By Eileen Beal
How did we get here? Scientific discoveries that began in the 1920s, and continue today, gave birth to the longevity revolution. Along with adding years to our lives, this revolution:
- Changed the nature of health care from acute to episodic/chronic care.
- Changed where care is provided (home, office, clinic/outpatient facility, hospital, rehab/skilled nursing facility, senior center).
- Changed who is providing it (primary care provider, sub-specialist, health educator, mental health counselor, family member, home health aide).
- Contributed to a huge increase in the costs associated with care.
In addition, it resulted in changes to and/or creation of many federal and state initiatives, including:
- The Older Americans Act (reauthorized by the Senate on July 16, 2015 and awaiting action in the House).
- The recent White House Conference on Aging.
- Medicare and Medicaid.
- Area Agencies on Aging and state and territorial units (offices) on aging.
It was also directly or indirectly responsible for the founding of scores of disease- or issue-specific organizations, including: the Alzheimer’s Association, National Hospice and Palliative Care Organization, Parkinson’s Disease Foundation, Family Caregiver Alliance and Compassion and Choices.
Covering the “geriverse”
The revolution also created a policy-driven, socio-medical mash-up. I call it the geriverse: cross-cutting issues, challenges, topics and trends that health care journalists need to cover.
Some of these issues – and where they intersect – are easy to spot: Alzheimer’s impact on long-term care, family finances, nursing homes and the effect of new drugs on the treatment of chronic conditions, survival rates and the insurance industry come immediately to mind.
Others, including the issues noted below, take a bit more digging.
The age-stages of “old”
Covering the intersection of aging and health care means disabusing yourself of the idea that everyone over the age of 65, which is how most data are presented, is alike. Gerontologists, (those who study aging), and geriatricians, those who consult on, treat and care for frail and disabled older adults, divide old age into three stages:
- Young-old (age 65-74), when significant cognitive and physical function are maintained.
- Middle-old (age 75-84,) when complexity of healthcare needs increases and age- or dementia-related cognitive decline tends occur.
- Old-old (age 85-plus) when frailty and cognitive decline make living independently nearly impossible – except for aging outliers like the ones described in this New York Times story.
Chronic conditions and associated care
Covering aging, means covering the often multiple chronic conditions that come with aging. The best places for basic information are condition- and/or disease-specific organizations championing the condition’s cause. For deeper-insights, go to the National Academy on an Aging Society’s report, Chronic Conditions: A Challenge for the 21st Century and the Alliance for Aging Research’s Silver Book.
And it means presenting that information so that it reflects the functional status and care needs of “average” seniors, rather than those of the financially secure, active agers typically portrayed in the media.
Issues you may want to think about covering include:
- The increase in the complex care and management being done at home.
- The help and/or information available to those with chronic conditions and those caring for them through the new Chronic Care Management Services.
- Disability Management Program and Aging and Disability Centers.
- The overlap between disability and aging.
- The roles that sub-specialists, therapists, counselors, and disease management educators play in management of chronic conditions.
- The increasing role that social service agencies, housing, and transportation options play in provision of chronic care.
- The role that diet and exercise play in management of chronic conditions.
- The role that attitude plays in perception of pain and disability.
- The increasingly important role that caregivers play in chronic care and management.
The caregiver dyad
The number of middle-old and old-old requiring home and community-based services and care is increasing dramatically. That is driving the explosive growth in the number of family members (and paid caregivers, too) who, according to this AARP report, work hand-in-hand with health care providers to not just manage their family member’s chronic conditions but also provide complex medical care.
Not surprisingly, family caregivers – who number upwards of 43 million and provide almost $500 million in unreimbursed care, according to the report are the reason nursing homes aren’t bursting at the seams. And, they are a major reason Medicare and Medicaid aren’t bankrupt. And they have lots of stories that need telling.
The major ones you might want to cover include:
- The increasing need for health literacy for members of the caregiver dyad.
- The physical and emotional stress and strain of caregiving, (also called caregiver burden) and strategies for coping.
- How caregiving directly and negatively impacts caregiver health.
- Resources available for caregivers and where to find them.
- Resources that are not available for caregivers and why.
- Seniors caring for seniors.
- Coping with no longer being a caregiver.
- The role of technology in relieving caregiver burden, from iPhone apps to wired homes.
Mental health and aging
When we are talking about older adults and mental, emotional, and behavioral health (what psychologists and psychiatrists call feelings and/or affect), Alzheimer’s disease tends to get the lion’s share of media coverage thanks in great part to extensive lobbying during the Decade of the Brain. While Alzheimer’s is perhaps best known, there are many other important mental health issues, concerns and challenges that older adults (and those caring for them) are dealing with, especially depression.
Depression is a major health issue among the elderly, and it’s also a significant health issue for caregivers. While research indicates that older adults can and do benefit from counseling, mood-elevating medications are the primary treatment used to address their depression. This can lead to substance abuse, including abuse of pain medications if the person’s depression is related to chronic pain.
While many journalists do a good job of covering the rise in medication abuse and addiction in older adults, little is being written about those who are aging with substance abuse problems. The same is true for older adults with alcohol problems. According to the CDC report, those who binge drink the most are over 65.
And, while there’s been lots of coverage about the important role that attitude and/or spiritual beliefs play in promoting and maintaining mental and emotional health, not much has been written about the very real role they play in aging well, according to this article.
I’ve already suggested many of the journalistic holes that need filling with regard mental health and aging. In addition, the following topics could use more coverage or revisiting:
- What’s new in Alzheimer’s research and testing. The best places to find information on that is the Alzheimer’s Association and National Institute on Aging.
- The pros and cons of testing for Alzheimer’s.
- The mixed benefits and results of “brainercizing.”
- The types of depression older adults usually experience.
- The increasing incidence of complicated grief among older adults; and shortage of geriatric trained mental health professionals especially geropsychiatrists.
A cautionary note
The White House Conference on Aging and pending reauthorization of Older Americans Act indicate that the nation recognizes the need for programs and services specifically aimed at and tailored to the needs of the nation’s aging population.
However, according to this blog post by the nonprofit Altarum Institute, neither has provided the necessary wherewithal – including funding and political will – to address the challenges the aging nation faces or the complex mix of resources needed “to meet the on-the-ground needs of the increasing number of elders with chronic conditions and functional decline.”
Sources and resources
All of these will provide excellent data or excellent background information – or both.
- A Caregiver: Guide to Care for Aging Parents in Working and Middle Class Families, 2015, Danielle Briggs.
- Caregiving in the Comfort of Home, 4th edition. This company also publishes a series of disease-specific home care books. All are in-depth backgrounders on what you may want to cover if you are writing about that particular condition.
- Merck Manual: Introduction to Geriatrics, Online Professional Edition.
- This toolkit on long-term services and supports.
- This PBS story on Seven Factors Driving up Your Health Care Costs.
- This book: You and Your Aging Parents: Guide to Legal, Financial and Health Care Issues, 2009, American Bar Association (especially chapters 6, 7, 8, and 12).
Eileen Beal, M.A., has been a freelance writer and editorial consultant – primarily covering health care, aging and the overlap between the two – since the late 1990s. Prior to that, she was assistant editor at Cleveland Jewish News. She has written four health-related books and her articles have appeared in a print and online publications, including AARP’s Bulletin, Aging Today, Today’s Caregiver, ReportingonHealth.org, PBS’s NextAvenue.com, HealthCallings.com and WebMD.com. In 2013, she was a New York Times Fellow in Aging; in 2012, she was a MetLife Fellow.
