Aging & Public Health
Section Newsletter
Winter 2011

Greetings from the Editor

Greetings from the Editor

Welcome to the Winter 2011 Aging and Public Health Section Newsletter!

We have a full issue with a message from Susan Miller, our Section chair, sharing news about the Annual Meeting, as well as informational updates from our Development, Membership and Awards chairs. It is with pleasure that we recognize our 2010 Award Winners and sponsors, all of whom are listed in this issue. We continue our book review section in this issue with a review of The Handbook of Aging and the Social Sciences, seventh edition. In our Legislative Updates, you may read the hottest news on the hottest topics, thanks to the Medicare Rights Center and other generous contributors. Please also take note of dates for contest and abstract calls.

Thank you for supporting our Section Newsletter. We look forward to hearing from you in the upcoming months!

Best regards,
Mary Beth Morrissey

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Message From the Chair

Winter 2011 Aging and Public Health Newsletter  

From the Chair:

Thanks to the many Section volunteers and members who supported and participated in the 2010 APHA Annual Meeting in Denver! We had great attendance at our business meetings and a wonderful reception, attended by many. Also, I found the posters and presentations at this Annual Meeting to be outstanding — the best I remember since I’ve been attending these meetings. So, congratulations to all of you on your great work and thanks to P.J. Desai, Junling Wang and Nancy Miller for organizing our program this year.

We were able to recognize the excellent work of many of you at the awards program. The award winners are listed in this newsletter, or you can see the entire printed program (including pictures of winners). Thanks to 2010 Awards Chair Daniela Friedman and to the award subcommittee chairs and members for the time they committed to this effort

We also recognized leaders of the Aging and Public Health Section at the awards program. Laurence G. Branch, PhD, received the Award for Lifetime Achievement which was presented by Connie Evashwich, and Marcia G. Ory, PhD, MPH, received the Philip G. Weiler Award for Leadership in Aging and Public Health, presented by Gerry Eggert. Listening to Larry’s and Marcia’s acceptance speeches reminded me of why I’m in this field; they were both quite inspiring and clearly love what they do. Additionally, during our awards program, Connie Evashwich memorialized our colleague James J. Callahan, Jr., PhD, (1936-2010) and shared with us his many professional contributions. Then, at the awards reception, Bob Burke led an Irish toast to James Callahan, his friend and colleague.

This year, even with our struggling economy, Section members and others were exceptionally generous in their support of Section awards and activities. Thank you for your generous donations. A listing of the 2010 donors is included in this Newsletter. Thanks to our development co-chairs, Gerry Eggert and Steven Wallace, for all their fund raising efforts on the Section’s behalf.  

Finally, I want to wish you and yours a healthy and happy 2011! It will be a challenging year ahead as we struggle to lead high-quality programs while undergoing budgets cuts and to advance knowledge in environments with shrinking dollars for education and research. However, I observed a lot of energy at our Annual Meeting and trust all of you will continue to successfully fulfill in some manner and with optimism our Section’s mission to promote the health and well-being of individuals as they age.

Happy New Year!

Susan Miller

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2010 APHA Aging and Public Health Section Award Winners

2010 APHA Aging and Public Health Section Award Winners

The 2010 Aging & Public Health Section Awards Session was held on Monday, Nov. 8, 2010. For our nine Section awards, we had a total of 18 award winners, including honorable mentions. The Aging and Public Health Section’s Lifetime Achievement Award was presented to Laurence G. Branch, PhD. The 2010 Philip G. Weiler Award for Leadership in Aging and Public Health was awarded to Marcia G. Ory, PhD. Congratulations to all of our award recipients!

Award for Lifetime Achievement

Winner ........ Laurence G. Branch, PhD

Philip G. Weiler Award for Leadership in Aging and Public Health

Winner........ Marcia G. Ory, PhD, MPH

Archstone Foundation Award for Excellence in Program Innovation

Winner........ Carolyn Weissbach, JD, MPH
“Area Geriatric Education Scholars Program for Upper Peninsula Youth (AGES)”

Honorable Mention........ Kathleen Cody, MBA
“Foundation for Osteoporosis Research and Education (FORE) Put a Brake On Fractures Program”

Aetna Award for Excellence in Research on Older Women and Public Health

Winner........ Corrine R. Leach, PhD, MPH

Aging and Rural Health Research Award

Winner........ Lin Fan, MS
Honorable Mention........ Yu Kang, PhD

Betty J. Cleckley Minority Issues Research Award
Winner........ Nan Tracy Zheng, BS
Honorable Mention........ James B. Kirby, PhD
Honorable Mention........ Sunha Choi, PhD

Erickson Foundation Research Award
Winner........ Perry Edelman, PhD
Honorable Mention........ Matthew L. Smith, PhD, MPH

James G. Zimmer New Investigator Research Award
Winner........ Shubing Cai, PhD
Honorable Mention........ Holly A. Beard, PhD

Nobuo Maeda International Research Award
Winner........ Keren Ladin, SM
Honorable Mention........ SangNam Ahn, PhD, MPSA

The Laurence G. Branch Doctoral Student Award
funded by the Retirement Research Foundation
Winner........ SangNam Ahn, PhD, MPSA
Honorable Mention........ Tasha Stehling-Ariza, MPH

Retirement Research Foundation Masters Student Research Award
Winner........Jenerius Aminawung, MD,
MPH Honorable Mention........ Sameer Arora, MD, MPH

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Aging and Public Health 2010 Sponsors

AGING AND PUBLIC HEALTH 2010 SPONSORS

The APHA Aging and Public Health Section 
gratefully acknowledges the following
individuals and organizations:

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Membership Corner

Membership Corner

We had a terrific turnout at first networking dinner at November’s Annual Meeting in Denver. More than 40 new and existing Section members connected with colleagues and made new acquaintances, while enjoying the casual atmosphere of a local restaurant. The feedback we received about the event was overwhelmingly positive, and we hope to make it a fixture of the annual meetings. If you would like to be involved in planning next year’s dinner in Washington, D.C., or for other opportunities to get involved in the membership committee, please contact Carolyn Mendez-Luck at camendez@ucla.edu or Daniel Meng at meng@bcs.usf.edu .

We’d like to extend a warm welcome to new members who joined our Section in the past three months (September-December 2010):

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Section Policy Committee

APHA Aging and Public Health Section Policy Committee

The Aging and Public Health Section Policy Committee is in full swing at the start of the new year and is actively working to develop its goals and agenda for 2011. The Committee has identified the following areas of interest for committee examination:

• older adults and long term care;
• the built environment and related housing and climate change issues;
• end-of-life and palliative care; and
• health literacy and communication.

Please be in touch with Policy Committee Chair Mary Beth Morrissey if you wish to serve on or be a resource to the Committee. The Committee welcomes input from members of the Section.

Mary Beth Morrissey, Esq, MPH
mamorrissey@fordham.edu

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Rachel Carson Intergenerational Sense of Wonder

2011 Rachel Carson Poetry, Essay, Photography and Dance Contest

5th Annual Rachel Carson Intergenerational Sense of Wonder Contest

The U.S. Environmental Protection Agency is pleased to announce the 5th Annual Rachel Carson Intergenerational Sense of Wonder Contest.

Entries must be developed by a multi-generational team of two or more individuals — with at least one each representing the younger and older generations. Teams may submit a poem, an essay, photograph or a dance video that captures the sense of wonder you see, hear, and feel in nature. The contest takes its names from a book written by Carson and published posthumously 45 years ago, The Sense of Wonder. It reflects Carson's desire to have adults share with youth a sense of wonder about nature and help discover its joys and beauty. The contest seeks to spur and instill that same sense of wonder among all generations.

Teams will share through one of these distinct mediums their own interactions and reflections on the wonders of nature. Mixed media entries are also welcome, such as a photo accompanied with a poem or essay. Dance video entries can be of performers or capture movements and visible changes in nature from dawn to dusk. The deadline for entries is Friday, June 10, 2011.

A panel of expert judges will select finalists. The winners in each category will then be determined by the public, who will have an opportunity to vote online in August and September for their favorite submission in each category: photography, essay, poetry and dance video. Winners are expected to be announced in November.

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 is sponsored by the U.S. EPA, the Dance Exchange, the Rachel Carson Council, Inc., and Generations United.

Get more information about the contest and see the works of previous winners.

Kathy Sykes, Senior Advisor, Aging Initiative
Office of Public Engagement
U.S. EPA (Mail Code 1702A)
1200 Pennsylvania Ave. NW
Room 2502 Ariel Rios North
Washington, D.C. 20460
PHONE (202) 564-3651
FAX (202) 501-1770
www.epa.gov/aging

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Handbook of Aging and Social Sciences

Book Review
Handbook of Aging and the Social Sciences, seventh edition,
San Diego: Academic Press, 2011
Robert H. Binstock and Linda George K. George (eds.)
and Stephen J. Cutler, Jon Hendricks, and James H. Schulz (associate eds.)

The Handbooks of Aging series (first published in 1976) consists of three separate volumes, the Handbook of the Biology of Aging, the Handbook of the Psychology of Aging, and the Handbook of Aging and the Social Sciences.

The Handbook of Aging and the Social Sciences, seventh edition, provides up-to-date information on issues in aging that are pertinent for both the individual and the greater community. This new edition encompasses a broad spectrum of aging issues, reflecting the rapid growth of ideas, information and research literature during the past five years. Eighteen of the 25 chapters are on subjects not in the sixth edition (2006); they are authored by 32 new contributory authors out of 40 total authors. Only one chapter is an update by an author who was in the previous edition.

The Handbook of Aging and the Social Sciences is organized into four sections: Theory and Methods; Aging and Social Structure; Social Factors and Social Institutions; and Aging and Society. The organization within each chapter facilitates the reader’s ability to drill down and focus on a specific element covered in the body of work, accomplished at the opening of each chapter by a section that outlines the contents. Conclusions, acknowledgments and future research subsections provide closure for each chapter, creating the feel of a monograph rather than a chapter.

Thomas Rando and Laura Carstensen of the Stanford University Center on Longevity eloquently state in the foreword:

"Even though the near doubling of life expectancy was a spectacular achievement, there were not concurrent advances in our ability to alleviate the disabling conditions of later lifer. Nor were there sociological advances to create a world as responsive to the needs of the very old people as to those of the very young. In order to realize the enormous potential of longer life, scientists must come to a more comprehensive understanding of human aging and the social, psychological, and biological factors that contribute to optimal outcomes. Along with phenomenal advances in the genetic determinants of longevity and susceptibility to age related diseases has come an awareness of the critical importance of environmental factors that modulate and even supersede genetic predispositions. This series provides a balanced perspective of the interacting factors that contribute to human aging."

I have found the Handbook of Aging and the Social Sciences to be a very comprehensive collection of subject matter relating to aging and the social sciences, from my standpoint as a clinician, physical therapist, and as a member of Generation X. I particularly found part 4 of the book, Aging and Society, enlightening; the chapters discuss the correlation of the aging individual as a group and as a collective and the resulting impact on social and financial policies here in the United States. Chapters 19 and 22 provide international perspectives on pension reform and on long-term care financing, service delivery and quality assurance, two of the current hot button political topics.

I highly recommend this book for its relevance to the individual in our aging society and to clinicians in a wide field of practice. There are many references germane to my role as a clinician working with an aging world population that I have marked for further self-study.

CAPT Kathleen M. O’Neill, PT, DPT, MPH, CPH
United States Public Health Service
Tuba City Regional Health Care Corporation
Director of Physical Therapy
Tuba City, AZ

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Lessons from Our Native Elders

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Legislative Update

Legslative Updates

The Challenge for States: Realizing the ACA's Promise for Low-Income Medicare Consumers

The Affordable Care Act expands Medicaid eligibility and creates a new eligibility standard, requiring states to use “modified adjusted gross income” (MAGI) to create seamless health coverage. But Medicare consumers, or “non-MAGIs,” are not included in the new MAGI standard and thus may not be included in new systems (e.g., exchanges) and in associated eligibility rules developed for non-Medicare consumers between now and 2014. Thus the ACA creates two classes of people eligible for Medicaid and threatens to leave the Medicare population behind as reforms for MAGIs and other uninsured Americans are developed in the coming years. States must ensure that non-MAGIs are included, to the maximum extent possible, in new Medicaid- and exchange-related systems and associated rules.

The Affordable Care Act’s (ACA’s) sweeping legislation expands Medicaid eligibility to many pre-65 individuals with incomes up to 133 percent of the federal poverty level (FPL) and creates a new standard for determining Medicaid eligibility, requiring states to use “modified adjusted gross income” (MAGI) and eliminating the asset test (see SSA 1902(a)(10)((A)(i)(VIII) and SSA 1902(e)(14)). But the ACA explicitly excludes from the MAGI standard the Medicare population: people age 65 and over and people with disabilities under 65 with Medicare; this population includes individuals for whom Medicaid is paying Medicare cost-sharing amounts (i.e., those who are dually eligible for Medicare and Medicaid and, in many cases, enrolled in Medicare Savings Programs, or MSPs). Medicare consumers are now being referred to as “non-MAGIs.”

In effect, the MAGI standard of the ACA creates two classes of people eligible for Medicaid: the MAGIs and nearly 9 million dually eligible non-MAGIs. While this inequity could be remedied by amending the ACA to align non-MAGI eligibility with MAGI standards, the federal legislative and fiscal hurdles to this solution are seemingly insurmountable in the foreseeable future. Nonetheless, routes exist for states to include low-income people with Medicare in exchanges and associated rules, enabling them to benefit from the new systems that will screen, determine, enroll, re-certify, and manage the insurance of millions of newly insured pre-65, non-disabled Americans. (For instance, while the ACA dictates that states must establish online application and re-certification processes for the MAGIs, states could make these processes available to non-MAGIs. Similarly, states may be able to reform non-MAGI eligibility budgeting to match or more closely parallel MAGI budgeting.)

To better understand how low-income Medicare consumers could be left behind as once-in-a-generation health reforms unfold, consider the case of Mr. R, who represents a consumer navigating health coverage systems if states do not extend ACA reforms to non-MAGIs:

In 2014, Mr. R is 58 years old and earning a living wage as a laborer in Rock Island County, Ill. That year, he goes online to the Illinois Health Insurance Exchange mandated by the ACA and enrolls in subsidized health coverage because he is at 170 percent FPL. Shortly after Mr. R’s 60^th birthday, he suffers a stroke, becomes disabled, and qualifies for Social Security Disability Insurance. His loss of income, which places him at 132 percent FPL, also qualifies him under the MAGI standard for Medicaid. Following a two-year waiting period for Medicare, Mr. R becomes Medicare-eligible when he is 62 years old. He is now a non-MAGI — and no longer eligible for Medicaid because the upper income level for a non-MAGI is 100 percent FPL. Mr. R, now struggling to pay for needed health care, may be eligible for the MSP known as QI but needs budgeting and income disregard advice. There is no system in place to notify Mr. R of this potential eligibility, provide him with counseling, or automatically enroll him in the QI program, because he cannot access the services of the Illinois Exchange. Instead, he must contact another state agency and re-submit paperwork to qualify as a first-time applicant to QI even though he recently had been eligible for full Medicaid.

To protect Mr. R and the thousands of vulnerable Americans like him, states must include non-MAGIs in their exchanges and any improved enrollment systems in order to provide this population with seamless coverage. Further, states will also need to review their Medicaid budgeting rules to comply with the MAGI standard. During this review, states will have the opportunity to modify budgeting rules for the non-MAGIs, thereby achieving greater eligibility parity between MAGIs and non-MAGIs.

Joe Baker
President
Medicare Rights Center

_____________________

Comprehensive End of Life Counseling:
Time for a Uniform Law Governing Comprehensive
End of Life Counseling

Compassion & Choices, the nation’s largest and oldest organization advocating on behalf of terminally ill persons, has submitted a proposal to the Uniform Law Commission (ULC) urging it adopt a uniform law directing health care providers to offer terminally ill patients counseling on all end-of-life care options legally available in the forum state. Such a law is necessary to respond to the failure of many physicians to discuss end-of-life care issues with their patients, and to ensure that terminally ill patients are fully informed about their treatment choices.

Studies have confirmed that:

(i) these conversations between health care providers and their patients often do not take place; and

(ii) when these conversations do occur, they result in significant benefits for the patient and the patient’s caregivers.

It is well established that competent people, including the terminally ill, have a right to direct their medical care. A patient has the right to refuse or direct withdrawal of life-sustaining treatment, even if it will precipitate death. A patient may also choose aggressive disease-focused treatment, palliative care or some combination of both.

Yet, despite the breadth of choices available to patients at the end of life, terminally ill patients are often uninformed – and, indeed, misinformed – about their choices. Conversations between patients and their physicians about end-of-life care do not regularly occur. Indeed, even when such conversations do take place, they may be too late to implement patients’ preferences.

Because doctors and terminally ill patients are not speaking candidly about patients’ values and preferences concerning end-of-life care, patients and their caretakers are deprived of the “cascading benefits” that may result from such conversations. As a recent study, reported in the Annals of Internal Medicine, explained, “patients who reported having end-of-life discussions received less aggressive medical care and were more likely to receive hospice services for more than a week. Less aggressive care and earlier hospice referrals were associated with better patient quality of life near death. . . . Better patient quality of life near death, in turn, was associated with better quality of life among surviving caregivers . . . .” Public education is not enough to inform terminally ill patients adequately. Instead, comprehensive counseling about end of life care options should occur within the context of the doctor-patient relationship. Foremost, this is because health-care providers are the ones primarily tasked with carrying out a patient’s wishes at the end of life. Moreover, within this relationship, such counseling can occur iteratively and informatively, based on a patient’s condition, history, and other characteristics.

California and New York have taken the lead to correct this pressing problem, enacting laws designed to promote the flow of critically important information about end-of-life care options to terminally ill patients.

California’s Right to Know End-of-Life Options Act provides in pertinent part: “When a health care provider makes a diagnosis that a patient has a terminal illness, the health care provider shall, upon the patient’s request, provide the patient with comprehensive information and counseling regarding legal end-of-life care options pursuant to this section.” Cal. Health & Safety Code § 442.5.

New York’s Palliative Care Information Act (PCIA) provides a similar guarantee for terminally ill patients. The substantive difference between these two statutes is that in California, the patient must request counseling, while in New York the health-care provider must offer it (which a patient could, of course, refuse). Because patients may not know to ask for counseling, the New York measure is an improvement over the California law. It represents a logical extension of existing patient rights to receive information about diagnosis, prognosis, and treatment options while retaining flexibility for health care providers to exercise their professional judgment in a number of ways.

The New York PCIA was touted as “landmark legislation and a model for the nation” in APHA’s Aging & Public Health Section newsletter. In the proposal to the ULC, Compassion & Choices cited the APHA Section’s newsletter piece as evidence for the need to adopt model legislation.

APHA’s Policy on Patients’ Rights to Self-Determination at the End of Life, addresses the need for comprehensive counseling in this portion of the Policy:

“Need for Provision of a Full Range of Information

“Empirical and anecdotal evidence reflect that health care providers do not inform terminally ill patients of all options legal in the state in which the patient is receiving care. As a result, patients are not able to make fully informed decisions about care at the end of life.”

Accordingly, the APHA: “Supports the provision of information about the full range of end-of-life care options to terminally ill patients permitted by law in the state in which the patient is receiving care.”

Compassion & Choices supports a uniform law modeled after New York’s Palliative Care Information Act, which requires physicians to broach the subject of end-of-life care with terminally ill patients, initiating conversations that will ultimately improve patients’ quality of life near death by informing them of options and allowing them to make fully informed decisions.

Kathryn L. Tucker, JD
Director of Legal Affairs
Compassion & Choices

_____________________

Advance Care Planning in CMS Rules Gets Killed by Obama Administration

Much to the surprise and chagrin of many health care professionals, the Obama administration killed the part of final physician payment rules issued in November 2010 by the Centers for Medicare and Medicaid Services that for the first time would have required physicians to offer voluntary advance care planning information to their patients as part of the annual wellness visit under the Medicare program. The final regulation became effective Jan. 1, 2011. While the scope of the applicable provision was very narrow, it opened the door for a long-overdue integration of advance care planning processes into mainstream physician practice for physicians participating in the Medicare program. There is strong research evidence supporting early conversations between physicians and their patients about goals of care and the positive outcomes of such conversations. A paradigm shift that is occurring in health care away from formalistic types of decisions to relational, process – oriented communication is consistent with such early conversations. The Medicare Payment Advisory Commission Report of June 2010 described Medicare beneficiaries as, on average, more likely to be poorer, less educated, less health literate and more chronically ill than other medical consumers (Medicare Payment Advisory Commission Report, 2010). For these reasons among others, generally, Medicare beneficiaries are at higher risk of making decisions that are not informed by evidence. The deferral of physician payment for advance care planning conversations runs counter to all of the goals of health care reform supported by the Obama administration – improving health literacy, giving incentives for shared medical decision making, supporting quality improvement in the Medicare Program, achieving efficiency in the health care systems, and, most importantly, strengthening communication between physicians and the vulnerable frail elderly persons whom they serve in the Medicare Program. All of these goals have strong ethical underpinnings. It will be important for health care professionals across disciplines to continue to educate physicians, older adults and their family members about the complexities of health care decision making and the role of early advance care planning conversations in good decision making.

Mary Beth Morrissey, Esq, MPH
Fordham Ravazzin Center on Aging

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APHA 2011 ANNUAL MEETING AND CALL FOR ABSTRACTS

APHA 2011 Annual Meeting and Call for Abstracts and Other 2011 Annual Meetings

The APHA 2011 Annual Meeting will be held Oct. 29-Nov. 2 in Washington, D.C. The APHA call for abstracts is now open. Please be reminded that deadlines are in early February. You may find full information about the meeting and abstract deadlines at the following link: http://www.apha.org/meetings .

ICNAP III Meeting and Call for Abstracts
The Interdisciplinary Coalition of North American Phenomenologists will hold its 2011 Annual Meeting May 6-8 in Washington, D.C. The call for abstracts is open and may be found at: http://www.icnap.org/call.htm .
Deadline for submission of abstracts is Feb. 1.

GSA Annual Meeting and Call for Abstracts
The Gerontological Society of America Annual Scientific Meeting will be held Nov. 18-22, 2011 in Boston. The deadline for abstract submission is March 15, 2011. You may link to the call for abstracts below:

http://gsa2011.abstractcentral.com/

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