Life expectancy in the United States has reached an all time high of 78, though at 30th on the list, we still lag behind many other countries. Japan is near the top of the list in life expectancy, 83 years for children born in 2006, according to World Health Organization data. Switzerland and Australia were ranked high.

Life expectancy is defined as the period a child born in 2006 is expected to live when assuming mortality trends remain constant. This increase in life expectancy is due to the falling mortality rates in almost all the leading causes of death such as heart disease, cancer and stroke.

Some interesting facts to note from this preliminary report from the National Center for Health Statistics are that Alzheimer’s disease passed diabetes to become the sixth leading cause of death in the United States in 2006 and death rates for flu and pneumonia had a 12.8 percent decline between 2005 and 2006.

Women still live longer than men, though the gap is closing, possibly due to an increase in female smokers.

People may be living longer, but the statistics don’t always speak to the state of health and the needs of seniors, and more people living longer will mean an increased demand for all types of senior care services.

Additionally, the increased demand for already limited nursing home beds may eventually mean that only the sickest seniors will be admitted, further taxing the system and the need for community based services will become even more important.

Nintendo’s Wii gaming system is all the rage, but a large subset of its many fans are senior citizens.

The Wii is sweeping retirement communities and seniors are able to participate in games they once enjoyed because the motions of the games approximate sports like tennis, golf or bowling, and people of all ability levels can participate.

Retirement communities and seniors are embracing the new Wii Fit for fun and exercise, and even rehabilitation, termed “Wiihab”:

“Fitness-oriented video games are also being used more and more in nursing homes for rehabilitation,” Stanley-Green said, providing a fun way to help elderly people expand their range of motion.

There’s also a little competition going on, too.

Last year, an 84-year-old woman beat a real-life bowling champ in Wii bowling at a Washington DC nursing home, and other seniors are hoping to get enough practice to challenge their grandchildren to a game or two.

Some nursing homes even have area children come in and instruct the residents in the games and it benefits both the residents and the young instructors. The residents enjoy the children and the familiar Wii can make children feel more comfortable in a sometimes scary place.

No matter the motivation, older people are benefiting from the the Wii with new activities, increased mobility and socialization. However, with so many seniors using the Wii, I’d like to see some games marketed just for them.

Hope is a person. She is my frail mother-in-law, who just turned 70. Not so old, in today’s world of super-seniors, but Hope has severe mobility challenges that reach back to when she was an infant, born in a tiny mountain-side village in Greece, a place (at the time) that had yet to meet modern medicine.

Yesterday evening I received a frantic phone call from one of her four sisters, who lives nearby. Hope had fallen in the grocery store two days prior, was badly hurt, and refuses to see a doctor. Her forehead is badly bruised, as is her nose, and her left eye is swollen shut. “I don’t think she can live alone,” said her sister.

Her sister is right. My husband and I have been worried about Hope’s mobility for years. We’ve been worried about just this very scene, or worse, where she gets injured in a fall. (Under the worse scenerio, she falls in the middle of the busy four-lane street that separates her condo from the shopping center that includes said grocery.)

Last year I bought Hope a small walker, and tried to disguise it as a birthday gift. “If she just had a little support,” I thought, “I would feel better about her walking around on her own. Plus drivers and pedestrians might be more likely to help if they saw the walker.”

I knew she wouldn’t want the walker. She is fiercely independent — read “stubborn” — which likely has something to do with the fact that she was raised in terrible poverty in a war-torn country but managed to get to the U.S. as a young girl and make her way in a strange country, largely on her own.

So I asked my 9-year-old son, the apple of Hope’s eye, to give her the walker. Which he did. This caused her to pause for a minute or two before she turned it down. She said she didn’t need it, that she could move around better using two canes, and besides, she said, it didn’t fit in her condo. (Never mind that we specifically wanted her to use it outside her condo.)

My husband, who is traveling on business, called his mother immediately. She claimed she would go to the hospital, an easy promise to make to someone hundreds of miles away, on the far end of a phone line. But, he added, it wasn’t clear when, how, and where she would be going. Vagueness, after all, is one of her avoidance strategies.

So where from here? I welcome your ideas, advice, suggestions, and tips.

-Lori Woehrle

There’s a new law in the State of Tennessee that expands home and community care for senior citizens. The Long-Term Care Community Choices Act of 2008 shifts money from nursing homes to community and home care options for the elderly and disabled.

The law allows for a more even distribution of TennCare (Tennessee’s managed care program) funds between traditional nursing homes and home and community-based programs. Prior to the new law, nursing homes received 98 percent of long-term care funds in Tennessee.

It’s significant in that currently, Tennessee ranks last in the nation in funding for alternatives to nursing homes.

Seniors not on TennCare benefitted from the legislative session as well. According to the AARP:

Lawmakers also voted to increase funding by nearly $4 million beginning July 1 this year for the Options for Community Living program. The program, administered by the state’s Area Agencies on Aging and Disabilities, provides funds for homemaker services, home delivered meals and caregiving services for the elderly or disabled who are not eligible for TennCare.

While public opinion is positive, I am sensitive to the nursing homes who will be affected by this new law. My mother was in a nursing home and we were very pleased with the care, and they did some great things with very limited resources.

Two things concern me about this new legislation: that the new home care options will cause a boom in home health businesses that will need to be watched closely, and, with seniors able to remain at home for longer, nursing home patients will be sicker and require more care at facilities receiving less money.

But, both concerns were addressed by Governor Phil Bredesen:

The legislation will also provide additional money to nursing homes that care for seriously ill patients who need more attention, and it creates a state ombudsman position to oversee the home health-care industry.

“We’re going to watch this like a hawk,” Bredesen said, adding he dealt with many “fly-by-night” home health providers when he worked in the health-care field, and he does not want such businesses to receive any of the state’s new money.

The bulk of the changes won’t take place until July 2009, but it’s a step in the right direction to give seniors more choices in their care.

The American Bar Association is urging states to adopt programs that allow retired attorneys to work for free to assist vulnerable seniors and low-income individuals.

Twenty-seven jurisdictions have emeritus attorney pro bono programs in place, according to the ABA’s Commission on Law and Aging. These programs provide a limited license for retired and non-practicing lawyers to practice on a volunteer basis for nonprofit legal providers serving seniors and low- and moderate-income individuals.

Pro bono programs offer the potential for expansion of legal services delivery and advocacy, the ABA said. Emeritus attorneys can provide legal services to home-bound residents; residents of hospitals, hospices, and long-term care facilities; and clients with limited access to transportation or who otherwise cannot visit an office.

The ABA provides a checklist of issues to consider in establishing an emeritus attorney pro bono program.

“Significant numbers of attorneys are expected to retire or modify their practices in the coming years,” says the ABA. “Emeritus attorney pro bono programs offer these attorneys a limited license…and are a great way to reinvest in our civil justice system the legal skills, training and experience of retired and non-practicing attorneys.”

– Lori Woehrle

Senate Republicans blocked a measure last week that would have prevented a Medicare pay cut for doctors, saying the bill would have been vetoed by the White House and that a new approach should be crafted for Senate consideration.

Lawmakers appear to agree that the 10.6 percent payment cut for Medicare doctors — slated to take affect July 1 — should not go through. But they disagree on how to make that happen.

On a procedural vote of 54-39, senators rejected a $20 billion Medicare refinancing plan, primarily supported by Democrats, that would have not only blocked the pay cut, but would have increased physician payments by 1.1 percent.  The refinancing plan would have been paid for through reductions in Medicare’s reimbursements to private health plans.

Republicans support a competing measure that also would block the pay cut, but would provide for lower reductions in private health plan reimbursements.

“We all know what this vote was about, and it wasn’t about what’s best for American seniors,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, who introduced the rejected measure. “The White House doesn’t want overpaid private health plans in Medicare to lose a single dime.”

Sen. Chuck Grassley (R-Iowa), urged senators to defeat the Baucus bill. He called it an “incomplete” measure that “delays bipartisan consideration of a Medicare bill.”

But as the arguments rage on Capitol Hill, the clock is ticking. And it’s Medicare doctors — providing healthcare services to you and your loved ones — who will be left holding the check.

-Lori Woehrle

I’m a big advocate of hospice. My mother died in a hospice residence and I can’t say enough good things about them. Everything you’ve ever heard is true.

Of course, if you’ve never had an experience with one, you may not even know what hospice is.

Hospice is a philosophy of care that accepts death as the final stage of life. The American Cancer Society has a good summary of the concept:

The goal of hospice is to enable patients to continue an alert, pain-free life and to manage other symptoms so that their last days may be spent with dignity and quality, surrounded by their loved ones. Hospice affirms life and does not hasten or postpone death. Hospice care treats the person rather than the disease; it focuses on quality rather than length of life. It provides family-centered care and involves the patient and the family in making decisions. Care is provided for the patient and family 24 hours a day, 7 days a week. Hospice care can be given in the patient’s home, a hospital, nursing home, or private hospice facility.

Even though they address end of life issues, hospice is certainly a senior house option whether a patient remains in their own home or moves to a care facility.

However, there are some common misconceptions about the hospice philosophy and some might even keep people from seeking this specialized care.

Hospice is something done when there’s no hope left - Hospice isn’t giving up hope, but it can mean a change in what you are hoping for: a good death. Receiving hospice care is “doing something” — controlling symptoms so that a person can live their days alert and with dignity.

Hospice is a place to die - Hospice is concept rather than a place, though some do have residence centers. A patient doesn’t necessarily have to die at home, but that option is available. Hospice care can be provided in a hospital or nursing home as well.

Hospice is only for cancer patients- Hospice cares for people with many end stage diseases besides cancer such as heart disease, respiratory disease and kidney disease.

The person must be bedridden - Criteria for hospice care is related to several factors, most important being the disease and the prognosis. When my mother was in hospice, the guy across the hall was up and dressed every day and apparently had a car there, and went about his business as usual. I have no idea what his diagnosis was, but I saw people in many different stages of their illness.

Must give up family doctor - While a hospice physician is usually assigned to the patient, it doesn’t necessarily mean not seeing your family doctor anymore. In fact, my mother was encouraged to see her regular physician at any time. Her doctor and the hospice doctor worked together, and my mother loved the hospice physician.

Can’t be hospitalized or get any treatment - A hospice patient can receive treatment to alleviate symptoms, and sometimes those treatments might require hospitalization.

Must be near death to be admitted - On the contrary, seek hospice services as soon as you know you might need them. They have so much to offer. You can be discharged from hospice if you get better, it’s not a sentence.

I’m a nurse and have had a parent receive this type of care, but I’m not an expert. Always check with your care provider for information specific to your situation.

-Elizabeth Thielke

As our society ages, more and more seniors want to remain in their own homes, and the growth of the elderly population means that senior care facilities may not be able to accommodate everyone and remaining at home may even become a necessity.

Safety is a primary concern for seniors living alone, and there’s often a gap between people who are completely independent and those who require the structured assistance of home health, assisted living, or nursing homes.

More and more families, especially those who live far away from their loved one, are turning toward high tech monitoring solutions to bridge this gap and make sure that an elder is taking proper care of themselves and is able to live independently for longer.

These types of devices can detect motion and send alerts if motion sensors detect deviation from someone’s usual routine indicating accident or illness, they can issue reminders to take medicine as well as indicate if medications have been taken properly.

However, the devices have raised some concerns as well as some resistance from older people who are not comfortable with technology. Funding for these devices is also a question as they can be expensive and they aren’t covered by insurance.

As with any new technology, there are the complex ethical issues of physical privacy as well as the privacy and security of health information that is transmitted. Among the questions we should consider: Should there be “monitor-free” zones in the house? Can/should the senior be able to turn off the monitoring? Who has access to the generated data and how will it be used? Does this “watch” actually encourage independence or does it promote dependence?

I’m glad there are safety devices such as these to assist seniors and their families, especially those families who live far away, but I can’t help but wonder that if anyone who is independent enough where this type of monitoring might be a reassurance more than a necessity would tolerate this type of intrusion.

We’ve come a long way from electronic pendants and bracelets (Think: “I’ve fallen and I can’t get up.”), as new developments and technologies being launched every day.

It will just take time to gain trust in the benefits of these devices as the concept of “aging in place” gains popularity.

-Elizabeth Thielke

UPDATE: Since this post went live in June 2008, the state of Social Security benefits has been dramatically altered. Please refer to the information below for the most up-to-date news regarding the changes made to this important program. For further details on the COLA, visit www.ncoa.org.

On Oct. 16, the Social Security Administration announced a cost-of-living adjustment (COLA) of 5.8 percent for 2009, the largest increase since 1982. Social Security COLAs are based on increases in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) over the past year.

In January, the COLA will be applied to the Social Security benefits of over 50 million Americans. The increase for Supplemental Security Income (SSI), which goes to more than seven million beneficiaries, will begin on Dec. 31. The average Social Security benefit will increase $63 per month, compared with an average $24 per month increase in 2008.

—

Earlier this year, the Congressional Budget Office published a little-noticed estimate that forecasts seniors will receive just a 2.8 percent increase in their Social Security checks beginning in January 2009.

Despite the increase, at least five million people aged 65 and over will remain in poverty because senior costs are rising significantly faster than the annual Social Security Cost of Living Adjustment (COLA).

Between 2001 and 2008, Medicare Part B premiums have soared by more than 93 percent while the COLA has crept up just 19 percent, leaving many seniors on their own to cover all other rising costs. Part B premiums cover doctors’ visits, tests, and outpatient hospital care.

Although the COLA is intended to help seniors keep up with inflation, a recent study by The Senior Citizens League (TSCL) that analyzed eight key expenditures found that people 65 and over have lost 40 percent of their buying power since 2000. Expenses such as home heating oil and gasoline have more than doubled since the beginning of the decade, while food staples such as potatoes and butter have increased by 47 and 39 percent, respectively.

A majority of the 48 million Americans aged 65 and over who receive a Social Security check depend on it for at least 50 percent of their total income, and one in three beneficiaries relies on it for 90 percent or more of their total income.

“Social Security is supposed to protect seniors in need – but with five million seniors below the poverty line, it’s clear the system is failing them,” said Shannon Benton, executive director of The Senior Citizens League. “If it’s true that a nation’s greatness is defined by how well it treats its most vulnerable citizens, then we must do a better job of protecting impoverished seniors.”

To help offset the cost of Medicare Part B, TSCL is lobbying for a change in the Consumer Price Index (CPI) used to determine the COLA. The government currently calculates the COLA based on the CPI for Urban Wage Earners and Clerical Workers (CPI-W), a slow-rising index that tracks the spending habits of younger workers who don’t spend as much of their income on health expenditures.

However, the government also tracks the spending patterns of older Americans with the CPI for Elderly Consumers, or CPI-E. By tying the annual increase in the COLA to the CPI-E, seniors would see much needed relief in their monthly checks.

If the shoe doesn’t fit, don’t wear it.

-Lori Woehrle

I don’t know what it’s like in your neck of the woods, but here in the Nation’s Capital we’re sweating it out under a heat advisory, and politics has nothing to do with it.

Temperatures this past weekend (June 6 and 7) hit the high-90s, and Monday and Tuesday this week they will be hovering near 100 degrees. Add in the humidity and it will feel like 105.

As we move into summer, remember that elderly persons are particularly vulnerable to heat-related illness. Your chances of getting sick in hot weather are increased if you suffer from:

• High blood pressure
• Circulation problems
• Diabetes
• Previous stroke
• Infections or fever
• Weak or damaged heart
• Asthma and other respiratory conditions
• Diarrhea

Warning signs of heat illness include:

• Headache
• Nausea, dampness, chills
• Weakness or fatigue
• Dizziness or periods of faintness
• Rapid breathing
• High body temperature
• Dry, hot skin
• Severe muscle pain
• Anxiety or listlessness
• Unconciousness

If you see an elder relative or friend that appears to be having these symptoms, first call 911; lie the person on their back; loosen their clothing or remove it (if possible); give the person sips of water (but only if they are alert and can swallow); raise their feet a foot from the ground; fan their skin; apply cool, wet cloths to their skin; and move the person to a cool area if possible.

Prevention, of course, is the best approach. Tips include:

• Drink plenty of fluids, especially water
• Avoid hot and heavy meals
• Avoid strenuous outdoor activities
• Try to sit in a shady area
• Wear a hat and loose clothing
• Avoid alcoholic and caffenated beverages
• Stay out of the sun
• Visit a cooling center in your area

The above information comes from the Washington, D.C., Department of Health.