In addition to WEL Coalition volunteers, volunteers from other community groups were recruited for this effort including the Medicare Rights Center, a United Way EVEP volunteer program and the Sarah Lawrence College Health Advocacy Program. In total, 33 volunteers participated in the project.
On April 16, more than 500 Health Care Proxies were made available by the volunteers in the libraries to individuals who took the Health Care Proxy forms for themselves and family members. Almost 300 conversations on the topic, many lengthy and in depth, took place between the volunteers and the recipients. Health Care Proxy forms and other materials were left at the libraries when the volunteers departed so they could be displayed along with other community information. The WEL Coalition is extremely pleased with the success of this effort and has decided to renew the program in 2009.
The Westchester End-of-Life Coalition is a community-based, not-for-profit organization dedicated to improving the end of life experience for Westchester residents and their families.
For more information go to www.westchesterendoflife.org
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Older Americans 2008: Key Indicators of Well Being
Older Americans 2008: Key Indicators of Well-Being
This report provides the latest data on 38 key indicators portraying aspects of the lives of older Americans and their families. It is divided into five subject areas: population, economics, health status, health risks and behaviors, and health care.
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Second Annual Conference for Qualitative Research in Human Sciences
Second Annual Conference for Qualitative Research in Human Sciences at Fordham University Focuses on Triad of Methods, Culture and Problems of Living
Frederick J. Wertz, PhD
Professor and Chair
Fordham University Department of Psychology
Mary Beth Morrissey, Esq., MPH
Doctoral Candidate and Adjunct Professor
Fordham University Graduate School of Social Service
The Fordham University Psychology Department sponsored its Second Annual Conference for Qualitative Research in the Human Sciences this past May, convening a distinguished group of researchers and graduate students from many universities including Columbia University, New York University and the University of Dallas for the purposes of promoting qualitative research in the human sciences and recognizing and discussing projects utilizing qualitative research methods. This conference is student organized and emphasizes the learning and applications of qualitative research methods in advanced study. The conference was interdisciplinary in both its planning and focus, drawing graduate students and professionals from the fields of psychology, education, public health and social services practicing in diverse settings and having broad research interests in the application of qualitative methods in the real world.
Research presentations addressed both problems of methods and problems of living, as well as research ethics. A panel that included Dr. Lisa A. Suzuki of New York University, Dr. Fran C. Blumberg of Fordham University’s School of Education and Dr. Frederick J. Wertz of Fordham University’s Psychology Department examined the role of qualitative inquiry in studying culture in the human sciences. Dr. Alejandro Interian of the UMDNJ Robert Wood Johnson Medical School presented important findings from a grounded theory study of an adaptation of a motivational interviewing intervention to improve antidepressant adherence among Latinos. A qualitative investigation of processes of recovery from serious mental illness among African Americans in the urban community reported by Justin Misurell, a doctoral student in the clinical pprogram at Fordham University, was also promising in its implications for possible future studies of older adults. Emily Sachs, another student in Fordham’s clinical psychology program, presented dramatic findings from her study of Tibetan refugees in India who consistently described the interference with their traditional religious practices as more profoundly traumatic than even their most violent physical torture.
The conference closed with a keynote address by Dr. Lisa Suzuki,
“Through the Looking Glass: Understanding Lives in Context Using Ethnography.” Dr. Suzuki is an associate professor in the Department of Applied Psychology at the Steinhardt School of Culture, Education and Human Development at New York University. In her presentation, Dr. Suzuki shared her very personal journey as a pioneer in the study of culture that has increasingly turned to the employment of ethnographic methods in order to faithfully grasp the experiences of various people ranging from holocaust survivors to a moving personal study of her own Japanese-American father. The story she told of her father’s life history was illuminated through ethnography, and in doing so she communicated most effectively the “fit” of qualitative methods for the study of older adults.
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Aging & Public Health Newsletter Archives