The Big Wave Of Aging Baby Boomers

Leave a comment

Couple on motor cycleWill the world be ready if or when aging boomers [born between 1946 and 1964] hang up their car keys? Most plan to stay in their suburban house even though their home may become unsuitable. It’s surprising that this huge generation is not being addressed by the housing industry.

Thoughtfully designed housing for older adults is not being created on a scale commensurate with the growing need. It’s not a market many architects or developers have embraced. Conversely, a disproportionate amount of attention has been focused on the presumed desires of millennials. We hear all the time that it’s this group craving walkability, good transit and everything-at-their-doorstep amenities — and that it can only be provided by cities.

There are a number of reasons for this: most of the people who do marketing are young. Doing stuff for old people is not fun. One marketing consultant who founded the Boomer Project noted:

It’s as if marketers all wear the same blinders. Because so many marketing executives are under 40 — or even under 30 — many presume most consumers not only think like them, but want to be like them. Most marketing that targets Boomers presumes there is something wrong with them that needs fixing, such as age spots or wrinkles. It’s malady-based. And, for the most part, it’s not accurate.

Sure, things will go wrong, but not in the order one would think

So when the companies do think about designing for those growing older, their thinking is malady-based too; by considering malady-based design issues like “step-free entrances, single-floor living, under-counter appliances, and halls and doorways that accommodate wheelchairs.”

But, by not really knowing for sure what kind of housing aging boomers need, these mobility-based problems are the last to consider; the first are household-based activities like driving, food shopping, taking medication and meal preparation. These start hitting in significant numbers in the mid 70s, and the boomers are not there yet.

These are also problems that are solved by community — being able to walk to shop, moderately priced restaurants where one can get prepared food, neighbors who might look in and check if a person is taking their medication.

Right now, boomers feel pretty good

The fact is that right now, most of the baby boomer cohort is still pretty healthy. According to a Del Webb study, they all feel a lot younger than they are, and until any health problems start hitting them, they will think they are much younger. So it should be no surprise that there are not too many of them worrying right now about giving up their cars; they all think they are fine.

Every day for the next 12 years, 10,000 people will reach age 65. That companies are not scrambling to exploit this market is not only unfortunate for their bottom line, but almost certainly treacherous, eventually, for everyone.

The power of boomers

Baby boomers buy 60 percent of packaged goods, spend 75 percent more on vacations, and buy half of all new cars. They own a third of all the iPhones and half of the Macs. Baby boomers, because they get out and vote in higher numbers, just elected the new American government and pretty much control it. President Trump is 70, Wilbur Ross, U.S. Secretary of Commerce, is 79, and the average age of the cabinet is 62. The baby boomers own America, and now they rule it.

There is an importance of living in walkable communities, those things that the millennials want, such as good transit and everything-at-their-doorstep amenities. People have to start thinking seriously about these issues, but most baby boomers simply haven’t yet. Most who have decent jobs or own businesses are not seeing any retirement barrier at age 65 either.

Technology can be part of the solution, with Uber, home delivery, apps and wearables. Summoning these cars is a no-brainer for heavy users of smartphones, but for older people with declining vision and motor skills, it’s a puzzle. But not for the baby boomers; they just upgrade to the iPhone 7 Plus and get a bigger screen. Again, conflating seniors with tech-savvy boomers who have fine, well-practiced index finger skills, along with Siri and Alexa.

In fact,  the biggest problem for boomers might well be over-reliance on technology. Most older seniors could easily park themselves in front of the television with only the 50 channels the cable company gave them. Now we can get endless streaming of Netflix and every other service to fill our time. Soon we all might be wearing Oculus headsets and never leaving our chairs.

Perhaps that is what happens when people are trapped in their homes, or when they lose their car keys. Which is maybe why we have to think community first, interior design second. And in the end, we’re talking about timing. The baby boomer demographic bulge is just getting into its senior years. As one senior living expert, Bob Kramer notes:

“Some of this is like surfing — you have to time the wave,” Kramer says. “You paddle too soon, and you wipe out spectacularly.”

The oldest boomers are just 70 or 71 now. But they are the leading edge with many, many millions to follow. We are 10 years away from the real crisis here. The question is, do we fix our cities and towns now so that they are ready for this wave, or will it drown us all?

 

Want To Live Past 100?

Leave a comment

Centarians

Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said.

John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets.

“Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.”

Mac Miller, who is 102, has a standard reply.

“People ask me ‘What is the secret?’ The answer is simple. Choose the right grandparents. They were in their 80s. My mother was 89, and my father was 93,” he said.

Genetics and behaviors do play roles in determining why some people live to be 100 or older while others don’t, but they aren’t guarantees. And now, as increasing numbers are reaching triple digits, figuring out the mysteries of longevity has taken on new importance among researchers.

Although those 100 and older make up a tiny segment of America’s population, U.S. Census reports show that centenarian ranks are growing. Between 1980 and 2010, the numbers rose from 32,194 to 53,364, an increase of almost 66 percent. The latest population estimate, released in July 2015, reflects 76,974 centenarians.

“The number of centenarians in the U.S. and other countries has been doubling roughly every eight years,” said James Vaupel, founding director of the Max Planck Institute for Demographic Research in Rostock, Germany.

“When the baby boomers hit, there’s going to be acceleration, and it might be doubling every five or six years,” he said.

Henderson and his wife of 77 years live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors, many of whom have ties to the University of Texas at Austin. Henderson is UT’s oldest-living former football player, arriving in 1932 as a freshman. They’re the only centenarians in the complex and are a rare breed: married centenarians.

Charlotte Henderson said she believes being married may have helped them reach these 100-plus years.

“We had such a good time when John retired. We traveled a lot,” she said. “We just stay busy all the time, and I’m sure that helps.”

Bernard Hirsh, 100, of Dallas agrees. His wife, Bee, is 102. They married in 1978 when both were in their early 60s and each had been widowed, she for the second time.

“I think it’s been such a wonderful marriage, and we’ve contributed to each other’s benefit,” he said.

Little research exists on the effects of marriage on longevity. One 2015 Belgian study of centenarians born between 1893 and 1903 did focus on their living arrangements during ages 60 and 100 and found “in very old age, living with a spouse is beneficial for men but not for women, for whom living alone is more advantageous than living with a spouse.” The study explained that “living with one’s spouse at the oldest ages does not provide the same level of protection as it does at younger ages. This may be explained by the decline of the caregiver’s own health as the needs of his or her spouse increase. Caregiving could also have negative consequences for the health and economic condition of the spouse who is the primary caregiver, especially for older women.”

However, Vaupel, who directs the Institute’s International Research Network on Aging, said being married is a positive for both.

“Especially if you’re quite old, it’s very helpful to have a spouse. If you’re very old and don’t have a spouse, the chance of death is higher,” he said.

Siegel, who lives in a senior living community in Boca Raton, Fla., outlived two husbands. She never smoked and occasionally has a glass of dry, red wine.

“I am not a big eater. I don’t eat much meat,” said Siegel, who said she weighs 90 pounds and used to be 5 feet tall but is shrinking.

She stays active by walking inside the building about a half-hour each day, playing bridge twice a week and exercising.

“I feel that’s what really keeps my body pretty good. It wasn’t sports. It was exercises,” she said of the routine she does daily twice a day for about 20 minutes.

Miller, of Pensacola, Fla., also outlived two wives.

He was a fighter pilot in the Marine Corps during World War II and spent eight years in active duty, which Miller said “was not so good for me because I sat in the cockpit of a plane for 5,000 hours.”

But, he was active as a youth — running track, playing football and spending hours surfing while living in Honolulu.

Miller is gluten-free because of allergies and doesn’t eat many carbohydrates. He also never smoked. And, he still enjoys a scotch in the evening.

The Hendersons usually have wine or a cocktail before dinner. She never smoked. He quit in 1950.

Hirsh, of Dallas, another non-smoker, attributes his long life to “good luck.”

“I was very active in my business and did a lot of walking during the day. I was not sedentary,” he said.

Now, exercise is limited to “some knee bends every morning to keep my legs stronger.”

“My father died of a heart attack in his early 50s, and my mother died in her early 60s of a stroke, so I don’t think my genes are very good,” Hirsh said.

Geriatrician Thomas Perls, director of the New England Centenarian Study at Boston Medical Center, said research shows that behaviors have had a greater influence on survival up until the late 80s, since he said most people have the right genes to get there as long as their behaviors aren’t harmful. But once people reach the 90s and beyond, genetics play a more significant role.

“To get to these very oldest ages, you really have to have the right genes in your corner,” he said.

As an international leader in the field, Perls’ focus is on finding the right mix of behavior, environment and genetics to produce long lives. His work includes a National Institute on Aging study called the Long Life Family Study.

“There are always questions about environment versus genes,” said endocrinologist Nir Barzilai, founding director of the Institute for Aging Research at the Albert Einstein College of Medicine in Bronx, N.Y. “ It’s really 50-50, no matter how you look at it.”

Barzilai’s studies include centenarians and their children, as well as efforts to slow the process of aging.

Perls said his research and that of Barzilai and others has found commonalities among those who reach the 100-year-old milestone: Few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.” Studies show that whatever their stress level, they manage it well. And they’re related to other centenarians or have a parent or grandparent who lived past 80.

These lessons of long life are playing well with the public, who have made changes for the better in the 21st century, Vaupel said.

“We don’t smoke or drink so much, and we’re better at exercise. People are taking better care of themselves. People are better educated, and the more educated know when to go to the doctor and follow the doctor’s advice,” he said, adding that people now tend to have higher income and can spend more on health care and improved diet.

“The most important thing is we’re living longer and living longer healthily,” Vaupel said.

 

Putting A Lid On Needless Medical Tests

Leave a comment

Doctors desk with patients test results, samples, stethoscope and blood pressure gaugeIt is common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful. Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution.

The Sacramento-based health system deleted the button physicians used to order daily blood tests. “We took it out and could not wait to see the data,” said Marie Giusto, a Sutter Health executive.

Alas, the number of orders hardly changed. That is because the hospital’s medical-records software “has this cool ability to let you save your favorites,” Giusto said at a recent presentation to other hospital executives and physicians. “It had become a habit.”

There are plenty of opportunities to trim waste in America’s $3.4 trillion health care system — but, as the Sutter example illustrates, it is often not as simple as it seems.

Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care can also harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.

“The changes that need to be made do not appear unrealistic, yet they seem to take an awful lot of time,” said Dr. Jeff Rideout, chief executive of the Integrated Healthcare Association, an Oakland, Calif., nonprofit group that promotes quality improvement. “We have been patient too long.”

In California, that sense of frustration has led three of the state’s biggest health care purchasers to band together and promote care that is safer and more cost-effective. The California Public Employees’ Retirement System (CalPERS), the Covered California insurance exchange and the state’s Medicaid program, known as Medi-Cal — which collectively serve more than 15 million patients — are leading the initiative.

Progress may be slow, but there have been some encouraging signs. In San Diego, for instance, the Sharp Rees-Stealy Medical Group said it cut unnecessary lab tests more than 10 percent by educating both doctors and patients about overuse.

A large public hospital, Los Angeles County-University of Southern California Medical Center, eliminated preoperative testing deemed superfluous before routine cataract surgery. As a result, patients on average received the surgery six months sooner.

These efforts were sparked by the Choosing Wisely campaign, a national effort launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation. The group asked medical societies to identify at least five common tests or procedures that often provide little benefit.

The campaign, also backed by Consumer Reports, encourages medical providers to hand out wallet-sized cards to patients with questions they should ask to determine whether they truly need a procedure.

Critics have blamed Choosing Wisely for playing it too safe and not going after some of the more lucrative procedures, such as certain spine operations and arthroscopic knee surgeries.

Daniel Wolfson, chief operating officer at the ABIM Foundation, said the Choosing Wisely campaign has been successful with unwarranted care. “I think we need massive change and that could take fifteen or more years,” Wolfson said.

Initially, the group focused on  reducing opioid use and avoiding overtreatment for patients suffering low-back pain.

Dr. Richard Sun, co-chairman of the Smart Care group and a medical consultant at CalPERS, said he is pursuing safer, more affordable treatments for low-back pain, a condition that cost the state agency $107 million in 2015. “One challenge is developing metrics that everyone can agree upon to measure improvement,” he said.

For patients, overtreatment can be more than a minor annoyance. Galen Gunther, a 59-year-old from Oakland, said that during treatment for colorectal cancer a decade ago he was subjected needlessly to repeated blood draws, often because the doctors could not find documentation of earlier results. Later, he said, he was overexposed to radiation, leaving him permanently scarred.

“Every doctor I saw wanted to run the same tests, over and over again,” Gunther said. “Nobody wanted to take responsibility.”

At Cedars-Sinai Medical Center in Los Angeles, officials said that economic incentives still drive hospitals to think that more is better.

“We have excellent patient outcomes, but it is at a very high cost,” said Dr. Harry Sax, executive vice chairman for surgery at Cedars-Sinai. “There is still a continued financial incentive to do that test, do that procedure and do something more.”

In addition to financial motives, Sax said, many physicians still practice defensive medicine out of fear of malpractice litigation. Also, some patients and their families expect antibiotics to be prescribed for a sore throat or a CT scan for a bump on the head.

To cut down on needless care, Cedars-Sinai arranged for doctors to be alerted electronically when they ordered tests or drugs that run contrary to 18 Choosing Wisely recommendations.

The hospital analyzed alerts from 26,424 patient encounters from 2013 to 2016. All of the guidelines were followed in 6 percent of those cases, or 1,591 encounters.

Sax said Cedars-Sinai studied the rate of complications, readmissions, length of stay and direct cost of care among the patients in whose cases the guidelines were followed and compared those outcomes with cases where adherence was less than 50 percent.

In the group that did not follow the guidelines, patients had a 14 percent higher incidence of readmission and 29 percent higher risk of complications. Those complications and longer stays increased the cost of care by 7 percent, according to the hospital.

In 2013, the first year of implementation of Choosing Wisely guidelines, Cedars-Sinai said it avoided $6 million in medical spending.

For perspective, Cedars-Sinai is one the largest hospitals in the nation with $3.3 billion in revenue for the fiscal year ending June 30, 2017. It reported a net income of $301 million.

In Northern California, Sutter has incorporated more than 130 Choosing Wisely recommendations as part of a broader effort to reduce variation in care. In all, Sutter said, it has saved about $66 million since 2011.

That is a significant sum. However, during the same period, Sutter reported $2.7 billion in profits. Last year alone, it posted an operating profit of $554 million on revenue of nearly $12 billion.

Giusto said her team of employees tasked with changing physician behavior and eliminating these variations is separate from administrators who are focused on maximizing reimbursement. She said there can be conflicting forces within a hospital.

“We get really excited about a project with [emergency department] doctors on reducing CT scans for abdominal pain,” said Giusto, director of Sutter’s office of patient experience. “Then I can hear the administration say, that was a [Medicare] fee-for-service patient and we just lost money, right?”

Giusto meets with doctors to present data on how many tests or prescriptions they order and how that compares to others. At one clinic, she shared slides showing that some doctors were ordering more than 70 opioid pills at a time while others prescribed fewer than 20. In response, Sutter set a goal of 28 tablets in hopes of reducing opioid abuse.

“Most of the physicians changed,” Giusto said. “But there were still two who said, ‘Sorry, but I’m going to keep doing it the same as always.’