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Aging & Public Health
Section Newsletter
Spring 2010

From The Editor

As you begin your summer sojourns, I encourage you to peruse our GHS summer newsletter. It contains an important update from the chair about the Section name change and the Annual Meeting, as well as other upcoming conferences and contests, and newsworthy reports submitted by our colleagues from around the country.

May you have a productive and fruitful summer!

Mary Beth Morrissey

 

Greetings From The Chair

From The Chair

 

The GH Section leadership has been busy on a number of fronts. First, we have been pursuing a change in our Section’s name. In May, GH Section members overwhelmingly approved (at 96 percent) a change in the section’s name, to be “Aging and Public Health.” The next step is to obtain APHA Executive Board approval for the name change, and this approval process is under way. We anticipate an approved name change by November’s Annual Meeting, and we hope you will be there to join us in celebrating our new name.

 

This year’s Annual Meeting will promote networking opportunities and will provide members with information on health care reform and long-term care. The Membership Committee is planning an “icebreaker” for students and new members prior to the Section’s business meeting on Sunday. Also, after the business meeting members can socialize at “topic tables” during dinner. These tables will focus on specific interests/themes and are aimed at encouraging networking and mentoring. Also, a funders’ roundtable session will allow GHS members to meet face-to-face with representatives from funding organizations to discuss funding priorities, and other related matters. As always, the Section will hold its reception and silent and live auction on Monday evening, after the award’s session.   

 

Three special symposia will occur at November’s Annual Meeting. In collaboration with the Disability Section leadership, Nancy Miller is planning a symposium with the theme of “looking ahead,” and focusing on action still needed 20 years after the Americans with Disabilities Act. Gerry Eggert has organized a symposium on the CLASS Act, which was included in the recently passed health care reform legislation. Ms. Connie Garner, who was instrumental in designing the CLASS Act legislation, will speak at this symposium. Also, another session will focus on the Medicare reform that was included in the health care reform legislation. This symposium will include presentations on changes to Medicare Part D as well as on targeted cuts to Medicare programs.

 

As always, we are looking for volunteers to help with the Section’s efforts. Specifically, we are looking for someone who is willing to maintain the section’s website. Steven Wallace had chaired this effort for many years and is looking to step down. This doesn’t require a lot of time and could be fun for someone who likes being creative. Also, we need a volunteer to oversee the staffing of the Section’s booth at the Annual Meeting. Essentially, this volunteer would recruit members to staff the booth and ensure there is booth coverage. Additionally, we are looking for additional members for the Policy Committee, particularly persons who are interested in drafting “late breaker” policy (for APHA) relating long-term care and health care reform. Please e-mail me if you are interested in any of these volunteer activities.

 

I wish you a wonderful and healthy summer!

 

Susan Miller

Long-Term Care

Universal Coverage of Long-Term Care in the United States: Can We Get There From Here?

The 2010 Maxwell Policy Research Symposium, held June 10-11, 2010, addressed the issue of long-term care insurance and services in the United States.  Many argue that our current long-term care system is inadequate, inefficient and unfair. The Community Living Assistance Services and Supports (CLASS) Act, included in the health reform legislation that was signed into law earlier this year, represents a possible step toward a more comprehensive and uniform system.

This year’s Policy Research Symposium will brought together leading scholars from the United States and Europe, with a goal of assessing the prospects for moving towards more comprehensive coverage of long term care services in the United States.  The Symposium was co-organized by Madonna Harrington Meyer and Douglas Wolf (of Syracuse University) and Nancy Folbre (of the University of Massachusetts – Amherst).  Papers presented at the Symposium will be compiled in an edited volume for later publication.

Symposium agenda: http://www-cpr.maxwell.syr.edu/econconf/index.htm .

Distribution list for future announcements, including notice of publication of Symposium papers, Martha Bonney mwbonney@syr.edu  .

Contests and Awards

4th Annual Rachel Carson Intergenerational Sense of Wonder Contest
The U.S. Environmental Protection Agency is pleased to announce the 4th annual Rachel Carson intergenerational "Sense of Wonder" contest. Entries for the contest should be developed by persons from younger and older generations. Teams can create poetry, take photographs, write essays, and/or dance. These creations should celebrate the legacy and love of nature that Rachel Carson so eloquently embodied. The contest is sponsored by the U.S. EPA, the Dance Exchange, the Rachel Carson Council, Inc., and Generations United.

Teams can select the medium for their work as it captures their interactions with and reflections on the wonders of nature.  Mixed media entries are welcome as well, such as a photo accompanied with a poem or an essay. Video entries can be of persons dancing or capture movements and visible changes in nature from dawn to dusk. A panel of expert judges will select finalists. The winners in each category of photography, essay, poetry, and dance will then be determined by the public, who will have an opportunity to cast votes online for their favorite submissions.

Carson wrote that she would endow every child with "a sense of wonder so indestructible that it would last throughout life." However, "if a child is to keep alive his inborn sense of wonder, he needs the companionship of at least one adult who can share it, rediscovering with him the joy, excitement, and mystery of the world we live in."  The contest seeks to spur and instill that same sense of wonder among all generations. Should you need some inspiration from Rachel Carson, check out this Web page about her and her works that captured nature so eloquently.
http://www.epa.gov/aging/resources/thesenseofwonder/about.htm


Entries were due June 16, 2010. For more information about the contest
please see 
http://www.epa.gov/aging/resources/thesenseofwonder/index.htm


Building Healthy Communities for Active Aging Recognition and Award Program
This award recognizes communities for their outstanding comprehensive approaches to implementing principles of smart growth, as well as strategies that support active aging. It is presented to communities with the best and most inclusive overall approach to implementing smart
growth and active aging on a variety of fronts, at the neighborhood, tribe, city, county, and/or regional level.

For more information on the past winning communities see
http://www.epa.gov/aging/bhc/index.htm

While this recognition program does not provide a financial award, the winners are the people living in these communities and this award recognizes the leadership of these communities in making their
communities a great place to live.  If you would like to submit an application to be considered for this recognition please see:
http://www.epa.gov/aging/bhc/awards

Applications for 4th annual Building Healthy Communities for Active Aging the 2010 are due July 17, 2010.

Smell and Taste and Other Fact Sheets

Smell and taste are important senses that may change as people age.  A fact sheet from the National Institute on Aging (NIA), Smell and Taste: Spice of Life, provides an overview of this subject and resources for more information. It describes the importance of smell and taste, possible causes of changes in these senses and how to deal with them, and suggests ways to keep eating a healthful diet when changes in taste occur during cancer treatment.

Smell and Taste: Spice of Life is part of the NIA’s series of free AgePage fact sheets on more than 40 topics of interest to older adults and caregivers. Each AgePage provides an overview of the subject and resources for more information.  Many of these fact sheets are available in Spanish. Topics address specific diseases or conditions (e.g., cancer, depression, forgetfulness), health promotion/disease prevention (e.g., exercise, healthy eating, sexuality), safety issues (e.g., fall prevention, medication use), and more. 

To download or order free copies of Smell and Taste: Spice of Life, visit www.nia.nih.gov/HealthInformation/Publications/smell.htm or call the NIA Information Center toll-free at (800) 222-2225. For bulk quantities, visit www.niapublications.org/bulkorder1.asp.

Other NIA AgePages and publications in English and Spanish are available at www.nia.nih.gov/HealthInformation/Publications.

The National Institute on Aging is part of the National Institutes of Health in the U.S. Department of Health and Human Services.

Guided Care

Guided Care, a new model of comprehensive health care for people with multiple chronic conditions, is moving beyond the research stage into the mainstream of health care. It is garnering attention throughout the United States and around the world as it has won several prestigious awards. APHA was the first to recognize the value of Guided Care with its “2008 Award for Excellence in Program Innovation,” which is given to one innovative model of health care for older Americans each year.

 

Guided Care then received the “2009 Medical Economics Award for Innovation in Practice Improvement” from the American Academy of Family Physicians, the Society of Teachers of Family Medicine, and Medical Economics magazine. This Award recognizes innovative practice improvement programs that transform medical office processes, promote patient participation, and contribute to an office practice’s overall success.

 

The British Medical Journal Group named Guided Care as a finalist for its “2010 Getting Research into Practice Award.” The Award honors individuals, organizations, and initiatives that have demonstrated outstanding and measurable contributions to health care. BMJ selected Guided Care as one of four finalists from a field of 127 submissions from around the world.

 

Then in April 2010, the Guided Care Program at Kaiser Permanente Mid-Atlantic States won the “2010 Case in Point Platinum Award for Case Management Provider Program” and was a finalist in two other categories. Sponsored by Dorland Health, the Case In Point Platinum Awards recognize the most successful and innovative case management programs working to improve health care across the continuum.

 

As the Guided Care model has gained recognition, Dr. Chad Boult has accepted recent invitations to describe its methods and its promising outcomes at professional conferences in Germany, Canada, the United Kingdom, Spain, China, Australia, Singapore and Israel, as well as the United States.

 

The Guided Care model was developed by an interdisciplinary team at Johns Hopkins University and is designed to improve quality of life and quality of care, while improving the efficiency of treating the sickest and most complex patients. Guided Care teams include a registered nurse, two to five primary care physicians, and other members of the office staff who work closely to monitor each patient’s health and offer comprehensive, coordinated, patient-centered health care. Following a comprehensive assessment and planning process, the Guided Care nurse educates and empowers patients and families, monitors their conditions monthly, and coordinates the efforts of health care professionals, hospitals and community agencies to be sure that no important health-related need slips through the cracks. Early results from a multi-site randomized controlled trial suggest that Guided Care improves the quality of care, reduces costs, reduces family caregiver strain, and improves physicians’ satisfaction with chronic care.

 

The research and development of Guided Care has been funded by a public-private partnership of the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, and the Jacob and Valeria Langeloth Foundation. For more information about Guided Care, please visit: www.GuidedCare.org. With funding from the John A. Hartford Foundation, the Lipitz Center has developed extensive materials to help practices adopt and succeed with the Guided Care model, including a step-by-step implementation manual and online courses for nurses and practice leaders. Practices can implement Guided Care within six to nine months using these resources. For details, please visit: www.MedHomeInfo.org.

 

 

The Guided Care Team at Kaiser Permanente Mid-Atlantic accepts the 2010 Case In Point Platinum Award for Case Management Provider Program.

 

 

 

 

 

 

 

Dr. Chad Boult accepts the 2009 Medical Economics Award for Innovation in Practice Improvement on behalf of the patients, family caregivers, doctors, and nurses for whom Guided Care was designed.

Disaster Planning

Members of the Disaster Planning and Preparedness Special Interest Group of the American Geriatrics Society have created an editable wiki site to post relevant info about disaster preparedness for the elderly. Find the site at http://elderlydisaster.pbworks.com/

We are soliciting help from our public health friends to build this website with useful information for geriatricians involved in disaster planning or response for seniors. Anyone can view the site, and GHL members may request editing privileges by hitting the "Edit" tab on any page. Alternatively you may send suggestions and information to  jrpierce@salud.unm.edu . 

The site is free for educational purposes, so please do not post any commercial products or advertisements. 

The AGS Special Interest Group would also appreciate feedback on the concept, usefulness and design.  Feel free to share the site with colleagues. 

For more information contact:

J Rush Pierce Jr, MD, MPH 
Associate Professor
Dept of Internal Medicine
Univ of New Mexico School of Medicine
MSC 10 5550
1 University of New Mexico
Albuquerque, NM  87131-0001
Phone: (505) 272-9460
Fax: (505) 272-9437
E-mail:  JRPierce@salud.unm.edu

New Long-Term Care Website

The Center for Gerontology and Health Care Research at Brown University is pleased to announce the launch of www.LTCfocUS.org , a new long-term care research and policy website.  The website is sponsored by the National Institute on Aging funded Shaping Long-Term Care in America project housed at the Brown University Center for Gerontology and Healthcare Research.  LTCFocUS.org is an exciting new resource for long-term care researchers and policy analysts because users can interact with the website in two ways: 1) by creating interactive maps and tables and, 2) by downloading all data available on the site.

LTCfocUS.org incorporates professional and graphically sophisticated maps, tables, and other visualizations of data related to nursing home care in the United States.  It provides users with research abstracts and publications and allows users to create linked maps to gather information about states, counties, or individual nursing homes. All data provided on the website are also available to download.

The website provides data gathered from existing federal sources including Medicare reimbursement claims, Online Survey Certification And Reporting (OSCAR) data, Minimum Data Set (MDS) data, as well as our own survey of state Medicaid policies. The goal of the website is to allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care. Policy-makers will also be able to use the information to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans.

Avoidable Falls

Older Californians At Risk for Avoidable Falls. Steven P. Wallace, Nadereh Pourat, Eva Durazo, Rosana Leos. UCLA Center for Health Policy Research Policy Brief. May 2010. http://www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=405  

This policy brief examines the growing rate of repeated falls among senior citizens using the California Health Interview Survey (CHIS). The authors found that over half million older Californians (565,000) fell more than once in 2007 -- about 100,00 more seniors with repeated falls than in 2003. Guidelines recommend reducing the risk of falling by older adults with a history of falls through an evaluation by a health professional with evaluation and counseling in a number of areas. However, the authors of this brief found that fewer than half of seniors with multiple falls engaged in the six recommended preventive activities in the previous year.

Aging and Public Health

Aging Section of the Texas Public Health Association

 

A petition to create an Aging and Public Health Section was successfully circulated at the recent Annual Educational Conference of the Texas Public Health Association, April 21-23, 2010.  Full recognition will follow the signing up of at least 10 new TPHA members in the Section and ratification by the TPHA Governing Council during its July meeting. Aging has become a regular theme at the Conference, this year featuring breakout sessions titled: “Evidence-Based Physical Activity Programs for Seniors,” “Evidence-Based Fall Prevention Program,” “Issues in Geriatrics and Geriatrics Education in South Texas,” and “A Study of Dementia.”

New Surrogate Health Care Decisions Act

Landmark health care legislation, which will impact tens of thousands of New Yorkers each year, was recently enacted in New York, effective June 1. The Family Health Care Decisions Act finally brings New York in line with virtually every other state. Loved ones will now be able to make health care decisions for patients who have lost the ability to do so, in certain situations and under rigid criteria, when those patients have not completed a health care proxy or a living will. The law is critically important as the vast majority of New Yorkers, like people nationwide, have not, often to their detriment, appointed a trust person to be their health care agent by completing a health care proxy form.

 

The goal of this laudable legislation is to ensure that the wishes and values of patients without decision making capacity will be respected. The FHCDA requires the surrogate to decide about treatment based on the patient's wishes, including the patient's religious and moral beliefs, or, if the patient's wishes are not reasonably known and cannot with reasonable diligence be ascertained, based on the patient’s best interests. This is a reasonable standard. However, the Family Health Care Decisions Act has many stringent limitations and criteria for surrogate decision making, which do not govern health care agents.        

 

For example, it now only applies to hospitals and nursing homes. Thus, health care decisions cannot be made for those at home whether in hospice or not, although the law may be amended to include those at home (an amendment may be passed next year to include those at home).  

 

Additionally, the decision maker is chosen in order of priority from a hierarchy, as in some other states, with a spouse or domestic partner first, followed by an adult child. And, while a challenge can be made by one lower in the hierarchy, in many cases it is likely that a person will be authorized to make health care decisions for patients whom patients would not have chosen.

 

Finally, the act only authorizes decisions to withhold or withdraw life-sustaining treatment if treatment would be an extraordinary burden to the patient and the patient is terminally ill or permanently unconscious, or if the patient has an irreversible or incurable condition and the treatment would involve such pain, suffering or other burden that it would reasonably be deemed inhumane or an extraordinary burden under the circumstances. Certain such decisions require ethics committee review.

 

These are very strict standards that are difficult to meet and not applicable to health care agents. Those of you in states with surrogate decision making laws may want to review them. When enacted they may have had stringent safeguards, understandably, in order to protect vulnerable patients. With two decades of mostly positive experience with surrogate decision making, do those laws still need to have very difficult standards for decisions, particularly for those involving life sustaining treatment?

David C. Leven, Esq. 
Executive Director, Compassion & Choices of New York

Palliative Care Conference Features Diane E. Meier, MD, as Keynoter

The Collaborative for Palliative Care of Westchester and the New York State Southern Region ("Collaborative") is pleased to report that Diane E. Meier, MD, will be the keynoter at the Collaborative's annual conference to be held on April 8, 2011 in White Plains, N.Y. Dr. Meier is director of the Center to Advance Palliative Care and director of the Lilian and Benjamin Hertzerg Palliative Care Institute, Professor of Geriatrics and Internal Medicine, and Catherine Gaisman Professor of Medical Ethics at Mount Sinai School of Medicine in New York City and one of the field's most prominent leaders.

The conference is expected to draw professionals from around the country to address important issues related to palliative and end-of life care.

If you wish to submit an abstract for the April 2011 program, please contact Mary Beth Morrissey, Esq., MPH, Chair of the Collaborative, at mamorrissey@fordham.edu.

More information about the Collaborative and the April 2011 conference may be found on Facebook.

APHA Initiatives on Transportation and Public Health

APHA Initiatives on Transportation and Public Health   


As we all appreciate, our health is profoundly affected by our transportation decisions and options. Limited opportunities for physical activity, higher exposure to poor air quality, higher incidences of adult and childhood obesity and greater prevalence of asthma and cardiovascular disease are a few of the inequities brought by poor transportation policies. As part of our effort to enhance crosscutting activity and knowledge among various APHA membersand sections, APHA is developing advocacy materials and helpful information related to the links between transportation and public health. If anyone is interested inlearning more about this initiative, sharing success stories or lessons learned, or establishing a new Forum on Transportation and Public Health, please reach out to us!

Interested members are asked to contact Eloisa Raynault at eloisa.raynault@apha.org