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Aging Well
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Experts seek ways to handle the coming boom in old age
by Patrick Egan T
he tsunami looms: By 2050, nearly 90 million Americans will have passed age 65, and every corner of soci- ety will feel the impact. With our inadequate health-care workforce, outmoded retirement ideas and rigid housing policies, how can our country prepare? Beyond rethinking ways to ensure retirement savings
(mandatory government savings plans?) and redefining retirement (phased retirements? working longer?), re- searchers and professionals are trying out, and in some cases reviving, some ideas.
Branta canadensis maxima
A summer’s worth of breeding has swollen bird populations, with many of them gathering in flocks that increase hazards for pilots.
543
“Tere are at least twice as many birds in the population as in June,” says Richard Dolbeer, a science adviser to the USDA Wildlife Services Program. “Recently fledged birds are inexperienced flyers and foragers . . . and are more likely to be struck by aircraſt than the more experienced adults.”
ILLUSTRATIONS BY MIKE QUON FOR THE WASHINGTON POST
A DOCTOR IN THE HOUSE Older Americans consume the greatest proportion of health-care dollars; people with five or more chronic con- ditions account for two-thirds of all Medicare spending. House calls allow doctors to treat elderly patients with such illnesses before they require expensive hospital visits or a nursing home. Bruce Leff, a geriatrician at
Johns Hopkins University, worked with a research team studying 455 patients who were treated in hospitals and at home over 22 months. The team’s 2005 report found that home treatment cost about 30 percent less than hospital care, because home patients re- quired fewer procedures and improved more quickly. Similar results at other hos- pitals and doctors’ practices have prompted the Independ- ence at Home Act, part of the health-care overhaul; it pro- vides for pilot house-call pro- grams aimed at reducing costs. On home visits, doctors and nurses can do more than write a prescription or take a blood sample. “Within two to three minutes, doctors at home can spot things,” says Leff, the founding director of Johns Hopkins’s Hospital at Home program. “From a physician’s perspec- tive, it is a very satisfying ex- perience,” says Mohamed Aniff, a geriatrician at New York’s Montefiore Hospital, which has 600 patients in its house- call program. Aniff typically spends nearly an hour with each of his patients at home. “We get to go through every- thing.”
CURING AN AILING WORKFORCE
The health-care workforce for older patients is unwell. The country must recruit mil- lions more doctors, nurses and aides with the skills needed for a surging geriatric population. A 2007 study showed a 20 percent decline in the ranks of certified geriatricians over 10 years; only 11 percent of med- ical schools require students to complete a geriatrics rotation. So Sharon Levine, a geriatri- cian, leads the Chief Resident Immersion Training program at Boston University Medical Center, where doctors from across the country gather for weekend boot camps on treat- ing the elderly. William “Skip” Nitardy, an internist at Marshall Univer- sity Medical School in Hun- tington, W.Va., left the immer- sion program with greater knowledge of delirium and more interest in treating the el- derly. “They’ve fought the world wars and built the coun- try, and they deserve our best,” he says. Meanwhile in Wiscon- sin, Cooperative Care provides home care by aides who are both employees and owners of the service, a possible key to re- taining workers in a field known for turnover.
Enthusiasm for the work, plus profit sharing and higher wages, has translated into re- markably low turnover at Co- operative Care: less than 10 percent, a far cry from the 70 percent national rate. Healing the workforce will
take time, but it’s essential. “These are all things that we’ve known about,” says Tracy Har- ris of the Institute of Medicine. “It’s not a pipeline that sudden- ly burst in the ocean.”
FINDING A HOME TO GROW OLD IN
Older adults almost univer-
sally say they want to age in place. “People want to be more in control,” says Maribeth Bersani of the Assisted Living Feder- ation of America.
But most seniors will require some form of care as they age. Some innovative ideas for sen- ior housing: College campus living: About 60 senior living commu- nities have sprouted on college campuses, including Stanford and the University of Michi- gan, offering independent, as- sisted-living and nursing home services, plus university cours- es and activities and a multi- generational environment. At Stanford, where the Hy-
att-built community requires a deposit of more than $1 mil- lion, “very few people end up going to the nursing home or assisted living center,” says Vic- tor Regnier, gerontologist and architect at the University of Southern California. “They’ll stay in their own apartments.” Apartments for life: Al- ready prevalent throughout northern Europe, these mixed- age complexes offer private units with home-care services available. In contrast to sprawl- ing suburban campuses, these urban buildings promote activ- ity and independence with medical services close by. Accessory dwelling units: Modular homes constructed on the same property as a family member’s house, these allow seniors to live independently while receiving care from fami- ly; when occupants move or die, the unit can be removed or resold.
FROM HOSPITAL HALLS TO CYBERSPACE: TELEMEDICINE
Imagine a 75-year-old receiv- ing wireless medication re- minders, straight to his beep- ing wristband. Or an 80-year- old with a new hip, linked by body sensors to a device em- bedded in her carpet that tracks her movement patterns in case her mobility worsens. In the future, we are going to
start seeing telemedicine “as part of the medical home,” says Dale Alverson, medical direc- tor at the Center for Telehealth and Cybermedicine Research at the University of New Mexi- co.
Although developers and ad-
vocates have promoted tele- medicine for years, Alice Borel- li of Intel points to barriers — including Medicare reimburse- ment policies and inadequate broadband in parts of the country — that have kept tele- medicine a mostly conceptual solution.
One supposed barrier, wari- ness of new gadgets, may prove unfounded. “I was shocked; they love the technology,” says Laurie Chichester, who directs home-care services at the Met- ropolitan Jewish Health Sys- tem in New York, where 170 pa- tients use remote monitoring. Telemedicine can’t replace hospitals or nursing homes, but it can delay the need for them. “We can move 30 to 40 percent of health care to the home,” Borelli says.
health-science@washpost.com
Josh Tapper, Alex Berg and Sharaf Mowjood contributed to this report. Along with Egan, they are fellows of News21.
Aircraſt bird strikes, 1990-2009 BY MONTH
12,000 8,000 4,000 BY YEAR 9,163
TUESDAY, AUGUST 10, 2010
The changing natural world at our doorsteps. URBAN JUNGLE
More birds, more flights, more strikes Aircraſt collisions with birds reach a yearly peak in August.
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In the past 20 years, populations of large birds such as pelicans, eagles and geese have been steadily increasing, which has led to many more reported collisions with an ever-expanding fleet of airliners. Since 1990, 24 people have died in 10 such strikes in North America.
Airliners have become more vulnerable to the effects of colliding with birds. Te more engines an airliner has, the less likely it is to be brought down by striking a flock. In the past two decades, two-engine aircraſt have all but replaced three- and four-engine jets.
Commercial turbojet aircraſt 1990-2008, U.S.
3 engines
In January 2009, a US Airways flight departing New York’s La Guardia Airport narrowly averted disaster when the Airbus 320’s two engines failed aſter thrusting through a flock of Canada geese. Pilot C.B. “Sully” Sullenberger managed to land in the Hudson River; all aboard were rescued before the jet sank.
1,438 2,278
432 4 engines
237 373
In the past 20 years, more than 1,200 Canada geese have been been hit by civil aircraſt.
Te abundance of nonmigratory giant Canada geese (a nine-pound jumbo subspecies) has mushroomed fourfold since 1990. Unlike their smaller migratory cousins, these geese generally stay put year-round, creating constant jeopardy for air traffic.
Giant Canada geese 1990-2008, IN MILLIONS
Te USDA’s Airport Wildlife Hazards Program assists with several methods for reducing goose hazards:
4 2 0
• Egg addling involves coating goose eggs with corn oil, which prevents respiration, halting embryo development.
• Harassment with pyrotechnic devices and other methods. Te technique may drive the birds a few miles away, but they tend to return.
• Habitat alteration converts areas surrounding the airport into less- desirable goose territory. Access to water is blocked; grass that is unattractive to geese is planted and mowed to discourage both grazing and nesting.
• Depredation: Geese are shot or rounded up and gassed with carbon dioxide. If a poultry processing plant is available, the carcasses may be donated to a food bank; if not, they’re either studied by scientists or buried.
SOURCES: FAA; USDA; Michael J. Begier, national coordinator, Airport Wildlife Hazards Program PATTERSON CLARK/THE WASHINGTON POST
clarkp@washpost.com
ALCOHOLISM RUINS LIVES... Journalism program helped produce this week’s special section
Several stories in this week’s Health and Science section were produced in conjunction with Columbia University’s Graduate School of Journalism and News21, a program promoting innovation in journalism with funding from the Knight Foundation and Carnegie Corporation. This year’s Columbia’s News21 fellows focused on aging. “Brave Old World,” their report on a graying nation, will appear at
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