All posts by Global Health Aging

Italy: How Location Affects Mental Health

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Depression among the elderly is very common and can cause suicidal thoughts. People think that having depression is part of growing old and a disease that needs to be lived with. However, depression can be treated. There are many factors that can cause depression such as losing a lifelong partner and seeing their own children grow up. These life situations can result in many elderly people feeling useless and asking themselves: What else is there to live for? Is death the only thing to wait for?

In Italy, researchers have found out that a certain factor contributes to depression among the elderly more than gender, marital status, age, or lifestyle choices. This factor is that the elderly who live on the island of Sardinia are less depressed than Italian elderly from anywhere else in the country. Does it really make a difference where you live? Yes, it does. In the field of Public Health, we know that availability and infrastructure of health care services as well as social and recreational services are important for the peoples’ well-being. Elderly from Sardinia have health care services nearby to get treatment and preventive services they need. In addition, they are more physically active and more socially and culturally engaged, which increases their self-esteem and mental health.

What can Italy and other countries worldwide take away from this study? I believe that offering cultural, social, and recreational events for the elderly can improve their mental health. In addition, improving health care services in cities as well as in rural areas can not only prevent many mental and physical illnesses, but also give the elderly the treatments needed to live a longer independent life.

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.

Promoting Advance Directives, Reducing Medicare Spending

*This article was extracted from a longer, in-depth, paper written during my internship with a policy forum in Washington, D.C. 

More and more people are living to the age of 100. As our longevity increases, it is crucial to have an advance directive to make health care decisions, which may reduce the overall cost of end-of-life care. While Medicare guarantees access to health insurance for individual Americans and lawful residents aged 65 and older, the program faces significant fiscal challenges over the long-term. Advance directives may reduce Medicare spending since older adults can opt out of aggressive medical intervention by dictating their wishes in the event of a life-threatening illness. As Congress continues to debate over the best way to fix Medicare, costs will likely increase if older adults continue to ignore advance directives.

Living Will document with pen, closeupAbout 27.4 percent of Medicare expenses for the elderly are spent in the last year of a person’s life. Advance directives can reduce that percentage because older adults may not prefer lifesaving machines that impact costs. If a person wants to avoid lifesaving machines without having an advance directive, doctors will keep such people alive at the expense of other patients. The latter will be deprived of necessary medical treatment and hospitals may become overcrowded. Also, these machines and other medical resources will contribute to the cost of care because they are expensive and scarce. Unless people write binding living wills, families are reluctant to “pull the plug,” and medical professionals are afraid of being sued if they do. Increasing the use of advance directives is necessary for preventing such problems.

Studies have shown that adults are more likely to complete advance directives that are written in everyday language and less focused on technical treatments. However, many people are currently unaware of advance directives and even fewer complete them. Since advance directives are very lengthy and tedious to complete, most seniors prefer family surrogates. The present state of healthcare systems also compounds the problem. For instance, there are only two states that offer living will “registries.” Residents can file their living will and allow doctors and other healthcare providers to have access to their documents. However, the Washington State living will registry has been closed by the state government because of lack of funds, among other problems.

If insurance pools take into account the costs spent on people that will never get well, premiums for younger and healthy people are going to be very expensive. It is difficult when people are without an advance directive and do not want lifesaving machines. At the same time, if such people wish to have invasive and aggressive medical treatment in poor prognosis states, then health systems should accommodate and respect their wishes.

Advanced directives are not only for the elderly. Our society is getting older, and people have to deal with it. Health professionals need to determine effective ways of promoting advance directives among elderly patients. For example, a study showed that a replicable intervention mainly targeting doctors achieved a moderate increase in advance directives among older ambulatory patients. Future interventions may need to address doctors’ attitudes and comfort discussing these documents since patients cite their physician most often as the one who influenced them most to make a health behavior change. Increasing the use of advance directives among elderly persons is essential since it reduces Medicare spending and the national budget concurrently.

Living wills and health care proxies need restructuring hence these documents have to be well prepared to reduce confusion, jargon, and ambiguity. It is also vital for healthcare institutions to advocate and support the use of advance directives. More states should invest in the living will “registries” and promote advance directives to increase enrollment. If a patient has an advance directive and requests lifesaving machines, families and health professionals should respect their wishes. In the long run, advance directives are necessary because they can reduce the overall cost of end-of-life care for individuals and families.

Sophie Okolo is the Founder of Global Health Aging.

Why Growing Old in the U.S. Sucks…and There is Nothing (Something) We Can Do About It

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I am close to thirty years old. According to the latest data from the World Bank, I can expect to live another 45 to 50 years (Current U.S. life expectancy 78.7 years). However, the quality of those years is up for debate. Our current baby boomer population, on average, is sicker than their parents. The childhood obesity rate for children across the world, but especially in the US, has led many to the conclusion that this generation will become the “sickest generation” in the history of mankind. On top of this, with the population of Americans aged 65 and older expected to double within the next 25 years, there will no doubt be a strain placed on an already taxed healthcare system.

Of course many will argue that numerous aspects of our health are the result of our own personal decision making. This is very true but consider for a second that many individuals, maybe some within your own community, do not have a choice. Maybe they don’t have access to healthy eating options. Maybe they live in an area that exposes them to environmental pollutants. Maybe their occupation requires labor that over time will contribute to chronic pain. For many individuals, we live in a society where the choice has been taken from them or made on their behalf.

For all of us, aging can and possibly will be a difficult process. The unfortunate reality is that we live in a country that has the best intentions, but poor execution. I personally look forward to my next 40-50 years, but I know that many others are not. We must consider that the aging process is not created equal, and that there are many who are and will be unjustly dealt an unfair hand. Aside from the education and outreach initiatives conducted with regard to healthy living and chronic disease, there must be a greater emphasis on policy implementation that catches those at risk. According to the Global AgeWatch Index, Sweden is the best country in the world for the elderly. With reduced costs and an individualized approach, Sweden puts forth a strong effort to ensure the quality of life of its aging population. These efforts illustrate that it’s not impossible for strides to be made in improving or at least maintaining our country’s aging populace.

To give everyone a fair chance, there must be equality at the starting point. It is not enough to expect that public health interventions and education for those at risk for the development of chronic disease will suffice as a method to prevent potential long term health problems. There needs to be more of an effort to eliminate that “risk” to begin with to ensure that children born today, no matter location, race, or socioeconomic status are born with the same expectation of a healthy life. So maybe there is something we can do about it. With time, effort, and collective sacrifice, all Americans can have the opportunity to experience their potential 78.7 years in full health and vitality.

Udo Obiechefu is an E-Tutor for the Master of Health Promotion and Public Health program at Robert Gordon University.

Affected, not Infected – HIV/AIDS and the Elderly in Thailand

The HIV virus is known to affect men and women in their reproductive age, between 15-49 years, leaving behind a large dependent population – children, the elderly, etc. The elderly play an important role in the epidemic although they are the invisible victims of this epidemic. They may not necessarily be infected with HIV, but are certainly affected by it.

The various roles of the elderly in the HIV pandemic include care-giving to the infected children, co-residence with the infected, providing financial and material support, fostering grandchildren, experiencing the suffering and ultimate loss of a child, and facing negative community reactions. HIV can place a huge physical, emotional and financial burden on the elderly population of a country.

Thailand, in South East Asia, reported its first case of AIDS in 1984. The latest UNAIDS estimates (2013) suggest a 1.1% national adult HIV prevalence. Like many developing countries, Thailand maintains a relatively high involvement of older parents in the lives of the adult children. Seven out of ten elderly people over 60 years live with, live near, or receive some form of material support from their adult children. Corresponding figures show that over two-thirds of HIV+ adults lived with or near their parents. Additionally, a similar proportion of HIV+ adults reported to receiving parental care at the terminal stage of illness.

Caregiving to a HIV+ adult child places a significant burden on the elderly. They lose the material, financial and emotional support from children that they are counting on. In Thailand, a study reported that over 50% elderly HIV caregivers experience fatigue, insomnia and anxiety. However, this information is before the provision of antiretroviral therapy (ART) in Thailand. With the improved access to ART, HIV is increasingly looking like a chronic disease. The lifespan of HIV/AIDS patients is increasing, and those under ART can lead a ‘normal’ life. HIV/AIDS is no longer the death sentence it used to be.  Consequentially, the use of ART greatly reduces the responsibilities placed on the shoulders of the elderly population.

A big advantage of ART for the elderly is economic stability. Parents of HIV/AIDS children need no longer use their limited resources on the health of their children. Additionally, they can continue to rely on their adult children with HIV+ for financial support since ART can allow those children to lead a closer to ‘normal’ life. Parents’ psychological well-being has also improved due to fewer worries about the health of their children with HIV/AIDS. Thailand incorporated older people affected by HIV/AIDS as a target group in their 10th National AIDS Plan (2007-2011) for the first time. This not only demonstrates a sensitized understanding of the victims who are infected and affected of HIV/AIDS, but also marks a significant step forward in understanding and providing holistic care for the elderly population in Thailand.

Similar models of HIV care, with the elderly looking after the HIV/AIDS adult children, have been reported in countries including Cambodia and Tanzania. Even with the increasing use of ART, the elderly may play a role, albeit a modified one, in HIV care. There is a strong need for updated and comprehensive data to shed light on the issue to better inform current public health and HIV/AIDS campaigns.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

Caring for the Needs of the Aging Workforce

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As the American population continues to age, there is an opportunity and a need to adequately respond to the unique needs of older adults. Ensuring a social structure that considers the needs of the aging is important, particularly as it is projected that by 2030, the number of Americans 65 and older will double and comprise nearly 20% of the total population. Comprehensively responding to the needs of the aging should include measures that protect the health, well being, and quality of life of older adults.

Included among the social changes that have been observed within the aging population in the U.S. is that more older American adults are delaying retirement and choosing to remain in the workforce past the traditional retirement age of 65. The desire to remain employed stems from improved quality of life among the aging and the capacity to continue working. However, for many older Americans, there is also a need to continue working due to economic pressure. According to recent research, 75% of Americans that were nearing retirement in 2010 had less than $30,000 available in their retirement accounts. With dwindling access to Social Security funds and the projected extension of the eligibility age to receive Social Security funds to 67 years of age in 2017, financial insecurity for the aging is requiring older workers to remain employed beyond the time they may have considered retirement.

There are benefits to older adults remaining in the workforce – both individually and occupationally. It has been noted that among older adults who remain employed, their cognitive capacity is less likely to diminish as compared to their non-employed peers due to mental engagement within the workplace. Additionally, research has shown that employers value the presence, contribution, and input of older workers and report that older employees exhibit knowledge related to job tasks, respond resiliently to job-related stressors and changes, and are willing to learn new tasks quickly. Added financial resources are also a significant benefit for older Americans who remain employed beyond retirement age.

Recent economic crises, however, have left few immune to financial loss. For older adults, financial loss as a result of the “Great Recession” have led to this need to continue working and raise enough money on which to live after retirement. For older adults who lost their jobs during the recent economic downturn, many reported that they continued searching for employment with little luck due to hiring preferences in many industries for younger employees. This represents a persistent area of vulnerability for the aging, as financial uncertainty after retirement remains a reality for many.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

Old and Homeless in Australia: It Can Happen to Anyone

In Australia, on any given night, 1 in 200 people are homeless.” One fifth of all people who are older than 55 years of age are homeless; many more live in unsecured housing.

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What is homelessness and what may cause someone to become homeless? A person is considered homeless when he or she does not have a conventional home and lives on the streets or in a park. Someone may be at risk of homelessness when living in unsecured housing. There are certain reasons that can cause homelessness which may include lack of social bonding and support from family or friends. What if you are in a crisis and cannot receive help from the closest people in your life—your family and friends? What would you do? You may think it can never happen to you but that may not be the case. Homelessness can happen to anybody. Young, old, women, and men.

Today, Australia and most other developed nations face more issues with divorces, family breakdown, and higher rent for affordable housing. Due to the growing aging population, homelessness will become a rising issue because of the lack of money to build affordable housing or lack of space for seniors in existing homeless shelters.

ABC Australia reports that Australian older women outnumber the men in homeless shelters. In fact, 9% of single women over the age of 45 are in crisis accommodation and that number will continue to rise. The woman being interviewed by ABC makes it clear that it can happen to anybody. She notes that “there is a fine line between having a roof over your head and having nothing.” Imagine if you, from one day to another, lost everything and couldn’t turn to anyone.

The report “Homelessness and older Australians: Scoping the Issues” reports that there are systems in place in Australia that give the homeless population access to certain services. However, the homeless believe that their complex needs are not addressed. In addition, they have difficulties to access those services and obtain the needed information because the service system in itself is too complex. There needs to be an increased collaboration and integration of existing service departments.

Australia must think of sustainable ideas and strategies to increase and invest in the affordable housing stock. The government, non-governmental organizations and service providers also need to step up and create strategies to reduce the bureaucracy and make easier access to the services the homeless population needs easier.

Martina Lesperance
is a Health Educator and Screening Technician in El Paso, Texas.

Alzheimer’s and Parkinson’s: A Great Threat to the U.S. National Budget

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Since the last Presidential Election, the national budget has been a sore spot for Republicans and Democrats, the two major political parties in the U.S. While government programs such as the Affordable Care Act (ACA) are leading debates on reducing the national budget, politicians are oblivious of a looming threat to the budget. People with Alzheimer’s and Parkinson’s diseases require constant and very expensive care. Also, these debilitating illnesses can prevent affected persons from working, which may have a devastating long-term impact on the budget.

Alzheimer’s disease (AD) is the sixth leading cause of death in the U.S. and an estimated 5.4 million Americans currently suffer from AD. If current population trends continue, the number of people with Alzheimer’s disease will increase significantly unless the disease can be effectively treated or prevented. The U.S. population is aging and the risk of Alzheimer’s increases with age. For instance, Alzheimer’s usually begins after age 60 and the number of people with the disease doubles for every five-year interval beyond age 65. About five percent of men and women ages 65 to 74 have Alzheimer’s disease and it is estimated that nearly half of those age 85 and older may have the disease. Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease and affects one million people in the United States. Symptoms of PD include muscle rigidity, tremors, and changes in speech and gait that worsen as the illness progresses over time. PD is more common in the elderly and most often develops after age 50. Sometimes, Parkinson’s disease occurs in younger adults. When a young person is affected with PD, it is usually because of a form of the disease that runs in families.

With strong research investment, heart disease deaths in the U.S. fell by 13 percent in the past decade. Alzheimer’s deaths rose by 68 percent from 2000 to 2010 and continue to increase. The issue is not how, but why we cannot increase our investment in research into fighting these diseases that have a tremendous impact on both the individual and society. Alzheimer’s and Parkinson’s get comparatively less funding than other top diseases because they are more common in the elderly and largely ignored. Stigma is another reason why it is hard to raise money since people with Alzheimer’s and Parkinson’s rarely talk about the disease. Also, Alzheimer’s is different from other diseases because Alzheimer’s patients rarely lead marches to fight for more funding since their memory is impacted. It is important to our nation’s economic future to reduce the deficit, but we cannot ignore the importance of investing in Alzheimer’s and Parkinson’s research. As the nation’s older populations grow, the cost of care for these diseases will rise dramatically. In fact, Alzheimer’s is expected to cost the U.S. more than $1 trillion annually and persons who leave the workforce to care for an affected family member impact economic productivity. Increasing funding for Alzheimer’s and Parkinson’s will require difficult choices and shared sacrifice in spending reductions and increased revenues.

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As the U.S. Congress continues to agree or disagree on the best way to fix Medicare, a government health program, the national budget will likely increase if there is no dramatic increased investment in research into fighting Alzheimer’s and Parkinson’s disease. The devastating statistics continue to increase and rising health care costs pose a great problem to the U.S. economy.

Sophie Okolo is the Founder of Global Health Aging.

Fighting Loneliness – Pet Therapy for the Elderly

For many, retirement and old age is a welcome stage of life with few responsibilities, and a lot of time to pursue interests. To others, it brings on that dreaded feeling which no amount of pills and doctor appointments can cure – loneliness. According to AARP, over a third of Americans over 45 years are lonely. Retirement, decreased mobility and income source are all contributing factors to increased social isolation. Studies show that loneliness puts the individual in greater risk of diseases and illness, and greatly impacts their well-being and quality of life.

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A variety of interventions are in place to combat loneliness in the geriatric population. They focus on various high risk groups and employ various individual and group approaches. There are also several programs in place, including social and cultural outings, health promotion, community engagement and group support. However, few show direct improvement in reducing loneliness among the elderly. A study comparing eighteen different interventions in Netherlands concluded that only two of them significantly reduced loneliness – one, an individual, at-home intervention for the elderly with chronic disease, and two, a group intervention in a residential home that included discussion and coffee breaks. There is limited success in identifying and employing interventions that significantly reduce loneliness

Another lesser known intervention to battle loneliness is the use of companion animals. Pet ownership and interaction positively contribute to the overall wellbeing of elderly citizens as pets can instil a sense of responsibility and purpose in the elderly, and provide much solace from loneliness. The role of Animal-assisted therapy (AAT) is increasingly being explored in elderly care. AAT is a formal, documented process with scheduled sessions and a treatment goal. AAT most commonly uses dogs, but is not restricted to fish, rabbits, cats, horses and dolphins. AAT should not be confused with service animals, and animal-assisted activities (AAA). Service animals and AAA are more spontaneous and do not necessarily have a treatment goal. Both AAT and AAA can help in increasing social behaviors, interaction with people as well and decreasing loneliness among the elderly.

In addition to temporary animal companionship, several organizations also look to provide seniors with the opportunity of pet ownership. The ‘Seniors for Seniors’ program is employed among many non-profits and animal shelters across the United States. This program looks to place adult dogs and cats with willing and able senior citizens. Since older dogs are usually house-broken, trained, and come with a fully developed personality, they can serve as great companions to the elderly.Several animal welfare organizations such as SAVE, Paws and the North Shore Animal League America successfully run such a program, often providing financial and other support to senior adopters. Pets for the Elderly Foundation, is a non-profit solely focused to this cause. It provides financial support to adoption centers around the United States that place dogs and cats with senior citizens.

Animal therapy, in all its forms, is a burgeoning field of study in geriatric care. There are only a handful of scientific studies documenting the efficacy of AAT on loneliness, but current research shows positive trends. Despite the challenges of working with animals, the therapeutic role companion animals can play in fighting loneliness is promising.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

Old and Forgotten: The Crisis of Africa’s Elderly

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Africa is currently the most youthful continent in the world. At least 35 per cent of its more than one billion population is between the ages of 15 and 35. While investing in the youth is a priority for the continent’s transformation, the elderly should not be forgotten. As Africa’s population grows, the number of older people also increases therefore it is important to highlight the issues that affect this population.

Traditionally, extended families have taken care of elderly members but since that is changing, aging Africans are now facing new problems. The United Nations Population Fund estimates that around 50 million people above the age of 60 account for around five percent of Sub-Saharan Africa’s population. In the past, most of them turned to families for help but the practice is becoming less widespread. It is difficult to convince people that the elderly in Africa are in need of help. Issues affecting this population are not popular because either everyone is just focusing on children, which is important, or they are under the notion that the elderly live happily with their extended families. It becomes more difficult when even development policy debates marginalize issues related to the elderly. For example, the Millennium Development Goals (MDGs) focuses only on women and children.

Despite these issues, society should not give up on the elderly because they need our assistance. There are many ways to help the elderly in Africa such as organizations can partner with local hospitals to train volunteer healthcare assistants who will visit the elderly in their homes and ensure that they receiving the care they need. Other complex issues can be tackled efficiently. For instance, there are at present senior citizens who cannot afford sufficient medical care in South Africa. The situation is more problematic because advocates for the elderly state that the services for senior citizens have dramatically decreased in the last two decades.

According to Anita Powell, Southern Africa reporter for Voice of America, few among South Africa’s rapidly growing elderly population are faring well, health wise, due to economic insecurity which is linked with worse health outcomes. Elderly advocates insist that Nelson Mandela, South Africa’s most famous senior citizen, is not the standard by which South Africa’s treatment of its weakest members should be judged. Unlike other aging South Africans, Mandela spent nearly two weeks in a Pretoria hospital for a lung infection, and received the best possible medical care. The nation’s growing elderly population is increasingly marginalized by a government that has focused its health care on young people and women. While child health is very important, the health care needs of the elderly should not be overlooked especially in a nation with only eight registered geriatric doctors. Despite these issues, it is good to know that South Africa’s pension system was the second most distributed of the African countries in the Global AgeWatch Index, the first-ever overview of the well-being of older people around the world. Without a formal pension system, the prevalence of poverty among older persons will likely increase. Currently, there are no formal systems in most other African countries.

It is critical to provide proper assistance and support to combat poverty and economic security for today and tomorrow’s seniors. Africa’s elderly still contribute to development, civic life, and the economy in many ways including caring for grandchildren when the middle generation has died or become very sick from HIV/AIDS. Ultimately, they need to be rewarded. This video portrays the work of the Ikaheng Daycare Centre for the Aged in the South African Township of Ikaheng.

Sophie Okolo is the Founder of Global Health Aging.