Mortality through the lens of a pair of reading glasses

The following is a guest post by Janice Lynch Schuster who works at the Altarum Institute, a new voice in the field of aging and end of life issues. This post orginally ran on September 23rd in the Washington Post.

Like all the mothers and grandmothers I knew when I was a child, my grandmother had a purse that was more a small suitcase, from which she pulled any number of essential items: tissues and mints, powder and lipstick. For reasons that puzzled me — I was only 4 or 5 — she also carried two pairs of eyeglasses, one of which she used for distance, the other for reading. As far as I was concerned, eyes were eyes and glasses were glasses, and having to search for certain glasses for a specific activity made no sense. Yet whenever she misplaced her reading glasses, a frenzied search would ensue. Without them, she could not teach me to crochet or read me a story, play cards or follow a recipe. I hoped I’d never need two pairs of glasses. It seemed a confusing way to live.

When I was in my late 20s, my mother started to have trouble seeing print on a page. Soon she was at the drugstore purchasing $10 reading glasses; for a while, hoping to keep them corraled, she wore these glasses on a string around her neck. We teased her that she looked like an old woman (she was in her mid-40s), and eventually she bought several pairs, which she placed at strategic locations around the house: on her nightstand, near the kitchen sink, next to the television. I remember her fretting over needing the glasses, how she equated it with aging and what lay ahead. I thought it was silly.

Now it’s my turn. For years, I’ve needed, but not worn, glasses for distance. The weight of the bridge on my nose drives me crazy: I’d rather squint at a blurry world than tolerate eyeglass frames in the periphery. A few years ago, the eye doctor persuaded me to purchase a few pairs of reading glasses — they were on sale! — and prescribed progressive lenses, the kind with the bifocal built in, no tell-tale dividing line. I wore them sporadically. In a pinch, I put my glasses on. But mostly I made do with the eyes I had.

I was blind to my own aging, which is ironic, because I write about aging issues for a living. I know all of the dire statistics about what the future has in store, not just for me but for millions of other boomers with whom I’ll share, if I’m lucky, the decades to come. I write about multiple chronic conditions and how hard it is to navigate them, about growing nursing home populations and the decreasing availability of family caregivers. Frankly, it can be a little overwhelming and grim; I try to focus on the ways in which people come together in hard times, and how they support and cherish one another along the way.

But I haven’t really thought about it as something that would happen to me: After all, I’m 49, and I eat well, exercise and get plenty of sleep. I always expected my body to go on forever. Until the other night, that is, when I bought a new pair of glasses.

I liked a certain frame, and it was too small for a bifocal. I opted to have it made for distance only — the frames were so cute! So youthful! I look good sitting in a crowd, looking up at a movie screen. But the glasses are useless when I try to read newspaper headlines, sign a school form or check my texts. My eyes struggle to focus but simply cannot. So I am relegated to having two pairs of glasses: one for distance and the other for reading. I have a pair on my nightstand and a pair on my desk. I’ve switched to a bigger purse, too.

It hits you all of a sudden that you are, in fact, only passing through. Bit by bit, the body does its work and comes to its end. There is no stopping it, for all the millions we spend on antiaging potions and promises, on cosmetic surgery and quick weight-loss gimmicks. For most of us, the future promises plenty of time with family and friends, time to pursue dreams and fantasies. But it also promises these small reminders that we will not be here forever.


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More health consumers look to pharmacists and pharmacy staff for health-related services

Jane Sarasohn-Kahn

Health consumers prefer supermarket-based pharmacies to chain or mass merchandiser drugstores, according to the J.D. Power and Associates 2011 U.S. National Pharmacy Study.  Mass merchants, however, often beat out both supermarket and chain drugstores when it comes to price.

In the study, J.D. Power segments brick-and-mortar pharmacies from mail-order. Brick-and-mortar pharmacies cover chain drug stores, supermarkets and mass merchandisers/Big Box stores.

What drives top performance for consumers shopping brick-and-mortar pharmacies are the ordering and pick-up process, the store itself, cost, the non-pharmacist staff, and the pharmacist.

In mail-order, quality translates into cost competitiveness, prescription delivery, ordering, and customer service. Consumer satisfaction with the mail-order Rx channel declined between 2010 and 2011, primarily due to ordering and delivery problems. But due to price and challenges in switching back to the brick/mortar option, mail-order customers are largely expectedly to remain in the channel and not switch to a store. One-third of consumers are required by their insurance provider to use mail-order for maintenance and repeat scripts – these customers are even less satisfied with their pharmacy than those who freely choose to go the mail-order route for prescriptions.

J.D. Power, analysts on consumer satisfaction, notes that Amazon has set a high bar for speed and convenience in the online shopping world. Mail-order pharmacy has a ways to go to catch up to those standards.

High customer satisfaction ties to those consumers who have an ability to have a private conversation with the pharmacist or staff in a private area of the pharmacy. Furthermore, added services such as immunizations and wellness services are driving higher consumer satisfaction with those pharmacies who offer them.

The highest rankings by segment were:

Chain drug stores: Good Neighbor Pharmacy, Health Mart, The Medicine Shoppe (all well above competitors in the segment)

Mass merchandisers: Target, Sam’s Club, Costco (with Walmart at the bottom)

Supermarkets: Publix, Wegmans, Winn-Dixie, Jewel-Osco, Vons (all above the segment average)

Mail-order: Kaiser Permanente Pharmacy, Humana RightSourceRx (both well above competitors).

This is the fifth year J.D. Power has conducted the national pharmacy survey. The poll, fielded in May and June 2011, was conducted among 12,300 consumers who filled a new prescription or a refill in early 2011.

Health Populi’s Hot Points: The pharmacy has always been a touchpoint in consumers’ health, but its importance is growing as a primary care site for wellness, prevention, immunization and a growing menu of consumer-driven primary health care services. The supermarket channel, in particular, has begun to marry messages about nutrition and healthy food with chronic health condition messaging. For example, Wegmans (ranked #2 after Publix stores, features a food/health related display adjacent to the pharmacy: this month, my local Wegmans has been promoting quinoa’s nutritional contributions to healthy eating at a “pharmacy teaching table.’ In the winter, the pharmacy promoted the purchase of frozen blueberries to enhance shoppers’ intake of the fruit’s health benefits in the cold season.

This is another example of health being where our Surgeon General says it is – not in isolation in the doctor’s office, but where we live, work, play and pray. Let’s add the word “shop” to that mantra.

On a personal note, I have a comment to make on J.D. Power’s mail-order pharmacy results. In the past six months, we have been forced to switch to the mail-order channel to acquire a repeat prescription for a member of our family. The company, whom I will not name, is one of the poorer performers on the table – and no surprise to me. The company has a cumbersome, un-helpful, poorly designed website which it claims streamlines the process. For the first three months of the fulfillment process, I’ve had to dial into the company’s call center – which has no hours on the weekend, when I, and most working people, usually run household errands. Suffice it to say, after speaking with the doctor-prescriber’s insurance associate, our experience with this mail-order company was not atypical.

Would that this company, whose services I am compelled to use, could demonstrate the efficiency, accessibility, and friendly quality of my favorite shoe purveyor – Zappos. This is a case where I cannot, if you’ll excuse the pun, vote with my feet.

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Peoples’ home economics are driving DIY Healthcare

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. I shared this perspective yesterday at the Social Health Unconference in Philadelphia.

In the post-recession economy, consumers are living in an era of the new sustainability, looking for products and services from organizations that help them conserve resources, save me money, nurture creativity, and keep me healthy. In their report, Eyes Wide Open, Wallet Half Shut, Ogilvy surveyed consumers’ perceptions of their new lives shell-shocked by an economy that changed everything for them and their families.

The new household economics are driving a DIY economy. From DIY’ing home improvement and photo developing and sharing to self-booking travel with Expedia and trading shares via Schwab online, consumers have adopted, en masse, a self-service ethos.

As people do more DIY in life, they’re doing the same in health for themselves and those for whom they care — aging parents, sick mates, ailing kids. Both healthy and chronically ill people self-track their steps, their food intake, their clinical numbers like glucose and blood pressure. Some download mhealth apps to their smartphones to DIY health. Some people pay for personal emergency response systems for their parents to ensure their wellbeing at home. Others seek health information via online search and in social networks, on- and offline. Further up the social networking curve, Very Empowered Patients share their health data online in communities to CureTogether. (more…)

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Community Resources Rated By New National Study

Stephanie Mensh

By Stephanie Mensh. We probably don’t need a new report to tell us this: middle class people cannot afford the cost of nursing home services or long term home health care services.    The AARP, Commonwealth Fund, and SCAN Foundation joined  forces to examine state-by-state affordability,  accessibility, choice, quality, and–interestingly–support  for family caregivers, in their first-ever “State Scorecard  on Long-Term Services and Supports for Older Adults, People  with Physical Disabilities, and Family Caregivers,”  just published earlier this month.

Caregiver supports are defined by the Scorecard to include:

  • Percent of caregivers getting needed support
  • Legal and system supports for caregivers
  • Health tasks able to be delegated to aides.

The Scorecard showed that 77% of family caregivers who were surveyed a few years ago reported that they get emotional and social support when they need it.   Legal and system supports scores were much lower, averaging a “3″ on a 12-point scale. These supports  were defined as:  state family medical leave laws;  mandatory paid family and sick leave; protection of  caregivers from employment discrimination; the  extent of financial protection for the spouses of  Medicaid beneficiaries who receive nursing home or  long term community support services; and  assessments of the caregiver’s health, quality of  life, etc.    The researchers also proposed that family caregivers would benefit if state nursing license laws permitted aides to perform a list of key “health maintenance” activities, such as administering medications, and diabetes testing and injections. (more…)

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OWL Honors September Menopause Awareness Month

A new OWL survey of women showed women of all ages need more information about menopause, and that younger women, in particular, often lack even basic information about this major life stage:

  • Nearly 70 percent of younger women (age 30-44), many of whom could shortly experience initial symptoms, say they don’t have enough information about menopause;
  • Two-thirds of younger women say they do not know most signs and symptoms of menopause
  • Nearly a quarter of younger women – 24 percent – say they have more information about symptoms and treatments for erectile dysfunction (ED) than menopause

Additionally, the survey results showed that younger women aren’t aware of some of the most serious and life-altering symptoms of menopause. Only 16 percent of women age 30-44 cited painful intercourse as a symptom of menopause, and only half of women in this age group thought vaginal dryness was a serious symptom. Younger women also showed substantially less understanding that weight gain and insomnia are common menopausal symptoms. In contrast, in women ages 55-60, about 50 percent recognized insomnia and painful intercourse as symptoms of menopause; three-quarters understood vaginal dryness to be a symptom; 58 percent reported weight gain as a symptom. 

“Many younger women have more information about ED than menopause,” said Bobbie Brinegar, Executive Director at OWL. “We need to demystify menopause.”  (more…)


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Numbers Dominate Our Experience With Health Care

The following is a guest post by Dr. Jessie Gruman. This blog post was originally published at Prepared Patient Forum: What It Takes Blog

“My doctor can titrate my chemotherapy to the milligram but can’t tell me when I am going to die,” a friend who was struggling with his treatment for cancer complained to me a couple years ago.

Had he lived, he might have been reassured by the announcement last week of a new scale that allows clinicians to estimate the time remaining to people with advanced cancer.  He was spending his final days “living by the numbers” of his white blood cell count, the amount and size of his tumors and suspicious lesions, the dosage of various drugs and radiation treatments. And he was peeved about what he saw as a critical gap in those numbers.  He believed (hoped?) that because his cancer was quantifiable and the treatment was quantifiable, that the time remaining should be similarly quantifiable.  He needed that information to plan how to use the time that remained.

Many of us would make a different choice about knowing how long we will live when we are similarly ill.  But most of us are attracted to the certainty we attach to the numbers that precisely represent aspects of our diseases. (more…)

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Healthy People 2020

Healthy People 2020 sets the Nation’s health agenda. It was developed by the U.S. Department of Health and Human Services (HHS) in partnership with other Federal agencies and with broad, cross-cutting stakeholder input. For three decades, Healthy People has provided a comprehensive set of national, 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans. Healthy People 2020 identifies nearly 600 objectives with 1,200 measures across 39 topic areas.   It aims to involve anyone and everyone interested in improving health in our communities.

One goal of the Office of Disease Prevention and Health Promotion (ODPHP), which manages the initiative, is to extend the use and value of Healthy People to those who may not traditionally consider themselves “public health professionals.” These professionals include city planners, educators, and those working in agriculture, labor, veteran’s affairs, housing, and environmental protection.

Healthy People 2020 and Women’s Health

Most Healthy People objectives are focused on improving the health of the general population; however, some topic areas specifically focus on women’s health, including the Family Planning and Maternal, Infant, and Child Health topic areas. Additionally, for the first time, Healthy People includes a topic area on Lesbian, Gay, Bisexual, and Transgender Health. Objectives for this new topic area are currently in development and will be released in the coming months. (more…)

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Alliance for Health Reform Briefing Transcripts Available

Briefing Transcripts Available


Please take a look at the transcripts for the Alliance for Health Reform briefings below. The webcasts and podcasts from these briefings are also available, brought to you courtesy of the Kaiser Family Foundation.

The Innovation Center: How Much Can It Improve Quality
and Reduce Costs – and How Quickly?

The new Center for Medicare and Medicaid Innovation seeks to test innovative health care payment and service delivery models that can potentially enhance quality of care for beneficiaries while reducing costs. How is the center planning to administer its $10 billion in funding? What early projects is the center undertaking? These questions and others were addressed at this briefing cosponsored by The Commonwealth Fund.

Click here for the transcript, webcast and podcast, as well as individual speaker videos and resource materials, including speakers’ PowerPoint presentations.

Preventing Chronic Disease: The New Public Health

The nation is facing an epidemic of chronic disease. To try to stem the tide, many efforts are underway in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. Can this focus on the new public health be sustained in light of budget constraints on the federal, state, and local levels? How are resources in the $15 billion Public Health and Prevention fund, set up under the ACA, being deployed? This briefing, cosponsored by the Robert Wood Johnson Foundation, addressed these questions and more.

Click here for the transcript, webcast and podcast, as well as individual speaker videos and resource materials, including speakers’ PowerPoint presentations.

Caring for People Covered by Both Medicare and Medicaid:
A Primer on Dually Eligible Beneficiaries

This was an introductory session designed to inform the staff of new members of Congress both in Washington and in district or state offices about the people who receive benefits from both the Medicaid and Medicare programs (often called “dual eligibles”). Who is dually eligible for Medicare and Medicaid? What are the characteristics and needs of this population? How do Medicaid and Medicare coordinate payment and care for this population? What federal and state barriers complicate these efforts? The briefing, cosponsored by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, answered these and other questions.

Click here for the transcript, webcast and podcast, as well as individual speaker videos and resource materials, including speakers’ PowerPoint presentations.

Keeping Coverage Continuous: Smoothing the Path
Between Medicaid and the Exchange

A key design challenge for those tasked with implementing the health reform law is how to manage this “churning” phenomenon — when people cycle in and out of public programs as their income varies — so that care is not interrupted. What approaches are states and the federal government taking to minimize the disruption from churning? Will people be able to keep their provider as they move across the Medicaid – exchange divide? How can private insurers and Medicaid overcome possible technical and cultural barriers to a cooperative working relationship? What issues must states consider as they establish “no wrong door” eligibility determination processes for Medicaid, CHIP and health insurance subsidies? This briefing, cosponsored by The Commonwealth Fund, answered these questions and more.

Click here for the transcript, webcast and podcast, as well as individual speaker videos and resource materials, including speakers’ PowerPoint presentations.

 


The Alliance for Health Reform is a nonpartisan, not-for-profit health policy education group. We are committed to helping journalists, elected officials and other shapers of public opinion understand the roots of the nation’s health care problems and the trade-offs posed by various proposals for change. Our aim is quality, affordable health coverage for all in the U.S., although we do not lobby or take positions on legislation. Sen. Jay Rockefeller (D-W.Va.) is our founder and honorary chairman; Robert Graham, MD, of George Washington University, is our board chairman.


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Non-Communicable Diseases: A Women’s Health, Rights and Empowerment Issue

The following is a guest post by Nyaradzayi Gumbonzvanda who is General Secretary, World YWCA  and Dr. Nalini Saligram the Founder and CEO of Arogya World. It was originally posted on The Huffington Post on September 6th.

Non-communicable diseases (NCDs), which include cancer, cardiovascular disease, diabetes, lung disease, and mental health are one of the greatest health and development challenges of the century, responsible collectively for 2/3 of all deaths worldwide. Though all people the world over are susceptible to the threat of these chronic diseases, this is a women’s health rights and empowerment issue because these diseases impact girls and women differently. At the same time, women are a crucial part of the solution to this crisis.

Arogya World, World YWCA and other organizations have joined forces to form the Women for a Healthy Future movement. We are mobilizing women and men from around the world to sign a petition demanding that world leaders reduce the vulnerability of women and children to NCDs.

As advocates for women’s right to health and empowerment, we call on the world leaders during the forthcoming United Nations High Level Meeting on NCDs to consider the following critical factors related to women and NCDs:

1. NCDs have a direct impact on women’s health
NCDs are the #1 killer of women. A staggering 50,000 women lose their lives to NCDs every single day. More than 1,000 women die from cardiovascular disease, one of the four main NCDs, every hour.

Women are uniquely affected by NCDs. New research published in The Lancet (Aug 2011) shows that for women, especially pregnant women, the harmful effects of smoking are even higher than for men. When it comes to coronary heart disease, smoking is 25% more dangerous for women. (more…)

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Connecting the dots between personal fiscal health and physical health

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. Home foreclosures negatively influence health in several dimensions: they cause stress on the lives of the home’s residents, including children, driving mental and physical illness; they impact neighbors who worry that home values will fall in their community; and, they can motivate unhealthy behaviors, such as drinking and foregoing medical treatment such as seeing the doctor and filling needed prescriptions for drugs treating chronic conditions.

In Is the Foreclosure Crisis Making Us Sick? published by the National Bureau of Economic Research in August 2011, Janet Currie and Erdal Tekin find that the number of foreclosures in a community is associated with increases in medical visits for mental health (anxiety and suicide attempts), preventable conditions such as hypertension, and a long list of stress-related diseases.

Furthermore, more foreclosures in an area are most harmful on people age 20 to 64, and disproportionately impact African-Americans and Hispanics compared to whites.

The map shows the “heat index” for areas with the most home foreclosures: the redder, the higher the foreclosure rates in the state. Currie and Tekin focused on four of the hardest-hit foreclosure states: Arizona, California, Florida and New Jersey. They combined foreclosure data from 2005 to 2009 with data on ER visits and hospital discharges at the zip code level. (more…)

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  • September 5th, 2011 Chocolate and Prevention: A Match Made in Heaven…No, Correct that: Made in Europe
    By Glenna Crooks
  • Trending in September: TEAL

    The following is a guest post by Karen Orloff Kaplan the CEO of the Ovarian Cancer National Alliance.

    TEAL is on trend this September. Not only is teal a top fashion color for fall 2011, it’s the color of ovarian cancer awareness—and September is national ovarian cancer awareness month. Here’s how you can help raise awareness of this disease.

    To support ovarian cancer awareness you can get involved in the Ovarian Cancer National Alliance’s United States of Teal campaign. The goal of the campaign is to have every state in America teal—which happens when state legislators pledge their support for ovarian cancer awareness. Twenty-four states are already teal—visit www.unitedstatesofteal.org to see if your state supports women with ovarian cancer.

    The website also shows how you can contact your state legislators and urge them to pledge their support to the ovarian cancer community. We need your help to raise awareness of the symptoms, and expand federal research to improve treatments and support the development of a desperately needed screening test. (more…)

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    September 2011 Man of the Month: Dr. John Eisenberg

     John EisenbergDr. John Eisenberg is a Man of the Month with quite a resume. Director of the Agency for Healthcare Research and Quality. Senior Advisor on Quality to the Secretary. Co-Chair of the Data Council. Principal Deputy Assistant Secretary for Health, Department of Health and Human Services. Operating Chair of the Federal Quality Interagency. Member of the Coordination Task Force.  His titles are only part of his large legacy.

    Amazingly, Dr. Eisenberg held all the positions listed above, wrote 150 articles, graduated from Princeton magna cum laude, and rose to be the Physician-in-Chief at Georgetown University.  He managed to do all of this before dying at age 55 of brain cancer.

    Eisenberg was driven to use his talents to change health care with concrete evidence and statistics. He recognized that anyone stand up and claim something was bad, but that hard facts are what counts when making an argument for legislative change.

    In one of his most famous testimonies, he pleaded with the Senate Labor and Human Resources committee to curb smoking in the nation through research about the facts of smoking’s effects and by putting this research into clinical practice and educating the public. He was able to prove the FDA’s right to regulation, devise a way to reduce teen smoking through price raises and penalties, as well as a way to protect tobacco farmers and their communities.  His well thought-out strategy led to many of the modern day changes in the way tobacco is distributed in America and has informed our anti-tobacco campaigns.

    Eisenberg’s legacy as a great health care researcher cannot be disputed.  He wrote on such diverse topics as assessing and using evidence for decision-making, the effect of payment on health care quality, and the increase in quality of care from improving the working conditions for health care providers.

    We honor Dr. Eisenberg as Man of the Month for his achievements in advancing health care – but also for his strict commitment to the use of research in making changes.

    See also: Fighting the Injustice of Health Disparities: Honoring the Legacies of Dr. Martin Luther King Jr. and Dr. John M. Eisenberg, by Robin Strongin.


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    Back To School Tip: Your Child May Need A Comprehensive Eye Exam

    Val Jones, MD

    By Val Jones. In a recent interview with the president of the American Optometric Association (AOA), Dr. Dori Carlson, I learned the surprising statistic that about 1 in 4 school age children have an undetected or undiagnosed vision problem. School vision screenings, while helpful, still miss more than 75% of these problems. And for those kids who are discovered to have a vision problem during a school screening, upwards of 40% receive no follow up after the diagnosis. Clearly, we need to do better at diagnosing and treating childhood visual deficits. My full conversation with Dr. Carlson can be listened to here.

    Dr. Carlson told me that the solution involves comprehensive eye exams – a full medical eye exam performed by an eye doctor. During a comprehensive eye exam, the optometrist will check the health of the eye tissues, including the eye muscles, cornea, conjunctiva, tear ducts, pupils, lens, and retina, as well as the patient’s ability to track objects, to see at different distances, and to focus adequately.

    Vision correction is important at the youngest age possible because learning is greatly impacted by vision. Children who can’t see the chalk board, or who can’t read a computer screen or book, may lag behind in school or have attention challenges. In fact, it’s likely that some visually impaired children are misdiagnosed with ADHD (Attention Deficit Hyperactivity Disorder) as their interest in lessons fade since they can’t participate well without seeing what’s going on. (more…)

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