Aging & Public Health
From the Editor
From the Editor: Spring 2009 Gerontological Health Section Newsletter
This season’s Newsletter brings news from members far and wide, including new publications, new mentoring efforts, calls for applications, plans for the upcoming APHA Annual Meeting, and announcements of a wide variety of programs across the country. You will also find some of the more pedestrian parts of running an organization, such as our financial report.
I would draw your attention to the history of a wonderful award program. This November, the Gerontological Health Section will celebrate the 25th anniversary of the Philip G. Weiler Award for Leadership in Aging and Public Health. You can read about its origins and luminaries here.
May you have productive but also restful summers.
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SPIG Announces 5K Fun Run/Walk
While in Philadelphia for the 2009 APHA Annual Meeting, join your colleagues for the 2nd Annual 5K Fun Run/Walk on the morning of Tuesday, Nov. 10. The 5K (3.1-mile) route will feature views of the Schuylkill River and the Philadelphia Museum of Art, the steps of which were made famous in the movie Rocky. More information about this activity, including a course map, will be published in the Fall newsletters of the Physical Activity SPIG and other Sections and SPIGs and will be made available at the Annual Meeting. In the meantime, please contact Genevieve Dunton (firstname.lastname@example.org) or Jim Konopack (email@example.com) with any questions. We look forward to seeing you in Philadelphia!
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New Web Site Will Promote Improvements in the U.S. Long-term Care System
More than 1.4 million Americans live in nursing homes today. By 2020, an estimated 12 million will need long-term care, whether in a nursing home, assisted living facility, chronic care hospital or from an at-home health service provider. With major grant funding from the National Institute on Aging, Brown University researchers have created a Web site, www.LTCfocUS.org (live July 2009) aimed at providing information to improve the nation’s long-term care system – and the lives of the elderly who rely on that system. The www.LTCfocUS.org Web site hosts data regarding the health and functional status of nursing home residents, characteristics of care facilities, state policies relevant to long term care services and financing, and new survey data regarding delivery of care in nursing home settings. The data on the site will enable researchers to trace a clear relationship between state policies and local market forces and the quality of long-term care. Researchers can use this Web site to examine care processes and resident outcomes within the context of their local markets and regulatory practices. Policy-makers can use the information to shape state and local guidelines, policies, and regulations that promote high-quality, cost-effective, equitable care to older Americans. Together, it is anticipated that these audiences will have the data, tools and results to better understand the long-term care system, and to achieve improvements in how care is organized, financed and delivered.
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New Report Identifies Economically Insecure Elders
Nearly half a million elders living alone in California cannot make ends meet, lacking sufficient income to pay for a minimum level of housing, food, health care, transportation and other basic expenses, according to a new policy brief released in February by Steven P. Wallace, PhD, of the UCLA Center for Health Policy Research, and Susan E. Smith of the Insight Center for Community Economic Development in Oakland, Calif. Among the findings are that older renters were more than twice as likely to be economically insecure as those who owned their homes and had paid off their mortgages (70.4 percent of older single renters were insecure, compared with 34.4 percent of homeowners without mortgages); and about three-fourths of Latino elders who lived alone, and almost half of those who lived with only a spouse, could not cover their basic costs of living.
The findings in the policy brief are based on the Elder Economic Security Standard Index (Elder Index) for California, a tool that measures the actual cost of basic necessities for older adults in each of California's 58 counties. The Elder Index is viewed by many as a more accurate measure of economic security than federal poverty level (FPL) guidelines, a standardized national estimate that does not take into account the cost of living in high-cost states such as California. The release of the brief occurred at a state Assembly hearing and was covered widely by the media. For the Policy Brief see http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=323 (full press release at http://www.healthpolicy.ucla.edu/news_02242009.html), and for more on advocacy about the Elder Index see http://www.insightcced.org/index.php?page=cal-eesi .
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New Publications from GHS Members
Calvo, Esteban, Kelly Haverstick, and Steven A. Sass. 2009. “Gradual Retirement, Sense of Control, and Retirees’ Happiness.” Research on Aging 31(1):112-135.
Haverstick, Kelly, Natalia Zhivan, and Esteban Calvo. 2009.
“Determinants and Consequences of Moving Decisions for Older Americans.” Issue Brief, Center for Retirement Research at Boston College, Chestnut Hill, MA.
Calvo, Esteban and Bernardo Martorell. 2008. “Salud del Adulto Mayor en Chile: Responsabilidad Compartida por las Personas, las Empresas y el Estado” (“The Health of Older Adults in Chile: A Responsibility Shared by Individuals, Companies, and the Government”). Pp. 103-21 in Construyendo Políticas Públicas para una Sociedad que Envejece (Public Policies for an Aging Society). Santiago, Chile: Corporación Expansiva y Escuela de Salud Pública de la Universidad de Chile.
Primary Considerations in Managing The Older Patient With Foot Problems, Hazzards - Geriatric Medicine and Gerontology, 6th Edition, McGraw-Hill, 2009
Foot Health For The Elderly: Podogeriatric Overview, Reichel's Care of the Elderly, Clinical Aspects of Aging, 6th Edition, Cambridge University Press.
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New HCUP Statistical Briefs
Northeast U.S. Has Most Brain Cancer Hospitalizations
People in the Northeastern United States are one-third more likely than those in the South or West to be hospitalized for treatment of brain cancer or to have brain cancer when they are hospitalized for another illness or complication, according to a new report from the U.S. Agency for Healthcare Research and Quality (AHRQ).
In 2006, about 30 of every 100,000 people in the Northeast were hospitalized with brain cancer. That compares to 23 per 100,000 for people in both the South and West. The rate was slightly higher for people in the Midwest — 25 per 100,000.
AHRQ's analysis also shows that in 2006:
- Nationally, the hospitalization rate for brain cancer remained stable since 1995 — roughly about 35,000 hospital stays a year.
- An additional 38,000 hospital admissions were associated with brain cancer — mostly for chemotherapy or radiotherapy to continue treatment, or for convulsions, pneumonia or other complication from the disease. These hospitalizations increased 18 percent since 1995.
- Among people over 65, men were 62 percent more likely to be hospitalized primarily for brain cancer and 55 percent more likely to be hospitalized with brain cancer as a secondary diagnosis than were women.
- While 6.2 percent of hospital patients admitted for brain cancer died while hospitalized in 1995, the rate dropped to 4.4 percent in 2006.
These findings are based on data from Hospitalizations for Brain Cancer, 2006 (HCUP Statistical Brief #68). The report uses statistics from the 2006 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.
Colorectal Cancer Hospitalization Rates Highest in the Elderly
Two-thirds of hospital stays for colorectal cancer involve Americans age 65 and older, according to a recent AHRQ report.
The agency's analysis also shows that when older patients with colorectal cancer are hospitalized not specifically for treating their cancer, the admission is often for complications, such as intestinal blockage or pneumonia.
The colon and rectum make up the lower part of the digestive system. Cancer of the colon and rectum are frequently reported together as colorectal cancer — the third most common type of cancer in the United States for both men and women.
AHRQ's analysis of colorectal cancer hospitalizations, based on 2006 data, found that:
- Treatment of colorectal cancer as a primary reason for admission accounted for about 152,000 hospitalizations in 2006. About 420,000 additional hospitalizations were for complications associated with cancer, such as pneumonia.
- About 4.5 percent — 6,800 — of the patients who were admitted for colorectal cancer died while hospitalized. This rate is much higher than the 2.6 percent overall death rate for the approximately 30 million hospital stays for all conditions that year.
- While the admission rate for people hospitalized primarily for colorectal cancer declined 15 percent between 1995 and 2006, the hospitalization rate for patients who were admitted for other conditions but also had colorectal cancer increased 15 percent.
These findings are based on data from Hospitalizations for Colorectal Cancer, 2006 (HCUP Statistical Brief #69). The report uses statistics from the 2006 Nationwide Inpatient Sample.
Eating Disorders Sending More Americans to the Hospital
The number of men and women hospitalized due to eating disorders that caused anemia, kidney failure, erratic heart rhythms or other problems rose 18 percent between 1999 and 2006, according to another recent AHRQ report.
AHRQ's analysis also found that between 1999 and 2006:
- Hospitalizations for eating disorders rose most sharply for children under 12 years of age — 119 percent. The second steepest rise was for patients ages 45 to 64 — 48 percent.
- Hospitalizations for men also increased sharply — by 37 percent — but women continued to dominate hospitalizations for eating disorders (89 percent in 2006).
- Admissions for anorexia, the most common eating disorder, remained relatively stable. People with anorexia typically lose extreme amounts of weight by not eating enough food, over-exercising, self-inducing vomiting, or using laxatives.
- In contrast, hospitalizations for bulimia declined 7 percent. Bulimia — binge eating followed by purging by vomiting or use of laxatives — can lead to severe dehydration or stomach and intestinal problems.
- Hospitalizations for less common eating disorders increased 38 percent. Those disorders include pica, an obsession with eating non-edible substances such as clay or plaster, and psychogenic vomiting, which is vomiting caused by anxiety and stress.
These findings are based on data from Hospitalizations for Eating Disorders from 1999 to 2006 (HCUP Statistical Brief #70). The report uses statistics from the 2006 Nationwide Inpatient Sample.
Repeat C-Sections Climb by More Than 40 Percent in 10 Years
The percentage of pregnant women undergoing a repeat Cesarean section (C-section) delivery jumped from 65 percent to 90 percent between 1997 and 2006, according to a recent AHRQ report.
C-sections are performed for medical reasons and they can be elective. Medical reasons include a previous C-section, malposition of the baby in the uterus, the mother having active genital herpes, the baby's head being too large to pass through the mother's pelvis, or problems with the umbilical cord.
AHRQ also found that:
- Nearly one-third of the 4.3 million childbirths in 2006 were delivered via C-section, compared with one-fifth in 1997.
- C-sections are more costly than vaginal deliveries, $4,500 versus $2,600 in deliveries without complications, and $6,100 versus $3,500 in deliveries with complications.
- Therefore, although C-sections account for 31 percent of all deliveries, they account for 45 percent of all costs associated with delivery.
- C-sections account for 34 percent of all deliveries by women who are privately insured but only 25 percent of deliveries by women who are uninsured.
These findings are based on data from Hospitalizations Related to Childbirth, 2006 (HCUP Statistical Brief #71). The report uses statistics from the 2006 Nationwide Inpatient Sample.
More Than 4 Million Potentially Preventable Admissions Cost Hospitals Nearly $31 Billion
American hospitals spent nearly $31 billion — 10 percent of their total patient care budget — in 2006 on more than 4 million patient stays that could possibly have been prevented with timely and effective ambulatory care, according to the another recent AHRQ report.
Hospital inpatient care is the most expensive type of health care. Reducing preventable hospitalizations is one way to lower America's $ 2.2 trillion medical bill.
According to AHRQ's review of the $31 billion spent on potentially preventable hospitalizations:
- Congestive heart failure and bacterial pneumonia accounted for about half of the expenses — $8.4 and $7.2 billion respectively.
- Chronic obstructive pulmonary disease and asthma accounted for roughly 16 percent — $4.9 billion.
- Diabetes, including complications, accounted for 13 percent — $4.1 billion.
- A large portion of the potentially preventable hospitalizations involved the elderly. One in five admissions of Medicare patients was potentially preventable, and overall Medicare patients accounted for roughly two-thirds of the $31 billion spent for these hospitalizations.
These findings are based on data from Nationwide Frequency and Costs of Potentially Preventable Hospitalizations, 2006 (HCUP Statistical Brief #72). The report uses statistics from the 2006 Nationwide Inpatient Sample.
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Know Your Choices Share Your Wishes
Benjamin Franklin once said only two things are certain ─ death and taxes. More than 100 professional and community organizations worked in partnership across New York state to increase conversations and promote awareness of the importance of advance care planning by hosting events to make the 2nd annual National Healthcare Decisions Day a huge success.
National Healthcare Decisions Day is a national grassroots effort to promote advance care planning that is being held annually on April 16, the day after tax filing day. All Americans are encouraged to start their conversation and take steps to ensure that their health care choices are known and shared.
The Medical Society of the State of New York, the New York State Bar Association, Excellus BlueCross BlueShield and more than 100 other collaborators from across the state formed the NHDD New York State Coalition and championed National Healthcare Decisions Day to pursue three goals.
First: To encourage everyone to select a spokesperson, have a conversation with their family and health care provider about what is important to them and complete a Health Care Proxy form.
Second: To increase awareness of MOLST (Medical Orders for Life-Sustaining Treatment) Program in the community.
The Medical Orders for Life-Sustaining Treatment (MOLST) Program, New York State’s Physician’s Orders for Life-Sustaining Treatment (POLST) Paradigm Program, is designed to improve the quality of care seriously ill patients receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored pink form and a promise by health care professionals to honor these wishes.
The MOLST form is a bright pink document that patients with advanced chronic illness and frailty complete with their doctor. The form then stays with them so end-of-life preferences will be followed as they move through the health care system ─ facility to facility, physician to physician.
Third: To ensure passage this year of the Family Health Care Decisions Act. This proposed legislation is so sensible that most New Yorkers might assume such a law exists. It would expand the authority of family members and others close to the patient to decide about treatment ─ including life-sustaining treatment ─ for loved ones who can no longer decide for themselves and do not have a health care proxy.
Most people are shocked to learn that currently they do not have the power to make health care decisions for their next of kin. The proposed law would also provide the most comprehensive policies in the nation for patients who do not have family or friends who are able or willing to decide about treatment on their behalf. Many patient safeguards are built into the proposal.
Presentations on advance care planning and the MOLST Program were offered to professionals, employees and the community. In addition, information was provided across the state in health care facilities, health fairs, senior centers and housing, college campuses, libraries, shopping malls and the workplace. Media coverage, Web site visibility and social networking extended the reach to the public at large. Several notable activities are worth highlighting:
The Medical Society of the State of New York (MSSNY) and Excellus BlueCross BlueShield launched a public education campaign about advance care planning. New MSSNY Public Service Announcements (PSAs) on advance care planning were produced and released to television stations across New York State.
The CompassionAndSupport.org Web site was revised to host and highlight the PSAs. The new Compassion And Support Video Library houses all videos on the Web site.
Excellus BCBS partnered with the New York State Bar Association (NYSBA) on the revision of the Advance Care Planning booklet to include the MOLST Program and the “Five Easy Steps.” The co-branded edition of the ACP booklet is distributed by the NYSBA and resides on the NYSBA Web site.
New York State Office for the Aging Director Michael Burgess distributed educational resources on Community Conversations on Compassionate Care with “Five Easy Steps” to complete a health care proxy, the Medical Orders for Life-Sustaining Treatment (MOLST) Program and the CompassionAndSupport.org Web site to county Offices for the Aging.
A “Take Action” button was added to the home page of CompassionAndSupport.org Web site with a direct link to the Advocacy page to highlight the need for the passage of Family Health Care Decisions Act in 2009. A link to the MSSNY Grassroots Action Center allows readers to send a letter supporting Family Health Care Decisions Act to their New York State legislators.
With passage of Family Health Care Decisions Act in 2009, the National Healthcare Decisions Day New York State Coalition will have accomplished one of its major goals!
Patricia Bomba, MD, FACP, is Vice President and Medical Director/Geriatrics for Excellus BlueCross BlueShield and Chair of the NHDD New York State Coalition.
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HOSPICES FACE RATE REDUCTION
With a final rule that went into effect on Oct. 1, 2008, the Center for Medicare/Medicaid Services began a three year phase out of a key element in the Medicare hospice wage index that will cut hospice payment rates by 4.1 percent, costing the nation’s hospices more than $2 billion over the next five years.
This cut came at a surprising time considering the fact that it has been documented that hospice saves money for the Medicare fund. According to an independent study conducted in 2007 by the Sanford Institute for Public Policy at Duke University (conducted under a grant from the Robert Wood Johnson Foundation), saves Medicare an average of $2,300 per patient, amounting to a total savings of about $2 billion a year. Reducing payment to hospice services may result in service cutbacks as well as a reduction in coverage to outlying areas, with the greatest impact being felt in rural areas. Additionally, job losses can be expected as a consequence of this rate cut.
Considered to be the model for high-quality care for terminally ill patients, hospice focuses on caring, not curing, and, in most cases, is provided in the patient’s home. The hospice interdisciplinary teams are experts in providing pain and symptom management on a physical, emotional, social and spiritual level. Their focus is on helping patients to die on their own terms. Along with the patients, families are counseled and supported and receive training in caregiving. A number of hospices also provide complementary care services such as massage therapy, music therapy, acupuncture and other non-pharmacological interventions that aid in pain and symptom management. These services are not reimbursed by Medicare, and the pending cuts threaten the existence of such programs. More than 1.3 million dying Americans received care from the nation’s hospice providers last year, a number that continues to rise. If hospice services are curtailed, then patients will receive care in more expensive settings within the health care system.
The American Recovery and Reinvestment Act, signed into law by President Obama, contained a provision that included a one-year delay in the implementation of this rate cut. But, it was only a one-year delay. If nothing else happens to further delay or rescind the regulation, the second year of the cut would go into effect on Oct. 1, 2009, resulting in a 3.1 percent cut in hospice reimbursements. The full impact of the regulation will go into effect on Oct. 1, 2010 and beyond, reducing hospice reimbursements by 4.1 percent. In New York, where our hospice is located, the average reduction is closer to 6 percent. The total cut to all hospices will be slightly over $2 billion. This $2 billion is out of a total expenditure that was $11 billion in 2008.
In May of this year, members of the House of Representatives signed a letter authored by Representatives Van Hollen and Brown-Waite that was sent to President Obama urging him to take action to stop further cuts. Senators Specter, Harkin, Roberts and Wyden are circulating a similar letter, asking that the 2008 regulation to slash hospice rates be rescinded. Like the House letter, it will be signed by supporters of hospice in the Senate and sent to the White House demonstrating that Congress would support presidential action taken to permanently rescind the rule to cut hospice rates. Hospices around the nation were successful in getting their Representatives to sign the House letter and are now working with their Senators to sign the letter so that it can be forwarded to the President.
Stopping the rate cuts is of vital importance to the hospice industry. The hospice community, which relies on Medicare for over 80 percent of its revenue, simply cannot withstand a 4.1 percent reduction in payment rates without having to reduce or eliminate certain services or limit service areas. According to a June 2008 Medicare Payment Advisory Committee (MEDPAC) report, hospice margins, in the aggregate, are only 3.4 percent. Many hospices, particularly smaller non-profits and those in rural areas, actually operate on negative margins and rely on fundraising to stay afloat – fundraising that is dwindling in this challenging economic environment. An average cut that exceeds the average margin can only result in a negative impact that will effect the most vulnerable of patients in the health care system - those who have a terminal illness and wish to die in their home.
While the debate on health care reform is taking shape, hospice will continue to work on two fronts: to demonstrate that it is a model of effectiveness that lowers cost to the larger health care system and to continue to care for patients and families who exercise their choice to live their lives with dignity, comfort and support.
Thanks to the National Hospice and Palliative Care Organization for source materials used in this article.
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Hispanic Nursing Home Residents More Likely Than White Counterparts to Develop Bedsores
Hispanic nursing home patients are more likely than their white counterparts to develop bedsores, or pressure ulcers, according to a study published in the Journal of the American Medical Directors Association. To read the full article, written by Michael Gerardo, please go to JAMDA or see:
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Healthy You Helps Seniors and GHS Members Too
Are you looking for easy-to-understand information on health topics that pertains to older adults and their families? Look no further than Healthy You, the free public health resource page from the APHA's award-winning newspaper, The Nation’s Health.
Each month, Healthy You provides facts, tips and information on a single public health topic in an easy-to-understand, public-friendly style. Healthy You topics cover a wide range of subjects, including many that pertain to seniors, their families, friends, or grandchildren.
Healthy You can be downloaded for free at www.healthfactsheets.org, and can be copied, reprinted and distributed. Pass out copies at your heath fair or on campus, hang it in your office or health department or hand it out at a community meeting. You can also link to Healthy You on your Web site or include it in your print or online newsletter!
Previous issues of Healthy You have addressed talking to your doctor, hearing protection, water safety, green living, oral health, heart disease prevention, food-borne illnesses, stress, emergency preparedness and more. More than two dozen tipsheets are available on the Web site.
The Nation’s Health wants to hear from you! Readers of Healthy You are encouraged to submit questions, comments and topics you would like to learn more about to firstname.lastname@example.org. Let us know how you’re using Healthy You to reach the older adult population.
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GHS Submits Theme for 2011 APHA Annual Meeting
In 2011, the first of the boomer population (born 1946-1964), will become eligible for Medicare. In recognition of this event, and to increase the visibility of aging-related public health issues, GHS leadership submitted a theme to the APHA Science Board for consideration as the 2011 APHA Annual Meeting theme. Health and Well-Being Across the Generations, the GHS submission, noted that through the efforts of health care providers, communities, state and local health departments and other government entities, healthier days, months and years of life can be achieved for all Americans — from newborns to those near the end of life. The theme emphasized the importance of wide-ranging public health advocacy, practice and research efforts — efforts needed to ensure “healthier days” for all. The theme also approached public health from a 21st century perspective in which health and well-being (with and without the presence of disease) are equally important goals. Although not selected as one of four themes to be considered by the APHA Governing Council this November, one of the four themes under consideration does incorporate many GHS interests, Building Healthy Communities for a Healthy and Long Life.
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GHS Celebrates 25 Years of the Philip G. Weiler Award for Leadership in Aging and Public Health
This November, the Gerontological Health Section (GHS) will celebrate the 25th anniversary of the Philip G. Weiler Award for Leadership in Aging and Public Health. Formerly the Key Pharmaceutical Leadership Award, in 1984 GHS recognized T. Franklin Williams, MD, as the first recipient. The award recognizes the best of past and present leadership concerned with ensuring the highest quality of life for our older population. Recipients are individuals and organizations who have provided leadership in the field of gerontological health, and include, but are not limited to, public officials, policy-makers, practitioners, teachers, and researchers.
In 2004, the Key Award was renamed the Philip G. Weiler Leadership Award in Aging & Public Health, in recognition of Philip G. Weiler. Dr. Weiler was a UC Davis Professor of Medicine and a founder of GHS. He served on the Governing Council and Executive Board of APHA and was a Key Leadership Award recipient in 1985. Dr. Weiler served as Chief Deputy Director for Preventive Health Services in the California State Department of Health, establishing one of the first adult day health centers in the country, co-authoring the first book on how to establish and manage such centers, and helping develop the Alzheimer’s Disease Diagnostic and Treatment Centers. His training and passions reflected Dr. Weiler’s lifelong interest in bringing important elements from social sciences, policy and planning, and public health to his work in geriatrics.
The 25th recipient of the Award is Connie Evashwick, ScD. Dr. Evashwick is Professor of Health Management and Policy and Community Health at the School of Public Health at Saint Louis University. Dr. Evashwick holds a bachelor's and a master's degree from Stanford University and a master's and doctoral degree from the Harvard School of Public Health. She has many years of experience with the continuum of care and long-term care delivery systems, as well as a more recent interest in community benefit. Dr. Evashwick’s multifaceted career has included positions in academia, consulting, and direct operations management. She has been vice president of long-term care for two major health care systems and consulted with health systems, hospitals, and long-term care organizations across the nation. Dr. Evashwick has been active in professional societies in the health administration and aging fields, including being a Regent and Fellow of the American College of Healthcare Executives and being chair of the APHA Gerontological Health Section. Dr. Evashwick has held an endowed chair at California State University Long Beach and served as the Dean of the SLU School of Public Health. She has authored over 112 publications, including 12 books. She has generated and managed over $9 million in grants from private foundations and federal, state, and local government agencies.
In addition to Drs. Williams and Weiler, previous recipients are:
1986 Anne W. Zimmer, MS
1987 Stanley J. Brody, JD, MSW
1988 Robert L. Kane, MD
1989 Pearl S. German, ScD
1990 James G. Zimmer, MD, DTPH (Lond)
1991 Laurence G. Branch, PhD
1992 Robert H. Binstock, PhD
1993 Joan F. Van Nostrand, DPA
1994 Joshua Wiener, PhD
1995 Bruce C. Vladeck, PhD
1996 Terrie T. Wetle, PhD
1997 Judith Feder, PhD
1998 Robyn I. Stone, DrPH
1999 Dennis L. Kodner, PhD
2000 James J. Callahan, Jr., PhD
2001 John W. Rowe, MD
2002 Retirement Research Foundation
Marilyn Hennessy, President
2003 Susan L. Hughes, DSW
2004 The Archstone Foundation, Joseph F. Prevratil,
JD, President & CEO
2005 Richard H. Fortinsky, PhD
2006 Nancy Persily, MPH
2007 Honorable Barbara B. Kennelly
2008 Caroll L. Estes, PhD
The Award will be presented at the GHS Awards Ceremony, Monday, Nov. 9, 2009, at the APHA Annual Meeting in Philadelphia. We hope you will be able to join us in celebrating the leadership of our current, as well as previous recipients.
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GHS Awards Portfolio Recognized by APHA
APHA recently recognized the Gerontological Health Section’s awards portfolio in its April 2009 The Nation’s Health
GHS sponsors the most diverse of the APHA Section awards portfolios.
Across the nine scientific awards, in both permanently and temporally restricted funds, the GHS endowment stands at over $300,000. This is the best funded awards portfolio of APHA. The diversity and financial strength of the GHS awards portfolio is solely due to our many, very generous individual (too many to mention, but we appreciate everyone!), corporate (Aetna, Inc.), University (George Washington and UCLA), and foundation (Archstone Foundation, Erickson Foundation, and Retirement Research Foundation) donors. GHS has maintained a good relationship with APHA, where their Investment Committee invests and monitors our funds. Additionally, the GHS Enrichment Account supports the Annual Meeting Awards Session, as well as GHS projects, including the recent GHS Membership Survey. As do all APHA Sections, GHS receives annual support from APHA, with the amount determined by Section membership. Our 2009 APHA funding was $2,050. APHA's Board has fiduciary responsibility, which is delegated to Executive Director Georges Benjamin, MD. GHS Chair Nancy Miller approves all expenditures prior to sending to APHA's Program and Accounting Divisions.
We need to continue fundraising to build our award endowments so as to recognize our members’ professional investment in GHS and APHA. We appreciate everyone's donation of time and dollars to GHS. You can read a more detailed account in a report posted on the GHS Web site. If you are interested in volunteering to work on GHS financial and development activities, please contact Nancy Miller at email@example.com .
Nancy Miller, Chair,
Susan Miller, Chair Elect
Bob Burke, Past Chair,
Gerry Eggert, Development Chair,
Steve Wallace, Co-Development Chair
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APHA GHS Proposals Listserv
The APHA GHS recently has launched a Google Group listserv, called "APHA GHS Proposals," to facilitate online communication among GHS members who are interested in collaborative research projects on health & aging. The purpose of this online network is to help GHS members announce their current research needs and identify experts in aging research who are interested in collaborating in ongoing research or grant applications. The listserv permits members to create a profile describing their research interests and expertise in specific health areas and to upload and share their curriculum vitae with others. If you have questions about the listserv, please contact Denys T. Lau, PhD, at D-Lau@northwestern.edu. If you are interested in joining the listserv, please contact Steve P. Wallace, PhD, at firstname.lastname@example.org.
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APHA 137th Annual Meeting and Exposition
From Nov. 7-11, 2009, thousands of public health professionals will convene in Philadelphia for the APHA 137th Annual Meeting and Exposition. More than 1,000 cutting-edge scientific sessions will be presented by public health researchers, academicians, policy-makers and practitioners on the most current public health issues facing the nation today. To ensure that no public health professional misses this opportunity, this year’s Annual Meeting will be more affordable than ever. Hotel rates have been slashed so that no rates are higher than $195. Eleven of the 15 contracted hotels are offering rates between $149 and $179.
Registration and Housing Open June 1.
Save up to $115 on registration by registering before August 28. Take advantage of these discounts and join your colleagues in a meeting you won’t want to miss. For more information about the Annual Meeting and the role your Section or SPIG will make toward its success, visit www.apha.org/meetings!
We’re on Twitter: APHAAnnualMtg
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2008 GHS Membership Survey Results
In August 2008, our Membership Committee conducted a survey to understand membership composition, assess member satisfaction, and explore topics for future membership development. A total of 394 invitations (347 e-mails and 47 mail-in surveys) were sent, and 128 members responded (32 percent). With this limitation in mind, here are some interesting results.
Who are our members?
- 63 percent were regular members, 17 percent were retired members, and 12 percent were student members.
- Seventy-two percent were female, 40 percent were between the age of 40-59, 32 percent were 60+, 28 percent were under 40.
- Seventy-one percent Caucasians, 11 percent Asians, 8 percent African Americans, 6 percent Hispanics.
- Fifty-four percent have academic doctorate degrees, 34 percent have Masters’, 8 percent have clinical or practitioner doctorate degrees.
- Forty-three percent work in higher education institutions, 7 percent work in federal/state/local government, 6 percent work in research institutes, 8 percent work as health care service providers.
- Ninety-one percent said GH is their primary or only affiliation.
- Top six concurrent professional organizations: GSA (71 percent), ASA (35 percent), AcademyHealth (20%), AGHE (15 percent), NCA (14 percent), and AGS (11 percent).
Satisfaction with the Section:
- Sixty-nine percent were satisfied or extremely satisfied, 28 percent were neutral, and 3 percent (4) were dissatisfied.
- Fifty-four percent rated the GH scientific sessions as above average or excellent.
Use of GHS resources:
- Only 69 percent were on the listserv; 61 percent read the newsletters on a regular basis.
- Twenty-six percent didn’t attend any annual meetings during the past five years. Twenty percent attended only one.
- Eighty-five percent usually make the decision of attending/not attending at least two months ahead of the meeting.
Preferences for future activities:
- Twenty-seven percent were not involved in any of the committees but said they are interested in participation.
- Learn the latest knowledge, networking, learn about research methods, learn about job opportunities, participating in leadership activities, and receiving GH newsletters are considered very important in the decision of remaining a member.
- Eighty-eight percent preferred e-mail as the form of communication.
As the chair of the Membership Committee, I would like to thank all members who took the time to complete the survey, and all committee members who helped putting the survey together. In the future, we would like to hear from more of you because your active participation and input will maintain the growth of the Section in the years to come!
For those of you who had indicated in the survey that you were interested in participating in Section activities, I would like to invite you to join the Membership Committee. I look forward to hearing from you.
Hongdao “Daniel” Meng
Department of Preventive Medicine
Stony Brook University Medical Center
HSC, Level 3, Room 071
Stony Brook, NY 11794-8338
Phone: (631) 444-7281
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Comprehensive Information on Aging and Alzheimer’s Disease
NIH’s National Institute on Aging (NIA) has a wealth of free information on many aspects of health and aging, including Alzheimer’s disease, for both professional and consumer audiences.
National Institute on Aging Information Center
The NIA Information Center offers publications and other resources in English, Spanish, and easy-to-read formats. To view or order publications or to sign up for e-mail alerts, visit www.nia.nih.gov/HealthInformation or the Spanish Web site at www.nia.nih.gov/Espanol. The NIA Web site also offers a database of 300 national organizations that help older adults and provides access to information about aging-related clinical trials through ClinicalTrials.gov.
National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
(800) 222-2225 (toll-free)
(800) 222-4225 (TTY/toll-free)
Alzheimer’s Disease Education and Referral (ADEAR) Center
NIA’s ADEAR Center offers information and publications for families, caregivers, and professionals on diagnosis, treatment, patient care, caregiver needs, long-term care, education and training, and research related to Alzheimer’s disease. Staff answer telephone, e-mail, and written requests in English and Spanish and make referrals to local and national resources. The ADEAR Web site provides free, online publications in English and Spanish; e-mail alert and online Connections newsletter subscriptions; a clinical trials database; library database; and more.
Alzheimer’s Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
(800) 438-4380 (toll-free)
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Inaugural Meeting of the Interdisciplinary Coalition of North American Phenomenologists
The inaugural meeting of the Interdisciplinary Coalition of North American Phenomenologists (ICNAP) was held at Ramapo College, New Jersey, on May 8-9, 2009 and welcomed a large group of researchers from the United States and Canada in a wide range of disciplines including philosophy, psychology, sociology, architecture, political science, communicology, health, law and social work.
The newly formed coalition is for phenomenologists who are committed to learning from the research of colleagues in other disciplines within the phenomenological tradition. The coalition leadership will be working with its membership to promote the goals of interdisciplinarity in phenomenological scholarship and research. This year’s editorial board included such noted scholars as Robert Bernasconi, Scott Churchill, Christine Daigle, Lester Embree, Hwa Jol Jung, Richard Lanigan, Frank Macke, Dennis Skocz, and Frederick J. Wertz.
This year’s conference was dedicated to Mary Rogers (1944-2009), a phenomenological sociologist who was a co-founder of ICNAP. Dr. Rogers was involved in research examining the feminist ethic of care informed by the work of Alfred Schutz, Carol Gilligan and Jane Addams.
Several keynote and paper presentations at the two-day ICNAP meeting were important to policy, research and practice with older adults. Dr. Frederick J. Wertz of Fordham University opened the conference with an account of trauma and recovery in illness comparing phenomenology in psychology as a research method with grounded theory, discourse analysis, narrative research and intuitive inquiry. Dr. Wertz’s beautiful phenomenological analysis of the phenomenon of trauma presented at the conference made the contributions of phenomenology in psychology as a method to the descriptive and qualitative study of experience clear and suggested the fruitfulness of the method for research in other disciplines. Leonard Lawlor, the Edwin Erle Sparks Professor of Philosophy at Pennsylvania State University, presented a keynote lecture entitled, “The Husserlian Limitation to the Mathematization of the Qualitative: A Critical Response to the Project of Naturalizing Phenomenology.” Dr. Lawlor’s address focused on important social problems of human suffering and powerlessness in the human sciences, the crisis of naturalizing phenomenology, coming to terms with who we are and who we are becoming, and how such problems can be addressed within the phenomenological tradition. Mary Beth Morrissey of the Fordham Ravazzin Center on Aging, bridging the disciplines of law, health and social work, presented a paper on the “Phenomenology of Pain and Suffering: An Ethical Perspective in Gerontological Social Work.” In challenging legal and ethical frameworks at the end of life, she identified central concerns for health and social work professionals working with older adults with life-limiting illness, offering a phenomenological account of pain and suffering that reframed assessment of suffering and end-of-life decision making in an ethics of sociality and relationality. Dr. Jacqueline Martinez of Arizona State University, representing the discipline of communicology, closed the conference with a keynote lecture on “Interdisciplinary Phenomenology and the Study of Gender and Ethnicity.” Dr. Martinez argued for an interdisciplinary and decolonial phenomenology in the social sciences recognizing the intersubjectivity of the human condition.
The next meeting of ICNAP will be posted on the organization’s Web site at www.icnap.org. Scholarly research papers will be accepted from various disciplines for presentation at the next meeting. Please check the ICNAP Web site for more information.
[Editor's Note: According to Taber's Cyclopedic Medical Dictionary, phenomenology is the science of the subjective processes by which phenomena are presented, with emphasis on mental prcesses and essential elements of experience. A phenomenological study emphasizes a person's descriptions of a feelings about experienced events.]
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Gerontological Health Section Begins Mentoring Program
Many students attribute their success in school and in their careers to the guidance that they received from a mentor. Mentors can have a significant impact on lives of young scholars. In this light, the Gerontological Health Section of APHA is forming a mentoring program. The purpose of this program is to match student members with senior members in the Section to create strong mentoring relationships. The length of this match can be short or long-term. This program will enable to students to receive both academic and professional advice. Students will also be able to meet with their mentors at the APHA Annual Meetings.
If you are a student interested participating in this newly developed program, contact the Gerontological Health Section Student Liaison Karon Phillips at email@example.com. Put Gerontology Mentorship in the subject line and indicate your research interests and what you would like to gain from having a mentor in the body of the e-mail.
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Call for Applications
Native Investigator Program, Native Elder Research Center, Resource Center for Minority Aging Research
The purpose of this solicitation is to recruit American Indian and Alaska Native junior faculty (MD, PhD) to apply to join the next two-year cohort of the Native Investigator Development Program, which is an academic career development program in the Resource Center for Minority Aging Research at the University of Colorado Denver.
For more information and application: http://aianp.uchsc.edu/nerc/application_process.htm
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Right to Know End of Life Options Act Now Law in California
I. The Need for Legislation
The Right to Know End-of-Life Options Act has been enacted in California, CALIFORNIA CODES, HEALTH AND SAFETY CODE SECTIONS 442-442.7, and should be replicated and expanded. It ensures that terminally ill patients can receive counseling about all legal end-of-life (EOL) care options in the state. This law is necessary for two important reasons. First, it encourages patients to ask for and receive information from their health care providers regarding EOL options. Second, it will address the reluctance of some health care providers to inform patients about EOL options. Research reveals that some providers do not share information about these options for a variety of reasons, including the objection to certain practices for personal or religious reasons. One recent study revealed that only 31 percent of patients with advanced cancer at the end of life had had discussions with physicians about end-of-life care. Patients who had EOL conversations had significantly lower costs in their final week of life, over $1,000 less; more importantly “higher costs were associated with worse quality of death.” (1)
Additionally, the lack of communication with respect to EOL preferences extends to the desire not to receive CPR, further illustrating the problem. In one study, less than one-fourth of patients had discussed their preferences for CPR with their provider (2). Even when providers discuss these options with patients, there is often a great deal of discordance between the patient-provider discussion (3) and the patient’s actual desires (4).
In places where there is significant public education and media discussion regarding end-of-life options, patients often still don’t know their legally available EOL options (5). They are often reluctant to initiate conversations with their providers (6). In short, informed consent is a myth in the context of EOL care. Too often patients and their families don’t receive sufficient information or don’t have enough time to consider palliative options.
In particular, two medically and ethically appropriate options for dying patients are not widely discussed: One is palliative sedation, the use of medication to induce sedation in order to relieve a dying patient’s severe distress when other aggressive measures are ineffective (6). The other is Voluntary Stopping Eating and Drinking, referred to as VSED, the option to forgo food and fluid, while receiving supportive comfort care until death arrives (7). Both Palliative Sedation and VSED are accepted by current law and medical practice norms in every state (8). Nevertheless, a significant percentage of physicians refuse to provide or refer patients for palliative sedation on "conscience" grounds (9). A recent survey of hospitals found that while nearly 100 percent of patients want palliative sedation for themselves if dying of obstructive lung disease, less than 1% percent of those hospitals informed patients about this option (10).
When a dying patient is suffering in the final stages of a terminal illness, they should have counseling available that includes a full range of information about EOL care options. These options include the continuation of disease targeted care, hospice care, aggressive pain management, palliative sedation and VSED. The patient is then empowered to act autonomously with all information to make their own medical decision.
II. The Benefits of End of Life Discussions (and Legislation to ensure they take place)
When such discussions take place there are enormous benefits. According to "Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment, (11) "End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment."
The study, by a group of Boston researchers, set out to "determine whether end-of-life discussions with physicians are associated with fewer aggressive interventions." Three hundred thirty-two advanced cancer patients were followed from the time they were enrolled until they died (an average of 4.4 months), and their caregivers' psychiatric illnesses and quality of life were assessed approximately six months later.
Of the patients, 123 reported in their baseline interviews at the beginning of the study that they had end-of-life discussions with their physicians. Those discussions were not associated with an increased incidence of major depressive disorders or with more worry, nor were there associations "between end-of-life discussions and patients' self reported sociodemographic characteristics, insurance status, cancer type, relationships with physicians, religiousness, or social support."
The EOL discussion patients were, however, "more likely to accept that their illness was terminal (52.9 percent vs. 28.7 percent), prefer medical treatment focused on relieving pain and discomfort over life-extending therapies (85.4 percent vs. 70.0 percent), and have completed a do-not-resuscitate order (63.0 percent vs. 28.5 percent)." They also were less likely to be on mechanical ventilators, to be resuscitated, or to be admitted to the ICU. They were "more likely to be enrolled in outpatient hospice for more than a week (65.6 percent vs. 44.5 percent)."
Those patients who had aggressive medical interventions had a worse quality of life in their final week, and that quality decreased as the number of aggressive therapies increased. In contrast, those patients who were enrolled in hospice had an improved quality of life the longer they were in hospice care, "except for patients who received less than a week of services."
'Right to know end-of-life options’ legislation is good policy. Based on what transpired in California, the wiser course appears to be a measure calling for comprehensive counseling, rather than listing interventions. This measure can dovetail with POLST programs by ensuring that the physician’s order regarding life sustaining treatment is based on a fully informed patient decision. Proposed legislation is pending in New York and other states.
(1) Zhang, et al, Health Care Costs in the Last Week of Life
Associations With End-of-Life Conversations, Arch Intern Med 2009;169(5):480-488.
(2) Hofmann, et. al, Patient Preferences for Communication with Physicians about End-of-Life Decisions, 127 Annals Int. Med. 1 (1997); see also Billing, Recent Advances: Palliative Care, 321 BMJ 555 (2000); The SUPPORT Investigators, A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatments (SUPPORT), 274 JAMA 1591 (1995).
(3) Desharnais, et. al., Lack of Concordance between Physician and Patient: Reports on End-of-Life Care Discussions, 10 J Palliative Med 728 (2007).
(4) Golin, et. al, A Prospective Study of Patient-Physician Communication about Resuscitation, 48:5 J Am Geriatrics Soc’y (2000).
(5) Silveria, et. al, Patient’s Knowledge of Options at the End of Life: Ignorance in the Face of Death, 284 JAMA 2483 (2000).
(6) Curtis, et. al, Why Don’t Patients and Physicians Talk about End-of-Life Care? Barriers to Communication for Patients with Acquired Immunodeficiency Syndrome and Their Primary Care Clinicians, 160 Arch Intern Med 1690 (2000).
(7) Z. Schuman et. al, Implementing Institutional Change: An Institutional Case Study of Palliative Sedation, 8 J Palliative Med 666 (2005).
(8) J. Schwartz, Exploring the Option of Voluntarily Stopping Eating and Drinking within the Context of a Suffering Patient’s Request for a Hastened Death, J Pall Med, Vol. 10, No. 6, pp. 1288-1297; (2007)
(8) Id.; Approved by American Medical Association, July 2008, see also; American Medical Women’s Association, Position: Aid in Dying, available online at http://www.amwa-doc.org/index.cfm?objectId=242FFEF5-D567-0B25-585DC5662AB71DF9 (2007); Schuman (2005); B. Lo, Palliative Sedation in Dying Patients, 294 JAMA 1810-16(2005); Rousseau, Terminal Sedation In The Care Of Dying Patients, 156 Arch of Int Med 1785 (1996).
(9) Curlin et. al, Religion, Conscience, and Controversial Clinical Practices, 356 New Eng J Med 593 (2007); Quill & Byock (2000).
(10) "When we presented (a case of a patient w/terminal lung disease) at the hospitalist conference, less than 1% of the clinicians stated that they routinely offered advance care plans that specified terminal sedation instead of emergency ventilator support to patients with severe obstructive lung disease; however, 98% would choose terminal sedation for themselves in similar circumstances J. Lynne, et. al, Advance Care Planning for Fatal Chronic Illness: Avoiding Commonplace Errors and Unwarranted Suffering, Ann Intern Med 2003;138:812-818.
(11) Wright, A.A., Zhang, B. & Ray, A. et al. Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment. JAMA 2008;300(14):1665-1673
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Aging & Public Health Newsletter Archives