Most of us have a love-hate relationship with aging. We want to grow older, but we don’t want to grow old. The good news is that we are living longer. The bad news is that many individuals and families and societies are not ready for what this means.
2018-2019 Health and Aging Policy Fellows
That is what inspired Dr. Harold Pincus to launch the Health and Aging Policy Fellows Program. I have the pleasure of serving as Deputy Director alongside Harold who has directed the Fellowship from the beginning. Last week, we officially welcomed our 12th class, bringing our total number of fellows to 140. Our fellows focus on a myriad of issues–from preventing elder abuse to promoting intergenerational communities and physical activity through community gardens to supporting caregivers and more. The common thread is a passion to advance policy to improve quality of life as we age. Of course, mental health is part of that story. Here are five areas where aging policy and mental health intersect:
Quality over quantity. Time and again, surveys show that people want to live as long as possible, as long as their days are of a high quality. Quality trumps quantity. People want to be comfortable and without pain at the end of their life. But the US healthcare system tells another story. Within the last six months of life, 40% of Americans are admitted into a hospital intensive care unit. Heroic procedures and continuation with intensive care at all costs has drastic implications for mental health and quality of life among older adults. Of course, this situation reflects a complex set of issues, but everyone agrees that many of our health policies need a rethink that moves beyond quantity to more fully integrate quality of life considerations.
In the end. People have a lot of anxiety around how they are going to leave this world. But there is a difference between what people want and what actually happens in end of life care. A survey in California found that over half of people who had lost a loved one in the last year said their loved one’s end of life preferences were not honored. One example is where people want to die. The number of hospital deaths in the US is decreasing, with 29% of Medicare patients dying in the hospital in 2015. Still, overwhelmingly people who want to die at home do not. What are the policy changes that would better support individuals, families, and medical professionals to ensure that wishes for end of life care are clearly communicated and acted upon?
Loneliness. Humans are pack animals and social beings. Individuals who self-identify as lonely are almost 30% more likely to die than those who report engaged social relations. Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day. When it comes to older adults, loneliness can be debilitating and deadly. This has led to the growth of senior co-housing communities, spaces where seniors can maintain independence while engaging in social activities in shared common spaces to improve their mental health and shared connection. Here aging and mental health intersect with housing policies.
Brain health. Our knowledge of how to promote brain health as we age is growing. Attending to sleep hygiene, avoiding brain slowing medications, maintaining meaningful social relationships and staying physically active are among strategies that we can adopt to promote brain health. And yes, with more years, comes more individuals with dementia. Worldwide, around 50 million people have dementia. We need to find cure. We also need to support individuals living with dementia now, as well as their caregivers. And that includes their mental health. Albert Einstein College of Medicine Professor and Health and Aging Policy Fellow, Dr. Tia Powell, has provided great insights in her book Dementia Reimagined championing the focus on building a life of joy and dignity from beginning to end. I have spoken to Tia about her work on dementia and mental health in past Five on Fridays.
Aging is a women’s issue. Paid caregivers are disproportionately women of color. These jobs have low wages, are insecure, and usually don’t give access to basic protections such as paid leave. Sixty percent of family caregivers are women– wives and daughters. And women live longer and are more likely to spend more years alone as older adults. What does this mean? A gender lens to policy solutions that aim to support the workforce and caregivers and older adults will help us further understand the unique impact of these policies on women of all ages and their mental health.