The landmark United States Supreme Court decision that same-sex marriage is a fundamental right guaranteed by the Fourteenth Amendment to the U. S. Constitution has important implications regarding the health and care of older Americans.
Studies show that denying same-sex couples the right to marry has a negative impact on their mental health, according to a 2006 report by Herdt & Kertzner. And a growing body of evidence suggests that policies conferring protections to same-sex couples are linked to lower health care and mental health care utilization, as well as to decreased health care spending.
There also are numerous studies confirming the health benefits of marriage for older heterosexual couples. “Married persons, on the whole, tend to have lower rates of fatal and nonfatal diseases, physical functioning problems, and disability compared to all other marital status groups,” reported Amy M. Pienta et al. in Health Consequences of Marriage for the Retirement Years, published in the Journal of Family Issues in 2000.
The White House Conference on Aging offers a special, once-a-decade opportunity to focus national attention on issues that the John A. Hartford Foundation has been working on every day for more than three decades. So I am honored and excited to be among those invited to attend this year’s gathering on July 13 with President Obama, national leaders, colleagues in the field, and people participating virtually across the country who will all join in a national conversation about our aging nation.
At the John A. Hartford Foundation, our focus is on better care for older Americans. We believe that improving the quality of care and the way it is delivered will result in better health for older adults and lower health care costs for the nation as a whole. “Healthy Aging,” one of four policy briefs drafted for the conference, addresses issues that are integral to the Foundation’s current grantmaking strategies, including managing chronic conditions, and prevention and treatment for diseases and behavioral health conditions.
I fervently hope that the national dialogue sparked by the conference will lead to more widespread recognition of the critical role to be played by health professionals with specific expertise in aging, and will support efforts to develop, test, and widely spread evidence-based models of care for older adults that achieve better health outcomes at lower costs.
Over the weekend, I walked past my wife and kids watching the new season three of Netflix’s House of Cards and was stunned to see the evil President Frank Underwood ranting at his cabinet to get on with designing his jobs program that would be funded by slashing the “entitlements” of Social Security, Medicare, and Medicaid that are “sucking us dry.”
I gave an impromptu lecture to the family on the folly of this policy position—I’m not sure they noticed. And of course, we’ve also written many times about the false narrative of zero-sum intergenerational conflict. (Read Pitting Older Adults Against Children Is a Zero-Sum Game and Analyze This: Misleading Federal Spending Stats Pit Children Vs. Older Adults.)
But what can anyone do when even television writers feel comfortable with this notion that the benefits that older adults earned in their lifetime of work are a dagger to the heart of the nation? While Underwood is certainly a morally compromised character, in this scene he is actually portrayed as the hero, taking decisive action in the face of a roomful of indecisive, equivocating, naysaying bureaucrats.
I think it would be safe to say that most of us have trouble facing our own mortality. The idea that tomorrow isn’t promised fails to get many of us to actually live that way (I know I’m guilty).
Longer term and more connected to the John A. Hartford Foundation’s work, we don’t like to think of ourselves as “old”—let alone dying—and we don’t plan well for futures that will likely include the need for long-term care or services later in life.
Our health care system and policies reflect this short sightedness, as well. That’s why it’s been refreshing to see some provocative writing about these issues over the past few weeks that might help us all think and do more to live our final years in old age the way we would want.
Before starting my internship with the John A. Hartford Foundation, the notion of improving health outcomes while decreasing costs appeared implausible. Securing strong patient-centered care for a loved one had to come at an extra expense—a large price tag for both the individual, his family, and the institution administering the care. After all, my family recently hired a home health aide to assist and advocate for my grandfather during his stay in the hospital and then during hospice, what is supposed to be one of the most patient-centered forms of care. My family believed that a consistent, if costly, presence and support system would serve him well during employee shifts and other downtime between caregivers.
And it made a difference. Our aide, Abdulai (last name withheld), served as my family’s lifeline, the person my grandfather could rely on for personalized and direct care, the person my mother could trust in clarifying medications and complicated procedures.
Author Caitlin Brookner (back, left) with her cousins and grandfather, Leonard Weisberg.
Recently, I had the privilege of discussing issues important to the John A. Hartford Foundation on The Ohio State University’s podcast, Viewpoints of Innovative Health Care Leaders.
It was a great opportunity to talk about the key trends we see in health care today, what still needs to be done, the impact of the Affordable Care Act on aging, and how the Hartford Foundation is seeking to address these issues. The biweekly podcast provides a forum for leaders in the field to share the best evidence-based practices and emerging thoughts in health care.
It is hosted by Bernadette M. Melnyk, PhD, RN, associate vice president for health promotion, university chief wellness officer, and dean of The Ohio State University College of Nursing. I’d like to thank Bernadette, who was dean of the Arizona State University College of Nursing and Health Innovation when it became a Hartford Center of Gerontological Nursing Excellence, for inviting me on the program. You can listen to the podcast by visiting Viewpoints of Innovative Health Care Leaders. The full interview is about 15 minutes, and is divided into five sections by topic.
Robert N. Butler, MD, made a profound and lasting difference in the field of aging and health.
Next week, we will launch the new Change AGEnts initiative at the Gerontological Society of America (GSA) annual meeting in New Orleans.
And I can’t help but think about Bob Butler. He would have loved the idea because, in the field of aging and health, Bob was the original Change AGEnt.
Last month, The Journal of the American Medical Association (JAMA) published a major report on the State of U.S. Health 1990-2010 as part of the Global Burden of Disease project funded by the National Institutes of Health, the National Institute of Environmental Health Sciences, and the Bill and Melinda Gates Foundation.
There’s a ton of information on changes in life expectancy and healthy life expectancy at birth over this 20-year span and all the usual international comparisons. Probably most people have heard the good news/bad news parts of the report: Both life expectancy and healthy life expectancy have increased in the U.S. (+3.0 and +2.3 years, respectively), but we continue to lose ground in comparison to other Organisation for Economic Co-operation and Development (OECD) nations, falling to 27th and 26th from 20th and 14th out of the 34 countries in the group.
But what interested me most is the change in the impact of Alzheimer’s disease in the U.S. Between 1990 and 2010, the rate of death due to Alzheimer’s increased by 524 percent, the most of any of 30 diseases and injuries contributing to reduced life. Even the rate of years of life lost (YLL), which takes into account the shorter life expectancy of people affected by a disease of aging, shows an increase of 391 percent.