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Social Support for Chronic Fatigue Syndrome
Strong social relationships with family and friends may play a powerful role in helping patients with chronic fatigue syndrome (CFS) improve, reports the Center for the Advancement of Health. And just as important, they say, is having a doctor who recognizes and validates that they are ill, giving them hope for the future.
"Hopefulness about the future was associated with improved health status and appeared to be facilitated by relationships with others - be it one's spouse, one's physician, or close friends," says Barbara J. Saltzstein, MSW, of Harvard Medical School, who led a team that conducted two-hour interviews with 15 women who had CFS. They asked open-ended questions about the beginning and history of their illness, their treatment, and the strategies they used to cope with it. Their findings are reported in the September issue of General Hospital Psychiatry (Volume 20, Number 5). In addition to social support and early diagnosis and validation, the research team said improvement in CFS status was associated with having low levels of depression symptoms and how the women perceived their illness, their future and their doctor's prognosis.
Almost all of the women engaged in some spiritual or group activity "where relationships with others are emphasized and where the focus is more on ... the promotion of hope and healing rather than on absolute cure," the researchers write. Equally significant, they say, is that most of them were diagnosed relatively early and believed their physician was optimistic about their prognosis - two factors that the researchers found key to improvement.
"Validation of patients' symptoms seems to be a crucial variable in the treatment of this condition," they write. CFS, a controversial illness that causes severe debilitation, often goes undiagnosed. Its symptoms - muscle aches, fatigue, memory loss, and fever - are frequently dismissed. Also surprising, the researchers say, is that the women they interviewed did not fit previous descriptions of CFS patients described in research literature as "primarily depressed" and "personality-disordered" individuals who "opt out of the stress of balancing work and family by becoming ill."
"None of the women withdrew from their lives. Rather, they grieved what they could no longer do, and revised their lives as necessary," they say. The study was funded in part by grants from the National Institute for Clinical Social Work Advancement and the Massachusetts CFIDS Association. "General Hospital Psychiatry" is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact the editor, Dr. Don Lipsitt, at (617) 499-5008.
See related articles in the AgeVenture archives.
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AgeVenture News Service, www.demko.com
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$25 Million Effort To Improve Chronic Care
Chronic illness is by far the foremost challenge confronting Aging America. It's common knowledge that approximately 86% of all senior citizens have one or more chronic conditions. What's more, the American Medical Association estimates that a total of 100 million Americans suffer from chronic medical conditions. Add to this equation the nation's enormous population of 78 million aging baby boomers, and even the casual observer can appreciate the coming crisis in American health care (see AgeVenture archives: Medicare's Future Busted By Boomers).
Will escalating healthcare costs eventually bankrupt the nation? Will the economics of healthcare force America to become a triage society? It's hard to tell because society's attempts at resolving healthcare dilemmas often backfire. Take, for example, the recent advances in healthcare technology that were supposed to create cost-effectiveness through increased efficiency. Ironically, mounting evidence now suggests that advances in medical technology have actually raised, not lowered, the cost of healthcare (see AgeVenture archives: New Technology Dominates Healthcare's Future).
No one can predict the future. But one thing's for sure. The rapidly rising number of Americans with chronic illnesses is forcing large health care organizations across the nation to reconsider the way in which they practice medicine. To assist organized health systems in improving chronic illness care, The Robert Wood Johnson Foundation is launching a new national program called "Improving Chronic Illness Care." This five-year, $25 million national program will be based at the Center for Health Studies within Group Health Cooperative of Puget Sound in Seattle, Washington, one of the nation’s oldest and most esteemed health maintenance organizations.
"Treating chronic illnesses will be one of the nation’s greatest health care challenges in the 21st century," explains Dr. Ed Wagner, national director for the new program. As the nation’s population grows older, the number of Americans with chronic illnesses such as heart disease and diabetes, will continue to rise. "Large organized health care systems are likely to dominate American health care for decades to come," Wagner adds. "This combination of trends--an aging population and the spread of large health care organizations--will continue to force health systems to consider ways to improve their performance in treating chronically ill patients."
The National Program for Improving Chronic Illness Care will work to better the health of chronically ill patients across the country by assisting up to 120 health systems design, implement and evaluate state-of-the-art disease management programs focused on specific illnesses. In addition, the program will organize a Center for Improving Chronic Illness Care, which will serve as a clearinghouse for information about effective approaches to treating chronic illness. Finally, it will establish a targeted research grants program for researchers who wish to study critical questions about the delivery of chronic illness care in health systems.
"As health care organizations continue to grow and deliver care to more Americans, they must seize this opportunity to improve the health of both their members and the communities in which they are situated," explains Steven A. Schroeder, M.D., president of The Robert Wood Johnson Foundation. "Improving chronic illness care must be at the heart of this effort, and Dr. Wagner and the National Program for Improving Chronic Illness Care are well positioned to set the highest possible standards for health organizations across the country." "This program is about working systematically with partners and colleagues across the country," says Wagner.
"We are seeking nothing less than raising the quality of care from coast to coast and to accomplish this goal we are seeking the broadest participation possible by health systems and other organizations dedicated to caring for America’s chronically ill." The Robert Wood Johnson Foundation, based in Princeton, NJ, is the nation’s largest philanthropy devoted exclusively to health and health care. It became a national institution in 1972 with receipt of a bequest from the industrialist whose name it bears, and has since made more than $2.7 billion in grants. The Foundation concentrates its grantmaking in three goal areas:
- to assure all Americans access to basic health care at reasonable cost;
- to improve way services are organized and provided to people with chronic health conditions;
- to reduce the personal, social and economic harm caused by substance abuse
Health systems wishing to participate in any of the elements of the National Program to improve chronic care should contact its director, Ed Wagner, MD, MPH, at the Group Health Cooperative’s Sandy MacColl Institute, 1730 Minor Avenue, Suite 1290, Seattle, WA 98101-1448. The phone number is 206-287-2876.
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AgeVenture News Service, www.demko.com
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Sensual Is Essential says Senior Survey
Nearly half of all Americans age 60 or older engage in sexual activity at least once a month, according to a survey released by The National Council on the Aging (NCOA). The survey, funded by a grant from Pfizer Inc, also found that 4 in 10 want to have sex more frequently than they currently do. The random survey of 1,300 older Americans was conducted by Roper Starch Worldwide.
Thirty-nine percent of all the respondents said they are satisfied with the amount of sex they currently have while 39% said they want more frequent sex. Men were more than twice as likely as women to report wanting more sex (56% of men vs. 25% of women). Only 4% of all respondents said they want less frequent sex. Men and women in their 60s are more sexually active than Americans in their 70s (71% of men vs. 51% of women in their 60s; 57% of men vs. 30% of women in their 70s).
The survey found that more older men than women said they are sexually active: 61% of men and 37% of women. This gap results, in part, from the longer life expectancy of women. Older women are more likely to be widowed and no longer have a partner. The higher ratio of women to men increases with age. "This study underscores the enduring importance of sex among older men and women—even among those who report infrequent sexual activity," said Neal E. Cutler, Ph.D., NCOA’s director of survey research.
"When older people are not sexually active, it is usually because they lack a partner or because they have a medical condition." "Our study debunks the prevailing myths about sexuality in older years," said James Firman, Ph.D., president and CEO of NCOA. "For many older Americans, sex remains an important and vital part of their lives."
Sexually Active Older Men and Women
Sexual activity continues to play an important role in relationships among older men and women. Among those respondents who said they are sexually active (engage in sexual activity at least once a month), 79% of older men and 66% of older women said that maintaining an active sex life is an important aspect of their relationship with their partner. When asked about the emotional satisfaction they get from their sex life, 74% of the sexually active men and 70% of the active women said they are as satisfied or even more satisfied than they were in their 40s.
Less Active Older Men and Women
More than half (52%) of all respondents said they engaged in sexual activity less than once a month. But 54% of these men and 26% of the women said they would like to have sex more often. Part of the explanation for less sexual activity in older years is a lack of partners. Only 19% of widows and widowers are sexually active, compared to 59% of married men and women.
Older men are more likely than older women to be married and have sex partners. The NCOA study also found that 73% of men but only 56% of women in their 60s had a sex partner within the past 12 months. This drops to 50% of men and 26% of women in their 70s and 80s. Lack of partners, however, is not the only reason for not having sex. One out of three (34%) married seniors said they did not have sex within the past 12 months.
Among respondents who said they had sex less than once a month, 54% of men and 44% of women said they have less emotional satisfaction in their sex lives compared to when they were in their 40s. They attributed their lower satisfaction to: A medical condition that prevents them from having sex (51% of men, 12% of women); A partner with a medical condition that prevents them from having sex (13% of men, 44% of women); Less physical desire to have sex (55% of both men and women); Medications that seem to reduce sexual desire (44% of men, 16% of women).
Qualities Sought in a Romantic Partner
The surveyed seniors were also asked what qualities they look for in a romantic partner. Nine out of 10 respondents (both men and women) identified a high moral character, a pleasant personality, a good sense of humor, and intelligence as important qualities in a partner. More women than men were likely to seek financial security in a partner (56% of men vs. 85% of women) and seek a partner who observes a religious faith (58% of men vs. 72% of women). Men were more likely to seek a partner who is interested in sex (76% of men vs. 46% of women) and who has an attractive body (67% of men, 48% of women). The National Council on the Aging is a private, nonprofit research, education, and
advocacy organization.
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AgeVenture News Service, www.demko.com
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Gerontrepreneurs: Form & Figure Media Inc
Although over one billion movie tickets were purchased last year in the US, more money was spent on plastic surgery -- two and one-half times more. Launching this fall, Form & Figure will be the first national consumer magazine dedicated to providing medically reliable information on aesthetic surgery, as well as cosmetic dermatology, cosmeceuticals, and dentistry.
According to the American Society of Aesthetic Plastic Surgery (ASAPS), over two million cosmetic procedures were performed in 1997. In the last five years, the number of liposuction and breast implant procedures increased 200-300%. Men are having three times more cosmetic procedures than they did just five years ago. This unprecedented growth in elective surgery and sales of cosmeceuticals has created an urgent need for reliable information about cosmetic products and procedures.
"When over two million people a year opt to undergo elective surgery," says Form & Figure's editor-in-chief, Suzanne L. Sergile, MD, MPH, "it seems to me that they need to base that decision on more than a friend's recommendation or a titillating article in a fashion magazine." Unlike other beauty magazines, an editorial board of renowned experts in plastic surgery, dermatology, and dentistry review Form and Figure's articles. Although most individuals would be hesitant to schedule a consultation with the Chairman of Plastic Surgery at UCLA to discuss a few facial wrinkles or minor acne breakouts, Form & Figure does just that; it gives readers access to the opinions of top physicians on every aspect of aesthetic health. Form & Figure's approach to beauty differs from other magazines. "We are not about teenage models in evening gowns," says the magazine's publisher, William Fischer.
"Our focus is on how individuals can arrive at their personal ideal of beauty and not some unobtainable archetype." As the first consumer magazine to consistently cover cosmetic procedures, Form & Figure has already begun to create a stir. The controversy was not unexpected, "I understand that not everyone agrees with the concept of cosmetic procedures," says Dr. Sergile, "but, the growth in consumer demand for high tech beauty is a reality. And, quite frankly, with the current advances in aesthetic health, why not look your best?" Here's a sneak preview of some articles you'll find in the forthcoming issue: "Oxygen Therapy for the Skin", "Choosing Breast Implants", "Do It Yourself Dentistry", "The Best Beauty Sites On-Line", "What To Expect Before, During, and After Cosmetic Surgery", and, of course, much more.
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AgeVenture News Service, www.demko.com
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What You Don't Know, Just Might Age You
What you don't know, just might age you, says a new report from the Center for the Advancement of Health. Elderly men and women with higher levels of education were more physically active, smoked less, were less heavy, and expressed a greater sense of control over their lives than did their less well-educated peers, an ongoing study of healthy older adults reveals.
"Educational attainment may influence health through its association with many individual-level psychosocial and biological factors where these effects are evident even in late life," writes Laura D. Kubzansky, PhD, and her colleagues in the September-October issue of Psychosomatic Medicine. "These important findings link education, which is generally defined in young adulthood, to a series of experiences in late adulthood linked more proximally to poor health." The researchers, from the Harvard School of Public Health and the Andrus Gerontology Center at the University of Southern California, interviewed nearly 1,200 men and women in their 70s from New Haven, Connecticut; East Boston, Massachusetts; and Durham, North Carolina. All were participating in ongoing John D. and Catherine T. MacArthur Foundation studies of successful aging and had been judged to be in the top third for their age group in cognitive and physical functioning.
Even among these higher functioning older adults, Kubzansky and her colleagues found, education was associated with a number of behaviors, biological conditions, and psychological factors related to better health and functioning. Compared to those with less education, those with more smoked fewer cigarettes and exercised more. They also had better lung function, higher levels of HDL ("good") cholesterol, and lower weight.
Finally, those with more education were happier and had greater mastery and self-efficacy than did those with less. The benefits of higher socioeconomic status on health have been well-documented, but some researchers have suggested that these benefits decline with age. In the new study, however, the link between education and a variety of health-related factors suggests "that social disparities may continue to affect health outcomes in late life." "These factors reflect how individuals interact with their social surroundings well into old age and may serve as pathways to different diseases and health outcomes," Kubzansky and her colleagues report. Their research was supported by the John D. and Catherine T. MacArthur Foundation Research Network on Successful Aging.
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Older Drivers Keep Going, & Going, & Going
The number of older drivers is expected to increase substantially as America ages, says a new study
conducted by Ecosometrics Inc under the sponsorship of the Departments of Health and Human Services (DHHS) and Transportation (DOT). The numbers of older drivers people 65 and older, 75 and older, and 85 and older can be expected to increase substantially, at least doubling.
Older women are expected to drive in greater proportions than is now the case. If they do, the numbers of older drivers could exceed 2.5 times the 1996 levels within 30 years. The number of drivers age 85 and over in 2030 will be four to five times greater than today. The proportion of older drivers on our streets will also increase significantly because of the increase in the numbers of older drivers and because the U.S. population as a whole is getting older.
Older drivers are driving more (taking more trips and driving more miles) than before. Between 1990 and 2020, the total annual mileage driven by male older drivers will increase by 465 percent and this estimate is conservative. For female elderly drivers, the total annual vehicle miles driven will increase almost 500 percent (again, based on conservative estimates).
The proportion of the total mileage for elderly drivers to the total miles driven by all drivers is also steadily increasing. In 1990, elderly drivers accounted for 6.7 percent of all miles driven. By 2030, according to our conservative estimate, elderly drivers will account for 18.9 percent of all vehicle miles driven, almost triple the 1990 figure.
Based on current rates, the number of elderly traffic fatalities will more than triple by the year 2030. If this expected increase occurs, the number of elderly traffic fatalities in 2030 will be 35 percent greater than the total number of alcohol-related traffic fatalities in 1995 a fatality number that is viewed by policymakers and the public as cause for serious concern. You might say that auto insurance is about to become a growth industry.
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AgeVenture News Service, www.demko.com
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Med Experts Say No Deal To Wallet ID Card
Nearly every person with a chronic medical condition, drug allergy, or implant worries about what might happen to them in an emergency. But they may not act on that worry by doing something positive. This is a serious consumer issue because 100 million Americans are estimated by the AMA to suffer from chronic medical conditions, says Medic Alert, a non-profit medical information service.
In the past, medical ID used to mean Medic Alert. But not anymore. Products and services from dozens of vendors have flooded the market, creating confusion about what forms of ID will actually help save your life in an emergency. Now, when medically at-risk individuals are told they need Medic Alert ID, they don't always know what to look for. As a consequence, they often wind up with "knock-off" products that do not meet established standards. Consumers buy them at retail outlets, over the Internet, or through the mail. Here's a list of what Medic Alert says is missing from many of the ID "knock-offs".
- readily visible, body worn ID
- 24-hour phone response capability
- supervision of intake procedures by medical professionals
- safeguards against breaches of confidentiality
These are all serious problems. But the one Medic Alert is most concerned about is a lack of visible, body-worn ID, because the majority of new vendors are selling wallet cards that professional emergency responders say "do not work". These deficiencies are unlikely to be recognized by at-risk consumers until it's too late. Meanwhile, unsuspecting buyers harbor a false sense of security, and are unlikely to receive the protection they need in a life-threatening medical crisis. Medic Alert maintains an archive of information on this subject that can be accessed on-line at the following Internet address www.medicalert.org
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AgeVenture News Service, www.demko.com
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