Aging Societies and the Ethical Challenges of Long Life

2018 ◽  
Author(s):  
Allison R. Heid ◽  
Steven H. Zarit
Keyword(s):  
United States ◽  
Life Expectancy ◽  
End Of Life ◽  
The United States ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Older Individuals ◽  
Ethical Challenges ◽  
Chronic Health

Individuals are living longer than they ever have before with average life expectancy at birth estimated at 79 years of age in the United States. A greater proportion of individuals are living to advanced ages of 85 or more and the ratio of individuals 65 and over to individuals of younger age groups is shrinking. Disparities in life expectancy across genders and races are pronounced. Financial challenges of sustaining the older population are substantial in most developed and many developing countries. In the United States in particular, employer-based pension programs are diminishing. Furthermore, Social Security will begin taking in less money than it pays out as early as 2023, and the debate over its future in part entails discussions of equitable distribution of resources for the young in need and the old. Living longer is associated with a greater number of chronic health conditions—over two-thirds of Medicare beneficiaries in the United States have two or more chronic health conditions that require complex self-management regimes partnered with informal and formal care services from family caregivers and institutional long-term services and supports. Caregiver burden and stress is high as are quality care deficiencies in residential long-term care settings. The balance of honoring individuals’ autonomous wishes and providing person-centered care that also addresses the practicalities of safety is an ever-present quandary. Furthermore, complex decisions regarding end-of-life care and treatments plague the medical and social realms, as more money is spent at the end of life than at any other point and individuals’ wishes for less invasive treatment are often not accommodated. Yet, despite these challenges of later life, a large percentage of older individuals are giving financial support, time, and energy to younger generations, who are increasingly strained by economic hardship, the pressures on dual earner parents, and the problems faced by single parenthood. Older individuals’ engagement in society and the help they provide others runs counter to stereotypes that render them helpless and lonely. Overall, the ethical challenges faced by society due to the aging of the population are considerable. Difficult decisions that must be addressed include the sustainability of programs, resources, and social justice in care, as well as how to marshal the resources, talents, and wisdom that older people provide.

scholarly journals IS BEING A PREMATURE OR HAVING ABNORMAL BIRTH WEIGHT ASSOCIATED WITH DEPRESSION AMONG 6 - 17 YEARS OLD U.S. CHILDREN?

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e51-e51
Author(s):  
Abdulaziz Bahassan ◽  
Colin Depp
Keyword(s):  
Mental Health ◽  
United States ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
The United States ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Chronic Health ◽  
History Of

Abstract BACKGROUND Reports in 2015 showed that premature birth rate in the United States increased when compared to 2014 data, and this was the first increment since 2007. Major complications of prematurity and birth weight abnormalities are well known, but other complications including mental health abnormalities require more investigation to understand their association well. OBJECTIVES We aimed in this study to determine if prematurity and birth weight abnormalities including very low birth weight (VLBW) and low birth weight (LBW) are associated with depression among United States children aged between six and seventeen years old. ​ DESIGN/METHODS This is a cross sectional study using data from the National Survey of Children’s Health (NSCH) 2011–2012. When we applied our selection criteria, 84,182 children out of the total 95,677 NSCH population were selected. Our exclusion criteria were: age less than six years, child’s history of cerebral palsy, and mental retardation. Multivariable logistic regression was done to control for confounding effects when studying the association of prematurity, birth weight abnormalities and depression. ​ RESULTS Our results reveal that 3.6% of our population had history of depression, 11% were born prematurely, 7.4% had low birth weight, and 1.5% had very low birth weight. Depression was more frequent in children who were born prematurely (prevalence 4.3%) when compared to children born at term. Different models were built to analyze the association between prematurity, birth weight abnormalities and depression. There was no detectable statistically significant association when controlling for demographic data (age, gender, race, family structure) and mental health risk factors (parental poor mental health, chronic health conditions) as well as other factors. Results reveal that children who had chronic health conditions or had adverse family experiences have greater odds of having depression. On the other hand, African-American, male, and younger (6–11 years old) children have lower odds of depression. ​ CONCLUSION Further longitudinal studies are required to establish a causal relationship of behavioral and psychological complications, and to determine the biological mechanisms of brain development that could be associated with depression among premature infants or those who have birth weight abnormalities.

Nativity, Chronic Health Conditions, and Health Behaviors in Filipino Americans

2017 ◽  
Vol 29 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Maria L. G. Bayog ◽  
Catherine M. Waters
Keyword(s):  
United States ◽  
Health Behaviors ◽  
Asian American ◽  
The United States ◽  
Chronic Health Condition ◽  
Health Condition ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
California Health Interview Survey ◽  
Chronic Health

Introduction: Nearly half of Americans have a chronic health condition related to unhealthful behavior. One in four Americans is an immigrant; yet immigrants’ health has been studied little, particularly among Asian American subpopulations. Methodology: Years lived in United States, hypertension, diabetes, smoking, walking, adiposity, and fruit/vegetable variables in the 2011-2012 California Health Interview Survey were analyzed to examine the influence of nativity on chronic health conditions and health behaviors in 555 adult Filipinos, the second largest Asian American immigrant subpopulation. Results: Recent and long-term immigrant Filipinos had higher odds of having hypertension and diabetes, but lower odds of smoking and overweight/obesity compared with second-generation Filipinos. Discussion: Being born in the United States may be protective against chronic health conditions, but not for healthful behaviors among Filipinos. Chronic disease prevention and health promotion strategies should consider nativity/length of residence, which may be a more consequential health determinant than other immigration and acculturation characteristics.

scholarly journals Identification of Latent Sleep Profiles in Middle-Aged Adults and Connections to Well-Being

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 338-338
Author(s):  
Soomi Lee ◽  
Claire Smith
Keyword(s):  
United States ◽  
Well Being ◽  
The United States ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Sociodemographic Characteristics ◽  
Middle Aged ◽  
Sleep Health ◽  
Middle Aged Adults

Abstract For middle-aged adults, achieving adequate sleep is a challenge but essential for long-term health. The present study identified latent sleep profiles to clarify how multiple sleep variables (i.e., regularity, satisfaction, alertness, timing, efficiency, and duration) cooccur within middle-aged adults and the implications these holistic sleep experiences have for well-being. Three profiles emerged within the Midlife in the United States II dataset (MIDUS; N=4030, Mage=56.23 years): (i) good sleepers, (ii) nappers/poor night sleepers, and (iii) sufficient but irregular sleepers. Generally, good sleepers reported the best well-being, sufficient/irregular sleepers reported comparatively moderate well-being, and nappers/poor night sleepers reported the worst well-being across a variety of indicators (i.e., chronic health conditions, life satisfaction, positive affect, negative affect, and psychological well-being) after adjusting for sociodemographic characteristics. Age moderated these associations. Our findings advance understanding of sleep health as a multifaceted construct and of its connection to well-being in middle-aged adults.

Modifiable Risk Factors for Neurocognitive and Psychosocial Problems After Hodgkin Lymphoma

Blood ◽  
2021 ◽  
Author(s):  
AnnaLynn M Williams ◽  
Sedigheh Mirzaei Salehabadi ◽  
Mengqi Xing ◽  
Nicholas Steve Phillips ◽  
Matthew Ehrhardt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hodgkin Lymphoma ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Cross Sectional ◽  
Chronic Health ◽  
Modifiable Factors ◽  
Task Efficiency

Long-term survivors of childhood Hodgkin lymphoma (HL) experience high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. 1,760 survivors of HL (mean[SD] age 37.5[6.0] years, time since diagnosis 23.6[4.7] years, 52.1% female) and 3,180 siblings (age 33.2[8.5] years, 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to NCI CTCAE v4.3 (1=mild, 2=moderate, 3=severe/disabling, 4=life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs. siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment factors and grade 2+ chronic health conditions. Compared with siblings, survivors had significant higher risk (p's<0.05) of neurocognitive impairment (e.g. memory 8.1% vs. 5.7%), anxiety (7.0%%vs. 5.4%),depression (9.1% vs. 7%), unemployment (9.6% vs. 4.4%), and impaired physical/mental quality of life (e.g. physical function 11.2% vs. 3.0%). Smoking was associated with higher risk of impairment in task efficiency (RR=1.56[1.02-2.39]), emotional regulation (RR=1.84[1.35-2.49]), anxiety (RR=2.43[1.51-3.93]), and depression (RR=2.73[1.85-4.04]). Meeting CDC exercise guidelines was associated with lower risk of impairment in task efficiency (RR=0.70[0.52-0.95]), organization (RR=0.60[0.45-0.80]), depression (RR=0.66[0.48-0.92]), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.

scholarly journals Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration

2019 ◽  
Vol 8 (7) ◽  
pp. 922
Author(s):  
Daisy J.A. Janssen ◽  
Simon Rechberger ◽  
Emiel F.M. Wouters ◽  
Jos M.G.A. Schols ◽  
Miriam J. Johnson ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life ◽  
Cause Of Death ◽  
The United States ◽  
Population Based ◽  
Health Conditions ◽  
Mortality Data ◽  
Self Organizing Map ◽  
Multiple Health

Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.

Burden of Morbidity in 10+ Year Survivors of Hematopoietic Cell Transplantation (HCT): A Report From the Bone Marrow Transplant Survivor Study (BMTSS)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 841-841
Author(s):  
Can-Lan Sun ◽  
John H. Kersey ◽  
Liton Francisco ◽  
K. Scott Baker ◽  
Saro H. Armenian ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Chronic Health Condition ◽  
Health Condition ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Chronic Health ◽  
Somatic Distress ◽  
Healthcare Needs ◽  
Life Threatening

Abstract Abstract 841FN2 Background: High-intensity therapeutic exposures and prolonged immunosuppression increase the risk of long-term complications after HCT, with an attendant increase in the healthcare needs of these long-term survivors. We have previously demonstrated that morbidity increases with increasing time after HCT (Sun CL, Blood, 2010;116:3129–39). However, the burden of morbidity in patients who survive extended lengths of time after HCT and the consequent healthcare needs of these survivors are unknown. Methods: Utilizing resources offered by the BMTSS, we evaluated the risk of chronic health conditions and psychological health of 366 10+ year HCT survivors and their siblings (n=309). A severity score (grade 1 [mild]; grade 2 [moderate], grade 3[severe], grade 4 [life-threatening], and grade 5 [death due to chronic health condition]) was assigned to each health condition using the CTCAE, v3.0. Cumulative incidence of chronic health conditions was evaluated, using competing risks method. Brief Symptom Inventory (BSI) was used to describe adverse psychological health. Multivariate regression analysis allowed identification of vulnerable subgroups. The current status of healthcare utilization by the HCT survivors was also evaluated. Results: The mean age at HCT was 22 years (range: 0.4–59.8) and at study participation was 37 years (range: 11–72); mean length of follow-up was 15 years (range: 10–28). Primary diagnoses included AML (28%), ALL (17%), CML (17%), NHL (11%), aplastic anemia (11%), HL (7%), and other diagnoses (9%). Stem cell graft was autologous (27%); allogeneic related (65%) and unrelated donor (8%); 72% of the patients received TBI-based conditioning. At least one chronic health condition was reported by 74% of the HCT survivors, compared with 29% of siblings (p<0.001); 25% of the survivors reported severe/life-threatening conditions compared to only 8% of the siblings (p<0.001). Commonly reported severe/life-threatening chronic health conditions included myocardial infarction, stroke, blindness, diabetes, musculoskeletal problems, and subsequent malignancies. As shown in Figure 1A, the 15-year cumulative incidence of any chronic health condition (grades 1–5) was 71% (95% CI, 67–75%), and of severe-life-threatening conditions or death was 40% (95% CI, 33–47%). HCT survivors were 5.6 times as likely to develop a severe/life-threatening condition (95% CI, 3.7–8.6), compared with age- and sex-matched siblings. The cumulative incidence of severe/life-threatening conditions did not differ by type of HCT (p=0.79, Figure 1B). Using BSI, we evaluated somatic distress, anxiety, and depression among HCT survivors and their siblings. While the prevalence of anxiety and depression were comparable between survivors and siblings, HCT survivors were 2.7 times more likely to report somatic distress (p<0.001). Among survivors, female gender (OR=3.6, 95% CI, 1.4–9.0), low household income (<$20,000 OR=4.4, 95% CI, 1.1–17.2), and poor self-rated health status (OR=10.6, 95% CI, 4.0–27.9) were associated with increased risk for somatic distress. Fortunately, 90% of HCT survivors carried health insurance coverage, because a high proportion needed ongoing specialized medical care; 69% of the HCT survivors reported cancer/HCT-related visits at an average of 15 years after HCT. Conclusions: The burden of long-term physical and emotional morbidity borne by 10+ year HCT survivors is substantial, resulting in a high utilization of specialized healthcare. Patients, families and healthcare providers need to be made aware of the high burden, such that they can plan for post-HCT care, even many years after HCT. Disclosures: No relevant conflicts of interest to declare.

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