Old Problems New Approaches : mHealth

Mobile Health (mHealth), a new initiative in health delivery—involves telemedicine, wireless health, and electronic health.  It refers to the use of mobile phones to provide limited but essential health care, that is being driven especially by older adults and the parallel increases in the prevalence of chronic conditions they experience. Chronic conditions can often be prevented by behavior change or treated through frequent monitoring and medication. An essential strategy for keeping older adults healthy means preventing chronic diseases and/or reducing associated complications. Older adults who take advantage of preventive services are more likely to remain healthy, live independently, and incur fewer health-related costs. About 80% of older adults have one chronic condition, and 50% have at least two. For those 65 years and older, the most common chronic diseases are heart disease, cancer, stroke, lower respiratory diseases, Alzheimer’s Disease and diabetes. All of these conditions benefit from close monitoring.

The growing use of mobile phones, with their increasing capacity for more applications, has opened opportunities to monitor patients frequently by using personal mobile phones.  As cell phone use becomes increasingly cheap and accessible, mHealth technology becomes that much more viable.

Part of mHealth’s great potential for older adults, is that it brings the caregiver into the picture by allowing family or providers to access the health status of their care recipient from remote locations. The provision of an effective way to monitor a care recipient’s status from a distance has never before been so cheap and attainable.

A 2011 report by the National Alliance for Caregiving, asked caregivers what technology they desired most and what barriers stopped them from using it. They reported that the three favorite applications would include one that tracks a care recipient’s vital signs, symptoms, medications, and other information. Another would be a shared electronic log for the care recipient’s medical appointments and other caregiving needs.  This application would include an interactive feature so family members and other caregivers could use it to sign up to help. The third application was an electronic system that reminds the care recipient about their medication and dispenses pills on schedule. This application, would alert caregivers by phone or e‑mail if a dosage is not removed from the dispensing device within a certain time period.

Such applications—unimaginable only a few years ago—are within our grasp.  However the most commonly reported obstacle is still the belief that such technology would be too expensive. While today’s younger caregivers are more likely than their parents to expect more “high tech” benefits from programs like mHealth, everyone can now benefit from this technology.

Many now believe that mHealth can help with saving time, facilitating caregiving, making the recipient feel safer, making sure that medication is taken, and closely monitoring the care recipient. With Medicare and Medicaid considering charge codes for mobile health it is only a matter of time before mHealth becomes part of the arsenal within San Diego’s healthcare system. Is it time to see your phone as a health care provider?

Pet Therapy: Four-legged Florence Nightingales

The story that older adults benefit from pet therapy is misguided. EVERYONE benefits from pet therapy. Who ever thought that a four-legged bundle of soft fur or a smiling dolphin can make you feel better and actually healthier? Pet therapy, also known as Animal Assisted Therapy (AAT), is a broad technique involving any interaction that patients have with animals to make them feel better. In 1859, Florence Nightingale wrote that a small pet “is often an excellent companion for the sick, for long chronic cases especially.” Apart from the possibility of small pets causing falls for frail older adults, pets provide multiple benefits to their companions. It not only feels good to be around pets, but it makes you healthier. Emerging studies show that pet therapy translates to positive clinical outcomes.

Even just owning a pet has been found to be beneficial. Dog ownership is associated with lower heart attack risks and increased survival one year after a heart attack. Older pet owners walk significantly farther when they walked with a dog, which might contribute to their making fewer visits to the doctor. And it is not just having a companion—talking to a pet rather than a person was associated with lower heart rate. Even in nursing homes, the presence of a dog is associated with reduced need for medication, improved physical functioning, and improved vital signs—even when patients are suffering from dementia. The list of benefits includes reductions in loneliness, agitated behaviors, and depression, and increases in engagement, well-being, nutritional intake, and social interactions. It sounds like a panacea. But what is the reason for these health-boosting outcomes?

One line of aging research that shows great promise investigates how pet therapy generate hormones that affect mood. The University of Missouri-Columbia, currently conducting research in this arena, suggests that hormonal changes that naturally occur when humans and dogs interact could help people cope with depression and certain stress-related disorders. Preliminary results show that a few minutes of stroking our pet dog prompts a release of a number of these "feel good" hormones in humans, including serotonin, prolactin and oxytocin. In addition, decreased levels of the primary stress hormone cortisol, the adrenal chemical responsible for regulating appetite and cravings for carbohydrates, occurs.

If you already have a pet, one of the hidden added benefits is that you can share them and help others. This is not only beneficial to patients but also to the volunteer on a number of fronts. Older adults can volunteer by going to nursing homes, hospice, clinics or schools and providing pet therapy with their pet. Before heading out the door with your little puppy you need to make sure that you are certified. The San Diego Humane Society and SPCA has been bringing the joys of animals to people for more than 30 years through its Pet-Assisted Therapy (P-AT) Program. For more information contact them at (619) 299-7012, ext. 2271 or pat@sdhumane.org. Paw’sitive Pals is another well-established program here in San Diego paws@pawsteams.org. While more information about the Pet Therapy Program at San Diego Hospice can be accessed at http://www.sdhospice.org/pdf/.pdf By training your dog to become a service dog you not only become better engaged with your pet and the community, you will become part of the therapy for frail older adults.

Mario Garrett PhD is a professor of gerontology at San Diego State University. He can be reached at mariusgarrett@yahoo.com © Mario Garrett 2011 blogs at http://iage-marius.blogspot.com/

Retirement: a Gold Watch or a Golden Nest Egg

Retirement is a construction of modern society. It was created when the German chancellor Otto von Bismark succeeded in launching the first social security program in 1889. The introduction of social security followed a decade of smaller workers’ programs addressing the economic insecurity at that time. By the end of the Second World War, the UN General Assembly adopted the Universal Declaration of Human Rights, whose Article 22 recognized that “Everyone, as a member of society, has the right to social security . . . .”

Americans, 120 years later, are now revisiting the “right to social security.” With an increasing older population, lengthening of life expectancy, diminishing personal savings, and an elusive government social security fund, we have started questioning the viability of retirement. Although current discussion under the Obama administration centers around raising retirement age and reducing benefits, a more radical debate centers on whether we can afford retirement at all and whether we deserve it. In San Diego, retirement news has become synonymous with the greedy geezers syndrome. The reality is however more complex.

Variations in wealth among older Americans are striking. Americans in the lowest fifth of the wealth distribution spectrum have little, or negative net worth. This contrasts with households in the highest fifth, averaging $1.5 million and $800,000 net worth. The recent downturn in the economy will see more people pushing back retirement. One survey found that about 40 percent will delay retiring by four or more years.

It seems that many Americans are still shell-shocked after losing much of their 401(k) nest eggs during the last two years. Even though many workers might have partially regained some of their investments, others are still concerned about their ability to save for the long term. Only 16 percent of baby boomers said they have confidence in their ability to save enough for a comfortable retirement. The rest—83% of the baby boomers— intend to keep working after retirement. A hardy group (14%) is reporting that they will never retire from their current job. But sometimes we have no choice.

Health problems can have a big influence on the decision to retire early. One analysis suggests that poor health is a stronger influence than financial variables on people's decisions to retire. Financial well-being is strongly related to the health of both partners. Average household net worth was $31,000 when both partners were in poor health but more than $400,000 when they were in excellent health. People who had a major unexpected health event, such as heart attack or stroke experienced an average cumulative income loss of nearly $37,000. On average, loss of earnings, rather than out-of-pocket medical costs was the major factor in the loss of wealth.

Studies show a consistent lack of knowledge among older workers about their pension plans. Lack of knowledge appears to be related to lower savings and wealth. Such findings underscore that education about retirement planning makes a difference in how we plan for our future. Staying healthy to enjoy the benefits is another story altogether.

Mario Garrett PhD is a professor of gerontology at San Diego State University. He can be reached at mariusgarrett@yahoo.com © Mario Garrett 2011 blogs at http://iage-marius.blogspot.com/

Anti-Aging : A New Windmill for Don Quixote

In 2009, the American Medical Association (AMA) assessed the risks and benefits of growth hormone, testosterone, estrogen and DHEA for anti-aging. The AMA concluded that the risks outweigh the potential benefits. As part of the anti-aging industry that has mushroomed in the last decade, growth hormone offers the most illustrious of histories.

Although much maligned, the 19th Century scientist Adolphe Brown Sequard provided his elixir for free—an extract in water from the testicles of two-year old dogs and guinea pigs mixed with semen and blood from the testicular veins—to anyone that requested it, at an estimated cost of $42,000 in today’s money. His search for the anti-aging hormone testosterone did, however, lead to the birth of the science of endocrinology. His philanthropic donation was a far cry from today’s industry. Global Industry Analysts report that the world market for anti-aging products reached $115.5 billion last year, roughly the size of Iraq’s gross domestic product.

The findings by the AMA expose a paradox of using powerful chemicals for anti-aging purposes. Although most of these hormones help the body look “young,” there are dangerous side effects. For example, adults whose pituitary glands overproduce growth hormone have premature heart and lung failure, as well as abnormal growth of other organs and tissues. We know that the steroid testosterone produces muscle mass, but it also results in short-term sexual and reproductive disorders, fluid retention, and severe acne. Possible long-term effects may include heart damage, stroke, and brain tumors.

In fact, lower growth hormone levels may indicate good health. So, although research with hormone replacement has resulted in some positive short-term results, it is clear that negative side effects also may occur as increased risk for cancer, cardiovascular disease, and behavior changes. This evidence still leaves us with a safer path—one of the best known methods for increasing the lifespan is simply consuming fewer calories. A low caloric diet reduces hormone levels and seems to activate specific genes that are responsible for longevity.

As far back as 1935, Mary Crowell and Clive McCay of Cornell University conducted experiments on laboratory animals to determine if caloric intake affects longevity. The results have shown that laboratory animals—across all species studied— extended their lives by 30% to 40% and age more slowly when they are fed healthy, very low calorie diets that contain essential nutrients.

In his book, Beyond the 120 Year Diet: How to Double Your Vital Years, Roy Walford proposed that longevity can be significantly increased by a diet that is high in nutrients but contains about a third less calories. Although Walford died of Lou Gehrig's disease at age 84, he expressed one of three distinct pathways that we know that affect longevity — the other two being insulin/IGF signaling and the mitochondrial electron transport chain pathway (see future articles). While the National Institutes of Health undertake their first preliminary study on caloric restrictions with humans, we can promote our chances of longevity by not over-indulging and consuming quality rather than quantity.

Mario Garrett PhD is a professor of gerontology at San Diego State University. He can be reached at mariusgarrett@yahoo.com © Mario Garrett 2011 blogs at http://iage-marius.blogspot.com/