Report Outlines Strategy for Combating Senior’s Social Isolation and Loneliness

Published in the Woonsocket Call on March 1, 2020

Nearly one in four older adults residing in the community are socially isolated. Seniors who are experiencing social isolation or loneliness may face a higher risk of mortality, heart disease and depression, says a newly released report from the National Academies of Sciences, Engineering and Medicine (NASEM), a Washington, D.C.-based nonprofit, nongovernmental organization.

For seniors who are homebound, have no family, friends or do not belong to community or faith groups, a medical appointment or home health visit may be one of the few social interactions they have, notes the NASEM report released on Feb. 27, 2020. “Despite the profound health consequences — and the associated costs — the health care system remains an underused partner in preventing, identifying, and intervening for social isolation and loneliness among adults over age 50,” says the report.

“I’m pleased the AARP Foundation sponsored study by NASEM confirms the connection between social isolation or loneliness and death, heart disease and depression for older adults. It also finds that the health care system and community-based organizations have a critical role to play in intervening,” says AARP Foundation President Lisa Marsh Ryerson.

“We also know social isolation, like other social determinants of health, must be addressed to increase economic opportunity and well-being for low-income older adults,” says Ryerson.

Addressing Social Isolation and Loneliness

The 266-page NASEM report, “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System,” undertaken by the Committee on the Health and Medical Dimensions of Social Isolation and loneliness in Older Adults, outlines five goals that the nation’s health care system should adopt to address the health impacts of social isolation and loneliness. It also offers 16 recommendations for strengthening health workforce education and training, leveraging digital health and health technology, improving community partnerships, and funding research in understudied areas.

Although social isolation is defined as an objective lack of social relationships, loneliness is a subjective perception, say the NASEM report’s authors. They note that not all older adults are isolated or lonely, but they are more likely to face predisposing factors such as living alone and the loss of loved ones. The issue may be compounded for LGBT, minority and immigrant older adults, who may already face barriers to care, stigma and discrimination, the report says.

Social isolation and loneliness may also directly result from chronic illness, hearing or vision loss, or having mobility issues. In these instances, health care providers might be able to help prevent or reduce social isolation and loneliness by directly addressing the underlying health-related causes.

“Loneliness and social isolation aren’t just social issues — they can also affect a person’s physical and mental health, and the fabric of communities,” said Dan Blazer, J.P. Gibbons professor of Psychiatry Emeritus and professor of community and family medicine at Duke University, and chair of the committee that wrote the report in a statement announcing the its release. “Addressing social isolation and loneliness is often the entry point for meeting seniors’ other social needs — like food, housing and transportation,” he says.

Providing a Road Map…

The 16 recommendations in this report provides a strategy as to how the health care system can identify seniors at risk of social isolation and loneliness, intervene and engage other community partners.

As to improving Clinical Care Delivery, the report calls for conducting assessments to identify at-risk individuals. Using validated tools, health care providers should perform periodic assessments, particularly after life events that may increase one’s risk (such as a geographic move or the loss of a spouse).
The NASEM report also recommends that social isolation be included in electronic health records (EHRs). If a patient is at risk for or already experiencing social isolation, providers should include assessment data in clear locations in the EHR or medical records.

It’s important to connect patients with social care or community programs, too. The NASEM report notes that several state Medicaid programs and private insurers already has programs that target the social determinants of health. These programs can be more intentionally designed to address social isolation and loneliness of the older recipients. Health care organizations could also partner with ride-sharing programs to enable older adults to travel to medical appointments and community events, the report recommends.

The NASEM report also suggests that as more evidence becomes available, roles that health care providers are already performing — such as discharge planning, case management and transitional care planning — can be modified to directly address social isolation and loneliness in older adults. The report also details other interventions that the health care system might consider may include mindfulness training, cognitive behavioral therapy, and referring patients to peer support groups focused on volunteerism, fitness, or common experiences such as bereavement or widowhood.

Strengthening health professional education and training can be another strategy to combating the negative impacts of social isolation and loneliness. The NASEM report calls for schools of health professions and training programs for direct care workers (home health aides, nurse aides and personal care aides) to incorporate social isolation and loneliness in their curricula. Health professionals need to learn core content in areas such as the health impacts of social isolation and loneliness, assessment strategies, and referral options and processes, say the report’s authors.

The NASEM report warns that there are ethical Implications for using Health Technology to reduce social isolation and loneliness. Technologies that are designed to help seniors — including smart home sensors, robots and handheld devices — might intensify loneliness and increase social isolation if they are not easy to use or attempt to substitute for human contact. Moreover, the report found that 67 percent of the current assisitive technologies in dementia care were designed without considering their ethical implications. Developers of technology should properly assess and test new innovations, taking into account privacy, autonomy and the rural-urban digital divide.

The NASEM report says that more research is need because of evidence gaps and calls for more funding of studies to determine the effectiveness of interventions in clinical settings; to develop measures to identify at-risk individuals; and identify trends among younger adults as they age (such as use of technology and economic trends) that may inform how the health care system should target social isolation and loneliness in the future. More research is also needed to identify approaches and interventions that best meet the needs of LGBT and ethnic minority populations.

The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

For a copy of the NASEM report, go to http://www.nap.edu/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the .

These Articles Are Worth a Second Read

Published in the Woonsocket Call on January 5, 2020

As an ‘age beat’ journalist for over 40 years, I have penned more than 756 stories covering aging, health care and medical issues. These authored and coauthored pieces have appeared in national, state and local trade and association publications, daily, weekly and monthly newspapers and even news blogs. For the last decade 334 articles have appeared weekly in the Pawtucket Times and Woonsocket Call.

I provide you with a few of my favorite published articles that you may have enjoyed reading over the last decade. These articles in their entirety and even hundreds more can be viewed on herbweiss.blog.

Spumoni’s: “Where Everybody Knows Your Name,”: published in the Feb. 26, 2017 issue of the Woonsocket Call, and one day later in the Pawtucket Times.

Mark and Nancy Shorrock, of Attleboro, Massachusetts, now in their seventies and married for 52 years, began dining at Spumonis twice a week with their children in the 1980s, and remember being drawn to the Italian-style restaurant because of its reputation of serving “good food.” Over the years, as the Shorrock’s three children became more independent and “doing things on their own,” the couple began increasing their trips daily to the Pawtucket resident for dinner since it was so close by. Of course, their network of friends increased, too.

What the Shorrocks know innately, a 24-page report, “The Brain and Social Connectedness: GCBH Recommendations on Social Engagement and Brain Health, “released by the Global Council on Brain Health in February 14, 2017, tells us that larger social networks may positively impact your health, wellbeing, even your cognitive functioning. This report is available at http://www.GlobalCouncilOnBrainHealth.org.

“It’s not uncommon for our social networks to shrink in size as we get older,” said Marilyn Albert, Ph.D., GCBH Chair, Professor of Neurology and Director of the Division of Cognitive Neuroscience at Johns Hopkins University in Baltimore, Maryland. “This report provides many helpful suggestions about the things we can do to improve the quality of our relationships with family and friends, which may be beneficial in maintaining our mental abilities.”

The Brain and Social Connectedness report addresses the social benefits of having pets, the role that age-friendly communities play in fostering social ties, and how close relationships promote both physical health and psychological well-being. The report also covers how social media like Facebook and Skype helps older adults maintain their social connections.

“Rediscovering Pawtucket’s Red Pollard,” published in the published in the June 22, 2012 issue of the Pawtucket Times.

Red Pollard rode into American history, overcoming a physical disability of partial blindness, accepting intense physical pain caused by severe riding injuries that fractured his bones, while humbly accepting his role in racing history, as the man who rode Seabiscuit 30 times, accumulating 18 wins.

This article noted that America’s iconic jockey, John Pollard, whose moniker “Red” Pollard, known for his flaming red hair, relocated to the City of Pawtucket in his middle years with his wife, Agnes, raising their two children, Norah and John at 249 Vine Street in the City’s Darlington neighborhood. At the end of their lives, Red and Agnes would be buried a stone’s throw from their modest Vine St. home in Norte Dame Cemetery on Daggett Avenue.

It is no coincidence that near the former Narragansett Race Track in Pawtucket– now a Building 19 retail store – you will discover city streets named “War Admiral” and “Seabiscuit Place, for surprisingly many Pawtucket residents do not know that the real-life jockey whose story was told in Seabiscuit, a 2003 dramatic movie and a critically-acclaimed non-fiction book authored by Laura Hillenbrand.

According my interview with his daughter, Norah Christianson, Pollard traveled the race track circuit for months at a time. When in Pawtucket, her father would take her and her brother, John to Pinault’s Drug Store on Newport Avenue, enjoy a movie at the Darlington Theater, visit Kip’s Restaurant, or have ice cream at Pinault’s soda fountain. Many a day Pollard would stop at the Texaco Gas Station, located at Armistice Blvd. and York Avenue, to sit and talk for hours with his friends, she said.

Other interesting tidbits of Pollard’s time in Pawtucket can be found in this article.

The Greatest Generation’s Last Hurrah, published in the Nov. 15, 2014 issue of the Pawtucket Times.

On August 2, 1956, Albert Henry Woolson, 106, the last surviving member of the Union Army who served in the nation’s Civil War, passed away. Frank Woodruff Buckles, 110, gained the distinction of being the last surviving American military veteran of World War I. This article, published five years ago, takes a close look at the passing of the “Greatest Generation,” coined by acclaimed Journalist Tom Brokaw in a 1998 book that profiled this generation who fought in WWI and helped on the home front in the war’s effort.

According to the article, 16 million American soldiers who served in World War II, are now dying at a rate of 555 a day. There are only 1.34 million veterans remaining. The National World War II Museum predicts that by 2036 there will be no living veterans of this global war that took place from 1939 to 1945, to recount their own personal battle experiences.

We will again see another generation of soldiers passing away, like Woolson or Buckles. The article calls for the nation to cherish the “Greatest Generation,” urging readers to gather oral histories to share with the younger generations that follow in footsteps.

Tips on Aging Boldly

Taking Charge: Collected Stories on Aging Boldly, published in 2016, contains a collection of 79 of my weekly articles printed in this paper, many over the last decade. These articles cover a myriad of aging issues ranging f rom care giving, retirement planning to thoughts about spirituality and death. Through these articles you are empowered with practical tools to live a happy, engaged and empowered during the second half of your life. For more details, go to herbweiss.com.

House Committee Moves to Rein in Skyrocketing Prescription Drug Costs

Published in the Woonsocket Call on December 1, 2019

On Nov. 18, House Antitrust Subcommittee Chair David N. Cicilline (D-RI) and Judiciary Committee Chairman Jerrold Nadler (D-RI) introduced The Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 (H.R. 5133) to put the brakes on skyrocketing prescription drug costs. The bill attacked increasing costs by prohibiting pharmaceutical companies from engaging in anticompetitive “product hopping.”

Two days later, the Committee unanimously passed the bipartisan bill to drive down the rising costs of prescription drugs. Now H.R. 5133 goes to the House floor for a vote.

“Big pharmaceutical companies have done everything they can to increase their profits regardless of who it affects. Their CEOs make millions in bonuses ever year while hardworking folks are forced to ration their medicine just so they can put food on the table for their kids,” said Cicilline, in a released statement announcing the introduction of the bill.

Since becoming Chair of the House Antitrust Subcommittee, Cicilline has sought to take on the anticompetitive behavior in the health care and pharmaceutical sectors. “This is wrong, and it needs to stop. This bill, along with the suite of legislation to lower health care costs the House has passed already this year, will put an end to anticompetitive behavior that is driving prices up while pushing the middle class further and further down,” says Cicilline in pushing for the bill’s passage.

“This bill builds on the Committee’s strong record of bipartisan legislation to confront one of the leading drivers of high prescription drug costs—efforts by drug companies to keep generic drugs off the market so that they can preserve their monopoly profits,” adds Chairman Nadler when H.R. 5133 was thrown into the legislative hopper. “The outrageous behavior of product hopping puts profits before patients and thwarts the competition that is essential to lowering prescription drug prices,” he charges. Nadler says that H.R. 5133 would “encourage drug companies to focus on delivering meaningful innovation for sick patients rather than delivering profits to their bottom line.”

Fixing the Problem

According to Cicilline and Nadler, pharmaceutical companies use a wide array of tactics when their patent on a drug is near expiration to switch patients to another version of the drug that they have the exclusive right to sell. Called “product hopping,” this anticompetitive practice extends the manufacturer’s ability to charge monopoly prices by blocking the patient’s ability to switch to a cheaper, generic alternative. Product hopping benefits the manufacturer’s bottom line at the expense of patients who are stuck paying higher prices often for many years at a time, they say.

The two Congressmen say that there is another roadblock to lowering prescription drug costs. Although antitrust agencies have made an effort to curb product hopping, the Federal Trade Commission (FTC) still faces a number of hurdles under existing law when trying to hold companies accountable for this anticompetitive conduct. The Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 strengthens the FTC’s ability to bring and win cases against pharmaceutical companies that engage in all forms of product hopping.

A similar version of H.R. 5133 was considered in the Senate and it would save taxpayers an estimated $500 million according to the nonpartisan Congressional Budget Office.

A week earlier, before H.R. 5133 was passed by the and Judiciary Committee, a new report was released by AARP Public Policy Institute (PPI), giving data to Congress to enact legislation to lowering prescription drug costs. The report findings indicate that brand-name drug prices rose more than twice as fast as inflation in 2018.

According to the AARP PPI report, retail prices for 267 brand-name drugs commonly used by older adults surged by an average of 5.8 percent in 2018, more than twice the general inflation rate of 2.4 percent. The annual average cost of therapy for one brand-name drug ballooned to more than $7,200 in 2018, up from nearly $1,900 in 2006.

“There seems to be no end to these relentless brand-name drug price increases,” said Debra Whitman, Executive Vice President and Chief Public Policy Officer at AARP, in a Nov. 13 statement announcing the release of the report. “To put this into perspective: If gasoline prices had grown at the same rate as these widely-used brand-name drugs over the past 12 years, gas would cost $8.34 per gallon at the pump today. Imagine how outraged Americans would be if they were forced to pay those kinds of prices,” says Whitman.

Brand-name drug price increases have consistently and substantially exceeded the general inflation rate of other consumer goods for over a decade, notes the AARP PPI data.

If brand-name drug retail price changes had been limited to the general inflation rate between 2006 and 2018, the average annual cost of therapy for one brand-name drug would be a whopping $5,000 lower today ($2,178 vs. $7,202). The report’s findings note that the average senior takes 4 to 5 medications each month, and the current cost of therapy translates into an annual cost of more than $32,000, almost 25 percent higher than the median annual income of $26,200 for a Medicare beneficiary.

“While some people will undoubtedly see a slower rate of price increases as a sign of improvement, the reality is that there is absolutely nothing to stop drug companies from reverting back to double-digit percentage price increases every year,” said Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the report. “Americans will remain at the mercy of drug manufacturers’ pricing behavior until Congress takes major legislative action,” adds Purvis.

With over 340 days before the upcoming 2020 Presidential and Congressional elections, Senate Democrats say that more than 250 House-passed bills are “buried in Senate Majority Leader Mitch McConnell’s (R-Ky) legislative graveyard.” The Senate’s top Republican}, referred to as the “Grim Reaper,” has blocked consideration on these bills (including prescription drug pricing bills) effectively killing them. As the election day gets closer this number is expected to increase.

President Trump and Republican lawmakers are loudly chanting that the Democrats are “getting nothing done in Congress.” This is just fake “political” news. Major reforms that would prop up Social Security, Medicare, and lower Prescription Drug prices get the legislative kibosh in the GOP-controlled Senate. It is now time to put these bills to an up or down vote in the upper chamber. The voters will send a message to Congress next November if they agree with the results. It’s time for McConnell to put down his reaper

For details, of AARP report, go to http://www.aarp.org/rxpricewatch.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Herb Weiss

Aging Issues

Category Archives for Healthcare