To tackle aging as a major risk factor for chronic disease, we need to develop a more aggressive public-private investment strategy in prevention and health promotion.
On the private side, as the Medicines in Development for Older Americans report shows, biopharmaceutical research companies are developing over 400 medications for the top chronic diseases to allow these older adults to live a better and in some cases longer life.
On the public side, it is about investing in federal programs such as nutrition. For example, studies have shown that the top three chronic conditions (hypertension, diabetes and high cholesterol) that affect 87 percent of older people could be prevented with better nutrition. Federal programs that provide better nutrition for older adults such as the Older Americans Act can also save billions in future Medicare and Medicaid costs because home- and community-based nutrition programs are far less expensive than hospitals and nursing homes. For the cost of one day in a nursing home, an older adult can receive nutritious meals for a year under Older Americans Act congregate or home-delivered meals programs.
Finally, aging as a risk factor in chronic disease can be alleviated with a higher degree of personal commitment to prevention and wellness. One of the more obvious forms of prevention (also noted in the report) is medication adherence. Drugs provide fewer benefits when not taken properly. In part, Medicare Part D and lower costs for older adults with the Affordable Care Act’s implementation are working together to solve this problem.
One of the great achievements of the last 100 years has been the significant increase in the lifespan of Americans. By 2050 it is estimated that 20 percent of the total U.S. population will be over the age of 65. While this is something to celebrate, there is also a downside. With the expected growth of the aging population, we expect to see a significant rise in many chronic diseases where age is a major risk factor.
The effects age-related chronic disease are immense both to the person experiencing them and society. Diseases like Alzheimer’s disease, frailty, diabetes, cardiovascular disease and stroke contribute to a decrease in quality of life, a precipitous increase in health care expenses and growing burdens on caregivers. Faced with these challenges, we need to find interventions for these chronic diseases so people not only enjoy longer lifespans, but longer healthspans as well.
The answer many leading scientists point to is to better understand how our bodies age. Research has uncovered common links between the way our bodies age and why we develop diseases. It is becoming evident that by slowing the aging process itself, we can postpone or even eliminate many costly chronic diseases. To do this, we must provide more funding for aging research in the public and private sectors.
The Pharmaceutical Researchers and Manufacturers of America reported this week that there are 435 medicines in development for diseases affecting older Americans, but of the$30 billion Congress allocates to the National Institutes of Health (NIH), less than 1 percent is spent on aging research. The National Institute on Aging, the NIH’s lead institute for aging research, receives about $1.1 billion annually. This figure, while impressive, does not do enough to adequately fund research targeting the process of aging and how it underpins chronic disease. The Alliance for Aging Research, through its Healthspan Campaign and Friends of the NIA Coalition, has called on Congress to substantially increase funding for aging research across the NIH.
If we are able to increase the length of healthy aging, the impact would be tremendous. A recent article in Health Affairs noted that if healthy life expectancy could be extended by 2.2 years, it would result in an added economic value of $7.1 trillion to the economy over the next 50 years. That would be for just a modest boost, imagine the benefits if healthspan could be increased over one or two decades!
Cynthia Bens is the Vice President of Public Policy at the not-for-profit Alliance for Aging Research in Washington, D.C. In this capacity, Ms. Bens is responsible for guiding the organization’s federal policy work, representing the Alliance in multiple national coalitions, and directing all aspects of the Accelerate Cure/Treatments for Alzheimer’s Disease (ACT-AD) and Aging in Motion (AIM) coalitions. Ms. Bens sits on the Alliance for a Stronger FDA Board of Directors and is a Founding Executive Committee Member of Friends of the National Institute on Aging (FoNIA). She has served on the Steering Committee of the Partnership to Improve Patient Care (PIPC) since 2008 and is the sole patient adviser to the FDA Subcommittee of BIOCOM, the largest regional life science association in the world, representing more than 550 companies in Southern California.
For the past 12 years Ms. Bens has worked to inform federal policymakers and educate the public on a variety of issues. For more than half of that time her efforts have centered on the formulation of policies to expedite the development of interventions to treat and prevent many debilitating age-related disease; to remove access barriers to needed treatments and therapies; and to improve the coordination and quality of care seniors receive. Since 2010, Ms. Bens has been the only patient stakeholder from the aging community consistently advocating before the U.S. Food and Drug Administration and the U.S. Congress for enhancements to the FDA’s user fee programs that would improve the development of treatments and medical devices intended for use by people 65 and older. These enhancements were codified in the Food and Drug Administration Safety and Innovation Act (FDASIA). Ms. Bens has also led advocacy efforts to elevate the profile of basic research into aging funded by all institutes and centers (ICs) at the National Institutes of Health (NIH). This advocacy led to the creation of a trans-NIH Geroscience Interest Group (GSIG) comprised of more than 20 NIH ICs, including the National Institute on Aging, the National Cancer Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung and Blood Institute, and National Institute of Neurological Diseases and Stroke, among others.
Prior to joining the Alliance in 2006, Ms. Bens was a senior manager of government affairs with the Loeffler Group. As part of its federal government affairs practice, she represented diverse client interests before the U.S. Congress and the administration. Her core areas of focus included appropriations, budget, health care, education, telecommunications, and international trade. Through various other positions on Capitol Hill and in the private sector, she has acquired extensive experience researching and analyzing federal legislation and regulations. Ms. Bens holds a Bachelors of Arts degree from New York University with concentrations in Political Science and Women’s Studies.
According to the Agency for Healthcare Research and Quality, (a division of U.S. Health and Human Services Department), the number of Americans who will suffer functional disability due to a chronic disease is expected to increase at least 300 percent by 2049. Currently, almost 75 percent of the elderly (age 65 and over) have at least one chronic illness and 50 percent have at least two chronic illnesses. Aging is an important marker of the accumulation of risks for chronic disease. A prevention- focused paradigm is necessary to break this trend.
Disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. Chronic diseases related to unhealthy diet, physical inactivity, sedentary life-style, depression and unhealthy weight are highly prevalent among older adults. Treatment and prevention practices that extend mobility, encourage productive life-style behaviors and advance health-centered communities would help reduce the burden of chronic disease in an ageing population.
Health care services with comprehensive access, urban design, social policy, healthy neighborhood environments and community services can operate in ways which reduce chronic disease risks through supporting individuals to make healthier lifestyle choices. Community and society level interactions with advocacy engagements can result in changes to policies, services and environments that can influence and support healthier individual behaviors.
Society-level factors affecting maintenance of a healthy lifestyle must be framed around the needs and perceptions of the elderly that include their health system and delivery, workplace flexibility, education of chronic disease prevention practices. They must also include cultural competency, social policy, and the norms of living for older persons.
Community-level factors considered for healthy life-styles of our maturing population include interpersonal relations, social networks, and local physical environments and services. Skillful engagement of disease- centered organizations and community organizations to assist with healthy life-style initiatives for the elderly would help extend standards of care for the prevention of chronic disease.
Individual factors that impact the success of healthy life-style interventions in this age group include self-worth, knowledge and beliefs, health literacy, health costs, ensuring a ‘health home’ and perceived health benefits.
Successful chronic disease prevention programs delivered via primary care providers, nurses and other allied health practitioners will help create supportive communities that successfully provide services to a maturing populace. “Health home’ clinics would provide preventive services including screening, counselling, chemoprophylaxis, and immunizations that would create a safe and comfortable place for the ageing to receive their care. An extensive launch of prevention education through social marketing campaigns (via television, internet and print) focusing on nutrition, physical movement and healthy life-style behavior would effectively increase knowledge about the health benefits beyond chronic illness management to a prevention health model that promotes personal participation of the elderly community.
In addition, a call to action of a maturing population for volunteerism, mentoring and advocacy engagement could provide resources that will promote the health and wellbeing of the individual and strengthen their wellness community.
Dorothy Leone-Glasser, RPN, HHC, has lived with systemic lupus for over thirty-five years. As a result, she has overcome two forms of cancer, disabling arthritis, kidney failure, a coma, heart attack, and two strokes. During this time she graduated from a wheelchair to crutches to ultimately walking with her own two feet. Between the ages of 20 and 37, Dorothy received three death sentences imposed by her doctors. Today she is not only alive, but she is living well and paving the way to the future of wellness as President and CEO of the Advocates for Responsible Care (ARxC), a non-profit wellness and advocacy organization.
As Dorothy drove her wheelchair, she also drove her career. Dorothy’s philosophy, “Illness lives in the mind, plays out in the body, and comes to a place of peace in the spirit of wellness” was the compelling energy behind her success.
She earned degrees in counseling, nursing, and theology to master the art of the mind, body, and spirit connection. Although this holistic approach to healthcare is popular today, for many years Dorothy has been a leader in its implementation through her private practice in counseling and public speaking. Empowering others with her personal philosophy and raising a strong voice of advocacy, Dorothy has taught countless others how to “live wise and live well.”
As she simultaneously conquered her personal challenges and enlightened individuals with chronic illness, Dorothy also designed and delivered the life-style engineering technology tools that her patients need to apply her lessons. One of these is a comprehensive integrated wellness and stress management program so aptly called, “The Coping Program®.” This program won Dorothy the Outstanding Patient-Community Service Program Award by the National Arthritis Foundation in 1990. In 1993, the Arthritis Foundation presented her with the Dorothy Day Humanitarian Award for pioneering this program. Finally, in 1998, when the Arthritis Foundation was celebrating its 50th year Anniversary, it awarded her the honor of being one of only 50 selected Heroes Living with Arthritis and appointed her one of three ambassadors representing all of the heroes nationwide.
Dorothy is a hero among us. Not only for what she has endured and overcome, but also for what she has consistently and generously given to others over the years. She is a twenty-nine year member of the Board of Directors at the Arthritis Foundation. She currently serves as the Advocacy and Disparities populations Chair on the Leadership Council for the SE Region of AF. Dorothy provides advocacy consulting to numerous organizations, societies and patient groups. She facilitates an ongoing patient group ARxC STARS that empowers its members to promote wellness and prevention practices along with being active healthcare advocates. She has published countless materials educating patients about harmonizing the mind, body and spirit. Dorothy is frequently seen and heard on TV, radio, and print media. She promotes using nutraceuticals as part of a complete wellness plan.
After completing her degrees from City University in New York, Dorothy completed a three-year internship in Chronic Illness and Family Counseling from Columbia-Presbyterian Hospital in New York. She is also ordained and certified with a ministry degree in Comparative Religions, in the order of St. Francis. Dorothy resides in Atlanta, Georgia where she founded the Wisdom of Wellness Project, LLC. She is now founder and the CEO of the Advocates for Responsible Care (ARxC) a non-profit 501(c) 3 organization.
On July 22, 2005, Dorothy was asked to speak to a crowd of 4,200 citizens, legislators, and community and civic leaders, at the Atlanta Civic Center, in Atlanta, GA, with President George W. Bush. They discussed the new Medicare Modernization Act and Dorothy’s experiences and insights educating people on the new Medicare benefits and enrollment for Part D prescription drug coverage.
Once a full time wellness counselor, Dorothy is now a motivational speaker, author, media personality, and resilient healthcare advocate. She regularly holds seminars on Manifesting Wellness, The Wisdom of Stress Reduction, and Advocacy: Mission Possible, Strengthening Support and Advocacy Groups and The Wisdom of Internal and Environmental Health. She testifies before congressional committees and local government Boards on health care advocacy issues and has been recognized by the National Association of Professional Women.
Along with her ARxC Program Director, Dorothy is currently writing an Advocacy and Medical Insurance Wellness Guide. Components of ARxC’s Georgia Wellness Initiative will be part of the prevention and wellness incentives in a new best practice template for health insurance; ARxC Medical Insurance Collective for Georgia. ARxC is conducting a Health Plan Survey on line to assess what Georgians need and want from their health insurance plan.
The Advocates for Responsible Care have always been actively involved in advocating for full access to medications and medical care with an emphasis on reducing health disparities. In 2011, ARxC, with Georgia Bio, took the lead to organize the Specialty Tiers Coalition of Georgia consisting of 18 health organizations, who will assist in implementing legislation that will end the dangerous cost-shifting practice of patients paying prohibitive out of pocket amounts for their life-saving prescription drugs.
As the representative of the patients of the Grady Dialysis Crisis, ARxC directs negotiations of their long term treatments and working toward a permanent solution to their care. In December 2010, Dorothy received the Mundo Hispanico Award, Amigo de los Hispanos, for her work in advocating for dialysis patients who were in jeopardy of dying without dialysis treatment. ARxC continues to lead the call to action for Specialty Tiers Legislation and a best practice template for a Health Insurance collective for Georgia.
When I think of preventive care, I think of a person who enjoys life, however, when I think of acute care, I am reminded of a person who really does not care, a person who has no concerns of ever being sick. Many have the rationale that we all have to die with something. This is saying to me; do I choose, life, death, pain, suffering, surgery, therapy? There is no question for me; I choose LIFE.
My imagination would run away with me if I had not followed the steps which I did when I had symptoms which made me feel as if I was losing my mind and thinking death was my only alternative.
The experiences I had 5 years prior to being diagnosed with lupus were unreal. Chest pains, fingers turning red, white, and blue, my hair falling out, a dark spot inside my ear, excruciating joint pain. The only thing I knew to do was to go see my family doctor for all of the symptoms. My body continued to go downhill with 2 hospital stays, fluid drawn from my lungs, a lung biopsy, and kidney problems. Finally, one doctor said you have lupus but he could not explain the disease. He gave me an article to read which stated I would die after about 10 years of being diagnosed.
Many days and years have gone by and I often wonder would I be alive if I had not gone to seek medical help. Doctors coming into my hospital room telling me that I would not make it were frightening. The excruciating pain and the many problems I had, death was the only way out. After officially being diagnosed with lupus and being treated, my will to live was back. I am thankful for doctors having the knowledge to diagnose, and treat patients with medications, surgery, therapy and other methods to give us all a better quality of life.
Preventive Care is the only way we all should go. Lives are saved because of preventive care. Lupus is one disease which does not have any preventive care methods but you can live a relatively normal life with lifestyle changes, being monitored by a Rheumatologist the rest of the patient’s life (see the Rheumatologist every 4 months without being sick), see the Rheumatologist when you are sick, listen to your body with all diseases, follow the physicians’ instructions in taking all medications and lifestyle, eat healthy, exercise, stay away from stress (especially with lupus). Your health is very important. Preventive Care can eliminate some pain and suffering, and most important, save your life. There is literally nothing doctors can do for a lupus patient but to make him/her more comfortable. Sure, you can go into remission but it is not often that this remission will last a lifetime, lupus flares come and go. There is no medication to take it away, there is no surgery to remove the disease, and there is neither therapy nor treatment to remove LUPUS. Therefore, the best thing for a lupus patient to do for this cruel and complex disease is follow the doctors’ orders completely.
I was born in Chicago, Illinois and raised in Indiana. I graduated from Oxford Business College in Chicago, Illinois. My marriage of 52 years produced 2 sons.
Diagnosed with Systemic Lupus Erythematosus February 1986 at Mayo Clinic was a frightening experience for me which lead me to join a Lupus Support Group in Indiana. The Lupus Foundation of America, Inc. requested that I start a lupus support group in Arkansas after we moved to Hot Springs, Arkansas. This support group was started October 1993 and May 1995, we became a chapter.
The support group in Indiana gave me my life back and I wanted to do the same for other lupus patients. We have been in existence for over 20 years and we have made many accomplishments. The volunteer hours we put forth as a group have paid off tremendously.
I am a published author of “How Strong is Strong” which was published shortly after my diagnosis of lupus.
My other activities basically include working at my church as a teacher for the Mixed Adult Class at Greater St. Paul Baptist Church in Hot Springs. I also serve as one of the first female Trustees, hosting clerk, Assistant church clerk, and a member of Circle No. 3. I was recognized in our local newspaper, “The Sentinel-Record” as one of 18 influential leaders in our community who have offered a helping hand and made a positive impact on others’ lives with their accomplishments, November 2013.
The answer is a multi-pronged approach based on a very simple premise: healthy seniors live happier more productive lives and save tax dollars through reduced healthcare expenditures.
Essentially, mitigating risk factors comes down to education and providing access to building blocks of good health. The Medicines in Development for Older Americans report clearly shows the importance of educating seniors about the correlations of medication adherence to staying healthy and out of the hospital.
A great example is treatment for solvable conditions such as high cholesterol and the resulting impact on the serious, and costly, consequences of heart disease.
The ultimate responsibility for someone’s health is themselves. That is why knowledge, access to good health practices and a support network are critical if we are to improve patient outcomes. While the new medications outlined in the report are a critical part of the puzzle, it is imperative that access to other safety-net services like senior nutrition programs, affordable housing, exercise and socialization must be factored in as well.
Paul Downey became President/CEO of Serving Seniors (formerly Senior Community Centers) in 1995 and has guided the agency’s innovative efforts to provide supportive services focused on keeping low-income seniors healthy and independent. Nutritious meals (breakfast and lunch) are provided 365 days per year to over 2,200 seniors at 10 sites in San Diego County.
Serving Seniors’ flagship facility, the Gary and Mary West Senior Wellness Center, provides case management, healthcare utilizing the latest in wireless technology, mental healthcare, life-long learning and civic engagement for the seniors. It is already considered a national model for the comprehensive provision of supportive services for seniors in poverty.
Paul has been a leader in the fight to provide affordable housing for seniors. He opened a 200-unit, low-income, senior housing complex called Potiker Family Senior Residence in downtown San Diego in August of 2003. He opened a second project, a 150-unit affordable housing complex for seniors in City Heights, in August 2007. The agency also operates transitional housing for homeless seniors.
He is the immediate past-President of the National Association of Nutrition and Aging Services Programs (NANASP) based in Washington DC and a Steering Committee Member for the California Elder Economic Standard Initiative. In August 2012, Paul was appointed to the California Commission on Aging by Assembly then-Speaker John A. Pérez. Diane Jacob, Chair of the San Diego County Board of Supervisors, appointed Paul in September 2013 to the County’s Social Services Advisory Board. He is past chair of the City of San Diego’s Senior Affairs Advisory Board and past chair of the Dean’s Advisory Committee for the College of Health and Human Services at San Diego State University.
He is a graduate of San Diego State University with a degree in journalism. In July 2010, he completed a certificate program in Strategic Perspectives in Non-Profit Management from Harvard Business School.
We’ve all heard the statement, “50 is the new 40” or “60 is the new 50” or (any decade) is the new (previous decade minus 10). What these statements boil down to is the fact that we are healthier and living longer. New medicines, new treatments, earlier diagnosis and a healthier environment have all helped us live longer. But living longer isn’t better if our quality of life doesn’t let us enjoy those added years and the impact on the cost to the healthcare system can be enormous. Chronic disease is almost solely a product of living longer and has a huge impact on both the quality of life and cost.
Those who have already written on this conversation have detailed some important issues to consider. I will touch on two points that I think are important, aging in place and adherence to doctor’s prescription for healing, especially when it comes to medicine.
It has been shown that older people our healthier and recover quicker from illness when they are in their own home. It’s also true that the cost to the healthcare system is much lower when seniors are in their home rather than in any type of institutional facility. While chronic illness(s) can add complications to giving care at home, an increase in communication and coordination between the caregiver and the healthcare provider can overcome these barriers. Public policy that encourages aging in place is key to lowering costs.
Adherence will be enhanced by this increase in communication and coordination but we should continue to pursue every avenue to encourage and promote adherence to our doctor’s prescriptions for treatment and medicine. Innovations in monitoring technology gives us added hope that we can make great strides in adherence. It is important to note that vaccines are a key (but often overlooked) part of the adherence success formula.
Chronic disease is a cloud that can dim the joy of living longer. Aging in place and adherence to our prescriptions for healing can push those clouds aside and let us enjoy those added years to the fullest.
After graduating with a degree in data processing Thair Phillips joined the Air Force and spent 8 years as a B-52 bombardier and a war planning specialist. After the Air Force he worked extensively in the computer field as a system developer, project manager, and formed his own business as a systems consultant. Later Mr. Phillips transitioned into the public policy arena where he served as the executive director of the National Subacute Care Association and then as the CEO of the nationwide Seniors Coalition. He now serves as RetireSafe’s President, an organization of 400,000 nationwide supporters dedicated to preserving the options and benefits of older Americans through advocacy, education, and the power of free markets.
Alzheimer’s disease, the most common form of dementia, is largely a disease of age. The longer a person lives the more likely they are to be diagnosed with Alzheimer’s. In fact, almost half of those over age 85 have Alzheimer’s type dementia. As our natural lifespan increases the number of people with Alzheimer’s disease will increase as well. Couple this with the aging of America and the baby boomer generation reaching the age where Alzheimer’s typically strikes and a looming crisis begins to emerge. This dramatic increase of Alzheimer’s cases will substantially impact state and federal budgets if we don’t find a cure or better medications to treat the disease.
Until new drugs reach market we will need to focus on prevention and finding new and innovative methods to help people with dementia remain in a community based setting for as long as possible. The average cost of nursing home care for someone with Alzheimer’s disease is over $90,000 per year and in the majority of nursing homes Medicaid is the primary payer. If we can delay institutionalization for even a brief period of time we will save an enormous amount of money.
Diet, exercise and maintaining brain health as well as overall body health are the best methods of preventing or delaying the onset of the disease that we know of today. We know that there is a relationship between brain health and heart health so we recommend eating heart healthy foods and regular exercise to keep the heart healthy. However, there is no guarantee no matter what a person does that they will not get Alzheimer’s disease. There is a great deal we still don’t know about the pathology of the brain and of the Alzheimer’s disease process. Only additional research will allow us to unlock the secrets we need to discover in order to develop new medications to treat and ultimately cure Alzheimer’s disease.
Rob is a graduate of Edgewood College in Madison, Wisconsin where he majored in Public Policy Administration and began his political career with an internship in the office of a State Representative. Rob is currently the Public Policy Director of the Alzheimer’s and Dementia Alliance of Wisconsin where he has served for the past 15 years. The Alzheimer's & Dementia Alliance of Wisconsin is a nonprofit organization that is specifically designed to provide a link to resources for people with Alzheimer's disease or related dementias and Alzheimer’s caregivers. The Alliance mission is to help caregivers take care of themselves, as well as provide a quality life for the person with Alzheimer's disease or a related dementia. The Alliance provides information and resources regarding Alzheimer's disease and related dementias and strives to find state based public policy solutions to statewide Alzheimer’s issues. Rob also chairs the Wisconsin Healthcare Access Network, formed to serve as a communications and resource network to keep its partners informed on access to quality healthcare issues.
Increasing patient care and access to medications as a way to tackle chronic disease is a vital consideration for the health of our senior generation.
I am an Officer of an organization that advocates for an increase in care with a focus on helping people at the individual level. As Americans live longer, we believe that care should focus more on the individual receiving care and not primarily on the system to which administers it.
Since patients by nature are from a wide variety of backgrounds with complex and unique health histories, the approach to care must focus on the individual. Such a focus would minimize health care costs as recipients feel more connection with their health care provider and are able to receive more personalized treatments and medicines. Ultimately, our goal should be to provide patients with more access to their doctors and enable people to deal with issues early instead of waiting for problems to worsen before addressing them.
Increasing patient access to care and innovative medicines would create a dynamic shift in health care and result in a decrease of some of the most prominent chronic diseases that affect the aging population, such as diabetes, heart disease, and Alzheimer’s. According to a new study released by PhRMA this month, there are currently more than 430 innovative medicines being developed by biopharmaceutical companies to address chronic disease in older Americans. This is great news for the health of older Americans, but we need to ensure that patients have access to these innovative medicines and personalized treatments in order to prevent and effectively manage costly chronic disease in our country.
As Americans live longer, chronic disease becomes more of a threat, and increasing individual access to personal health care is vital for success. We believe that the best thing we can do for preventive care is reduce the barriers separating people from their health care professionals and the medicines they count on. If we can grow doctor-patient time and decrease wait time, people will be more inclined to receive care early rather than waiting.
Our current health care system is difficult to navigate, leading people to forgo seeing their doctor which is troublesome and only adds more cases of chronic diseases unchecked. Decreasing the role of the middle-man in health care will increase people's ability to get healthy and stay healthy, and thereby decrease the staggering rates of chronic disease in our aging population.
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