Tag Archives for M.P.H

Seniors say they hesitate to mix healthcare and matters of faith

Published in RINewsToday on December 26, 2022

When it comes to matters of one’s personal beliefs, most seniors choose to keep their health care and their spiritual or religious lives separate, a new University of Michigan poll finds. But they do see a role for their health care providers in assisting them to cope with illness by looking for meaning or hope.

The National Poll on Healthy Aging (NPHA) is based at the U-M Institute for Healthcare Policy and Innovation (IHPI) and supported by AARP and Michigan Medicine, U-M’s academic medical center.

For this new NPHA report, the poll team worked with Adam Marks, M.D., M.P.H., a hospice and palliative care physician at Michigan Medicine, and L.J. Brazier, M.Div., a chaplain at Michigan Medicine’s Department of Spiritual Care.

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in July 2022 among 2,163 adults, aged 50 to 80. The sample was subsequently weighted to reflect the U.S. population. 

Religious and Spiritual Beliefs and Health Care Decisions

According to new data from the National Poll on Healthy Aging (NPHA), released on Dec. 12, 84% of people between the ages of 50 and 80 say that they have religious and/or spiritual beliefs that are somewhat, or very important to them, including 71% who cited religious beliefs and 80% who cited spiritual beliefs.  About 40% of these older adults say those beliefs have gotten more important to them as they grow older. 

NPHA’s poll findings indicate that women were more likely than men (63% vs. 46%) to report that religious or spiritual believes were important, as those living in the South and Midwest (61% and 59%) compared to those in the West and Northeast (51% and 43%).

In addition, the researchers found that older adults with lower levels of education were also more likely to report religious and spiritual believes as being very important (61% high school or less, 56% some college, 47% bachelor’s degree or higher), as were those with annual household incomes less than $100,000 compared to those with $100,000 or more (59% vs. 43%).

Among older adults with religious or spiritual beliefs that are important to them, 19% say their beliefs have influenced their health care decisions, and 28% say they want health care providers to ask them about their beliefs, note the researchers.

Meanwhile, 77% of all older adults, regardless of beliefs, say health care providers should keep their own personal beliefs separate from how they deliver care.

“While 45% of older adults say their religious beliefs are very important to them, and 50% say that about their spiritual beliefs, even this group largely wants to keep this aspect of their lives separate from their health care,” says Marks, an associate professor of geriatric and palliative medicine, in a Dec. 12 statement announcing the poll’s findings.

“But a sizable majority of all older adults – whether or not they say belief is important to them – reported that they’d turn to health care workers to help them find deeper meaning in their illness, and 78% believe health care workers will help them find hope when they’re having a health-related challenge,” he adds.

According to Brazier, many health care systems have a way to record the religious affiliation of patients in their electronic medical records, and that medical students and others training for health professions are told to ask their patients about any beliefs that might affect their future care.  Having this information available can help providers ensure that patients with strongly held beliefs or specific religious affiliations receive everything from appropriate hospital food to visits with chaplains of a specific faith tradition when they’re having a health crisis or nearing the end of life. 

But for those who do not follow a faith tradition or have strongly held beliefs, having that information available to health providers can also be helpful, says Brazier.

“Being a religious or spiritual person, or not following a faith tradition or spiritual practices, is a highly personal matter,” notes poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System. “So perhaps it’s not surprising that only about a quarter of all people in this age range say they’ve talked about their beliefs with a health care provider, though this rose to about one-third of those who say their religious or spiritual beliefs are very important to them.”  In all, 70% of those who say their beliefs are somewhat or very important to them reported feeling comfortable discussing their beliefs with their health care providers, he says.

Researchers say that even if patients don’t want to discuss their beliefs with their health providers at a typical appointment, it’s important for providers to know if patients with significant health needs, or those experiencing a health crisis, are connected to a faith community that can help provide support. 

In all, 65% of the older adults whose religious or spiritual beliefs are important to them said they belong to a community of people who share their beliefs. 

My Say…

Kathryne Fassbender, Founder and Executive Director of the Hem of Christ: A Dementia Care Ministry, notes that she has never met anyone in her 15 years of work in the field of aging who has wanted to keep their health care and spiritual/religious life separate as the NPHA study states. “What I have found is hesitancy to bring up faith with health care professionals both in physical and mental health care,” she says.

“As Catholics, our health care is woven into how we live our faith, and we wish to have the care we receive be in line with the teachings of the Church. In all honesty, it is increasingly difficult to find doctors who will respect that wish, which opens up a much broader topic of discussion,” she notes. “This hesitancy is across generations, so even care partners for older adults are not always as forthcoming with information regarding faith and health for fear of losing a current healthcare team,” Fassbender observes.

“While the number of doctors who would dismiss someone as a patient because of one’s wishes to keep with the teachings of the Catholic faith in the care they receive is small, the fear is there and it does happen,” says Fassbender, noting that the current medical and social landscape magnifies this fear. “The hostility toward religion and in particular the Catholic Church has a greater impact than I think we understand sometimes,” she warns.

Fassbender says that while it can be helpful to know the personal beliefs of our care providers, it is more important that the doctor, nurse, and therapist, respect our faith. “I know some great care providers who are deeply atheist, yet when they work with their clients of deep faith, they don’t allow their personal beliefs to influence care in any way. They instead assist their client in living out their faith traditions,” she says, stressing that this is what we all seek.

“While I may question some of the findings of this research, I see the findings as a call for care providers to increase seeking to help people of all ages, and all beliefs to live their purpose until their final breath,” says Fassbender.

Fassbender adds: “We must never dismiss one’s faith, regardless of their physical or neuro-cognitive abilities, and most certainly one’s age. I see this study as an invitation to crack open this conversation and allow the hostility, misunderstandings, and fears regarding faith and health to be overcome by the pursuit of care for the human person, fully who they are, what they seek, and how they wish to live life until the final breath.”  

The Hem of Christ started when the time was taken to pause and hear that still, small voice. After years of witnessing how a person’s faith can be diminished simply because of a dementia diagnosis or because someone put their life on hold to care for a loved one, Kate decided that it was time to formalize the small ministry work she had been doing for almost a decade.  Kate answered the call to formalize and set a path for others to walk down, reaching for the hem of Christ. 

NPHA Poll Puts Spotlight on Health Care and Aging Issues

The National Poll on Healthy Aging (NPHA) is a recurring, nationally representative household survey. By understanding the perspectives of older adults, the NPHA provides information to the public, health care providers, policymakers, and aging advocates on issues related to health, health care and health policy affecting U.S. adults ages 50 to 80 and their families.

Launched in spring 2017, the NPHA grew out of a strong interest in aging-related issues among members of the U-M Institute for Healthcare Policy and Innovation (IHPI) bringing together more than 600 faculty members  who study health, health care and the impacts of health policy. In addition to IHPI, the poll receives support from AARP and Michigan Medicine, AARP and U-M’s academic medical center.

The NPHA results can put a spotlight on future research needs and to create an informed national dialogue on poll issues examined. 

Taking a Look at Physical Activity and Cardiac Health

Published in Woonsocket Call on March 8, 2020

Spring time is coming. Get out your walking shoes…

Physical exercise (that doesn’t have to be strenuous to be effective) can lead to longer, healthier lives, according to two preliminary research study findings presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic P Scientific Sessions 2020. The EPI Scientific Sessions, held March 3-6 in Phoenix, is considered to be the premier global exchange of the latest advances in population-based cardiovascular science for researchers and clinicians.

“Finding a way to physically move more in an activity that suits your capabilities and is pleasurable is extremely important for all people, and especially for older people who may have risk factors for cardiovascular diseases. Physical activities such as brisk walking can help manage high blood pressure and high cholesterol, improve glucose control among many benefits,” said Barry A. Franklin, Ph.D., past chair of both the American Heart Association’s Council on Physical Activity and Metabolism and the National Advocacy Committee, director of preventive cardiology and cardiac rehabilitation at Beaumont Health in Royal Oak, Michigan, and professor of internal medicine at Oakland University William Beaumont School of Medicine in Rochester, Michigan.

In one session, Dr. Andrea Z. LaCroix, Ph.D., of the University of California San Diego (UCSD), presented her study’s findings that showed the importance of walking, stressing that every step counts in reducing cardiovascular disease deaths among older women.

USCD’s study was supported by The National Heart, Lung, and Blood Institute of the National Institutes of Health.

According to the UCSD study’s findings, women who walked 2,100 to 4,500 steps daily reduced their risk of dying from cardiovascular diseases (including heart attacks, heart failure, and stroke) by up to 38 percent, compared to women who walked less than 2,100 daily steps. The women who walked more than 4,500 steps per day reduced their risk by 48 percent, in this study of over 6,000 women with an average age of 79.

LaCroix says that the UCSD study’s findings also indicated that the cardio-protective effect of more steps taken per day was present even after the researchers took into consideration heart disease risk factors, including obesity, elevated cholesterol, blood pressure, triglycerides and/or blood sugar levels, and was not dependent on how fast the women walked.

“Despite popular beliefs, there is little evidence that people need to aim for 10,000 steps daily to get cardiovascular benefits from walking. Our study showed that getting just over 4,500 steps per day is strongly associated with reduced risk of dying from cardiovascular disease in older women,” said LaCroix, the lead study author who serves as distinguished professor and chief of epidemiology at the UCSD. Co-authors of the study are John Bellettiere, Ph.D., mph; Chongzhi Di, Ph.D.; Michael J. Lamonte, Ph.D., M.P.H.

“Taking more steps per day, even just a few more, is achievable, and step counts are an easy-to-understand way to measure how much we are moving. There are many inexpensive wearable devices to choose from. Our research shows that older women reduce their risk of heart disease by moving more in their daily life, including light activity and taking more steps. Being up and about, instead of sitting, is good for your heart,” said LaCroix.

LaCroix’s study included more than 6,000 women enrolled in the Women’s Health Initiative with an average age of 79 who wore an accelerometer on their waist to measure their physical activity for seven days in a row; these participants were followed for up to seven years for heart disease death.

This study was prospective, and half of the participants were African-American or Hispanic, stated LaCroix, noting that the use of an accelerometer to measure movement is a strength of the study. However, the study did not include men or people younger than 60, she said, calling for future research to examine step counts and other measures of daily activity across the adult age range among both men and women.

In another session, Joowon Lee, Ph.D., a researcher at Boston University (BU) in Boston, noted that higher levels of light physical activity are associated with lower risk of death from any cause.

According to the findings of BU’s study, older adults were 67 percent less likely to die of any cause if they were moderately or vigorously physically active for at least 150 minutes per week, (a goal recommended by the American Heart Association) compared to people who exercised less.

However, the researchers observed that, among the participants with an average age of 69, physical activity doesn’t have to be strenuous to be effective. Each 30-minute interval of light-intensity physical activities – such as doing household chores or casual walking – was associated with a 20 percent lower risk of dying from any cause, they said, noting that on the other hand, every additional 30-minutes of being sedentary was related to a 32 percent higher risk of dying from any cause.

“Promoting light-intensity physical activity and reducing sedentary time may be a more practical alternative among older adults,” said Joowon.

The BU research study, supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, evaluated physical activity levels of 1,262 participants from the ongoing Framingham Offspring Study. These participants were an average age of 69 (54 percent women), and they were instructed to wear a device that objectively measured physical activity for at least 10 hours a day, for at least four days a week between 2011 and 2014.

The researchers say that the strengths of this study include its large sample size and the use of a wearable device to objectively measure physical activity. However, the participants of the Framingham Offspring Study are white, so it is unclear if these findings would be consistent for other racial groups, they note.

Co-authors of the study are Nicole L. Spartano, Ph.D.; Ramachandran S. Vasan, M.D. and Vanessa Xanthakis Ph.D.