Elder Law Prof Blog

DTC drug commercials don't give the full story...duh

An analysis of television commercials for prescription drugs found that few mentioned risk factors or non-drug treatments for the conditions they target, scientists reported Monday.  The researchers recorded commercials that aired in prime time on ABC, CBS, NBC or Fox from June 30 to July 27, 2004. They ended up with 38 unique ads representing seven of the 10 top-selling prescription drugs of 2004, they write in the Annals of Family Medicine.  "All of the ads … contained elements that we considered problematic," says lead author Dominick Frosch, assistant professor of medicine at the University of California-Los Angeles. "I think consumers should be more skeptical of the pharmaceutical ads than some surveys find they are."  Among flaws identified by Frosch and his collaborators:

•Only a quarter of the ads mentioned causes or risk factors for the condition treated by the drug.

•None of the commercials mentioned lifestyle changes as an alternative to medication (for example, diet and exercise to lower cholesterol), although about a fifth mentioned such changes as an adjunct to medication.

•Only a quarter of the commercials mentioned how common or uncommon the treated disease is.

Read more in USA Today.

Center for Budget and Policy Priorities: No "general entitlement crisis"

THE LONG-TERM FISCAL OUTLOOK IS BLEAK
By Richard Kogan, Matt Fiedler, Aviva Aron-Dine, and James Horney

This analysis finds that restoring fiscal sustainability will require major changes to programs, revenues, and the nation’s health care system.

Press Release:
http://www.cbpp.org/1-29-07bud-pr.pdf        2pp.

Summary:
http://www.cbpp.org/1-29-07bud-summ.pdf        4pp.

Full Report:
http://www.cbpp.org/1-29-07bud.pdf        21pp.

Methodology:
http://www.cbpp.org/1-29-07bud-meth.pdf        27pp.

THERE IS NO GENERAL "ENTITLEMENT CRISIS"
By Richard Kogan and Aviva Aron-Dine
      This report finds that in coming decades, Medicare, Medicaid, and Social Security will grow rapidly, but other entitlements will shrink as a share of the economy.

http://www.cbpp.org/1-29-07bud2.htm
http://www.cbpp.org/1-29-07bud2.pdf        4pp.

Prof. Pietsch (Hawai'i): Hawai'i elder abuse legislation would better protect seniors

Lawmakers have introduced a bill that would broaden protections for vulnerable Hawai'i residents suspected of being abused, a problem that experts say is growing among the elderly, especially in the area of financial exploitation. But opponents of the legislation say the bill goes too far because it creates a special category for seniors 75 and older, raising the question of age discrimination. Proponents say the elder component is necessary to add an extra measure of protection for the aged and to send the message that Hawai'i cares about its seniors, who comprise one of the fastest growing segments of the state's population and are among the most susceptible to physical, emotional or financial abuse. About 12 states already have elder-abuse laws citing a specific age. The proposed legislation, if enacted, would ensure that scores of suspected abuse cases that currently go unchecked in Hawai'i would at least get a cursory review by Adult Protective Services, the state agency that investigates such cases, according to the proponents.  Professor James Pietsch, who heads the University of Hawai'i's Elder Law Program, said not having an elder-age component would enable some cases to slip through the cracks much like they do today. Besides, he noted, both state and federal laws already afford extra protections for the elderly in areas such as criminal sentences for physical abuse and civil penalties for consumer fraud, and this bill would accomplish something similar.What's more, Pietsch said, the legislation still would preserve a suspected victim's right to tell the state, once an initial inquiry is made, that no abuse occurred, putting a stop to an investigation. Relatives, friends, caregivers or others who know the alleged victims often are the ones who report the suspected abuse, not the alleged victims themselves.

Read the rest of the story in the Honolulu Advertiser.

Report: The Decline of Defined Benefit Retirement Plans and Asset Flows

"The Decline of Defined Benefit Retirement Plans and Asset Flows," by James Poterba, Steven Venti, and David A. Wise (w12834, January 2007, .pdf format, 46p.).

Abstract:

Demographic change can have an important effect on the stock of assets held in defined benefit pension plans. This paper projects the impact of changes in the age structure of the U.S. population between 2005 and 2040 on the stock of assets held by these plans. It projects the contributions to and withdrawals from these plans. These projections are combined with estimates of the future evolution of assets in 401(k)-like plans to describe the prospective impact of demographic change on the stock of assets in retirement plans. Information on demography-linked changes in asset demand is a critical input to evaluating the potential impact of population aging on asset returns.

Get it at http://papers.nber.org/papers/W12834

Upcoming conference

March 8 – 10, 2007
National Association on HIV over 50 National Conference
Hyatt Regency, Washington DC

Aging & HIV/AIDS in the 21st Century Prevention, Advocacy, Care & Treatment

Info here.

Professor Baines testifies on Long Term Care bill

Beverley Baines, professor of law, women's studies and policy studies at Queen's University, yesterday made a presentation to the provincial Standing Committee on Social Policy on Bill 140, Ontario's proposed Long-Term Care Homes Act.   The essence of her remarks were published in the Toronto Star as an opinion piece.  Exceprts: 

Bill 140, Ontario's proposed Long-Term Care Homes Act, contains no reference to women despite the commitment in its preamble to "resident-centred care." Since most residents are women, the question arises whether their care needs differ from those of their male counterparts.  The research is preliminary but it shows that at least 75 per cent of long-term care home beds are occupied by women, many of whom have a moderately severe dementing illness.  Dementia is increasingly found among our aging population and its impact is quantitatively more debilitating for women. For example, in 1991 of seniors aged 85 or more who suffered from dementia, 70 per cent were women.  The nature of dementia is such that it leads to falls and fractures, which, in turn, call for complex care for the residents of long-term care homes.  Since Bill 140 commits to resident-centred care, the proposed legislation should articulate the fact that long-term care home residents are predominantly women whose needs deserve to be recognized and met.

Read the rest in the Star at http://www.thestar.com/article/173711

Israel: Life table statistics

The Israeli Central Bureau of Statistics has just published  the "COMPLETE LIFE TABLES OF 2000-2004 and 2001-2005 "

Get it here:  http://www.cbs.gov.il/publications/life_tables05/life_tables_e.htm

German mocu-mentary depicts senior citizen revolt

Two veteran film-makers have confronted Germany's troubled health care and pension systems, throwing themselves into a sensitive debate that many political leaders have shied away from.  With governments apparently reluctant to get to grips with the political time-bombs, film-makers Regina Ziegler and Dieter Wedel are helping to force the topics into the spotlight with separate controversial television feature movies.  Chancellor Angela Merkel and other politicians often talk of "demographic developments" to try to explain away problems in pensions and health care. But the population is shrinking, health care is becoming unaffordable for some and the pension system is under-funded.  Ziegler, 62, and Wedel, 64, have used fiction to hammer home the point that Germany, once one of the world's richest nations, faces what they believe are health and pension crises.  "The political leaders are afraid to be honest," Wedel said in an interview with Reuters ahead of his February film "Mein Alter Freund Fritz" (My Old Friend Fritz) that takes a scathing look at profit-hungry hospitals and doctors.  "It's unfortunate that there is so much cowardice and ducking away from problems," added Wedel, who wrote and directed the 99-minute, 2.4 million-euro ($3.11 million) film for ZDF television.  Ziegler's 135-minute science-fiction film "Aufstand der Alten" (Uprising of the Old People) is a faux documentary-style production set in 2030. More than 10 million viewers saw it on ZDF last week and it sparked widespread debate in Germany.  In the film, most senior citizens are on the brink of starvation with minimal pensions and almost no health care.  A journalist played by Bettina Zimmermann is investigating the mysterious death of an elderly rebel leader and "looks back" at the uprising's roots, discovering empty promises by leaders about pensions and a failure to fix the problems in the past. The film has upset viewers, many unable to distinguish fact from fiction. One retired political leader, Kurt Biedenkopf, said "Uprising of the Old People" is a belated wake-up call.  "If films like these were made 15 years ago, we wouldn't have wasted as much time and wouldn't now be worrying about the disaster we're heading for," said Biedenkopf, formerly a leader in Merkel's Christian Democrats and premier of Saxony state.

Source:  Reuters Health

Read about the film at Wikipedia.

Poverty among elderly likely to rise

Without changes in the U.S. retirement system, poverty among people 65 and over is likely to increase, according to a report released Tuesday by the Center for Retirement Research at Boston College.  The center measures households at risk of being unable to maintain their standard of living once they stop working. For the highest-income households, being unable to maintain their standard of living may mean cutting back on extras.  But for the lowest third of households, 45 percent of whom are at risk, being unable to maintain their standard of living may mean cutting back on essentials, the report said.  The bottom third of households are less likely to own their homes, have pensions or have meaningful 401(k) assets, making them more reliant on Social Security than their wealthier peers.  As a result, the increased minimum age for Social Security benefits, from age 65 for those born in 1937 or earlier to age 67 for those born after 1960, will hurt them more, according to the report.  The delay in Social Security means that 60 percent of Generation Xers in the bottom third of income are at risk for being unable to maintain their standard of living in retirement.

Source: Houston Chronicle.

Read the report.

   

UK: Financial advisors warned about LTC planning

Financial advisers who lack the new long term care (LTC) qualification should not advise on any aspect of LTC planning - even if they do not plan to use designated LTC products, the financial regulator has warned...in a stark written warning, the Financial Services Authority (FSA) has referenced new guidelines contained in the FSA’s latest adviser newsletter, state: ‘If you are recommending any product that meets long-term care fees planning needs, we expect you to have an appropriate level of knowledge of all relevant care fees planning issues (even if the product is not covered by the long-term care insurance qualification).  ‘Additionally, in order to meet the suitability requirements in giving advice, you should not be in a position where you avoid recommending certain products because you have not passed the relevant examination.’

More on this story at Citywire.

Article: A New Perspective on Population Aging

A new perspective on population aging Warren C. Sanderson, Sergei Scherbov, Demographic Research Vol.16, No. 2 (January 2007) [ Abstract |]

Abstract:  In Sanderson and Scherbov (2005) we introduced a new forward-looking definition of age and argued that its use, along with the traditional backward-looking concept of age, provides a more informative basis upon which to discuss population aging. Age is a measure of how many years a person has already lived. In contrast, our new approach to measuring age is concerned about the future. In this paper, we first explore our new age measure in detail and show, using an analytic formulation, historical data, and forecasts, that it is, in most cases, insensitive to whether it is measured using period or cohort life tables. We, then, show, using new forward-looking definitions of median age and the old age dependency ratio, how combining the traditional age concept and our new one enhances our understanding of population aging.

British health minister launches elder abuse awareness campaign

A British health minister has admitted that elderly people are effectively being starved to death within numerous care facilities and hospitals.  Health Minister Ivan Lewis says many British care officials abuse their elderly charges by providing minimal amounts of food, representing the overall lack of appropriate care within the nation's health care system, the Daily Mail said Monday. Lewis has decided to launch a nationwide campaign to improve food quality for seniors.  "We wouldn't put up with this happening to our children, so why should we find it acceptable for our older people?" Lewis said.  A December 2005 report supports Lewis' claim, citing that more than 2,000 of Britain's care facilities that do not provide appropriate nutrition care.  The Mail said the government's "Dignity for Older People" campaign would focus on assigning area officials to promote improved healthcare and would also concentrate on overall elder nutrition.

Source:  http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20070122-15551600-bc-britain-eldercare.xml

Final Exam: A Surgeon's Reflections on Mortality

Here's an excerpt from a recent book review of Pauline Chen's new book, Final Exam: A Surgeon's Reflections on Mortality:

Our culture is rooted in a tradition of rugged individualism and unwavering faith in the power of technology to improve our lives. This deeply ingrained conviction in never giving up, no matter how long the odds are, makes it a lot easier  --  for patient and physician alike  --  to keep a body alive with powerful medications, ventilators and heart pumps than to look a person in the eye and tell him enough is enough.  "Final Exam" is ultimately about a single question: How do you want to die? It is a truly awful question, one that produces an instinctive, practically visceral need to ignore it. But if we're lucky, it is also a question that each one of us will eventually have a chance to weigh in on. Pauline Chen has given us her answer. We would all do well to listen to what she has to say.

Book review by John Vaughn in the San Francisco Chronicle.

AARP publishes report on alternative and complementay medicine

Do Americans age 50 and older talk with their physicians about their use of complementary and alternative medicine (CAM) — diverse medical and health care systems, practices, and products not presently considered part of conventional medicine including herbal supplements, meditation, chiropractic, and acupuncture?  In the spring of 2006, AARP and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health partnered to measure CAM use among older Americans and to understand communication practices between patients and their physicians. They found that people between the ages of 50 and 59 are the most likely to report CAM use.  While 63 percent of the 1,559 age 50+ individuals surveyed have used one or more CAM therapies, 69 percent of those who reported using CAM had not discussed it with a physician because the physician never asked (42%), they did not know they should (30%), or there was not enough time during the office visit (19%). Additional barriers include patient perceptions that physicians are unwilling to discuss CAM therapies or will react negatively to disclosure of CAM use.

Get more info or the full report here.

Jan. 22 is 2007 "unhappiest day"--so things are looking up

         

Researchers in England, citing unpaid holiday bills, rotten weather and people's realization that they likely won't live up to their New Year's resolutions, say Jan. 22 is the unhappiest day of 2007.  Cliff Arnall, a Cardiff University psychologist, devised the depressing formula.  His equation takes into account six factors: weather, debt, time since Christmas, time since failing our New Year’s resolutions, low motivational levels and feeling a need to take action.  Taken together, they calculate to equal "Blue Monday."  Arnall said that by understanding the main factors for depression, we can prevent becoming unhappy next year.  "Use the day as a springboard for a higher quality life," he told the London Daily Mail. "For example, keeping Christmas spending to a strict budget next year will make you less depressed in the last week of January.

Read more at Fox News online.

Final reg requires restraint training in LTC facilities

New federal seclusion-and-restraint regulations include a requirement that nurses and physician assistants must contact the attending physician when they believe there is a need to use these interventions.  Nursing homes, psychiatric, rehabilitation, and alcohol/drug treatment centers are among the medical facilities that will need to ensure that their training complies with new federal guidelines on the use of seclusion and restraint. The Centers for Medicare and Medicaid Services (CMS) published a final rule last month governing the use of seclusion and restraints by physicians and health care workers who treat patients in hospitals that participate in Medicare or Medicaid.  The regulations, which go into effect on February 6, establish more rigorous training requirements that aim to assure appropriate treatment and protect patients' rights.  The regulations are part of Medicare's revised conditions of participation (CoPs) in the Medicare and Medicaid programs and apply to a wide range of settings including short-term, psychiatric, rehabilitation, long-term, pediatric, and substance abuse treatment facilities.

Full story:  Psychiatry OnLine, http://pn.psychiatryonline.org/cgi/content/full/42/2/12?etoc

Final rule:  http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-9559.pdf

Wisconsin LTC groups call for increase in Medicaid reimbursement rates

Local long-term care officials have joined a statewide call to raise Medical Assistance reimbursement rates for nursing homes and other care services by 5 percent in the next state budget.  Members of the Coulee Region Long-Term Care Workforce Coalition in La Crosse met Friday in La Crosse with state Rep. Mike Huebsch, R-West Salem, to push for the increase for personal care, home health and other community services.  Huebsch, the Assembly’s majority leader, said he is aware of the problems with long-term care and would have to look at the proposal’s financial ramifications. Two priorities for the biennial budget, he said, will be public education and taking care of people who can’t provide for themselves.  "€œWe'€™re nearing a crisis again in long-term care, and we need a comprehensive look at the problem and plan for the future, because baby boomers will increase the need for this care," Huebsch said.  Members of the workforce coalition are concerned about the quality and consistency of care when personal and home-care aides make low wages.  They said some workers have trouble paying bills and wind up leaving for higher-paying jobs. That can make home care inconsistent because vacancies are hard to fill.  The average salary is $8 to $9 an hour for staff at Independent Living Resources, which provides personal and home care services in the La Crosse area, said Kathy Noble-Iverson, the agency’s executive director. Staff have not received a raise since 2002, when Medical Assistance rates last were increased, she said.

Read more in the LaCross Tribune.

Not elder law: Selected Zen thoughts

1. Do not walk behind me, for I may not lead. Do not walk ahead of
me, for I may not follow. Do not walk beside me either. Just pretty much leave me alone.

2. The journey of a thousand miles begins with a broken fan belt and a leaky tire.

3. It's always darkest before dawn. So if you're going to steal your neighbor's newspaper, that's the time to do it.

4. Don't be irreplaceable. If you can't be replaced, you can't be promoted.

5. Always remember that you're unique. Just like everyone else.

6. Never test the depth of the water with both feet.

Ed: Special thanks to JD Hanson

Upcoming conference: The Luxembourg Income Study 2007 Introductory Workshop

LUXEMBOURG INCOME STUDY 2007 INTRODUCTORY WORKSHOP: "The Luxembourg  Income Study (LIS) Summer Workshop is a one-week workshop designed to introduce researchers in the social sciences to comparative research in income distribution, employment and social policy using the LIS database. We welcome applications from researchers with varying levels of knowledge and experience.

The Luxembourg Income Study has made comparable over 160 large microdata
sets that contain comprehensive measures of income, employment and
household characteristics for 30 industrialized countries (Australia,
Austria, Belgium, Canada, the Czech Republic, Denmark, Estonia, Finland,
France, Germany, Greece, Hungary, Ireland, Israel, Italy, Luxembourg,
Mexico, the Netherlands, Norway, Poland, Romania, Russia, the Slovak
Republic, Slovenia, Spain, Sweden, Switzerland, Taiwan, the United Kingdom
and the United States).

The language of instruction is English. By the end of the workshop,
attendees will be fully trained to use the database independently.
Workshop faculty includes the LIS directors, Janet Gornick and Markus
Jantti, the LIS staff and guest lecturers. In addition, the winner of the
annual Aldi Hagenaars Memorial Award will present his/her paper. The
workshop format includes a mixture of lectures on comparative research,
laboratory sessions and individual one-on-one advisory sessions. Attendees
will also be introduced to the new Luxembourg Wealth Study Tuition of
1,400 Euros covers instructional materials, single-occupancy
accommodations, and full board. Transportation to and from Luxembourg is
the responsibility of the student. The 2007 workshop will be held from
June 24 to June 30, 2007 (with departure on July 1). Applications are
available (.pdf format, 2p.) at:

http://www.lisproject.org/workshop/2007application.pdf

Pension Policy in EU25 and its Possible Impact on Elderly Poverty

ESRC RESEARCH CENTRE FOR ANALYSIS OF SOCIAL EXCLUSION (CASE) [LONDON
     [UK]]: "Pension Policy in EU25 and its Possible Impact on Elderly
     Poverty," by Michael Fuchs, Aaron George Grech, and Asghar Zaidi
     (CASE/116, December 2006, .pdf format, 33p.).

Abstract:

This paper reviews changes in pension policies in EU countries between 1995 and 2005 and describes how they might affect risk of poverty for  future pensioner populations. The pension landscape in Europe has changed
considerably in the past decade and the paper highlights commonalities as
well as differences in pension reforms across these countries. A common trend is that the retirement incomes drawn from the public pension systems are on the decline, the changes are likely to shift more risks towards individuals, and there are fewer possibilities of redistribution in favour of the lower income individuals. The paper includes exploratory projections of how the risk of elderly poverty might evolve in the future. The countries where the benefit ratio is set to decline significantly, as expected, would see at-risk-poverty rates increase quite substantially, especially during the period 2025-2050, when the bulk of the decline is expected. This analysis points towards the importance of a more comprehensive assessment of the reforms, in particular in their impact on vulnerable groups (such as women and disabled people with disruptive work history) and in the clarity of the signals they give to individuals in extending their working career if they want to avoid greater risks of poverty during retirement.

http://sticerd.lse.ac.uk/dps/case/cp/CASEpaper116.pdf