GBO NEWS: New “Death in America” Report; 19 Reporting Fellows Chosen; & More
GENERATIONS BEAT ONLINE NEWS
E-News of the Journalists Network on Generations
September 18, 2014 — Volume 14, Number 12
Editor’s Note: GBO News, e-news of the Journalists Network on Generation publishes alerts for journalists, producers and authors covering generational issues. Send your news of important stories or books (by you and others), fellowships, awards or pertinent kvetches to GBO News Editor Paul Kleyman. If you receive the table of contents as e-mail, just click through to the full issue at www.gbonews.org.
IN THIS ISSUE: Boots-on-the-Ground Journalism
1. GOOD SOURCES: Dying in America Institute of Medicine Report; *** “Improving Prescribing for Patients Late in Life,” in Journal of the American Medical Association’s (JAMA)
2. EYES ON THE PRIZE: Record 19 Journalists in Aging Fellows Announced; ***Health Care Reporting Fellow Deadline, Oct. 1; National Press Foundation Cancer Issues Fellowship, Application Deadline Oct. 14
3. STORY BOARD: LINKS TO — “Grow Your Own ‘Unretirement’ — Minnesota Hmong on the Farm,”by Chris Farrell, Next Avenue/New America Media; *** “In Retirement Savings, the Poor Get Poorer,” by Anne Tergesen, Wall Street Journal; *** “How the Pay Gap Leads to the Retirement Savings Gap,” by Jonnelle Marte, Washington Post; *** “Device Puts Hearing Impaired in the ‘Loop’,” by Marci Shatzman, South Florida Sun-Sentinel
4. GEN BEATLES NEWS: California Generations Beat Writer Joan Aragone Revives “Health and Aging News” as New Blog;*** Five Gen Beat Reporters on Panel at The SCAN Foundation’s 2012 California Summit on Long Term Service & Supports
1. GOOD SOURCES
*** Dying in America —Improving Quality and Honoring Individual Preferences Near the End of Life is the Institute of Medicine’s (IOM) new 507-page report, released Wednesday, calling for a comprehensive overhaul of how end-of-life care is done in the United States. The consensus report of a 21-member expert committee, which took testimony at open hearings across the country in 2013, stressed that the impetus for change is particularly timely now. That’s because of to “the rapidly increasing number of older Americans with some combination of frailty, physical and cognitive disabilities, chronic illness and functional limitations.” In addition, says the report, increasing cultural diversity, heightens “the need for responsive, patient-centered care.” IOM also calls for addressing “barriers in access to care that disadvantage certain groups.”
Major concerns bullet-pointed in the Dying in America summary are that:
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A mismatch between the services patients and families need and the services they can obtain, especially better quality and availability of medical and social services for patients and their families;
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Inadequate numbers of palliative care specialists and too little palliative care knowledge among other clinicians caring for individuals with serious advanced illness;
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And a fragmented care-delivery system, spurred by perverse financial incentives that contributes to the lack of service coordination across programs and unsustainable growth in costs.
The report recommends greater focus on “person-centered, family-oriented end-of-life care,” with wider adoption of the palliative approach. Palliative care may include hospice usually rendered in the final six months of life. But palliative treatment can begin well before hospice. The committee defines palliative care as relieving pain and controlling symptoms while offering support for better quality of life.
IOM also calls for improved communication between clinicians and patients, along with advance care planning. (You know, the conversation with your doctor about your options, which Sarah Palin called “death panels,” setting the public debate back five years.) The report also calls for better professional education, public education and “a major reorientation of payment systems to incentivize the integration of medical and social services, the coordination of care across multiple care settings, and the use of advance care planning and shared decision making to better align the services patients receive with their care goals and preferences.”
However, the New York Times story on the report, “End-of-Life Care Needs Sweeping Overhaul, Panel Says,” by Pam Belluck, quoted concerns expressed by Burke Balch, director of the National Right to Life Committee’s Powell Center for Medical Ethics. The conservative group released his statement saying, “The report’s emphasis on cost-slashing will intensify, rather than calm, the well-founded fears of older people and those with disabilities that the renewed push for government funding and promotion of advance care planning is less about discovering and applying their own wishes than about pushing them to accept premature deaths.”
GBO’s editor believes this Balch raises a legitimate concern, regardless of one’s political perspective. But a reporter might ask Balch or other right-to-life leaders what they think about America’s current way of death, increasingly pushing patients toward highly medicalized care beyond its potential for therapeutic value and often against patients’ wishes. (See my recent article about recent research on this.)
In fact, the IOM report recommends a “major reorientation and restructuring of Medicare, Medicaid and other health care delivery programs” and the elimination of “perverse financial incentives” encouraging expensive hospital procedures while growing numbers of very sick and very old patients want low-tech services like home health care and pain management.
The hope is that the new IOM Report, whose committee included strong bipartisan membership, will prompt advocates to strip their very serious worries of political rhetoric, and bring them into a prudent process that might rebuild the broken system that now give so many nothing more then the right to misery.
*** “Improving Prescribing for Patients Late in Life,” is an essential commentary from the Journal of the American Medical Association’s (JAMA) “Internal Medicine” that serves as a sharp reminder of a persistent issue GBO’s editor first wrote about in the 1980s. Adverse drug effects continue to be an under-the-radar issue affecting millions of people as they age. It’s a story reporters can take on from local to national practice and policy levels.
In the JAMA commentary, Greg Sachs, M.D., an investigator at the Regenstrief Institute, in Indianapolis, writes, “Caring for older patients with their multiple health problems is problematic. Doctors, who only have limited time with each person they see, tend to reach for prescription pads or e-prescribing tools. Patients expect prescriptions, and if they don’t receive one will wonder what their doctor has done for them. As a result, the elderly receive too many prescriptions.”
According to Sachs, also on the faculty of the Indiana University School of Medicine, current prescribing guidelines fail to adequately address instances in which drugs are not beneficial or may even be harmful to older adults. And they neither identify age-adjusted dosage standards, nor address use, drug interactions and metabolism concerns. The latter is especially critical because, for example, older bodies tend to metabolize medications more slowly. If physicians fail to monitor and adjust medications, dosage amounts that a person used to absorb more quickly may remain and accumulate with each additional dose.
Because of this, too often doctors have often misdiagnosed an adverse drug reaction, such as confusion, as incipient dementia. That’s an error that could result in premature nursing home admission for someone who might have otherwise returned to health and independence had the physician first bothered to examine the patient’s drug intake.
Sachs and colleagues propose a model for prescribing medications that additionally incorporates a patient’s anticipated life expectancy, the treatment target, the time needed for medication to produce its intended benefit and the patient’s goals of care.
Sachs goes on, “Physicians often have trouble talking with patients and their families about where the patient is in their lifespan.” He continues, “These conversations shouldn’t be put off until the patient is in the ICU; they should occur during routine office visits and be updated as the patient ages.”
His commentary accompanies “Medications of Questionable Benefit Used in Advanced Dementia,” a study of nursing home residents from across the United States. The University of Massachusetts Medical School and Harvard Medical School authors of the study reported that a majority of nursing home residents with advanced dementia received at least one medication with questionable benefits, possible harms and substantial associated costs.
Journalists can request both articles by contacting JAMA Network Media Relations at 312-464-JAMA (5262); e-mail mediarelations@jamanetwork.org. Or Cindy Fox Aisen at the Regenstrief Institute can send reporters a PDF of Sachs’ essay: 317-843-2276; caisen@iupui.edu.
2. EYES ON THE PRIZE
***Record 19 Journalists in Aging Fellows Announced: New America Media (NAM) and the Gerontological Society of America (GSA) selected a record 19 reporters for the Journalists in Aging Fellows Program, now in its fifth year. They represent a wide range of general audience and ethnic media outlets, such as several daily newspapers, online media, national publications and public radio affiliates. The program is held in collaboration with the Journalists Network on Generations, publisher of GBONews.org.
The fellows will convene during GSA’s Annual Scientific Meeting — scheduled for November 5 to 9 in Washington, D.C. — and tap into the event’s over 400 presentations and 4,000 expert attendees to develop a major aging-focused story or series. These proposed projects, to be published in 2015 will span such concerns as elder abuse, aging in ethnic populations and financial security.
This year’s program received major funding from AARP, plus a substantial grant from the Silver Century Foundation and additional support from John A. Hartford Foundation.
In Washington, the fellows also will report on new discoveries in aging and participate in a daylong workshop, where experts will discuss the latest research and provide insight on key issues facing older Americans. The program will also provide Continuing Fellowship grants to 15 previous years’ fellows to participate in the meeting. A continuously updated list of stories generated by the program’s participants is available at www.geron.org/journalistfellows.
But you don’t have to be a selected as a fellow to attend the conference. GSA provides complimentary registrations to journalists. Just go to the GSA conference Media website to apply for a press registration. For questions contact GSA’s Todd Kluss: e-mail: tkluss@geron.org; (202) 587-2839. The conference will include press lunch presentations on Nov. 6, 7 and 8, and there will be a special journalists meet-up reception on Friday, Nov. 7.
Reporters can search the online conference program according to topic, speakers, location and so on by going to http://tinyurl.com/qyf79q6. You can bypass the first box asking you to create an itinerary simply by clicking “Continue as Guest.”
Here is the list of this year’s NAM-GSA Journalists in Aging Fellows:
Melody Miranda Aulet (digital reporter, Cox Media Group’s Mundo Hispánico, Atlanta, Ga.) — Project: video and written series on the lack of geriatric physicians (especially Spanish speakers), Hispanic elders’ participation in clinical trials, such as for Alzheimer’s disease, and in community programs.
Frank Browning (contributor, Kaiser Health News and California Magazine) — Project: Emerging approaches to aging in place, such as the Village Model, through the lens of gender. Also, and examination of how U.S. demographic shifts, especially in Asian and Latino communities, could affect the lives of older women.
Jennifer L. Boen (Health Columnist and Writer, Fort Wayne News-Sentinel, Indiana) — Project: Transforming culturally relevant elder care, focusing on the growth of refugee and immigrant populations in the American heartland, such as from Burma, West Africa and Latin America.
Jenny Chen (editor, Asian Fortune Newsmagazine, Washington, D.C.) — Project: Mental health in the Asian American senior population.
Jen Chien (senior producer, “Crosscurrents,” KALW Public Radio, San Francisco, and NPR contributor) Fellowship topic: Social connections for seniors — from ethnic elders dancing for health to cultural barriers for ethnic elders to technology and social media.
Erica Curless (features and age beat reporter, Spokesman-Review, Spokane) — Project: The lives of elders in small towns and in the countryside, from diehard individualists to those on Indian reservations.
Rachel Dornhelm (freelance contributor, KQED Public Radio’s “State of Health” blog and KQED Radio News, San Francisco) — Project: Overmedication in seniors.
Sandra J. Larson (Staff Writer, Bay State Banner, Boston) — Project: The impact of gentrification on elders’ housing.
Frederick H. Lowe (founder/editor, NorthStar News & Analysis, Chicago) — Project: Series on older, African American men such as those with little or no Social Security income, often due to low lifetime wages; family caregiving challenges; and prison release at older ages.
Lisa Wong Macabasco (contributor/former chief editor, Hyphen Magazine) — Project: The trend in remarriage among Chinese seniors, especially widowers and widows, who have remarried people from Asia, focusing on life and cultural challenges in America today for the aging Chinese population.
Laura McCamy (freelance contributor, Oakland Local, California) Project: Impact of gentrification on seniors in Oakland’s Chinatown and the African American community on income security for seniors.
Greggory W. Morris (contributor, BQ Brew, Brooklyn and Queens, New York) Project: Ethnographic, street-level stories profiling the quality of life of elders in one of the most dangerous neighborhoods in New York City: East New York, Brooklyn.
Kimberly Palmer (business and personal finance writer, U.S. News & World Report) — Project: How changing health care needs and the medical system put stress on caregiving relationships (and finances) of aging Americans and their children.
Encarnacion Pyle (human-services reporter, The Columbus Dispatch, Ohio) — Project: Elder abuse in personal and public policy terms.
Sarita Sarvate (“Last Word” Columnist, India Currents Magazine) — Project: How modern pressures are rapidly changing multigenerational family structures, often leaving older adults isolated, facing cultural, language, transportation and economic barriers, even in the affluent Silicon Valley.
Liz Seegert (freelance writer/producer, “HealthStyles,” WBAI, New York, and blogger, HealthCetera) — Project: Portraits of family caregiving among New York City’s aging ethnic adults.
Elizabeth Simpson (health writer, Virginian-Pilot, Norfolk, Virginia) — Project: Disruptive blending in assisted living facilities of seniors with younger mentally ill people often due to economic downsizing.
Mark Taylor (Chicago-based contributor to the Philadelphia Inquirer and Kaiser News Network) — Project: How the Affordable Care Act is impacting the way hospitals treat patients with chronic conditions.
Pamela Yip (business and personal finance reporter/columnist, Dallas Morning News) — Project: The growing challenges of financial elder abuse for cognitively challenged seniors.
*** Health Care Reporting Fellowships: October 1 is the application deadline for the Association of Health Care Journalists’ (AHCJ) yearlong program allowing journalists to pursue “a significant reporting project related to the U.S. health care system.” The project can be local, national or a mix, such as an aspect of the Affordable Care Act showing regional examples with a wider effect, “or the impact of particular evidence-based treatments on health outcomes, or an analysis of a health care organization’s performance, using public data sets.” Fellows pursue their projects via their newsrooms or with freelance outlets committing to publish or air the work.
The fellowship covers the cost of attending the program’s seminars and AHCJ conferences, with a $4,000 project allowance to defray the cost of field reporting, health data analysis and other project-related research. In addition, each fellow will receive a $2,500 fellowship award upon the successful completion of the project. The Commonwealth Fund is supporting the project.
*** The National Press Foundation’s (NPF) Set an Oct. 14 Deadline to apply for it’s 6th Cancer Issues fellowship, The all-expenses-paid program for 16 U.S. journalists will examine “the latest research and policy around a disease that still kills more than half a million people in the United States every year,” according to the NPF website. “On-the-record” sessions will include scientists, scholars and journalists and offer ample time for questions from our fellows. Among planned topics are cancer screening policies, access to care, end-of-life support and a look at how the U.S. pays for cancer research.
Chosen reporters will attend the seminar in Washington, D.C., Dec. 7-10. Journalists from all media—web, print, radio & TV broadcast and photography—are eligible. The fellowships will cover travel, lodging and most meals. See this NPF website for a short video a peek at previous programs. Bayer is sponsoring this program. NPF also posts its guidelines for program sponsors here.
3. STORY BOARD
*** “Grow Your Own ‘Unretirement’ — Minnesota Hmong on the Farm,” PBS Next Avenue/New America Media, News Feature, Chris Farrell. Part of the retire-to-farm movement, immigrants are carving out a new life for themselves and their families,
*** “In Retirement Savings, the Poor Get Poorer,” by Anne Tergesen, Wall Street Journal (Sept. 10): A new Federal Reserve report says that although the stock market and increased contributions boosted the average U.S. retirement account by 10 percent from 2010-2013, “declines in participation were most serious among those in the bottom half of the income distribution. Among those families, participation rates fell from 48.2% in 2007 to 40.2% today, according to the Fed report.”
*** “How the Pay Gap Leads to the Retirement Savings Gap,” by Jonnelle Marte, Washington Post (Sept. 17): “The pay gap between men and women narrowed last year, but not by much.” Marte cites U.S. Census Bureau figures showing that in 2013, women earned 78.2 cents for every dollar earned by men, “up from 76.5 cents in 2012.” She calls that “slow progress from 1961, when women earned about 60 cents for every dollar.” The Employee Benefit Research Institute previously calculated that women with individual retirement accounts have saved an average of $81,700 saved, compared to the average $139,467 for men.
Lower lifetime earnings for female workers are a key reason. Marte adds, “But even women who save as much as men may find other setbacks when it comes to retirement income. The lower pay they receive throughout their careers will also lead to smaller Social Security benefits in retirement.” (Note that the Washington Post may require free registration before providing access to the article.)
*** “Device Puts Hearing Impaired in the ‘Loop’” by Marci Shatzman, South Florida Sun-Sentinel: A new, wifi-like technology called a Hearing Loop is enabling seniors to hear better at movies, lectures and concerts without as much distracting background noise as earlier technologies. Although a senior’s cost is $13,000, the technology is being installed in more and more locations. One man, 85, who Shatzman interviewed, “It works best with movies. You don’t hear ambient noise.”
4. GEN BEATLES NEWS
*** Northern California Generations Beat Writer Joan Aragone, is reviving “Health and Aging News,” her decade-long weekly column that the San Mateo County Times cut two years ago in a merger-mania frenzy. (San Mateo is just south of San Francisco and just north of Silicon Valley, so the paper’s editors evidently determined that no one there was aging anymore—or at least can’t afford to. Longevity for that newspaper is another issue.) Aragone, who has written for papers such as the Los Angeles Times, San Francisco Chronicle and San Jose Mercury, is posting it as a new blog. One recent column highlighted “The Genius of Marian,” a sensitive, tender and moving, 90-minute documentary about a bright and talented woman diagnosed with early on-set Alzheimer’s Disease and her family’s response.” It was aired on PBS stations nationwide earlier on “Point of View” (POV). The column also included items on local caregiving workshops, and notices of media reports on flawed nursing home inspections. Readers can reach her at joanaragone@gmail.com.
***The SCAN Foundation’s 2012 California Summit on Transforming Long-Term Services and Supports (LTSS), is not only a mouthful of a conference title, but will offer attendees–California’s leading advocates and experts on this topic area–plenty of media advice on with to ruminate. Being held in Sacramento, Sept. 30, the program will include a panel on media with Araceli Martinez of La Opinion (the largest Spanish-language daily paper in the country; Anna Gorman, Kaiser Health News; Ina Jaffe, NPR News; Paul Kleyman, New America Media and GBONews.org; and David Gorn, California Healthline. The moderator will be Patrick McCabe of GYMR (Get Your Message Right) Public Relations.
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