Wednesday, January 22, 2020
Kaiser Health News published an interesting piece a few days ago, What The 2020s Have In Store For Aging Boomers opens with some interesting data. "Within 10 years, all of the nation’s 74 million baby boomers will be 65 or older. The most senior among them will be on the cusp of 85. ... Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to Census Bureau projections." The author interviewed a number of experts to get a sense of what this decade will look like for the boomers and the trends they will face.
- Care Crisis: "Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance."
- Living longer and "better, " with a focus on quality of life.
- "Altering social infrastructure" such as more easily accessible transportation, increased affordable housing, making existing housing more appropriate for aging in place, and inter-generational programs.
- Flipping the perceptions of aging from negative to positive.
- "Advancing science", that is “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments ...."
- Responding to inequalities in aging.
- Longer careers in the work force
A new decade with ongoing challenges and a chance for progress!
Wednesday, January 8, 2020
For the last few years, I've found myself with conflicts during semester breaks that interfered with attending the AALS Annual Meeting. So I was especially happy this year to attend and catch up with long-time and new friends, especially those who work in fields relevant to elder law.
The annual meeting kicked off for me with a Joint Session hosted by the Sections on Aging and the the Law, Civil Rights, Family & Juvenile Law, Employee Benefits & Executive Compensation, and Immigration Law. The collaborative event offered lots of interesting "Emerging Issues in Elder Law," with speakers including:
Mark Bauer, Stetson Law, who spoke about recent enforcement efforts to combat elder exploitation, and pointed to a lingering weakness associated with banks that make SARS reports that never go beyond the regulatory body, and therefore never reach first responders, such as local police. He talked about support for a state-wide effort in Florida to improve police reports to make it easier to identify abusers who target older persons. He also called for better record-keeping for sales of gift cards, as these have become the number 1 method that telephone scammers get older adults to send them money.
Wendy Parmet, Northeastern University School of Law, who focused on the impact of immigration laws and policies on the health of older adults, including attempts by the current administration to change the definition of "public charge" to include anyone who could receive any public benefits whatsoever, thereby expanding the the pool of inadmissible immigrants and further restricting eligibility for legal permanent residency. She traced the impacts of such policies on older adults once eligible for family reunification, on older citizens overall, and on a nation that once took pride in providing help to immigrants who were "tired and poor."
Jalila Jefferson-Bullock, Duquesne Law, who talked about how some states are not applying sentencing reforms to elderly offenders, even though such inmates statistically are at the least risk of reoffending and, at 19% of the total prison population, are often generating care costs that are unsustainable. I learned, sadly, that my own state of Pennsylvania is one of the states that is not yet making significant progress on sentencing reforms for older adults.
Rachel Lopez, Drexel University Law, who is director of Drexel's Stern Community Lawyering Clinic, carried forward the theme of needed prison reforms for older inmates, reporting the latest events that follow the Graterford Think Tank Prison Project in Pennsylvania, and making the sobering observation that the most effective argument may not be one that sounds in human rights or human dignity, but the demonstration that return to the community for aging and ill residents saves the state money.
Naomi Cahn, George Washington Law, who is also the incoming chair for the AALS Section on Law and Aging, presented facts and figures on "gray divorce," especially with respect to financial impacts on women. She urged a de-coupling of Social Security benefits from marriage (or perhaps marriage longevity requirements), arguing that Social Security credits should be available for time spent as caregivers.
Browne Lewis, Cleveland-Marshall College of Law, pointed to the emerging issue of "reproductive rights" for older individuals, identifying jurisdictions that restrict women's access to assisted reproductive technologies (ART) including placing age or time restrictions on use of banked or stored eggs.
For faculty members who would like to be part of next year's Law and Aging program at the 2021 AALS Annual meeting in San Francisco, contact Naomi Cahn with your topics and interest.
January 8, 2020 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, International, Retirement, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Tuesday, January 7, 2020
Two articles, updating us on two topics important to all of us.
First, statistics. We know women statistically live longer than men,and a recent data report from Pew updates us that this still is true and in many instances women are younger than their husbands. That it means that late in life, many women will be alone. Globally, women are younger than their male partners, more likely to age alone tells us that "[t]he pattern of spousal age gaps – and the fact that women tend to live at least a few years longer than men – helps explain another universal theme: Across the world, women are about twice as likely as men to age alone. One-in-five women ages 60 and older live in a solo household (20%), compared with one-in-ten men (11%)." The report looks at religion and geography to measure the extent of this trend. "Rates of living alone over the age of 60 are tied to many factors, including cultural norms, economic development, levels of education and life expectancy. In countries where governments offer fewer retirement benefits or other support systems for older adults, families may face a greater responsibility to provide care."
The next article is from Sunday's New York Times, on the continuing shortage of geriatricians.Older People Need Geriatricians. Where Will They Come From? notes the long-term shortage of geriatricians and explains their importance, using one real-life example to "spotlight the rising need for geriatricians. These doctors not only monitor and coordinate treatment for the many ailments, disabilities and medications their patients contend with, but also help them determine what’s most important for their well-being and quality of life." There's very little progress on closing this gap, according to the article. "An analysis published in 2018 showed that over 16 years, through academic year 2017-18, the number of graduate fellowship programs that train geriatricians, underwritten by Medicare, increased to 210 from 182. That represents virtually no growth when adjusted for the rising United States population."
The article explains why there aren't more doctors going into the field, including the economics realities. One measure to address the shortage is cross-training.
Medical associations representing cardiologists and oncologists have begun focusing on older patients...
Health systems are adopting age-friendly approaches, like specialized emergency rooms. The American College of Surgeons’ new verification program sets standards hospitals should meet to improve results for older patients.
Last month the Senate Committee on Health, Education, Labor and Pensions voted to reauthorize a $41 million program that educates health professionals in geriatrics; it awaits a floor vote. A companion bill has already passed the House of Representatives.
Health professionals increasingly recognize that if they’re not in pediatrics, they will be seeing lots of seniors, whatever their specialty. A 2016 American Medical Association survey, for example, found that close to 40 percent of patients treated by internists and general surgeons were Medicare beneficiaries.
Pay attention to these issues. They will affect all of us either directly or through a family member.
Monday, January 6, 2020
I had blogged previously about meeting with two professors from the School of Social Work at the U. of Missouri. One, Dr. Erin Robinson, was kind enough to write the following blog on this important topic.
The Greying of HIV in America
By: Dr. Erin L. Robinson, MSW, MPH
Assistant Professor, University of Missouri School of Social Work
My name is Dr. Erin Robinson and much of my research focused on older adults, sexual health, and the prevention of HIV. I get a lot of questions about my research, including the need for such research, therefore I am going to share some information with you about the ‘greying of HIV’ in the United States. Over the past decade, older adults have been one of the fastest growing population groups affected by HIV/AIDS in the United States. Currently, 17% of all new HIV infections in the U.S. occur among people ages 50 years and older. This age group also accounts for nearly half of all people currently living with HIV. While the routes of HIV transmission in older adults is similar to that of their younger counterparts, there are some unique factors that contribute to the ‘greying of HIV’ in the U.S. Below are some interesting facts:
Facts about HIV and Aging:
- Older men are disproportionately impacted by HIV, however rates of older heterosexual women becoming newly infected are rapidly growing. This has led to specialized prevention interventions for older, heterosexual women.
- Older African American and Hispanic men and women are disproportionately impacted by HIV.
- 60% of all older adults living with HIV are virally suppressed, which means they have no risk of sexually transmitting the disease to others.
- Older adults are more likely to be diagnosed when HIV is further along in the disease progression (i.e. late-stage HIV). This means treatment options may not be as effective and mortality rates increase. Many of the symptoms for HIV can be similar for other illnesses, therefore if an older person does not test for HIV then they (and their healthcare provider) may attribute the symptoms to other causes.
- HIV can cause dementia-like symptoms, this is called HIV-associated neurocognitive disorders (HAND), AIDS dementia complex, or HIV-associated dementia. However, those symptoms can be reversed with proper HIV medications.
- Over the past few years, new HIV infections have decreased among the aging population. This is due, in part, to tailored prevention interventions among public health officials. However, we still have progress to make in order to curb the disparities.
Why are we seeing this ‘greying of HIV’ in the U.S.?
- Historically, older adults today have higher divorce rates than previous generations. This means older adults are engaging in new romantic relationships at higher rates as well.
- Our older generation today has lived through major historic events that have helped shape their outlook on themselves, their relationships, and their sexuality. This includes the industrial revolution, the 2nd wave of the women’s rights era, the Civil rights movement, the sexual revolution, the gay rights movement, and others.
- Older adults are healthier now than ever before, allowing them to experience sexually satisfying relationships later in life. Over the past 20 years, erectile dysfunction medications have also enabled men to engage in sexual relationships well into their later years.
- After women have reached menopause and can no longer get pregnant, we see lower levels of condom use. This is true for both committed relationships and new sexual encounters with a casual partner.
- Older adults do not perceive themselves to be at risk for STIs and HIV, therefore are less cautious in avoiding transmission.
- A lot of stigma exists around older adults and their sexuality. Many people like to believe that older adults do not engage in sex. Therefore, this creates an environment where older adults feel like they have to hide or deny their sexuality, which exacerbates STI and HIV infection and diagnosis rates.
- Healthcare providers have a difficult time talking to their older patients about their sexual health and HIV. In fact, when there is an age differential and a gender differential between the provider and the older patient, providers report being uncomfortable prompting such conversations. Providers also report that time is a big barrier in initiating such conversations, especially when their older patient has other health concerns.
Thursday, December 19, 2019
The Area Agency on Aging for Pinellas-Pasco (Florida) along with the Pinellas Community Foundation did a Community Assessment Survey of Older Adults (CASOA):
The Community Assessment Survey of Older Adults, or CASOA, is a printed survey that was sent to 10,000 randomly selected households across every Pinellas and Pasco zip code in which at least one resident was known to be aged 60 and over. The Pinellas Community Foundation and the Area Agency on Aging of Pasco-Pinellas joined forces to conduct this comprehensive needs assessment of the area’s aging community.
The survey, which is available here offers key findings in 9 categories:
Overall Community explores how older residents view the community overall, how connected they feel to the community and overall feelings of safety, as well as how likely residents areto recommend and remain in the community.
. . .
Health and Wellness Of all the attributes of aging, health poses the greatest risk and the biggest opportunity for communities to ensure the independence and contributions of their aging populations. Health and wellness, for the purposes of this study, included not only physical and mental health, but issues of independent living and health care.
. . .
Housing The movement in America towards designing more “livable” communities –those with mixed-use neighborhoods, higher-density development, increased connections, shared community spaces and more human-scale design –will become a necessity for communities to age successfully.
. . .
Outdoor Spaces and Building Generally, communities that have planned for older adults tend to emphasize access --access to parks, green spaces, buildings, and places where the public wants to gather. Accessibility of public places in a community has a major effect on older residents’ quality of life, allowing them to remain mobile, access services, participate in productive activities and engage socially.
. . .
Transportation and Streets Mobility access increases the likelihood that seniors will be engaged with the community and the economy. Because the US is currently highly reliant on automobiles, older drivers may become concerned with their dependency on others for transportation because they can become isolated without their motorized mobility. Those that reside in livable communities where they can reach their destinations easily and comfortably on foot or in public transportation are more likely to remain engaged in their communities and to demonstrate signs of successful aging.
. . .
Social Participation, Inclusion and Education Opportunities. A “community” is often greater than the sum of its parts, and having a sense of community entails not only a sense of membership and belonging, but also feelings of emotional and physical safety, trust in the other members of the community and a shared history.
. . .
Volunteer and Civic Engagement Productivity is the touchstone of a thriving old age. This section of the report examines the extent of older adults’ engagement in the Pasco-Pinellascommunity as determined by their time spent attending or viewing civic meetings, volunteering or providing help to others.
. . .
Job Opportunities People in the U.S. are working longer and retiring at an older age than they did 20 years ago. Of all developed countries, the U.S. has the highest labor force participationof adults age 65 and older. Older adults are postponing retirement for a variety of reasons: improved health, to benefit from delayed pension plans, to accumulate additional wealth, and because the knowledge worker economy is less physically demanding than jobs in the economy of 20 years ago. Some experts believe that older workers will become an untapped resource for economic stability when Baby Boomers begin retiring.
. . .
Community Information Sometimes residents of any age fail to take advantage of services offered by a community just because they are not aware of the opportunities. The educationof a large community of older adults is not simple, but when more residents are made aware of attractive, useful and well-designed programs, increasing numbers of residents will benefit from becoming participants.
. . .
The summary of the results are available here.
Sunday, November 10, 2019
Everyone agrees that we need a stronger national commitment to "retirement security" in America. But what, exactly does that mean? This topic will be a central focus for discussion during a Public Forum hosted at Penn State's Dickinson Law on Tuesday, November 12, 2019. The keynote speaker is former Maryland Lt. Governor Kathleen Kennedy Townsend, who is currently the Director of Retirement Security at the Economic Policy Institute, as well as serving as a research professor at Georgetown University.
Along those very lines, last week I read a news article about the latest stalemate at the federal level on specific legislation that could promote better retirement savings. The measure in question is H.R. 1994, the "Setting Every Community Up for Retirement Enhancement" Act -- and of course that name was chosen to reinforce the goal of SECURE futures. The bill passed the House with strong, bipartisan backing in May 2019, but is now mired in the Senate. Excerpts from The Hill describe the roadblocks to passage:
GOP senators on Thursday attempted to bring a House-passed retirement savings bill to the Senate floor with votes on a limited number of amendments, but the effort was rejected by Democrats.
The Republican effort and Democrats' rejection highlighted how, despite widespread bipartisan support and backing from industry groups, it is still unclear when the retirement bill will be enacted.
The House in May in a nearly unanimous vote approved the bill, known as the SECURE Act. The bill includes a host of provisions aimed at making it easier for businesses to offer retirement plans and for people to save for retirement. It also reverses a provision in the 2017 Republican tax-cut law that inadvertently raised taxes on military survivor benefits paid to children....
Sen. Patty Murray (D-Wash.) objected to the Republican request, saying that Senate Democrats want the chamber to pass the House-passed bill as-is, without any amendments.
“We have a few Republican senators who want to sidetrack it with last-minute amendments, including proposals that are not in the interest of working families and will kill any chance this bill has of becoming law,” she said.
Murray asked Toomey to modify his request in order to allow the bill to pass as-is, but Toomey said he wouldn’t modify his request.
For another perspective, see "What is the SECURE Act? How Could It Affect Your Future?"
Sunday, October 13, 2019
NAPSA has announced two resources for the fight vs. elder abuse. The first is an updated version of the National Guidelines for Financial Institutions: Working Together to Protect Older Persons from Financial Abuse. "The Guidelines and forms [are] ... designed to promote standardization and clarity among financial institutions and Adult Protective Services." Note that the guidelines include a variety of useful forms, which are accessible here in addition to their inclusion in the guidelines.
NAPSA also announced the creation of "the National Clearinghouse on Financial Exploitation, your "go to" for for all things related to financial exploitation. The Clearinghouse will provide answers to questions, links to resources, introduction to partners and problem solving to help strengthen our resources and partnerships in our fight against financial exploitation."
Go to NAPSA-Now for more information and resources.
Monday, September 9, 2019
Recently I had the enjoyable experience of being interviewed by Jon Wainwright, Project Manager for the Capital Center for Law and Policy at McGeorge School of Law, University of the Pacific. He asks great questions. His podcast project, CAP-Impact, is a well-developed resource to foster nonpartisan understanding of law and policy, offering a wide array of discussion topics, ranging from the role of lobbyists to science-based support for law reform.
The interview focused on the Guardian Education Project I'm working on currently with community stakeholders, law students (Summer 2019 Team pictured here) and faculty, with financial support from Penn State University. This project is an outgrowth of the Pennsylvania Supreme Court's Elder Law Task Force that recommended changes in procedures and policies governing adult guardianships in Pennsylvania, including better education for new guardians.
For the actual podcast -- about 25 minutes in length -- go to Episode 53: Data Driven Best Practices for Protecting the Elderly with Professor Katherine Pearson.
Don't forget to "like" it -- or whatever is appropriate as support for Jon's podcast project. As he amusingly pointed out, "elder law" isn't usually considered to be a sexy area for researchers, but as he demonstrates, what happens with older adults or others in potential risk of neglect or exploitation, is important!
Sunday, September 8, 2019
With Dorian finally moving on, I thought it would be good for all of us to post something that was happy. So Kiplinger ran an article, 10 of the Happiest Places to Retire in the U.S. According to the article, these "10 retirement destinations rank the highest in terms of the overall well-being of residents." These are Charlottesville, VA; Ann Arbor, MI: Portland, ME;Carlsbad, CA; Durham-Chapel Hill, NC; Cape Coral, FL; Richland, WA;; Provo, UT; Charleston, S.C.; and Burlington, VT. Not having lived in these, I can't comment on if they are happy places to live.
To come up with the rankings, Kiplinger relied on the "Well-Being index" which the article explains " is based specifically on residents' feelings about five elements of well-being: "purpose" (liking what you do and being motivated to achieve goals), "social" (having supportive relationships and love), "financial" (managing your budget to feel secure), "community" (liking where you live) and "physical" (being in good health). " Using this index, then Kiplinger "factored in the "community" and "physical" components of the Well-Being Index, where available, as well as living costs, safety, median incomes and poverty rates for retirement-age residents and the availability of recreational and health care facilities."
The article is available here.
Tuesday, August 27, 2019
We have all had that after lunch afternoon slump where we just want a nap. Do you find yourself napping more than usual? There is a new study on changes to sleep-wake cycles and Alzheimer's. For the non-scientist like me, here's the USA Today story: Napping more? That could be an early symptom of Alzheimer's, new study says.
So wait, don't panic if you are a normal napper. Here's a segment from the article that explains: "People who develop Alzheimer's tend to sleep more during the day, taking naps or feeling drowsy and dosing off. Sometimes, they wake up during the night; that's called fragmented sleep .... If napping is a part of your routine on a regular basis though, you don't need to worry about taking an afternoon snooze, or mid-morning for that matter." So it's all about the change in sleep patterns. Whew.
Here's the abstract for the article about the study.
Sleep-wake disturbances are a common and early feature in Alzheimer's disease (AD). The impact of early tau pathology in wake-promoting neurons (WPNs) remains unclear.
We performed stereology in postmortem brains from AD individuals and healthy controls to identify quantitative differences in morphological metrics in WPNs. Progressive supranuclear palsy (PSP) and corticobasal degeneration were included as disease-specific controls.
The three nuclei studied accumulate considerable amounts of tau inclusions and showed a decrease in neurotransmitter-synthetizing neurons in AD, PSP, and corticobasal degeneration. However, substantial neuronal loss was exclusively found in AD.
WPNs are extremely vulnerable to AD but not to 4 repeat tauopathies. Considering that WPNs are involved early in AD, such degeneration should be included in the models explaining sleep-wake disturbances in AD and considered when designing a clinical intervention. Sparing of WPNs in PSP, a condition featuring hyperinsomnia, suggest that interventions to suppress the arousal system may benefit patients with PSP.
The full study is available here.
Monday, August 19, 2019
The Washington Post offers a feature story on Maine's current care employment crisis for all industries serving frail elders, including nursing, home-care agencies, nursing homes, hospice programs and hospitals. Pointing to one town's dramatic needs, as the demographic "oldest" city in the "oldest" state in the nation, the article makes clear that the problems are likely coming to communities all across the country -- and certainly I have witnessed it first hand in Arizona.
With private help now bid up to $50 an hour, Janet and her two sisters have been forced to do what millions of families in a rapidly aging America have done: take up second, unpaid jobs caring full time for their mother.
“We do not know what to do. We do not know where to go. We are in such dire need of help,” said Flaherty, an insurance saleswoman.
Across Maine, families like the Flahertys are being hammered by two slow-moving demographic forces — the growth of the retirement population and a simultaneous decline in young workers — that have been exacerbated by a national worker shortage pushing up the cost of labor. The unemployment rate in Maine is 3.2 percent, below the national average of 3.7 percent.
The disconnect between Maine’s aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that’s especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show.
In terms of statistics, one "crucial milestone" is the percentage of a population older than 65, the "super-aged" label. In Maine, one-fifth of the state's population is in that category, and by 2026, Maine is predicted to be joined by 15 other states, with another dozen reaching the same level by 2030.
Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling.
There are tough statistical realities to confront, including the tension between living wages for workers and affordability for families paying for care out-of-pocket. One of the subtle issues is how to manage pay. Employment agencies often retain at least half of the dollars charged for hourly care. Families who want or need to pay privately must make a very real decision on whether to pay "on" or "off" the books. For those paying on the books, it means learning to navigate systems for withholding proper amounts for taxes, any insurance and other deductions.
Tuesday, August 6, 2019
With the New Jersey law going into effect last week (August 1, 2019), there are now 8 states that allow medical aid in dying, according to a recent New York Times story, Aid in Dying Soon Will be Available to More Americans. Few Will Choose It.
Maine's law becomes effective September 15, 2019, about 5 weeks from now. So with 9 states providing that option, "by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)" Even with these laws in place, there are still issues facing the patients, the story explains. There is "an overly complicated process of requests and waiting periods" as well as the sections of the law that allows doctors to opt-out, so access may be limited.
The article also discusses why there seems to be a "trend" (if you call 9 states a trend) toward changing attitudes regarding medical aid-in-dying:
All these laws require states to track usage and publish statistics. Their reports show that whether a state has six months or 20 years of experience, the proportion of deaths involving aid in dying (also known, to supporters’ distaste, as physician-assisted suicide) remains tiny, a fraction of a percentage point.
California, for example, in 2017 received the mandated state documents for just 632 people who’d made the necessary two verbal requests to a physician, after which 241 doctors wrote prescriptions for 577 patients. More than 269,000 Californians in all died that year.
With such data showing no slippery slope toward widespread use or abuse, “a lot of the hypothetical claims our opponents made no longer carry so much weight with lawmakers,” said Kim Callinan, chief executive of Compassion & Choices.
There is even a change within the health care profession re: this issue, but there are still opponents to it. Even those who support it may not use it, and the process within the law may provide barriers to patients, according to the article. Safeguards in the laws may be imposing obstacles to some including the waiting period, the 6 month limit and others.
Clearly this is a topic on which we still will see developments. So....stay tuned.
Thursday, August 1, 2019
The Washington Post reported an updated development for Physician-Aided Dying in Oregon. Oregon removes assisted suicide wait for certain patients explains that the governor signed a bill that allows individuals who have 15 or less days to live to skip the 15 day cooling off period.
Those seeking life-ending medications had to make a verbal request for physician-assisted suicide, wait 15 days and then make a written request. They then had to wait an additional 48 hours before obtaining the prescription.
Under the new amendment, doctors can make exceptions to the waiting periods if the patient is likely to die before completing them.
The article discusses the position of those who opposed the amendment and notes that the number of folks availing themselves of PAD remains low.
The number of people who have taken advantage of Oregon’s law has been relatively small. Since it enacted the nation’s first physician-assisted suicide law in 1997, nearly 1,500 people died from taking life-ending medications prescribed to them by a physician. In 2018, about 46 per every 10,000 deaths could be attributed to the state’s death with dignity law, according to state data.
Thursday, July 25, 2019
The Global Brain Health Institute is taking applications for those who are interested in becoming an Atlantic Fellow for Equity in Brain Health at the GBHI.
The Atlantic Fellows for Equity in Brain Health program at GBHI is an opportunity to elevate ...r dedication and contributions to brain health. Applicants should demonstrate a commitment to brain health and health care policy, as well as an ability to implement effective interventions in their home community and to become a regional leader in brain health.
GBHI welcomes applications from people living anywhere in the world and working in a variety of professions. Fellows are typically early and mid-career. At least one-half of fellows will come from outside the US and Ireland, with an initial emphasis on Latin America and the Mediterranean.
Thanks to Sarah Hooper, Executive Director & Adjunct Professor of Law, UCSF/UC Hastings Consortium on Law, Science & Health Policy, Policy Director | Medical-Legal Partnership for Seniors, Senior Atlantic Fellow for Health Equity | Atlantic Institute for sending me the announcement.
Wednesday, July 24, 2019
The Washington Post ran a story with this eye-catching headline, He was deemed too old to be dangerous. Now, at 77, he’s been convicted of another murder.
When we teach elder law, oftentimes the focus is on the elder as a victim, but we do know that an elder can also be a perpetrator. In this case, the perpetrator, who
When he came before a judge in Portland, Maine, in 2010, he was in his late 60s, and had spent roughly a third of his life in prison. After doing time for killing his wife, he had assaulted another woman and gone back to jail, only to get out and attack a third woman. Flick’s violent tendencies didn’t seem likely to go away with age, both the prosecutor and his probation officer warned. But the judge chose to sentence him to just shy of four years in prison, noting that by the time he was released in 2014, he would be 72 or 73.
Here's the crux of the matter--the quote from the judge who sentenced him: "[a]t some point Mr. Flick is going to age out of his capacity to engage in this conduct... , and incarcerating him beyond the time that he ages out doesn’t seem to me to make good sense.” The article notes that statistics support the judge's perspective on this, but those statistics didn't predict the outcome here:
Eight years after that hearing, [he] struck again, fatally stabbing a woman outside a laundromat ... as her 11-year-old twin sons watched. Now 77, he was convicted of murder ... and, this time, it looks likely that he’ll spend the rest of his life in prison. The charges carry a minimum 25-year sentence, and prosecutors plan to request that he be placed behind bars for life.
So to answer the question posed in the title of this post, No, he wasn't too old to commit another murder.
Thursday, July 18, 2019
The Employee Benefits Research Institute (EBRI) has announced a webinar on July 24, 2019 at 2:00 p.m. edt. on Spending Patterns of Older Households and Their Financial Planning Implications.
Here's a description of the webinar:
Please join EBRI for a webinar reviewing findings from its latest research on spending behavior of older Americans. EBRI researcher Zahra Ebrahimi will examine how spending varies by retirement status, wealth, and demographic characteristics. We will then hear from Sharon Carson, Retirement Strategist, Executive Director at J.P. Morgan Asset Management, to understand the implications of these findings in assessing retirement income adequacy for financial planning purposes.
To register for the webinar, click here.
Monday, July 15, 2019
According to a recent story published in Modern Healthcare, Nursing home staffing levels often fall below CMS expectationsfocuses on a new study that "[n]ursing home staffing levels are often lower than what facilities report, which could compromise care quality, new research shows....Self-reported direct staffing time per resident was higher than the CMS' payroll-based metrics 70% of the time, according to a new study published in Health Affairs. Staffing levels were significantly lower during the weekends, particularly for registered nurses."
We know the importance of staffing as a quality measure and ensuring quality of care, so this study is very important. "Researchers compared facility-reported staffing and resident census data and annual inspection survey dates from the Certification and Survey Provider Enhanced Reports to the CMS' long-term care facility Staffing Payroll-Based Journal from 2017 to 2018. The payroll-based data offered a more granular look, showing how staffing evolves over time rather than relying on static point-in-time estimates that were subject to reporting bias and rarely audited...."
When comparing for-profit SNFs with NFP SNFS, the researchers found the for-profits "more likely to report higher staffing numbers ... and [s]taffing levels increased before and during the times of the annual surveys and dropped off after."
The use of payroll data to determine staffing levels has only been in effect a little over a year. The story focuses specifically just on staffing levels. A log-in is required to access the study.
Friday, July 12, 2019
Pew Research has a new Fact Tank, "On average, older adults spend over half their waking hours alone" which explains that "Americans ages 60 and older are alone for more than half of their daily measured time – which includes all waking hours except those spent engaged in personal activities such as grooming. All told, this amounts to about seven hours a day; and among those who live by themselves, alone time rises to over 10 hours a day, according to a new Pew Research Center analysis of Bureau of Labor Statistics data."
That seems like a lot, especially when you compare the "alone-time" for other generations to this one: "people in their 40s and 50s spend about 4 hours and 45 minutes alone, and those younger than 40 spend about three and a half hours a day alone, on average. Moreover, 14% of older Americans report spending all their daily measured time alone, compared with 8% of people younger than 60."
Alone time isn't a bad thing-just ask any introvert-but even too much of a good thing can be ... too much. Alone time "can be a measure [used for] social isolation" which can have a correlation to "negative health outcomes among older adults. Medical experts suspect that lifestyle factors may explain some of this association – for instance, someone who is socially isolated may have less cognitive stimulation and more difficulty staying active or taking their medications. In some cases, social isolation may mean there is no one on hand to help in case of a medical emergency."Living arrangements also play a role in how much time a person is alone. "More than a third (37%) of older adults who live alone report spending all their measured time alone. Among those who live with someone other than a spouse, the average amount of alone time a day is seven and a half hours."
Tuesday, July 9, 2019
Do you plan to retire? If you answer is no, you aren't alone. According to a recent poll in the Associated Press, almost 25% of folks plan to keep work. Poll: 1 in 4 don’t plan to retire despite realities of aging found a possible "disconnection between individuals’ retirement plans and the realities of aging in the workforce." The realities of life ... and aging... "often force older workers to leave their jobs sooner than they’d like." The article notes things like caregiving and health as reasons that cause folks to leave employment. In addition to this nearly 25% who plan to keep working, which "[includes] nearly 2 in 10 of those over 50.... [r]oughly another quarter of Americans say they will continue working beyond their 65th birthday."
The article contains data regarding the impetus to keep working (including financial needs) and the perceptions among those in the workforce regarding the continued employment of older workers:
39% think people staying in the workforce longer is mostly a good thing for American workers, while 29% think it’s more a bad thing and 30% say it makes no difference.
A somewhat higher share, 45%, thinks it has a positive effect on the U.S. economy.
Working Americans who are 50 and older think the trend is more positive than negative for their own careers — 42% to 15%. Those younger than 50 are about as likely to say it’s good for their careers as to say it’s bad.
However, desire and reality aren't always a match. The article also discusses reasons why folks who want to keep working have to leave the workforce.
Thanks to Professor Naomi Cahn for sending me the link to the story.
Wednesday, July 3, 2019
In May, AARP ran a story about research identifying a new dementia that is not Alzheimer's. Is It Alzheimer's ... or LATE? explains about recent results into research of cases that although thought to be Alzheimer's are not. "[A] report published in the medical journal Brain reveals that in cases involving people older than 80, up to 50 percent may, in fact, be caused by a newly identified form of dementia. It's called LATE, which is short for limbic-predominant age-related TDP-43 encephalopathy....The news, published last month, is being heralded as a potential breakthrough, as identifying a new type of dementia could be critical for targeting research — for both LATE and Alzheimer's. In fact, the report included recommended research guidelines as well as diagnostic criteria for LATE." The disease can mimic some aspects of Alzheimer's, the story explains, and it can only be identified in an autopsy.
Here is the abstract from the study:
We describe a recently recognized disease entity, limbic-predominant age-related TDP-43 encephalopathy (LATE). LATE neuropathological change (LATE-NC) is defined by a stereotypical TDP-43 proteinopathy in older adults, with or without coexisting hippocampal sclerosis pathology. LATE-NC is a common TDP-43 proteinopathy, associated with an amnestic dementia syndrome that mimicked Alzheimer’s-type dementia in retrospective autopsy studies. LATE is distinguished from frontotemporal lobar degeneration with TDP-43 pathology based on its epidemiology (LATE generally affects older subjects), and relatively restricted neuroanatomical distribution of TDP-43 proteinopathy. In community-based autopsy cohorts, ∼25% of brains had sufficient burden of LATE-NC to be associated with discernible cognitive impairment. Many subjects with LATE-NC have comorbid brain pathologies, often including amyloid-β plaques and tauopathy. Given that the ‘oldest-old’ are at greatest risk for LATE-NC, and subjects of advanced age constitute a rapidly growing demographic group in many countries, LATE has an expanding but under-recognized impact on public health. For these reasons, a working group was convened to develop diagnostic criteria for LATE, aiming both to stimulate research and to promote awareness of this pathway to dementia. We report consensus-based recommendations including guidelines for diagnosis and staging of LATE-NC. For routine autopsy workup of LATE-NC, an anatomically-based preliminary staging scheme is proposed with TDP-43 immunohistochemistry on tissue from three brain areas, reflecting a hierarchical pattern of brain involvement: amygdala, hippocampus, and middle frontal gyrus. LATE-NC appears to affect the medial temporal lobe structures preferentially, but other areas also are impacted. Neuroimaging studies demonstrated that subjects with LATE-NC also had atrophy in the medial temporal lobes, frontal cortex, and other brain regions. Genetic studies have thus far indicated five genes with risk alleles for LATE-NC: GRN, TMEM106B, ABCC9, KCNMB2, and APOE. The discovery of these genetic risk variants indicate that LATE shares pathogenetic mechanisms with both frontotemporal lobar degeneration and Alzheimer’s disease, but also suggests disease-specific underlying mechanisms. Large gaps remain in our understanding of LATE. For advances in prevention, diagnosis, and treatment, there is an urgent need for research focused on LATE, including in vitro and animal models. An obstacle to clinical progress is lack of diagnostic tools, such as biofluid or neuroimaging biomarkers, for ante-mortem detection of LATE. Development of a disease biomarker would augment observational studies seeking to further define the risk factors, natural history, and clinical features of LATE, as well as eventual subject recruitment for targeted therapies in clinical trials.
The full article is available here as a pdf.