Elder Law Prof Blog

Five Star Rating System: Clarity or Confusion?

You recall Medicare's 5 Star Rating System to aid consumers in making choices regarding services and facilities. Kaiser Health News (KHN) ran a story on February 23, 2016 about the difference between how consumers rate facilities vs. how Medicare rates facilities.  Dueling Star Ratings May Confuse Some Home Health Patients explains that Medicare assigns stars "primarily based on Medicare’s assessment of how often patients got better. But [looking] further ... may lead to confusion. Medicare also posts stars to convey how patients rate agencies after their care is over."

KHN did a survey on the frequency of these disparities  and found that "[s]uch contradictory results between how patients view home health agencies and how the government rates them are hardly unusual."  

In a statement, the Centers for Medicare & Medicaid Service said the different star ratings should not be confusing. “CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” the statement said. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

The disparity at least in part is explained: "[s]ome of the differences between home health care patient experience and clinical quality stars can be chalked up to the fact that the two domains focus on different facets of home health care." The article goes on to quote elder care experts on their views about the reasons for the differences in the rankings.  The article wraps up noting it is unknown how many Medicare beneficiaries use the 5-star rating system, and understand them.

Genworth Announces "Refocus" for Sales for Its Insurance Products

Genworth is one of the three surviving companies still offering Long-Term Care Insurance.  So, when it reports plans for the future, that is important.  In February 2016 Genworth's CEO released a letter saying, "We will be refocusing our sales efforts to develop solutions that meet the financial challenges of aging, including individual and group long term care (LTC) insurance, and over time, the development of other products and services that meet this growing need."

Genworth’s strategic priorities remain to improve the performances of our businesses and increase our financial and strategic flexibility — while keeping our promises to policyholders. To support these priorities, Genworth has decided to suspend sales of all our traditional life insurance and fixed annuity products. Our decision to suspend new sales of these products in no way diminishes our commitment to providing service to our existing 2.8 million life and annuity policy and contract holders and their beneficiaries.

Exactly what this means for financing options for long-term care remains to be seen.  

McKnight's Senior Living News sees this as a move in the right direction, as discussed here.  

Abandoned Nursing Home Residents?

Kaiser Health News (KHN) ran a story titled The Agonizing Limbo Of Abandoned Nursing Home Residents. The story focuses on the refusal of some California nursing homes to readmit residents after a hospital stay.  The story opens with a story of one resident who "had been living[in a nursing home] for four years... [and] the home refused to readmit him, even after being ordered to do so by the state. Nearly nine months later, [the resident] is still in the hospital."  It seems that these residents are trapped in a sort of limbo.

Nursing home residents are entitled to hearings under federal law to determine whether they should be readmitted after hospitalization. The state Department of Health Care Services holds the administrative hearings, but has said it is not responsible for enforcing the rulings.

But the state Department of Public Health, which oversees nursing homes, neglects to enforce the rulings and sometimes disagrees with them, according to advocates and court documents.

That leaves residents .... [even those] who won ... [the]  hearing .... with little recourse — and not many places to go. And since many nursing home residents have publicly-funded insurance, it means taxpayers are on the hook for hospital stays long after the patients are ready for discharge.

California Advocates for Nursing Home Reform (CANHR) in November, 2015 filed suit against California Health & Human Services on behalf of some of these residents with an upcoming hearing in March of 2016. The suit seeks "to require California to establish a hearing process that complies with federal law and to enforce the rulings." The defendant has filed a motion to dismiss.

Call for Presentations-2016 National Aging & Law Conference

The 2016 National Aging & Law Conference is set for October 27-28, 2016 in Alexandria, Va.  Here is an excerpt from the conference announcement .

On October 27-28, 2016, the Commission on Law and Aging and the Center for Professional Development will sponsor the National Aging and Law Conference in the Washington, DC, area at the Hilton Alexandria Old Town in Alexandria, VA. 

Conference attendees will enjoy:

• Low registration rates and a two-day agenda to minimize travel time and costs

• An expanded agenda with 4 plenary sessions and 30 workshops

• A focus on core substantive legal issues affecting older Americans with the greatest economic and social needs

• Programming on legal service development and delivery

• High-quality written materials

A call for presentations is also included in the announcement. If you are interested in presenting, the RFP can be downloaded from here.

Filial Friday: "Updating Connecticut's Filial Responsibility Statutes"

Quinnipiac Law Student Katherine C. Clark has recently published a note titled "Duty to Reform: Updating Connecticut's Filial Responsibility Statutes," in the Quinnipiac Probate Law Journal (Vol. 29, page 45, 2015).

The author argues for repeal of Connecticut's criminal law and modifications of the state's civil laws regarding filial obligations, arguing in part that:

Connecticut should define indigence to include only those elderly people receiving state assistance, and those whose total income falls below a certain amount. This limited definition ensures that those elderly people who have a legitimate need for assistance would have their needs met.

 

 

Additionally, using those two benchmarks could limit any sort of fraudulent claims. It is relatively easy to determine if a party receives state assistance, so that verification is not overly burdensome. However, by also taking into account the total income, parents who are not recipients of state assistance, but who still have unfulfilled needs, may still gain access to the care they need. Another important consideration is determining at what age parents are entitled to protection. Setting a specific age, such as 65, would make it clear when the statutory obligation begins.

 

The full article currently appears available only through a paid service, such as Lexis.  

University of Hawaii Elder Law Program Celebrates 25th Year

The University of Hawaii William S. Richardson School of Law recently celebrated the 25th anniversary of its Elder Law program with a half-day educational program for the public on veterans rights. The program included a question and answer session with the Honorable Coral Pietsch, a judge on the U.S. Court of Appeals for Veterans Claims (CAVC). Judge Pietsch offered an overview of CAVC and covered unique aspects of practice before this court.

Judge Pietsch is the spouse of University of Hawaii Law Professor James Pietsch, who launched the Elder Law and Veterans Clinics at the law school. Together, they reflected on their service as military lawyers on active duty, in the Army Reserve and as civilian Rule of Law Advisors in Iraq.

For more on Professor Pietsch's interesting career see our earlier Elder Law Prof Blog profile.

More Articles on Physician-Aided Dying

Here are three recent articles of note on Physician-Aided Dying (PAD) that might be useful in your classes.

First,  the Journal of the American Medical Association (JAMA) Psychiatry ran at article on February 10, 2016, Physician-Assisted Death for Patients With Mental Disorders—Reasons for Concern.  As the article opens: 

Physician assistance to help people end their lives—by prescribing or directly administering medication—is now legal in some form in 4 American states, Canada, and 4 European countries. In the United States, laws permitting physicians to write prescriptions for medications intended to end patients’ lives are limited to patients with terminal conditions and preclude physician administration of the medication. However, other countries, including the Netherlands, allow direct physician involvement and have expanded the criteria to include patients with irremediable suffering, whatever the cause. Therefore, the door has been opened for people whose suffering is primarily due to mental disorders to seek assistance in dying. (citations omitted)

Next in the same volume is the article about the study referenced in the first article: Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014.  The full article is free, and the tables and references are also available in the online version.  The authors conclude

Despite some limitations, an important strength of our study is that we examined reports of actual psychiatric EAS cases across an entire jurisdiction, rather than asking physicians to recollect their experiences or opinions. The results show that the patients receiving EAS are mostly women and of diverse ages, with various chronic psychiatric conditions, accompanied by personality disorders, significant physical problems, and social isolation or loneliness. Refusals of treatment were common, requiring challenging physician judgments of futility. Perhaps reflecting the complexity of such situations, the physicians performing EAS generally sought multiple consultations (but not always), and disagreement among physicians—especially regarding competence and futility—was not unusual. Despite these complexities, a significant number of physicians performing EAS were new to the patients. We conclude that the practice of EAS for psychiatric disorders involves complicated, suffering patients whose requests for EAS often require considerable physician judgment. The retrospective oversight system in the Netherlands generally defers to the judgments of the physicians who perform and report EAS. Whether the system provides sufficient regulatory oversight remains an open question that will require further study.

The New York Times ran an article about the study on February 10, 2016. Assisted Suicide Study Questions Its Use for Mentally Ill notes that

A new study of doctor-assisted death for people with mental disorders raises questions about the practice, finding that in more than half of approved cases, people declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. The study, of cases in the Netherlands, should raise concerns for other countries debating where to draw the line when it comes to people’s right to die,

Discussing the findings from the study, the NY Times article notes that that it

finds that cases of doctor-assisted death for psychiatric reasons were not at all clear-cut, even in the Netherlands, the country with the longest tradition of carefully evaluating such end-of-life choices. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a “mobile end-of-life clinic” — a nurse and a doctor, funded by a local euthanasia advocacy organization.

Good sources for your classes and for students writing papers on the topic!

 

Stakeholders and Policymakers Collaborate on Proposals for Better Approach to Financing Long-Term Care

On February 22, 2016, a diverse collection of individuals, representing a broad array of stakeholders interested in long-term care, released their report and recommendations for major changes.  In the final report of the Long-Term Care Financing Collaborative (LTCFC) they propose:

•Clear private and public roles for long-term care financing

•A new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model.

•Redefining Medicaid LTSS to empower greater autonomy and choice in services and settings.

•Encouraging private long-term care insurance initiatives to lower cost and increase enrollment.

•Increasing retirement savings and improving public education on long-term care costs and needs.

The full report is available here.  

ElderLawGuy Jeff Marshall wrote to supplement this post by providing details of the report, written by Howard Glecknan of the Utban Institute.  Thanks, Jeff!  

Members of the Collaborative included:

Gretchen Alkema, The SCAN Foundation; Robert Blancato, Elder Justice Coalition; Sheila Burke, Harvard Kennedy School; Strategic Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz; Stuart Butler, The Brookings Institution; Marc Cohen, LifePlans, Inc.; Susan Coronel, America’s Health Insurance Plans (AHIP); John Erickson, Erickson Living; Mike Fogarty, former CEO, Oklahoma Health Care Authority; William Galston, The Brookings Institution; Howard Gleckman, Urban Institute; Lee Goldberg, The Pew Charitable Trusts; Jennie Chin Hansen, immediate past CEO, American Geriatrics Society; Ron Pollack, Families USA; Don Redfoot, Consultant; John Rother, National Coalition on Healthcare; Nelson Sabatini, The Artemis Group; Dennis G. Smith, Dentons US LLP; Ron Soloway, UJA-Federation of New York (retired); Richard Teske (1949-2014), Former U.S. Health and Human Services Official; Benjamin Veghte, National Academy of Social Insurance; Paul Van de Water, Center on Budget & Policy Priorities (CBPP); Audrey Weiner, Jewish Home Lifecare, immediate past Chair, LeadingAge; Jonathan Westin, The Jewish Federations of North America (JFNA); Gail Wilensky, Project HOPE;Caryn Hederman, Project Director, Convergence Center for Policy Resolution; Allen Schmitz, Technical Advisor to the Collaborative, Milliman, Inc.

Only Limited Authority as Health Care Agents? The Latest Grounds to Challenge Dreaded Arbitration Clauses in NH Cases

The New York Times offers another window into concerns about pre-dispute binding arbitration provisions that are routinely found in nursing home agreements.  This is a long-simmering war, with many battlefronts and tactical arguments, as documented in the article.  However, the article also focuses on a narrow group of cases where courts have rejected a binding effect for arbitration clauses signed by someone serving "merely" as a health care agent for the incapacitated resident. (I hope my Contracts course students this semester are reading this article!)  

The article offers an additional opportunity to consider the tensions between public policies on either side of the debate over "fairness" of arbitration as a forum for consumer claims:

Arbitration clauses have proliferated over the last 10 years as companies have added them to tens of millions of contracts for things as diverse as cellphone service, credit cards and student loans.. Nursing homes in particular have embraced the clauses, which are often buried in complex contracts that are difficult to navigate, especially for elderly people with dwindling mental acuity or their relatives, who can be emotionally vulnerable when admitting a parent to a home.

 

State regulators are concerned because the secretive nature of arbitration can obscure patterns of wrongdoing from prospective residents and their families. Recently, officials in 16 states and the District of Columbia urged the federal government to deny Medicaid and Medicare money to nursing homes that use the clauses. Between 2010 and 2014, hundreds of cases of elder abuse, neglect and wrongful death ended up in arbitration, according to an examination by The New York Times of 25,000 arbitration records and interviews with arbitrators, judges and plaintiffs.

 

Judges have consistently upheld the clauses, The Times found, regardless of whether the people signing them understood what they were forfeiting. It is the most basic principle of contract law: Once a contract is signed, judges have ruled, it is legally binding.

 

Mr. Barrow’s case [set for trial in Massachusetts] is pivotal because, with the help of his lawyers, he has overcome an arbitration clause by using the fundamentals of contract law to fight back. As is often the case when elderly people are admitted to nursing homes, Mr. Barrow signed the admissions paperwork containing the arbitration clause on his mother’s behalf.

 

Although his mother had designated Mr. Barrow as her health care proxy — someone who was authorized to make decisions about her medical treatment — his lawyers argued that he did not have the authority to bind his mother to arbitration.

For more, read Pivotal Nursing Home Suit Raises a Simple Question: Who Signed the Contract?

Our thanks to attorneys Karen Miller in Florida and Morris Klein in Maryland, plus Dickinson Law students Joe Carroll, Corey Kysor and Kadeem Morris in Pennsylvania for sending us the link to the NYT coverage.

Good News on the Dementia Front?

The latest issue of the New England Journal of Medicine (NEJM) has two articles about a recent study on dementia.  The first Is Dementia in Decline? Historical Trends and Future Trajectories and the second is Incidence of Dementia over Three Decades in the Framingham Heart Study.

A subscription is required to access the full article about the Incidence article, but a free preview is available.  Here is an excerpt from the preview

Background

The prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study.

The Dementia in Decline perspective article is available for free. A pdf of the article is available here.  Here is the opening paragraph from that article

In 2005, researchers from the Duke Center for Demographic Studies reported a “surprising trend”: data from the National Long-Term Care Surveys showed that the prevalence of severe cognitive impairment in the Medicare population had decreased significantly between 1982 and 1999. At a time when baby-boomer demographics led to predictions of a looming dementia crisis, this finding offered hope. Since that time, other reports have similarly shown that the incidence or prevalence of dementia is decreasing in various populations. Researchers have offered many possible explanations, including increased wealth, better education, control of vascular risk factors, and use of statins, antihypertensive agents, and nonsteroidal antiinflammatory drugs. However, even as researchers describe their “cautious optimism” about specific populations, they still project a quadrupling of global prevalence over the coming decades. (citations omitted)

Feeding Tubes at End of Life? Study Uses Medicare-Data to Evaluate Care for Older Patients

A John A. Hartford Foundation-sponsored study released this month uses Medicare data to examine health care for older Americans, with a self-described "emphasis on the patient's perspective." Both the methodology and the conclusions are intriguing.  The researchers report:

For the first time, we measure the intensity of care in terms of how many days per year the average Medicare beneficiary is in contact with the health care system. We can see that beneficiaries in some regions see twice as many unique clinicians for ambulatory care than in others. We also can see in which regions beneficiaries are more likely than not to have a primary care physician as their predominant provider of care.

 

We also examine the adoption of new evidence-based practices to show that, while some regions showed substantial progress, others still fall short. For example, in some regions, fewer seniors are being prescribed inappropriate high-risk medications, and in others, thirty-day readmission rates are falling. Yet screening tests for prostate cancer and breast cancer among beneficiaries 75 and older remain unnecessarily high, and the data in this report suggest that we are still waiting too long to refer patients to hospice care.

On the one hand, the report demonstrates wide regional variation in the percentage of patients enrolled in "hospice" during the last three days of an individual's life.  The researchers conclude: "Referrals to hospice care that are done too late ... adversely affect the quality of care, the reported experiences of patients and families, and their satisfaction with the health care system." 

On the other hand, the report cites "clinical evidence" that shows that "feeding tube placement" in patients with advanced dementia "does not prolong life or improve outcomes, and in fact leads to further complications and adverse effects such as the increased use of restraints."  Nonetheless, the report shows that in some regions of the country, 12% to 14% of patients with dementia may be on feeding tubes, pointing to locations such as southern California, Lake Charles, Louisiana, and Dearborn, Michigan.

For the full report, see the Dartmouth Atlas project report, "Our Patients, Ourselves: Health Care for an Aging Population." 

Further, for an region-specific analysis of the report findings, see iNewsource's "Care for San Diego's Dying Patients Needs to Improve, Study Finds."

The Gerontologist Special Issue on Veterans

The February 2016 issue of The Gerontologist is devoted to Veterans issues.  The issue contains a number of articles on a variety of interesting topics. Check it out!

When the Sandwich Generation Is Squeezed into a "Footlong" Sub....

George Washington Law Professor Naomi Cahn sent us a link to a Washington Post article exploring the impact of ever increasing number of Boomer  Generation elders turning to  younger generations for care:  

Life’s challenges began to stack up as Rowe, 45, cared for her two young sons and also her mother. “I was emotionally exhausted,” said Rowe, who lives in Takoma Park with her wife and boys, ages 6 and 9.

 

Rowe is on the cusp of a fast-growing population — a mashup of Generation X and millennials — that is starting to care for a revolving door of young and older loved ones.

 

The term “sandwich generation” was coined in the 1980s to describe people who are squeezed between taking care of their children and their parents. Now, as members of the baby boom generation are entering their 70s, that sandwich is poised to become a footlong.

For more examples and discussion, read: How to Cope With Caring for Baby Boomer Parents While Raising Small Children.  Thanks, Naomi!  

Call for Papers: Aging & Society: Sixth Interdisciplinary Conference

The 2016 Aging & Society: Sixth Interdisciplinary Conference has released a call for papers for the October 6-7, 2016 conference to be held in Sweden. The call for papers includes papers,  poster presentations, workshops/interactive sessions, or colloquia on one of the four conference themes.  The themes are economic and demographic perspectives,  social and cultural perspectives, medical perspectives and public policy perspectives. More information is available here.

Check Out This Video from Professor Hoffman

Professor Sharona Hoffman of Case Western Law is featured in a ten minute video podcast that focuses on her book,  Aging with a Plan: How a Little Thought Today Can Vastly Improve Your Tomorrow. According to the website promoting the video, "[t]he book is a concise but comprehensive resource designed to help people who are middle aged and beyond plan for their own aging and for taking care of elderly loved ones."

Here is the abstract from the book:

This book offers a concise, comprehensive resource for middle-aged readers who are facing the prospects of their own aging and of caring for elderly relatives — an often overwhelming task for which little in life prepares us.

Everyone ages, and nearly everyone will also experience having to support aging relatives. Being prepared is vital to being able to make good decisions when challenges and crises arise. This book addresses a breadth of topics that are relevant to aging and caring for the elderly, analyzing each thoroughly and providing up-to-date, practical advice. It can serve as a concise and comprehensive resource read start-to-finish to plan for an individual's own old age or to anticipate the needs of aging relatives, or as a quick-reference guide on specific issues and topics that are relevant to each reader's circumstances and needs.

Using an interdisciplinary approach, Aging with a Plan: How a Little Thought Today Can Vastly Improve Your Tomorrow develops recommendations for building sustainable social, legal, medical, and financial support systems that can promote a good quality of life throughout the aging process. Chapters address critical topics such as retirement savings and expenses, residential settings, legal planning, the elderly and driving, long-term care, coordinated medical care, and end-of-life decisions. The author combines analysis of recent research on the challenges of aging with engaging anecdotes and personal observations. Readers in their 40s, 50s, and beyond will greatly benefit from learning about aging in the 21st century and from investing some effort in planning for their own old age and that of their loved ones

 

Advocacy, Aging and the NaCCRA Example

In 2010, I spent several months of my sabbatical in Northern Ireland.  I soon learned that older people there are highly organized and very visible, working together on issues such as protection from abuse, housing, utility costs, elder care options, access to benefits and more.

They knew that their best chances for success were to band together to tackle problems. They knew that they could not depend on a few to keep the work going, and they consciously brought "younger" seniors into leadership positions to keep the advocacy teams well staffed and to provide continuity of effort.  Plus, they were not shy about presenting a unified national platform of concerns and recommended solutions -- as suggested by that year's "Pensioners' Manifesto," promoted at parades and public gatherings.  The advocacy plan was supported by AgeNI, Age Sector Platform, Changing Ageing Partnership and other "separate" organizations.  

In the US, seniors' concerns often cross jurisdictional boundaries, including state boundaries.  The distances are farther apart in the U.S. than in Northern Ireland, but again there can be power in organizing.  As part of my research, I've been watching several groups across the country using the power of the internet to share information and "gather " in order to advocate for solutions to common problems.  A key to success seems to be advocating from a position of strength in numbers and shared concerns.

One of the U.S. organizations I've watched closely has been the National Continuing Care Residents Association or NaCCRA, a national body that grew out of early advocacy on behalf of residents in life care and continuing care residences in Florida. Residents came to recognize that as much as they appreciate and even love their individual communities, there are often common concerns about matters such as provider accountability for entrance fees and service fees paid by residents, understanding Fair Housing and ADA rules for residents with disabilities, residents' rights during changes of "ownership," resident rights during provider insolvency, reorganizations or bankruptcy, transparency of management decision-making and more.   

NaCCRA has both individual members and state chapters, and recently, resident-members in the State of Washington recognized that stronger funding of the national organization through the state chapters is needed to support effective advocacy at every level.  By comparison, the senior housing providers certainly share information (and money) on a national basis -- see e.,g., LeadingAge and American Seniors Housing Association -- especially when addressing their advocacy positions with regulators and government leaders.

It will be interesting to see whether residents in CCRCs and Life Care communities in other states join Washington residents in supporting a strong national team through NaCCRA.  

Diane Rehm and More on Assisted Dying

Many of you recognize the name Diane Rehm, from NPR, where she has had her show, The Diane Rehm Show, for many years. "Retiring" at the end of 2016 doesn't mean she will be out of the public eye, according to a recent article in the Washington Post. Diane Rehm’s next act: Using her famed voice to fight for the good death is a profile of Mrs. Rehm that also summarizes her writings.  Her 2014 memoir relates how her husband ended his life on his own by refusing food and fluids, since physician-aided dying is not legal in their state. 

Mrs. Rehm is quoted "[I]t’s time for me to retire, especially on the issue of right-to-die, to be able to speak out and to speak freely....”  In addition to supporting the right to die, she plans to champion research on Alzheimer's and Parkinson's.

New York Summer Internship Opportunity for Law Students Interested in Protection of Older Adults

Our friends at the Weinberg Center for Elder Abuse Prevention sent application information for law students interested in a summer 2016 internship in New York:

The David Berg Center for Law and Aging is seeking select students for its Summer 2016 internship programs. The Center focuses on a wide range of legal and policy issues affecting the older adult population and victims of elder abuse and exploitation. 

 

Interns will be offered the unique opportunity to work at the nation’s first elder abuse shelter, The Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale.  Located in the Riverdale section of the Bronx, New York, on 17 acres of the Hudson River, the comprehensive elder abuse center provides an emergency residential shelter as well as psychosocial, health care and legal advocacy and community-based services for victims of elder abuse. 

 

Under the direct supervision of the Weinberg Center’s Assistant Director and General Counsel, students will potentially be exposed to legal practice in all five boroughs of New York City and Westchester County. Students may have the opportunity to work collaboratively with Weinberg Center partners such as the New York Attorney General’s Office, the New York City Police Department, District Attorneys’ Offices and Family Justice Centers. Interns will complete substantive research and writing on the different legal and policy issues impacting the older adult population and victims of elder abuse. 

 

Past issues have included HIPAA regulations, questions surrounding legal capacity, immigration, powers of attorney, Medicaid eligibility, copyright, and right to privacy.  The interns will gain case management skills and potential courtroom exposure through drafting petitions for guardianship, family court orders of protection and housing court matters.  The interns will also have the opportunity to participate in multidisciplinary conferences, meetings of the American Bar Association Senior Lawyer’s Division’s Elder Abuse Task Force and other community outreach and training events. To apply, please send a resume, cover letter and writing sample to [email protected].

A Walkable Life Matters

My friend, colleague and renaissance guy, Mark Bauer, keeps an eye out for interesting articles for me, including those that focus on a community's livability for elders.  He sent me this great article that looks at how a vibrant, walkable community can increase one's longevity once one reaches 80.  The article, Land use mix and five-year mortality in later life: Results from the Cognitive Function and Ageing Study, appears in volume 36 of Health and Place at pages 54-60 (Mar. 2016). Here's the abstract

This study explores the potential modifying effect of age and mediation effect of co-morbidity on the association between land use mix, a measure of neighbourhood walkability, and five-year mortality among the 2424 individuals participating in the year-10 follow-up of the Cognitive Function and Ageing Study in England. Postcodes of participants were mapped onto Lower-layer Super Output Areas, a small area level geographical unit in the UK, and linked to Generalised Land Use data. Cox regression models were fitted to investigate the association. For the younger older age group (75–79 years), the effect of high land use mix on an elevated risk of mortality was mediated by co-morbidity. For older old age groups (80–84, 85+ years), a higher land use mix was directly associated with a 10% lower risk of five-year mortality. The findings suggest differential impacts of land use mix on the health of the younger and older old.

I thought this quote from the implications/future research section persuasive: "[P]olicy planning should take note of such variation within older populations, and in particular the needs of the middle and oldest old cohorts. This observation is particularly relevant to the recent movement toward age-friendly environments, which have been advocated worldwide to create inclusive and supportive living environments for active ageing... improving the mix of land uses in local areas may be a potential approach to reduce limitations in activity of daily life and support active ageing for these older age groups."

 

A pdf of the article is available here.

Time Magazine's 4th Cover Issue on "Hope" for Alzheimer's Disease Solutions

Time Magazine's February 29 issue has a provocative image and title, showing a silhouette of a young woman about to ingest a spotlighted, shining capsule.  The issue, titled "The  Alzheimer Pill: A Radical New Drug," focuses on a pill called LM 11 A-31.

By my count, this is at least the fourth cover by Time focused on the latest hopes for a solution to this disease. Prior issues include:

• October 25, 2010: Alzheimer's: At Last Some Progress Against the Most Stubborn Disease
• May 14, 2001: Believe it or Not, this 91 Year-Old Nun Could Help Your Beat Alzheimer's, promoting a "landmark study of the disease." 
• July 17, 2000: The New Science of Alzheimer's Disease