Course Learning Objectives

To introduce students to a range of health issues that older persons, their health providers, and society face in the next decade. These include the demographics and biology of ageing, an understanding of the basic health and mental health issues, and policy decisions that state and federal government will need to solve related to these issues.

Course Requirements

Paper and Presentation Students must write a 10- to 12-page paper on one health issue for older individuals addressed in the class. In addition, the student must give a 10-15 minute presentation to the class based on this material. The focus of the presentation should be a policy issue related to the paper's subject matter. All class members are expected to participate in the discussion of the topics and to turn in one question relevant to the topic of the student presenter at the conclusion of the talk. Examples of policy questions:

Is it possible to compress illness into the last months (days) of life, thereby reducing disease burden and futile end of life care for older persons? If it is possible, what can the government do to promote such compression?
Currently, over 50% of the costs of institutional long-term care for older persons are paid for with public funds from Medicaid. What are the options being discussed for public and/or private funding? What would you recommend?
The informal support system of a frail older individual is critical to the type and amount of formal health services that the individual will need to stay in the community. What is an equitable way to encourage the use of the informal system? What types of services should informal caregivers provide and what should be left to the formal health care system

Readings

Topic	Readings
Demography of Aging	A Profile of Older Americans: 2005, Administration on Aging. US Department of Health and Human Services (DHHS) For extensive census data on older persons, look at 65+ in the United States: issued December 2005. Current Population Reports, Special Studies. US DHHS
Biological Aspects of Aging	National Institute on Aging, National Institutes of Health. Ageing under the Microscope: a biological quest. NIH, 2006 National Institute on Aging, National Institutes of Health. Research Programs (Extramural). National Institute on Aging, National Institutes of Health. Intramural Research Program.
Physical Disorders of Older Persons	Federal Interagency Forum on Aging-Related Statistics, 2006. Older Americans 2006: Key Indicators of Well-Being. Health Status, Health Status Indicators. (Chapters on health status and health risk behaviours) Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-156 Manton KG, Gu X. Changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999. PNAS 2001;98:6354-6359 Partnership for Solutions. Chronic conditions: making the case for ongoing care. Johns Hopkins University,2004.
Mental Disorders Among Older Persons	Mental Health: A Report of the Surgeon General, Chapter 5, Older Adults and Mental Health. US Public Health Service, 1999 Willis SL, et al., 2006. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 296:2805-14 Black BS, et al. Identifying dementia in high-risk community samples: the memory and medical care study. Alzheimer Dise Assoc Disor 2003;17:9-18. Rabins PV, et al. Effectiveness of a nurse-based outreach program for identifying and treating psychiatric illness in the elderly. JAMA 2000;283:2802-9. Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer Disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. JAMA 1997;278:1363-1371
Functional Impairment, Disability, and Compression of Morbidity	Katz S, Branch LG, Branson MH, Papsidero JA, Beck JC, Greer DS. Active life expectancy. N Engl J Med 1983;309:1218-1224. Verbrugge LM, Patrick DL. Seven chronic conditions: their impact on US adults' activity levels and use of medical services. AJPH 1995;85:173-182. Fries JF. Measuring and monitoring success in compressing morbidity. Ann Intern Med 2003;139:455-459. Manton KG. Changes in the prevalence of chronic disability trends United States black and nonblack population above age 65 from 1982-1999. PNAS 2001;98:6354-9. Fries JF. Ageing, natural death and the compression of morbidity. N Engl J Med 1980;303:130-135.
Health Services: Acute and Long-Term Care	Federal Interagency Forum on Aging-Related Statistics, 2006. Older Americans 2006: Key Indicators of Well-Being. Health Status, Health Status Indicators. Health Care Indicators 28-37. Leff B, et al. Hospital at Home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med 2005;143:798-808. Feder J, Komisar HL, Niefeld M. Long-term care in the United States: an overview. Health Affairs 2000;19:40-56. Burton LC, German PS, Gruber-Baldini AL, et al. Medical care for nursing home residents: differences by dementia status. J Am Geriatr Soc 2001;49:142-147. Boult C, Boult LB, Morishita L, et al. A randomized clinical trial of outpatient geriatric evaluation and management. J. Am Geriatr Soc 2001;49:351-359. Kane RL, Homyah P, Bershadsky B, Flood S. Variations on a theme called PACE. J Gerontol A Biol Sci Med Sci 2006;61:689-693. Newcomer RJ, Harrington C, Kane R. Implementing the second generation social health maintenance organization. J Am Geriatr Soc 2000;48:829-834. Mui AC. The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States. J Aging Soc Policy. 2001;13:53-67. Ware JE, Baylis MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems JAMA. 1996;276:1039-47. Weissert WG, Hedrick SC. Lessons learned from research on the effects of community-based long-term care. J Am Geriatr Soc 1994;42:348-353.
Preventive Health for Older Persons	Guirguis-Blake J, Calonge N, Miller T, Siu A, Teutsch S, Whitlock E. For the U.S. Preventive Services Task Force (USPSTF), 2006. Refining Evidence-based Recommendation Development, Current Processes. US Preventive Services Task Force, 2006. Recommendations. Rowe JW, Kahn RL. Successful ageing. Gerontologist 1997;37:433-440. German PS, Burton LC, Shapiro S, et al. Extended coverage for preventive services for the elderly: response and results in a demonstration population, Am J Public Health 1995;85:379-386. Burton LC, Steinwachs DM, German PS, et al. Preventive services for the elderly: would coverage affect utilization and costs under Medicare? Am J Public Health 1995;85:387-391.
Family Caregiving for Patients with Long Term Care Needs	Sorensen S, Pinquart M, Duberstein P. How effective are interventions with caregivers? An updated meta-analysis. Gerontologist 2002;42:356 Schulz R, Beach SR, Lind B, et al. Involvement in caregiving and adjustment to the death of a spouse: findings from the Caregiver Health Effects Study. JAMA 2001;285:3123-3129 Wolff JL, Kasper PD. Informal caregiver characteristics and subsequent hospitalization outcomes among recipients of care. Ageing Clinical Experience and Research 2004;16:307-313
Federal and State Health Policies for Older Persons	Spillman BC, Lubitz J. The effect of longevity on spending for acute and long-term care. N Engl J Med. 2000;342:1409-15. Thomas C, Sussman J. Medicare Part D: Successes and Continuing Challenges. Impact of Medicare Part D on Massachusetts Health Programs and Beneficiaries Mass Health Policy Forum Issues Brief 2007;32:1-32. Wiener JM, Tilly J. End-of-life care in the United States: policy issues and model programs of integrated care. Int J Integrated Care 2003;3:1-11 Meara E, White C, Cutler DM. Trends in medical spending by age, 1963-2000. Health Affairs 2004;23:176 Foote SM. Population-based disease management under fee-for-service Medicare. Health Affairs, Web-exclusive, 2003 Spillman BC, Lubitz J. New estimates of lifetime nursing home use: have patterns of use changed? Med Care 2002;40:965-75 Cuellar AE, Wiener JM. Can social insurance for long-term care work? The experience of Germany. Health Affairs 2000;19:8-25
Ethical Issues in Long-term Care	Schneiderman LJ, Gilmer T, Teetzel HD, et al. Effects of an ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 2003;290:1166-1172. Okie S. Physician-assisted suicideï¿½ Oregon and beyond. N Engl J Med 2005;352:1627-1630. Thomasma DC. From ageism toward autonomy. in: Binstock RH, Post SG, eds. Too Old for Health Care? Controversies in Medicine, Law, Economics, and Ethics Baltimore, MD: Johns Hopkins University Press, 1991. Council on Scientific Affairs and Council on Ethical and Judicial Affairs, American Medical Society. Persistent vegetative state and the decision to withdraw or withhold life support JAMA 1990;263:426-430. Callahan D. Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster, 1987.
Social Aspects of Health and Aging	Baltes PB, Smith J. New frontiers in the future of ageing: from successful ageing of the young old to the dilemmas of the fourth age. Gerontology. 2003;49:123-135. Rodin J. Aging and health: Effects of the sense of control. Science. 1986:1271-1276 Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Social Science and Medicine 2000;51:843-857.

Other Resources

» Selected books
Moon M. Medicare Now and in the Future. Washington, DC: The Urban Institute Press, 1993. Rowland D, Lyons B. Financing Home Care: Improving Protection for Disabled Elderly People. Baltimore, MD: Johns Hopkins Press, 1991. Biegel D, Sales E, Schulz R. Family Caregiving in Chronic Illness. Newbury Park, CA: Sage Publications, 1991. Lavizzo-Mourey R, Day S, Diserens D, Grisso JA. Practicing Prevention for the Elderly. Philadelphia, PA: Hanley & Belfus, Inc., 1989. Riley M, Kahn R, Foner A. Age and Structural Lag: Society's Failure to Provide Meaningful Opportunities in Work, Family, and Leisure. New York, NY: John Wiley and Sons, 1994. Calkins E, Boult C, Wagner E, Pacala J, eds. New Ways to Care for Older People: Building Systems Based on Evidence. New York, NY: Springer Publishing Company, 1999

» Selected web sites for information regarding aging populations
http://www.census.gov/prod/2006pubs/p23-209.pdf Extensive census data on older personshttp://www.agingstats.gov/ Age-related statistics compiled by a federal interagency forum http://www.nahc.org/NAHC/Research/research.html Clearing house for information on home care and hospice http://www.cms.gov Official site for Centers for Medicare and Medicaid Servicesï¿½information for beneficiaries, researchers, providers http://www.ahrq.gov Agency for Health Care Research and Quality http://www.nia.nih.gov National Institute for Aging, research, requests for proposals, news briefs on sponsored aging research.

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» Selected books

» Selected web sites for information regarding aging populations

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