Tag Archives: elderly

Project addresses readmission concerns by focusing on the frail

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

A new project is addressing the special concerns of frail elderly hospital patients in an attempt to help prevent lengthy hospital stays and readmissions for elderly folks, Anna Gorman of the Los Angeles Times reports.

Through the “frailty project” at Cedars-Sinai Medical Center, at-risk seniors are identified and, within 24 hours, assessed for “their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.” Continue reading

New findings on frailty challenge assumptions

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

We often accept frailty, with its depleted energy and general wearing down of the body, as an inevitable part of aging. About 4 percent of men and 7 percent of women older than 65 were frail in a 2001 study. After the age of 85, that rises to about 25 percent.

Frailty leads to more serious problems, such as an increased risk of falling. People who are frail also have a more difficult time recovering if they are hospitalized.

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But, as Judith Graham points out in AHCJ’s core topic pages on aging, exercise can help stave off the decline in body mass, strength, balance and other characteristics of frailty.

Findings like that challenge our view of frail adults as beyond remedy. They’re not. With careful assessment and help from physicians, social workers, nurses, and physical therapists, their functioning can be improved and their lives made easier.

Learn more about frailty, how it affects aging and get links to some relevant studies in the key concepts section of AHCJ’s core topic on aging.

Seniors have special concerns in natural disasters like Sandy

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

It’s well known that older adults are more vulnerable in times of natural disaster. But there’s nothing like a storm the size of Sandy to drive this point home.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

In the past week, we’ve read about New York City hospitals and nursing homes that decided to wait out the storm rather than evacuating. Sheri Fink, who won a Pulitzer Prize for her report on decisions made at Memorial Medical Center in the wake of Hurricane Katrina, got out ahead of Sandy and talked to city and state health officials as well as facility executives. Her ProPublica story is must-reading for anyone who wants to understand the thinking of officials responsible for preparing for the storm.

A take-home point: Evacuations can be extremely difficult for frail seniors living in nursing homes. Balancing the potential impact of displacing residents against the potential impact of sheltering in place during a storm isn’t easy.

I hope that reporters writing these kinds of Sandy-related stories take this into account. For another look at decisions made by city and state decisions vis a vis nursing homes, see this piece by Ben Hallman in the Huffington Post. Kudos to this reporter for going out during the storm and going to a site where nursing home residents were being sheltered. Continue reading

Experts with ties to drugmakers promoted prescribing opiates to older patients

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

Should older adults use powerful narcotics for ongoing pain relief?

This is a much-debated topic in geriatric circles. Last week, it burst into the public sphere with an article in the Milwaukee Journal Sentinel and MedPage Today by John Fauber and Ellen Gabler.

Their story focuses on a 2009 recommendation by the American Geriatrics Society that physicians consider prescribing opiates more often to seniors with moderate to severe pain.

Potential conflicts of interest may have compromised the Geriatric Society’s guidelines, Fauber and Gabler discovered. Five of 10 panel members who prepared the report had financial ties with opiate drugmakers and a sixth member began serving as a speaker for a drug company in the following year.

In another disturbing finding, Fauber and Gabler reveal that a pain guide endorsed by the Geriatrics Society and funded by an opioid drugmaker highlighted benefits of narcotics while downplaying risks – the potential for addiction, cognitive problems, overdosing, falls and fractures, and the enhancement rather than diminishment of pain.

“None of these side effects was included” in the document; instead, it claimed that “opiods allow people with chronic pain to get back to work, run and play sports,” they write.

The Geriatrics Society told the reporters that it stands behind the guide and is “deeply concerned that public policy may create barriers that will limit older adults’ access to pain medicine.”

In a sidebar, Fauber and Gabler examine a related issue in this controversy: the contention that alternatives to opioids – common over-the-counter drugs such as Aleve, Advil and Motrin – can have more deleterious health effects than narcotics. Continue reading

Reporters must listen to learn, accurately report about the experience of aging

Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

How do people feel about growing older?

You might think this is a much-examined subject in the media. It’s not.

While the angst and energy of youth appears endlessly fascinating – what are they wearing and drinking? Which apps do they use? What movies or music are most appealing? – the interior life, tastes and thoughts of older adults are largely ignored.

Public opinion research on the topic is surprisingly scarce. The most authoritative study I know of was published almost three years ago by the Pew Research Center. Results were based on a survey of 2,969 adults.

One of the most provocative findings relates to peoples’ perception of when old age begins. Answers varied across the generations: while young people (age 18 to 29) said they thought 60 was the threshold, middle-aged people moved the bar closer to age 70 and people 65 and older pushed it even further, to age 74.

In an equally interesting, parallel finding, older adults said they felt younger than their actual age – by 10 years or more.

In academic circles, the study of people’s age perceptions is known as “age identification.” Research suggests that older adults think they’re younger than they actually are when they’re healthy, active, and have a purpose in life.

“To me, old age is always fifteen years older than I am,” said Bernard Baruch, a famous financier who died in 1965 at the ripe old age of 95, voicing a widespread sentiment.

This disconnect between society’s notion of what constitutes old age and how individuals perceive themselves is revealing. Who wants to identify as “old” when our cultural narrative about aging – one that revolves around physical decline, loss of efficacy and purpose, isolation and irrelevance – is fundamentally negative?

It turns out, there are health consequences attached to our perceptions about getting older.

In an intriguing line of research, Becca Levy of Yale University’s School of Public Health has shown that people who internalize negative stereotypes of aging are more likely to respond poorly to stress, less likely to take good care of themselves, and more likely to experience cardiovascular events and other serious health problems.

Conversely, people with positive images of getting older live 7.6 years longer than those with negatives outlooks, Levy’s research has demonstrated.

In other words, images of dimwitted, sluggish, incompetent, and unattractive old people that circulate widely in our society aren’t just in bad taste. They’re potentially dangerous to people’s health.

There’s a countervailing push from organizations that recognize the insidiousness of negative stereotypes and want to alter our social construct of aging. One example is the International Council on Active Aging “rebranding aging” campaign, launched last year.

The danger here is that efforts to create a new narrative focused on the positive aspects of aging – one that centers on activity, wellness, encore careers, volunteering, and having more time to spend with friends, family – risks marginalizing older people who aren’t especially healthy or well off financially.

This split is reflected in the terminology we use to describe this stage of life. Recently, I’ve come across the terms “wellderly” and “illderly.” Their meaning is clear, and more commonly used terms such as the “young-old” (translate: healthy and active) and the “old-old” (translate: frail, with a larger share of disabilities) essentially serve the same purpose.

Which brings me back to that Pew Research poll.

While there are many interesting insights in the Pew study about older people, reporters who want to know how people actually experience aging – one of life’s profound transitions – will find no substitute for face-to-face interactions.

One of the best pieces of advice I ever got from an editor was “go out there and see what’s going on, even if you don’t necessarily know what you’re looking for.” I’ll repeat it here, in a different context. When you’re writing about older people, go out and sit down with them and ask them about their lives.

You may encounter a degree of resistance: Many seniors are reluctant to talk about themselves. You may have to probe gently and be agile in redirecting your questions if the conversation isn’t moving along as you had hoped. You may have to spend some time making a personal connection before you start getting answers.

But I suspect you’ll be surprised by what older people will tell you, if you take the time, suspend judgment and truly listen.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

CLASS Act is gone but long-term care problem remains

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

The ill-fated CLASS Act is gone.

What’s not gone is the problem of how to provide long-term care to the millions of disabled and/or elderly people who need it – numbers that will only grow as the baby boomers age.

What, if anything, does the Affordable Care Act do to address the problem?

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

The health reform law did not solve the long-term care problem. Not today’s problem, not the growing problem of the future. Even the most ardent backers of the CLASS Act (Community Living Assistance and Services and Supports), which was part of the health care law, did not see it as a complete answer. CLASS was designed to ameliorate, but not eliminate, long-term care costs, which can easily run $70,000 or more a year. Had CLASS been implemented, it would have given families who chose to participate about $18,000 (the finances were never finalized) a year that could pay a piece of a nursing home bill, or for assistance at home, or to build or a wheelchair ramp or accessible-bathroom etc to enable someone to stay at home.

But CLASS sank in an actuarial/legal/political swamp.

Is there anything else in the ACA to help family caregivers?

The law does have dozens of provisions that – depending on how well they are funded and implemented, how widely they are adopted and, quite frankly, how well some of the new care models turn out to work in the real world – can at least nibble around the edges of the long-term care needs.

New models of care

Some of you have started reporting on hospital readmissions. If we’re going to keep older people out of that revolving hospital door, they are going to need to be taken care of – well – outside the hospital. And that’s where a lot of the new models step in – community health teams to support primary care practices, the independence at home act, medication reconciliation programs, transition teams etc. A part of the legislation called “rebalancing” addresses some of the requirements and obstacles that up until now have led states to put institutional/nursing home care ahead of home and community based services.

The AARP just put out a report on how health reform addresses aspects of long-term care and family caregivers. It’s just nine pages, and some of the programs are going into effect this fall, or early next year. There are lots of good local angles for stories there. (The SCAN Foundation is also a good resource on these issues, and I wrote a while back about some of the relevant care models here.) We tend to think of the elderly when we think about long-term care but remember families of the disabled, whether adults or children, and some of people with serious mental disabilities also have these needs.

The report from the AARP Public Policy Institute by Lynn Feinberg and Allison Reamy notes that the health reform law explicitly includes both individuals and their caregivers in shared decision making an in quality assessment. What the family thinks and experiences matters; the family is a partner in care. The law includes family caregivers in some of the programs to improve caregiver training. The AARP report notes, in fact, that “The law explicitly mentions the term ‘caregiver’ 46 times and ‘family caregiver’ 11 times.”

Graham to lead AHCJ’s resources on aging

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Veteran health care journalist Judith Graham will be AHCJ’s topic leader in building new resources for journalists covering aging.

Judith Graham

Judith Graham

Graham, who was at the Chicago Tribune for 14 years, will write tip sheets and background briefs, recognize important reporting on the issue, ask other journalists to share their experience on the topic and she will curate lists of resources for journalists.

She will encourage and review suggestions from AHCJ members on what resources they need to cover this increasingly important beat.

We’ve asked Graham to introduce herself:

I’m a long-time journalist who started writing about health care finance and policy in the mid-1980s when this was a new beat, with only a handful of reporters tracking it closely across the country. Over dozens of years, I’ve reported on Medicare, Medicaid, long-term care, chronic care, patient safety, public health, efforts to improve health care quality, end of life care, and the business of health care, among other topics.

Understanding aging is both a personal and professional passion of mine. On the personal front, my mother had multiple sclerosis for 63 years and very early in life, I came to understand how the health care system fails people with long-term chronic illnesses. As a caregiver, I dealt for years with problems that frail, older people experience – finding transportation to medical appointments, uncoordinated medical care, securing reliable home health assistance, debilitating isolation, dealing with insurance hassles, and more.

For the past year, I’ve authored a monthly column on aging for the Tribune Co. newspapers, which was distributed widely across the country. Also, I’ve hosted more than half a dozen hour-long Web chats on aging issues and written extensively about these topics on my blog, Triage (now discontinued), and in the news pages of the Chicago Tribune, where I was a senior health and medicine reporter until recently.

Please feel free to contact me via email (judith@healthjournalism.org) with questions or suggestions about how to improve this site. I’m eager to make it as useful to you as possible.

Resource is a fact book on older Americans

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

The latest version of “Profile of Older Americans: 2010,” published by the HHS Administration on Aging is available.

AHCJ member Eileen Beal, an independent journalist based in Cleveland, recommends the resource as “a great little booklet of facts and data on older Americans: health, income status, marriage status, etc.” She says it is something that reporters interested in Medicare/Medicaid and senior health care issues will want to have.

AHCJ members: What resources have you come across that your fellow journalists will find useful? Let us know in the comments below.

Members’ investigations prompt bills in Wash.

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Three health-related bills moving through the Washington legislature came about as a result of articles reported by AHCJ members at The Seattle Times and InvestigateWest.

One bill is part of a “proposed overhaul of laws on long-term care of elderly adults” that was prompted by “Seniors for Sale,” a series by Seattle Times reporter and AHCJ member Mike Berens that detailed problems in the state’s adult family homes.

Another bill, unanimously approved by the state senate, will push a state agency to create standards on how to handle chemotherapy drugs. It was prompted by reporting from AHCJ member Carol Smith of InvestigateWest, a nonprofit journalism organization, that revealed that nurses who handle those drugs are exposed to health problems.

A related bill, intended to identify potential links between occupational exposures and cancer outcomes, also was unanimously approved by the senate. It would “require that a cancer patient’s occupation be reported to the registry, and that if the patient is retired, the patient’s primary occupation before retirement be reported,” InvestigateWest reports.

45 nursing homes added to CMS program to improve care

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

On Jan. 20, the Centers for Medicare & Medicaid Services released the most recent list of nursing homes in its Special Focus Facility Initiative. These are homes that have a history of serious quality issues and are in a special program to improve their quality of care.

The initiative is intended to address nursing homes that cycle in and out of compliance. Homes in this program are visited by survey teams twice as frequently as other nursing homes. This list includes nursing homes added to the SFF initiative and updates the status of homes already in the program.

As far as we can tell, CMS only released the information as a PDF, making it more difficult to search, but AHCJ has posted the list as a series of web pages and has made them available to download as Excel spreadsheets.

The list of nursing homes recently added to the program includes 45 facilities in 24 states. You also can check on the status of homes that have been taking part in the program, including the 62 that have shown improvement, the 49 that have not, the 31 that recently graduated from the program and the four that are no longer participating in Medicare and Medicaid.

Covering the Health of Local Nursing HomesSlim guide:

Covering the Health of Local Nursing Homes

This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.

AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.

AHCJ resources

Other resources