Aging

I am not surprised that Joe Paterno died at the age of 85 after undergoing treatment for lung cancer.  My guess is that the lung cancer, although it would have eventually taken his life, was not the immediate cause of his death.  I  believe that Joe Paterno died of a broken heart after being fired as the head coach of Penn State football. Bear Bryant, the legendary Hall of Fame coach of Alabama football, although not fired, similarly died soon after leaving the head coach position. 

Likewise, it is not uncommon for a surviving spouse to pass away soon after the death of a spouse.  I wrote about the loss of a spouse in my winter 2010 newsletter which I am posting below.

There is a nationwide shortage og geriatricians and it's going to get worse as the 70 million members of the baby-boom generation — those now 46 to 65 — reach their senior years over the next few decades. The American Geriatrics Society says today, there's roughly one geriatrician for every 2,600 people 75 and older. Without a drastic change in the number of doctors choosing the specialty, the ratio is projected to fall to one geriatrician for every 3,800 older Americans by 2030. Compare that to pediatricians: there is about 1 for every 1,300 Americans under 18.

Geriatricians, at their best, are medicine's unsung heroes. They understand how an older person's body and mind work differently. They listen more but are paid less than their peers. They have the skills to alleviate their patients' ailments and enable them to live fuller, more satisfied lives. Though not every senior needs a geriatrician, their training often makes them the best equipped to respond when an older patient has multiple medical problems. Geriatricians have expertise in areas that general internists don't, including the changes in cognitive ability, mood, gait, balance, and continence, as well as the effects of drugs on older individuals.

Source/more: Seattle Post Intelligencer/AP (November 7, 2011)

“I'm mad as hell and I'm not going to take it anymore.”

            Peter Finch played Howard Beale in "Network" (1976).                       

            Sometimes I feel like shouting this, especially when talking about financing of long-term care in this country.  The Obama administration has recently decided to halt implementation of the CLASS Act, a proposed national long-term care insurance program that was part of the health reform law.

            It was easier for the Obama administration and vocal GOP critics of the program to kill CLASS than to answer the real question:  How will the U.S. finance the long-term care needs of 20 million Americans who will need assistance within the next few decades.  If not CLASS, which would have made it possible for nearly all working people to buy an insurance policy from the government – then what?     

            "For 19 months, experts inside and outside of government have examined how [the Department of Health and Human Services] might implement a financially sustainable, voluntary, and self-financed long-term care insurance program under the law that meets the needs of those seeking protection for the near term and those planning for the future,' Secretary Kathleen Sebelius wrote in a letter to congressional leaders. "But despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time."

            The Community Living Assistance Services and Supports (CLASS) Act, Sen. Edward M. Kennedy's final legislative legacy, would have created a modest, voluntary insurance program aimed at helping to keep the elderly and disabled out of nursing homes and off the Medicaid rolls.

            Americans who wished to be in the program would have paid a monthly premium for five years, after which they would have been vested and eligible to receive benefits averaging between $50 and $75 a day to pay for a range of long-term care services that would have helped them stay in their homes, or the money could have been used to defray the cost of nursing home care.

            But the proposal came under intense criticism from Republicans and some Democrats, who charged that it would be financially unsustainable. The program's critics contended that because it would be voluntary, only those with expensive health problems would sign up for it. If too few younger, healthier workers participated, the resulting "adverse selection" would mean that the benefits would be too meager or the premiums too high for the program to work.

            The CLASS program's chief actuary, Bob Yee, had concluded that it would be difficult, but not impossible, to make CLASS self-supporting. Apparently, the Administration was not convinced or did not want to assume the political risks involved in continuing to move the program forward. The health reform law required Secretary Sebelius had to certify that the program would be financially sound.

            According to an administration analysis of CLASS shared with Congress on October 14, under one scenario a basic CLASS plan with a $50-a-day benefit could cost $235 to $391 month, which could have been cost-prohibitive for many consumers. However, by making small changes to reduce adverse selection, the analysis noted that the premium could be reduced to a far more affordable $114 to $160 a month.

            AARP expressed disappointment in the decision. "Medicare does not cover long-term care, and 70 percent of people age 65 and over will need long-term care services at some point in their lifetime," said Joyce A. Rogers, senior vice president for government affairs at AARP.

            The CLASS Act is the first big part of the health overhaul to be killed and there was speculation that its demise would embolden the law's critics to go after other sections of the law.

            Ironically, ending the program will likely add to the deficit, at least in the short term. It was to pay out far less in benefits than it would have received in premiums over its first 10 years, reducing the deficit by about $72 billion, and by a smaller amount in the following decade.

            As a society, we are simply unprepared for the crushing burden of long-term care services.  Advocates for the elderly & disabled, long-term care providers, and insurance companies must sit down and work out a consensus plan.  If people who care about seniors and the disabled do not act with a sense of urgency, it will be a personal and financial disaster for tens of millions of Americans and their families. 

People concerned about Alzheimer’s disease and its effect on families, on the healthcare system, and on the country as a whole, have lobbied for years for a national action plan. How should the nation confront a disease projected to afflict more than 13 million Americans by 2050 — a disease gaining on cancer as the illness Americans dread most? Those advocates celebrated in December, when Congress passed the National Alzheimer’s Project Act, aimed at developing such a plan. Even though the bill had no budget appropriation (which probably explains how it could pass the Senate unanimously), the Alzheimer’s Association called the act a “historic legislative victory.” President Obama signed it into law in January. The act mandated the creation of an advisory committee to the secretary of Health and Human Services, Kathleen Sebelius — a.k.a. “the Busiest Woman in Washington” — as she devises the federal strategy. Now the committee exists. Led by the Mayo Clinic neurologist Dr. Ronald Petersen, it will convene for its first quarterly meeting in Washington on September 27. The pace has been quick, for a federal effort. White House and HHS staff have already begun meeting, an inventory of the federal programs that support dementia research and care is largely complete, and Ms. Sebelius intends to send the committee a first draft of the National Plan for Alzheimer’s Disease and Related Dementias by the end of the year.

Source/more: New York Times (September 26, 2011)

It's a quiet  fact of senior residences across the country: Grandpa is living with someone else's Grandma. In their 70s, 80s, and beyond, older couples meet in seniors-only housing and live together unencumbered by marriage vows. Their relationships are committed and bonded, meant to last the rest of their lives, sometimes even informally blessed by clergy. According to U.S. census figures, co-habitation numbers for people 65 and older have tripled in the past decade, jumping from 193,000 in 2000 to 575,000 in 2010. A generation or two ago, the idea of older adults living together might have been shameful, even scandalous. That's changed, in part because societal attitudes toward marriage have changed. Only 52 percent of all American adults identified themselves as married in the 2010 census – and almost 60 percent of people age 50 and younger have lived with a partner without being married, the Pew Research Center says. As a result, as the baby boom generation edges into old age, researchers expect co-habitation among seniors to continue to soar.

The number of older Americans living in nursing homes continues to fall, and the proportion of residents who are black, Hispanic or Asian has climbed sharply.

New York Times (July 15, 2011)

http://newoldage.blogs.nytimes.com/2011/07/15/white-flight-from-the-nursing-home/

Months before he passed away, saxophonist Clarence Clemons told Rolling Stone magazine that Bruce Springsteen and the E Street Band's 2009 tour was pure hell for him physically. But despite being 69 years old and having his knees and hips replaced, Clemons spoke eagerly about getting back on the road with “The Boss” in 2012 and maybe touring with Lady Gaga, who he performed with on her "Born This Way" CD. Clemons died in Florida from complications related to a stroke he suffered on June 12, 2011. Clemons' passing — along with a recent spate of deaths of other artists from the '70s and '80s — is forcing some baby boomers to reconcile that the seemingly indestructible musical idols that provided the soundtrack of their lives are either dying or growing old and suffering from the same aches, pains, and illnesses that they do.

A new study of financial exploitation of the elder just released by MetLife suggests that the annual financial loss by victims of elder financial abuse is estimated to be at least $2.9 billion dollars, a 12 percent increase from the $2.6 billion estimated in 2008. Medicare and Medicaid fraud resulted in the highest average loss to victims ($38,263,136) followed by fraud by business and industry ($6,219,496), family, friends, and neighbors ($145,768), and fraud by strangers ($95,156).

Source: MetLife Mature Market Institute (May 2011)

In the first Congressional examination of assisted living in the past eight years, the Senate Special Committee on Aging convened a roundtable discussion to explore state and federal policies towards assisted living.  The Assisted Living Consumer Alliance (ALCA) was represented by its president, Eric Carlson, an attorney for the National Senior Citizens Law Center (NSCLC).  On behalf of ALCA and NSCLC, Mr. Carlson aggressively advocated for greater consumer protections.  Among the issues addressed by Mr. Carlson during the roundtable:  1) Preventing evictions of low-income residents; 2) Maintaining quality of care; 3) Setting care standards, not just disclosure standards; and 4) Rejecting "negotiated risk" agreements in order to protect care standards.

Source:  Assisted Living Consumer Alliance (March 18, 2011)

Full story:  http://www.assistedlivingconsumers.org/

Video of the roundtable:  http://aging.senate.gov/hearing_detail.cfm?id=331935&

The annual update to Administration on Aging's compendium of useful statistical information on the nation's older population has just been released. Highlights of "A Profile of older Americans: 2010" include the following tidbits: The number of Americans aged 45-64 – who will reach 65 over the next two decades – increased by 26% during the past decade. Over one in every eight, or 12.9%, of the population is an older American. Persons reaching age 65 have an average life expectancy of an additional 18.6 years (19.9 years for females and 17.2 years for males). Older women outnumber older men at 22.7 million older women to 16.8 million older men. In 2009, 19.9% of persons 65+ were minorities--8.3% were African-Americans.** Persons of Hispanic origin (who may be of any race) represented 7.0% of the older population. About 3.4% were Asian or Pacific Islander,** and less than 1% were American Indian or Native Alaskan.** In addition, 0.6% of persons 65+ identified themselves as being of two or more races. Older men were much more likely to be married than older women--72% of men vs. 42% of women (Figure 2). 42% older women in 2009 were widows. About 30% (11.3 million) of noninstitutionalized older persons live alone (8.3 million women, 3.0 million men). Half of older women (49%) age 75+ live alone. About 475,000 grandparents aged 65 or more had the primary responsibility for their grandchildren who lived with them. The population 65 and over will increase from 35 million in 2000 to 40 million in 2010 (a 15% increase) and then to 55 million in 2020 (a 36% increase for that decade). The 85+ population is projected to increase from 4.2 million in 2000 to 5.7 million in 2010 (a 36% increase) and then to 6.6 million in 2020 (a 15% increase for that decade).

Source: Administration on Aging (February 25, 2011)
Full report: http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2010/2.aspx

Reverse mortgages offer older homeowners a way to tap home equity to meet financial needs in retirement. However, the collapse of the mortgage market in 2008–2009 has led to major changes that impact consumer choices. While consumers have more product choices, reverse mortgages are generally more expensive and more complicated—leading to more scrutiny from Congress and regulatory agencies charged with protecting consumers.

Source: AARP Public Policy Institute (February 2011)
Full report: http://assets.aarp.org/rgcenter/ppi/ltc/fs211-economic.pdf

Life expectancy of Americans fell for the first time in 15 years, as the nation's oldest adults died from heart disease, cancer and respiratory ailments, according to a report by the National Center for Health Statistics.  Based on data from 2008, the latest available, life expectancy in the United States fell 36.5 days from 2007 to 77.8 years, according to the report released Thursday. Life expectancy is calculated by taking the death rates from the U.S. population in a specific year and figuring out the average number of years remaining for a person born in 2008.  Children born in 2008 lost a little over a month of expected life. The drop in expectancy was largely the effect of increased mortality among the oldest adults -- those at least 85 -- and a rise in age-related ailments such as Alzheimer's, high blood pressure, kidney disease, flu and pneumonia, according to the report. Infant mortality declined, as did deaths among all age groups under 85.  "It's hard for us to tell exactly what's driving this," said Arialdi Minino, a statistician at the health center and one of the report's authors. The number of older people who died "has been going up consistently, and in this particular year, there was a little more of that than we usually see."  The drop in life expectancy was mostly in the white population, which fell 73 days, while the rate among black women was unchanged at 76.8 years, and rose among black men to an all- time high of 70.2 years.

With health care reform a reality, just about everyone is wondering how it will impact their pocketbooks and medical care. For answers, check out the government's new, easy to navigate health care portal, http://www.healthcare.gov/.  A number of excellent, senior-specific facts sheets are also available from the National Council on Aging, .

 Normal 0  > Exercising in your 40's, 50's and 60's is like saving for your retirement, experts say. Starting early is money in the bank, but even late bloomers can reap astonishing benefits. "The game isn't over, even if you haven't been active," said Dr. Angela Smith, past president of the American College of Sports Medicine. "Aerobic fitness, bone health, agility, you may be able to catch up. It's remarkable to see the things people can actually do." Smith, a physician at Philadelphia Children's Hospital, said studies have shown that even octogenarians can double their strength with weight training. "There's good evidence that among people who have arthritis, the stronger have less pain, and that getting fit decreases the chance of having cancer," she said. But if you're a former high school athlete who became sedentary as your temples grayed, don't expect your history to save you. "Some of the benefits you built up aren't going to maintain themselves if you become a couch potato," Smith said. "That wonderful bone strength you built in your 20's will melt away a lot faster if you don't stay active." Smith said logic dictates that 40-, 50- and 60-year olds need to pay attention to all components of fitness. "Make certain to do flexibility, strength and aerobic training, even if you have to decrease the amount of impact. A jumping sport may be difficult. But many of the non-sport activities, swimming, weight training, yoga, people can do just fine in 40's, 50's, 60's."

The population of older Americans is growing faster than ever and living longer than ever, but not as long as in much of Europe and elsewhere in the developed world, according to “Older Americans 2010: Key Indicators of Well-Being,” a report compiled by 15 federal agencies.

The full report, with tables detailing senior demographics, economics, health status, health risks and health care, is available at agingstats.gov. It contains a number of surprises, and raises a number of questions, for those interested in how Americans are aging.

Americans who live to age 65 can now expect to survive on average 18.5 more years, four years more than in 1960, according to the report. Of those who survive to age 85, women have an average 6.8 years to live, and men, 5.7 years. But life expectancy is even longer in most of Europe, Australia, New Zealand, Japan, Singapore, Hong Kong, Cuba and Costa Rica.

In 2008, an estimated 39 million people in the United States were 65 or older — just over 13 percent of the population. By 2030, when all surviving baby boomers will be over 65, the report projects there will be 72 million seniors, about 20 percent of the population. (Seniors already make up 20 percent of the population in Germany and 21.5 percent in Japan.)

The 85-and-over United States population, the fastest-growing cohort in the country, is projected to rise from 5.8 million today to 19 million in 2050.

Living longer does not come cheaply. After adjustment for inflation, annual health care costs for the average senior increased from $9,224 in 1992 to $15,081 in 2006, the report says.