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Month: March 2021

Which Americans Live Longest? This Matters Most

Latest Senior Health News

News Picture: Which Americans Live Longest? Education Matters More Now Than Race

MONDAY, March 8, 2021 (HealthDay News)

A four-year college degree is becoming the key to living a longer life in the United States, a new study argues. In fact, education appears to be a more potent factor in determining lifespan now than race, researchers say.

In the study, white and Black people who earned a bachelor’s degree experienced an overall increase in their average adult life expectancy between 2010 and 2018.

On the other hand, people without a college degree tended to have fewer expected years left to them.

This “education gap” in life expectancy more than doubled between 1990 and 2018 for both Black and white Americans — at the same time that race-based differences in life expectancy decreased by 70%, researchers said.

About one-third of Americans have a four-year college degree, and they are living longer and more prosperous lives while the rest face rising death rates and declining prospects, said researcher Angus Deaton, a professor at the University of Southern California’s Center for Health Policy and Economics.

“The importance of having a BA has been increasing, while the importance of the color of your skin seems to be diminishing,” Deaton said. “The gap between Blacks and whites is narrowing, and the gaps between people who do and do not have a four-year college degree are widening.”

Deaton places the blame for the education gap on diminishing economic opportunities afforded to people who don’t go to college.

Wages for people without a BA continue to decline, and automation and globalization have narrowed their career prospects, Deaton said. They also are more vulnerable to suffering a death of despair, either by suicide, drug overdose or addiction-related illness.

“The problem here is not so much that everybody doesn’t have a BA,” Deaton said. “There are lots of people who don’t want to have a four-year college degree, and shouldn’t. What we really need to do is make good jobs for people who don’t have a BA.”

Without a four-year college diploma, it is increasingly difficult to build a meaningful and successful life in the United States, added Deaton, a Nobel Prize-winning economist who retired after 33 years at Princeton University.

For this study, Deaton and his colleagues looked at what they refer to as adult life expectancy, or the life expectancy of people between ages 25 and 75. They combined U.S. federal death certificate data with population survey results to calculate mortality rates.

They found that Black people with a BA tended to have 3.6 more expected years of life in 2018 than those without, compared with 1.4 years in 1990.

A similar advantage held for white people with a college degree. They had 3.5 more expected years of life in 2018 than those who don’t hold a degree. In 1990, the difference was 1.6 years.

The findings were published March 8 in the Proceedings of the National Academy of Sciences.

Margaret Weden, acting director of the RAND Population Research Center, said the narrowing of the racial gap in life expectancy has been observed in prior studies.

“It suggested to me a real impact of the civil rights movement,” Weden said. “In these findings, you see a dramatic uptick for Blacks regardless of education.”

However, the data set used by Deaton to make the education-based observation “has been critiqued pretty robustly in the demographic literature” because it combines information from two different sources that don’t completely jibe, Weden said.

The COVID-19 pandemic likely has shaken up these observations, particularly the narrowing of the racial gap in life expectancy, said Krutika Amin, associate director of the Kaiser Family Foundation Program on the ACA (Affordable Care Act).

COVID has hit U.S. racial and ethnic groups particularly hard, and those deaths are not reflected in this data, Amin said.

On the other hand, the pandemic might have fueled a further increase in the education gap, given that people without a college degree tend to work front-line jobs that carry increased risk of exposure to the coronavirus, Amin said.

“Folks who had higher education were able to work from home, whereas other folks didn’t have that advantage,” Amin said, adding that college-educated people might also have more time to take care of their personal health.

More information

The U.S. Centers for Disease Control and Prevention has more about life expectancy.

SOURCES: Angus Deaton, PhD, professor, University of Southern California Schaeffer Center for Health Policy and Economics; Margaret Weden, PhD, acting director, RAND Population Research Center; Krutika Amin, PhD, associate director, Kaiser Family Foundation Program on the ACA; Proceedings of the National Academy of Sciences, March 8, 2021

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Copyright © 2020 HealthDay. All rights reserved.


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Texas Winter Storm Exposes Gaps in Senior Living Oversight

HOUSTON — When the big, red and extremely loud fire alarm went off in Maria Skladzien’s apartment, the 74-year-old ventured into the hallway with fellow residents of her Houston-area senior living community. The brutal winter storm that swept through Texas had knocked out power, which, in turn, disrupted water to the four-story building. The blaring alarms raised fears of fire.

The building’s elevators were unusable without power. Dependent on her wheelchair, Skladzien went back inside her second-floor apartment. She watched as residents gathered in the subfreezing temperatures outside, wondering if she would have to “throw herself out the window” to survive.

“It’s a very uneasy feeling,” she said, sitting in the living room of her small apartment a week later, packages of water brought by friends and volunteers tucked against walls and sitting on tables. No fire had occurred, but her fears continued because the elevators were still not functioning. “So many crazy things race through your mind in a situation like this.”

Winter storm Uri brought power failure and burst water pipes to millions of homes and businesses throughout Texas. But the impact, as is often the case in emergencies, was most profound on the state’s most vulnerable — including residents of senior living facilities.

Of the state’s 1,200 nursing facilities, about 50% lost power or had burst pipes or water issues, and 23 had to be evacuated, said Patty Ducayet, long-term care ombudsman for Texas. Of 2,000 assisted living facilities, about 25% had storm-related issues and 47 were evacuated. Some facilities reported building temperatures in the 50s.

The federal government requires nursing homes to maintain safe ambient temperatures but does not stipulate how and does not require generators or other alternative energy sources to run heating and air conditioning systems. States can implement more stringent guidelines, but, to date, Texas has not. Several bills were introduced in the Texas legislature after Uri to do just that, said Ducayet.

Uri was the latest disaster to highlight an ongoing problem. Evacuations and nursing home deaths in Hurricane Katrina in 2005 led to calls for similar protections. In 2009, Hurricane Sandy forced the evacuation of more than 4,000 nursing home residents in New York when backup power systems failed and emergency plans buckled. And calls for stricter rules were renewed when Hurricane Irma tore into Florida in 2017 and left a dozen residents dead in a nursing home that lost air conditioning. Multiple blackouts and wildfires in California also have exposed lax adherence to federal requirements for backup power at skilled nursing facilities, as well as weak state enforcement of those rules, according to a 2019 report from the U.S. Department of Health and Human Services.

“Every time we come back around with a new disaster, you see that these facilities still aren’t as prepared as, maybe, they can or should be,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy organization based in Washington, D.C. “And many of them still aren’t following the requirements that are in place. So it’s like: What’s it going to take to actually get the plans in place and to get enforcement of those plans?”

In November 2016, the Centers for Medicare & Medicaid Services implemented a slate of new regulations, including rules on disaster planning and emergency backup power in the nation’s nursing homes.

A month later, Mark Parkinson, president and CEO of the long-term care industry’s trade group, the American Health Care Association and National Center for Assisted Living, sent a letter to then-President-elect Donald Trump requesting new rules because the regulations were burdensome and financially onerous, according to reporting by ProPublica.

In 2019, CMS published final rules with revised emergency preparedness guidance, agency spokesperson William Polglase said, after feedback from the public that those requirements were “overly burdensome and duplicative.” But, he added, the rules require such facilities to have emergency and standby power systems and emergency plans. “We did not remove or modify any requirements that would endanger patient health or safety,” he said.

Advocates for older adults, however, decried the changes as watering down the protections.

“The facilities push back because of the expense, but what I think recent years have shown us is that we’re not talking about once-in-a-century type of disasters,” said Eric Carlson, directing attorney with Justice in Aging, a national legal advocacy nonprofit.

But it’s not just nursing homes at risk.

Cristina Crawford, an AHCA spokesperson, said prioritizing long-term care facilities at all levels is important in emergencies. “Nursing homes and assisted living facilities should be prioritized for power restoration and supplies for resource delivery in emergency situations,” she said. “Long-term care facilities should also be included in community-based exercises to help ensure successful coordination in actual emergencies.”

Although nursing homes face federal oversight, the licensing and regulatory authority for assisted and senior independent living facilities lies with the states, meaning a patchwork of definitions and guidelines for the facilities. Given that assisted and independent living communities have been the fastest-growing sector in senior living for many years, the disparate definitions and rules often leave residents and their families without a clear understanding of a facility’s offerings and safety guardrails.

“There’s no transparency from a consumer perspective about what are these different options, what am I getting in each of them,” said David Grabowski, professor of health care policy at Harvard Medical School.

Years ago, Grabowski and others said, independent and assisted living facilities were filled with a generally healthier population who didn’t need much medical assistance and who could afford to pay out-of-pocket for enhanced lifestyle amenities such as restaurants or outings.

But as the population ages, residents are often less healthy and may not have the financial resources to afford the higher level of care they need. And unlike nursing homes, assisted and independent living facilities do not necessarily operate under regulations that require building codes to address the needs of elderly or disabled residents, or requirements for backup power or emergency systems. It depends on where they are.

In Texas, assisted living facilities are required to have emergency plans but not generators. The legislation introduced in the wake of winter storm Uri seeks to change that. Independent living facilities like the one Skladzien lives in might not be covered, though; they already have even fewer state guidelines to follow.

“We still don’t have good emergency management planning and preparation ingrained within the regulations to make sure our loved ones are safe within these facilities, because it just comes down to the money,” said Brian Lee, executive director of Families for Better Care, a nonprofit in Austin, Texas, focused on the nation’s long-term care facilities.

The debate is analogous to previous efforts to require sprinkler systems in nursing homes, he said. “How many more people have to be injured, maybe even have to have suffered death, because of power failure negligence?”

Lee and others said there is a distinction to be made between staff members — some of whom stayed in their facilities throughout the winter storm to keep residents safe — and industry forces resisting regulatory efforts to beef up backup safety systems.

“We can’t, and shouldn’t, let the industry decide how this is going to work,” said Ducayet. “There needs to be involvement and organization at government levels, so that there is clarity and information about how these different settings work.”

With elevators still not working at Skladzien’s independent living building a week after the storm, she was trying to figure out how she would get to her weekly post-cancer medical treatment.

Skladzien, who owned her own cleaning business for 25 years and drove a school bus for 15 years, moved into senior housing in 2019 when she could no longer handle the upkeep on her home. When she was looking for a place to live, though, it never occurred to her that apartments marketed toward older adults would not have a generator or plans to help residents in an emergency. And she never thought to ask.

“I had no experience,” she said.

It may not have mattered: Medical bills had depleted her savings, leaving her only the choice of what was available in low-income housing. In her building, she was told, wheelchair-accessible apartments on the first floor were beyond her financial reach.

Source

Guys, Exercise Will Boost Your Aging Hearts, Testosterone Won’t: Study

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News Picture: Guys, Exercise Will Boost Your Aging Hearts, Testosterone Won't: StudyBy Alan Mozes HealthDay Reporter

TUESDAY, Feb. 23, 2021 (HealthDay News)

Testosterone levels tend to fall in older men, but a new study shows that exercise — and not supplemental testosterone — is the way to rejuvenate the aging male heart.

Australian researchers found that without exercise, testosterone replacement therapy offered patients no improvement at all in cardiovascular health. But exercise alone — absent any testosterone supplementation — did boost arterial function.

As a bonus, exercise also boosted the men’s natural testosterone levels, the study found.

According to study author Dr. Bu Yeap, the bottom line is clear: “To improve the health of arteries, exercise is better than testosterone.”

Yeap, who is president of the Endocrine Society of Australia, acknowledged that “there is a gradual decline in testosterone levels as men grow older, extending into middle and older age.” And that decline is often accompanied by expanding waistlines and a wide array of health conditions.

As a result, testosterone therapy has gained traction, largely in a bid for increased energy and muscle mass. In fact, global sales of the hormone have skyrocketed 12-fold in just the first decade of the 21st century.

That’s not necessarily a good development, Yeap cautioned. He argued that men should not embark on testosterone treatment “unless they have medical conditions affecting the pituitary gland or testes which interfere with the production of testosterone.” Using testosterone as a body-building tool “is not medically approved, and should be discouraged.”

Safety considerations aside, can testosterone help protect an aging heart?

Yeap, a professor in the medical school of the University of Western Australia, said a lack of rigorous research makes it hard to answer that question, or to know whether any potential benefit might outweigh potential risk.

To gain more insight, Yeap and his team set out to weigh the relative impact of testosterone therapy and exercise routines on the heart health of 78 men between ages 50 and 70.

Testosterone levels among the participants ranged from low to normal. None had a history of heart disease, smoked, or was on testosterone therapy at the study’s start.

All initially underwent arterial blood flow testing as a measure of heart health and function, before being randomly divided into four groups. One group did aerobic and strength exercise two to three times per week while receiving testosterone therapy; a second got testosterone alone; a third was given placebo therapy; and a fourth got placebo therapy with an exercise routine.

The team found that on its own, exercise triggered a rise in testosterone levels, though not to the same extent as the 62% rise in hormone levels seen among men who did undergo testosterone therapy.

But most critically, arterial function shot up by 28% among those who exercised without taking testosterone therapy. That bested the 19% improvement seen among those exercised and took testosterone replacement therapy.

Those men who only received testosterone therapy saw no heart health improvement at all. The researchers concluded that exercise may be preferable over testosterone supplementation to improve heart health in older men.

That thought was echoed by Dr. Robert Eckel, past president of the American Heart Association and immediate past president of medicine and science with the American Diabetes Association.

“This trial was not [designed] to assess safety of testosterone,” he noted, leaving the question of whether taking testosterone replacement therapy might actually pose a heart risk unanswered.

Still, Eckel, a professor of medicine emeritus at the University of Colorado, said he agrees that “in general, testosterone should not be given unless someone is hypogonadal,” referring to a condition in which the sex glands stop producing enough sex hormones.

As to the potential heart health benefits of exercise, Eckel said there are “no surprises here. Exercise is beneficial… [and] should be promoted.”

Yeap and his colleagues reported their findings Feb. 22 in the journal Hypertension.

More information

There’s more on COVID-19 and office building recommendations at U.S. Centers for Disease Control and Prevention.

SOURCES: Bu Yeap, MBBS, PhD, professor, medical school, University of Western Australia, and endocrinologist, department of endocrinology and diabetes, Fiona Stanley Hospital, Perth, Western Australia, and president, Endocrine Society of Australia; Robert Eckel, MD, past president, American Heart Association, immediate past president, medicine and science, American Diabetes Association, and professor emeritus, medicine, division of endocrinology, metabolism and diabetes, and division of cardiology, University of Colorado Anschutz Medical Campus; Hypertension, Feb. 22, 2021

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