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.
Amy Berman, right, with surgeon, author, and “Twitter rock star” Atul Gawande.
I tweet therefore I am. That is quite an overstatement. But it’s true that my life has been greatly enriched by Twitter. I continually learn and grow through engagement with an incredibly robust network of people found in the Twittersphere.
I have blogged about Twitter on HealthAGEnda before. It is the fastest growing form of social media—launched just seven years ago—and now has more than 500 million users. Sharing 140-character “byte-sized” messages is just enough to make a point, share a link, and be engaged.
John Tatum, left, and his brother Bradford swim their way to gold in Age of Champions.
Even among their peers who have taken to heart the myriad benefits of physical activity as they age, a group of pugnacious older adults profiled in the documentary Age of Champions are raising the bar to once unthinkable levels. Facing 10,000 fellow competitors, these remarkable athletes volley, dribble, swim, and pole vault their way to gold medals at the annual Senior Games.
As readers of the Health AGEnda blog know, the John A. Hartford Foundation has long championed patient choice and active community engagement to promote the person-centered care we support. The documentary touches on issues of patient choice about which Amy Berman has written an inspiring series of posts dealing with her own experience navigating serious illness.
In mid-May, I was at the Social Impact Exchange (SIE) meeting, thinking about the relationship between our work and what I was hearing from other funders and non-profits. I was struck by how much of the “problem” that others were describing had to do with too many funder dollars chasing the same non-profits and too many non-profits working on the same social issue (e.g., to improve the education of at-risk youth).
It made me feel very lonely. With the coming spend-down of The Atlantic Philanthropies and the Donald W. Reynolds Foundation, two of our biggest colleagues are exiting the field. Not only will we miss their money helping to advance the care of older adults, but we will also miss the expertise and shared knowledge of our peers. Of course, there are new funders emerging, such as the Margaret A. Cargill Foundation who have an aging focus, but, given the growth of the population, it just doesn’t feel like enough.
One thing that one hears at the SIE meeting is a lot of succinct case statements describing the rationale for an area of funding. For example, the poverty rate for children in America was reported this week to have reached 23 percent. And of those low-income children, fewer than half will graduate from high school. It isn’t unusual when the wasted lives are described to see stern professional program officers get a bit teary.
Marcia Brown (center) and friends at Lincoln Center, New York City
“Diversity, small children, and dogs.”
“A nice park with good paths for walking or wheelchairs.”
“A flower and vegetable garden.”
“Museums, grocery stores, clinics, senior centers, churches, and an opera house all within walking distance.”
These are a handful of responses I got when I asked one of my favorite over-65-year-olds, Marcia Brown, Executive Assistant at the Hartford Foundation, how she defines an “age-friendly community.” (She had many ideas on this topic and I stopped her after “a nearby French bistro, a bagel shop, a pizza place, a shop that sells children’s clothing, a day care center, a school, and a pet store.”)
A number of articles and posts this week have called out the dangers that medications can pose for older adults. This is a topic near and dear to our hearts, and one we have frequently covered on Health AGEnda.
Unfortunately, far too many potentially dangerous drugs are still being prescribed to older people. Even more unfortunately, not giving drugs that are known to cause harm is the easy problem. What’s much more difficult is understanding and dealing with the complexity involved in medication management for elders.
This complexity can arise from a particularly difficult single condition such as Parkinson’s disease or from the often tangled knot of social, financial, and functional barriers that can make a medication regimen totally unmanageable for an older patient. Often, the complexity comes from the numerous medications taken for different, overlapping chronic conditions that create tough treatment trade-off decisions.