Jules Rosen, M.D., a certified geriatric psychiatrist and chief medical officer at Mind Springs Health, the largest provider of psychiatric services in western Colorado, recently answered some important questions about senior suicide.
What are the most common risk factors for suicide in older adults?
The biggest one is major depression.
Major depression [in older adults] is difficult to recognize and diagnose, especially in the primary care setting where most diagnosis is going to be done. That’s because older people don’t come in with the classic symptoms [of major depression], related to things like schizophrenia or substance abuse disorder, which are fairly easy to recognize. They come in with somatic and functional complaints. They say: “I’m sick. I’m tired all the time. I’m not enjoying things I used to.”
So many times I hear people say “I feel this way because I’m old” and it’s not that they are old, it’s that they are depressed.
So, how do potentially suicidal seniors get the “right” diagnosis?
To get an appropriate diagnosis, patients need a medical work-up – to see how their thyroid is doing, how their electrolytes are, what their vitamin D level looks like, and so on – but they need a psychological work-up, too, to find out why they are “sick” or “tired” of “not enjoying things.” Continue reading
Joseph Coughlin, director of the MIT AgeLab, is fascinated by the intersection of technology and aging. As a keynote speaker at this year’s American Society on Aging conference, he challenged the audience to think about how evolving technology can not only improve health outcomes but can improve aging as a whole.
“The disruptive demographics of a new aging society is presenting a new generation gap,” he said. “This is a generation of new expectations when it comes to living longer.”
Technology is a cornerstone of how this generation views aging. However, don’t get taken in by “gee-whiz” gadgets that don’t enhance quality of life. “There’s a big difference between invention and true innovation.” Continue reading
In the United States, far too many people – including many older adults – don’t get the vaccines they need to prevent getting and spreading preventable diseases. In a recent CDC press release, Director Tom Frieden, M.D., M.P.H, says many people think “that infectious diseases are over in the industrialized world.”
However, global travel and trade can spread diseases quickly, leaving seniors vulnerable to infection. Here, Eileen Beal discusses the risks of not being vaccinated and the reasons seniors aren’t getting vaccinations, and also provides resources for people looking for more information on vaccines.
Image by homesower via flickr.
Older patients like the kind of team care delivered in medical homes and most of those who get this care say it is actually improving their health, according to a new survey released today by the John A. Hartford Foundation. A representative sample of 1,107 adults aged 65 and older were asked about their experiences with patient-centered medical homes show that relatively few patients receive team care but more want it; and those who have experience with it like it and believe it improves health status.
Even among older adults not receiving this type of care, 61 percent say they believe team care would improve their health, and 73 percent would want this type of care, the survey found.
“The weakness of care coordination in our health care system represents a clear and present danger to many older patients, causing avoidable harm, errors, complications, overtreatment, and hospital readmissions,” said Christopher Langston, Ph.D., program director of the John A. Hartford Foundation. Continue reading
Photo: Pia ChristensenDavid Casarett, M.D., talks about hospice care during a panel at Health Journalism 2014,
Journalists need to talk about death responsibly and honestly, and should be part of the communication process between provider and families, said AHCJ Board Member Irene Wielawski, who moderated “Crisis, cost and quality: New angles on end-of-life care” on Saturday at Health Journalism 2014 in Denver.
David Casarett, M.D., director, hospice and palliative care, University of Pennsylvania Health System, shared the story of a 66-year old patient with advanced heart failure, whose perspective on treatment caused him to shift his thinking about what end-of-life care should look like and what hospice care should be all about.
He convinced CMS to fund a pilot project that supported upstream alternative, palliative care, which focuses on improving quality of life and assisting with medical decision making while living in concert with aggressive treatment. This approach helps patients manage day-to-day symptoms, provides emotional and spiritual support and helps patients to figure out what treatments make sense; it also provides practical support for family and caregivers, all while reducing hospitalizations and improving outcomes. Continue reading
Image by lars hammar via flickr.
In many parts of the United States, older adults are turning to home sharing as an innovative way to age in place longer. This may conjure up visions of “The Golden Girls,” but Rachel Caraviello, vice president of Affordable Living for the Aging, a Los Angeles-based nonprofit that matches seniors with potential house mates, said that shared housing addresses real needs for both homeowner and renter.
“There’s a real need for affordable housing in L.A. and other major cities, and this can be an ideal arrangement for people who don’t qualify for state housing subsidy programs to rent a room at lower cost,” said Caraviello.
At the same time, older adults have someone around – whether it’s to help with expenses, or take on some basic tasks like driving to doctor appointments, cooking or simply alleviating social isolation. Continue reading
“Have we matched our healthspan to our life span?”
AgeWave.com founder and author Ken Dychtwald asked that question yesterday of a standing-room-only audience at the American Society on Aging Conference in San Diego. “Are we doing the right version of aging?”
Dychtwald moderated a panel discussion on the social, health, financial and cultural implications of our aging population which included Joseph Coughlin of the MIT Age Lab; Fenando Torres-Gil, director of the Center for Policy Research on Aging, UCLA School of Public Affairs; and Jo Ann Jenkens, chief operating officer of AARP. The speakers joined Dychtwald to offer some predictions on a very different looking future of aging than previous generations lived through.
“The new challenge of an aging society is not just living longer,” said Coughlin, “but how we will live better.” After getting some appreciative laughter when showing a slide of aging hippies, and commenting “These are the people your parents warned you about,” he turned serious and asked, “Do you think these folks are going to age as politely and nicely as their grandparents and great-grandparents did?” Continue reading
Hospitals and post-acute care providers, Medicare drug providers, and older adults could see substantial changes in payments and benefits if President Obama’s 2015 fiscal year budget proposal is passed as presented.
The president’s $3.9 trillion plan includes more than $400 billion in cuts over the next decade in Medicare and Medicaid spending, as well as changes in provider reimbursement to place greater emphasis on quality. As Politico reported, additional savings would come from higher premiums of wealthier beneficiaries, changes in Medicare Part D payments to drug companies, and reimbursement cuts to post-acute providers like skilled nursing facilities and home health care agencies.
AARP criticized the proposal for “simply cost shifting.”
“We know that brand name prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs, said AARP Executive Vice President Nancy A. LeaMond in a statement. “But instead of shifting additional costs onto Medicare beneficiaries, we must look for savings throughout the entire health care system, as the rising cost of health care threatens people of all ages.” Continue reading
Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.
For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes. Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.
Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Continue reading
Providing mentally ill older adults with home based services can be logistically daunting and expensive. However, a study in the March 3 issue of The American Journal of Geriatric Psychiatry found 10 long-standing programs that the authors say can serve as successful models for other communities.
Being homebound is a significant barrier to the detection of mental health problems and mental health services delivery. A growing number of communities are developing programs designed to improve the identification, treatment, and ongoing care of mental health problems in homebound older adults, according to authors Burton V. Reifler, M.D., and Martha L. Bruce, Ph.D. Many can benefit from successful models that have proven effective over years, or decades.
About 10 percent of the 40 million people over age 65 are considered homebound and require home-based care. Homebound older adults are twice as likely to be suffer from depression and other mental disorders as their community dwelling counterparts. Inadequately treated or undiagnosed mental health problems can lead to poorer medical outcomes, greater functional limitations, increased social problems and increased risk of premature death. It also leads to higher rates of health care use and premature institutionalization. Continue reading