Ebola and the Elderly: Focusing on a Vulnerable Population

Certain diseases like pertussis and dementia are associated with distinct populations. Pertussis is generally linked to children and dementia is generally linked to older adults. While both diseases can affect atypical populations, health professionals cannot have the same mindset when rare diseases like Ebola are concerned.

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The Ebola outbreak continues to make headlines around the world and the focus has been on adults and children. If one studies the media and research papers, older adults are nearly absent. The aging population remains sidelined from the Ebola epidemic although the disease has affected the elderly around the world. Some may argue that Ebola mainly affects adults and children but few reports have shown that the elderly are also casualties. The rate of casualties regarding the elderly may not be accurate since there is little focus on this population. How long will older adults continue to be sidelined from issues that also affect them? Ebola attacks the elderly in unique ways compared to adults and children. For instance, older adults are prone to disease and disability because of their age. Specific risk factors that affect older adults also include:

  • Injury and poverty
  • Development of non-communicable diseases
  • Social isolation and exclusion, mental health disorders
  • Elder maltreatment.

These medical conditions in addition to contracting the Ebola virus disease (EVD) make matters worse for the elderly.

Cases regarding the elderly and EVD are not widespread in the media hence this piece will highlight just a few of these instances. The first case is an elderly woman who tested positive of the Ebola Virus Disease in Port Harcourt, Rivers State, Nigeria. The elderly woman had been quarantined in the Ebola Isolation Centre because she shared the same ward with the late Dr. Ike Enemuo, a Port Harcourt-based medical practitioner who treated an ECOWAS diplomat with the Ebola virus. Dr. Enemuo was ill and receiving treatment at the Good Heart hospital in Port Harcourt. He died of Ebola on August 22, 2014. The second case is an 87-year-old woman from Madrid, Spain, who was isolated in the senior center where she lives. The elderly woman was driven in the same ambulance as Nurse Teresa Romero, the first person to become infected in Europe. A key point about this case is that the elderly woman had suffered a fall which made matters worse. Another case in Spain is 75-year-old Miguel Pajares, an elderly priest who was working in Liberia. He was carrying out missionary work when he tested positive for Ebola.

The goal is not to ignore populations that are affected by certain diseases. Health professionals need to have a holistic view for disease outbreaks, knowing that outbreaks still affect populations that are marginalized. As Ebola remains in the news, let us remember the elderly, people with disabilities, and more because each population faces unique challenges during disease outbreaks. Treatment is not just for certain groups, it’s for all groups affected. Health and media professionals can think outside the box when it comes to reporting events. If not, public health interventions may continue to ignore elderly issues around the world.

Sophie Okolo is the Founder of Global Health Aging.

The Need to Address Chronic Conditions in Timor-Leste

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Timor-Leste or East Timor is a small low income country in Southeast Asia with a population of 1,114,000. It has years of conflict, violence and brutality, and a tumultuous past with Portuguese and Indonesian forces. The conflict and political upheaval have left its marks on all aspects of development in the country. In 2002, Timor-Leste became an independent nation.

Being one of the newest countries in the world, Timor-Leste’s current WHO Country Cooperation Strategic Agenda 2009-2014 is primarily focused on developing a robust health system and improving capacity building. Key health issue focus areas are infectious diseases, maternal and child health and nutrition. There is an immediate need for data and adequate focus on chronic conditions, especially among the adult and elderly population. Although Timor-Leste has the lowest number of publications in medicine, available preliminary data particularly on cardiovascular diseases and diabetes highlights the growing burden of chronic conditions among the elderly. With increased urbanization and improved economic conditions, there is a need to address this growing burden among the elderly population.

Among the 50-96 year population, cardiovascular and circulatory diseases account for approximately a 25% of the total disability adjusted life years (DALYs). For the population aged 70 years and above, these diseases account for approximately 36% of the total DALYs. Specifically, ischemic heart disease in 2010 accounted for approximately 12% and 16% of the total DALYs for 50-69 year and 70+ year population respectively. The disease burden of diabetes mellitus (in terms of DALYs) among the 50-69 and 70+ year population has also increased from 3.6% to 4% of the total disease burden affecting this population. The overall diabetes prevalence in Timor-Leste is currently low at 2.9%. Available data indicates that 7 out of 10 cases occur in those over 40 years. Furthermore, there is very low awareness of diabetes in the country which is a risk factor for increased diabetes prevalence. Urbanization and economic development have the potential to rapidly increase the prevalence rate. Currently, Timor-Leste does not have a national strategy in place to address the diabetes.

As Timor-Leste works on creating a robust and comprehensive health system, it will be imprudent if chronic conditions affecting older populations are not taken into account. With increased economic growth, access to health services and urbanization, the rising burden of chronic conditions can lead to the high prevalence of communicable and non-communicable diseases i.e. the double burden of disease. Collection of valuable data and surveillance, and strategies to improve awareness and reduce the current burden of chronic diseases are ideas for sustainable good health in Timor-Leste.

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.

 

 

The Healing Power of Optimism – A Positive Outlook Can Improve Quality of Life and Health

The Benefits of Staying Positive

There are many benefits associated with staying positive. This is supported by the fact that a continually growing body of research points to the benefits of viewing things in a positive light rather than negatively. Researchers believe that positive thinkers have no lasting negative effects since they are able to handle the effects of stress much more effectively than negative thinkers. Stress leads to fatigue, headaches, insomnia, and many other health issues which can in many cases be attributed to negative thinking.

                                                                                  Photo Credit: Philips Communications

Focus on the Positive

During a drastic life change such as losing a job, loved one, or chronic illness, it is often hard to view things in a positive light. There are many times when the blame is focused inward which compounds the stressful effects. Optimists focus on the good and what they can change in the situation rather than assume the solution is out of their control. When it comes to a chronic illness or the loss of a job (especially when a company is doing regular cutbacks, etc), there often are not many things a person could have done differently. The key to managing stress is believing one can make a change and then working little by little to implement the change.

Life Events and Their Correlation with Attitude

One long-term study conducted by Harvard researchers looked at 99 of the 1944-1945 graduating class members. The graduating members answered questions from surveys and the researchers rated the questions from positive to negative. The study found a strong correlation over the years with those who had always been positive, those who changed from negative to positive in their early to middle adulthood and those who went from positive to negative over the course of the study. They found that those who had always been positive and those that changed from negative to positive fared the best. On the contrary, those that changed from positive to negative and those that remained negative throughout had many more health complications. Their overall health situation was also much worse.

Why Does Pessimism Lead to Harmful Health Consequences?

As discussed above, pessimism in early adulthood that was not corrected led to health risks in later adulthood. What was causing the elevated health risk? When the body is stressed, it produces a hormone called cortisol. This hormone was great for our ancestors who needed to be alert in situations of peril. However, many day-to-day stressful activities such as a mean boss can lead to elevated cortisol levels. Scientists have known for years that elevated cortisol levels interfere with learning and memory, lower immune function and bone density, increase weight gain, blood pressure, cholesterol, and more.

A Case Study of Positive Thinking

One last case study is in regards to a doctor who studied 750 Vietnam War veterans. These veterans were prisoners of war that were abused and tortured. Dennis Charney, MD, dean of Mount Sinai School of Medicine, had all 750 veterans take a test and noticed one thing in common. Those who did not develop post-traumatic stress disorder or suffer from depression or depression-related symptoms had optimism at the top of the list of ten things that set them apart from the other veterans. Next to optimism was selflessness, humor, a belief in a higher power, and that there was meaning behind their lives and risks – all aspects of a positive outlook.

Jacob Edward is the Manager of Prime Medical Alert and Senior Planning in Phoenix, Arizona, USA. Jacob founded both companies in 2007 and has helped many Arizona seniors and their families navigate the process of long-term care planning. Senior Planning provides assistance to seniors and people with disabilities in finding and arranging assisted living in Phoenix, as well as applying for state and federal benefits.

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.

past lessons, future directions

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