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Aging

Aging, Global Health, In the News, Public Health, Research

As life expectancy rises worldwide, many are living longer with illness and disability

10812180384_18496a55f3_zGood news: Average life expectancy has continued to climb over the past two decades. The downside is that those extra years are often marked by chronic disease or disability, according to a new analysis published in the Lancet.

In the study, an international team of researchers examined fatal and nonfatal health loss across countries in an effort to help direct global-health policies to improve longevity and quality of life regardless of where a person lives.

HealthDay reports:

The analysis of data from 188 countries found that life expectancy for both sexes increased from just over 65 years in 1990 to 71.5 years in 2013, while healthy life expectancy rose from almost 57 years to slightly more than 62 years.

“The world has made great progress in health, but now the challenge is to invest in finding more effective ways of preventing or treating the major causes of illness and disability,” study author Theo Vos, a professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, said in a journal news release.

The rise in overall life expectancy is due to significant declines in illness and death caused by HIV/AIDS and malaria, the researchers said, along with major advances in combating infectious diseases, nutritional deficiencies, and mother and baby health problems.

Earlier this year, Laura Carstensen, PhD, director of the Stanford Center on Longevity, spoke at the Big Data in Biomedicine conference about modern society’s gains in life expectancy and called it an “unprecedented” time in history. During her presentation, she presented data on the current aging population and what aging might look like in the future.

Previously: A look at aging and longevity in this “unprecedented” time in history, “Are we there yet?” Exploring the promise, and the hype, of longevity research and Living loooooooonger: A conversation on longevity
Photo by jennie-o

Aging, Podcasts, Public Health, Research, Stanford News

Stanford doctor on a mission to empower patients to talk about end-of-life issues

Stanford doctor on a mission to empower patients to talk about end-of-life issues

Each year, about 2.6 million people die in America. Although past research has shown that 7 out of 10 of us prefer to die at home, an estimated 70 percent of people die in the hospital, nursing home or long-term care facility. The disconnect between where people die and how they would prefer to spend their final days often happens because loved ones and doctors don’t know their end-of-life wishes. Only 20 to 30 percent of Americans have completed advanced directives.

It’s not easy to talk about death, and the terminology used in advance directives can be confusing. I remember having to complete the form with my husband shortly before the birth of my first child. Despite having been in a relationship for 12 year, we had never discussed end-of-life issues. Imagining the scenarios that might lead to either of us being in a life-threatening situation was an extremely emotional exercise — especially as we awaited our son’s arrival. Did we want doctors to use every intervention possible to save our life? What if it meant sacrificing our quality of life? Did we want to be on life support? If so, how long?

We eventually turned to a friend, who was also a physician, to help us sort through the process. But we didn’t talk to our own primary care doctors and, to this day, our doctors have never asked us if we have an advance directive or about our end-of-life preferences. And this isn’t unusual. Recent research from VJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training, shows that most doctors struggle to talk with patients about what’s important to them in their final days, particularly if the patient’s ethnicity is different than their own.

In the latest 1:2:1 podcast, Periyakoil discusses her study findings and why it’s critical for all adults to complete an advance directive and initiate a conversation about their end-of-life wishes with their doctor and family. To get these conversations started and help patients navigate the emotionally-charged process, she launched the Stanford Letter Project, which provides templates in a range of languages asking patients simple questions about how they want to die.

Listen to the full podcast to learn more about the project and hear from Stanford Letter Project users about how they want to spend their final days.

Previously: How would you like to die? Tell your doctor in a letterIn honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues, Study: Doctors would choose less aggressive end-of-life care for themselves and On a mission to transform end-of-life care

Aging, Research, Sleep

Having trouble sleeping? Research suggests spending more time outdoors

Having trouble sleeping? Research suggests spending more time outdoors

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Raise your hand if you didn’t sleep well last night. Findings published in the latest issue of Preventive Medicine show that increasing the amount of time you spend outdoors can improve sleep quality, particularly for men and people over the age of 65.

To better understand the relationship between insufficient sleep and outdoor space, researchers analyzed data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, which surveyed of more than 250,000 adults in the United States. This information was paired with data from a U.S. Department of Agriculture index that scores the country’s geographical areas for natural amenities, using hours of sunlight, an important factor in regulating a person’s circadian rhythm, and temperature. According to a release:

For men, the relationship between sleep and exposure to green space was much stronger than for women. And males and females 65 and over found nature to be a potent sleep aid, [Diana Grigsby-Toussaint, PhD, said.]

Grigsby-Toussaint noted that living near green landscapes is associated with higher levels of physical activity and that exercise in turn predicts beneficial sleep patterns.

The finding should be a boon for people who are having trouble sleeping as they age. “If there is a way for persons over 65 to spend time in nature, it would improve the quality of their sleep—and their quality of life—if they did so,” Grigsby-Toussaint said.

Researchers added that the findings underscored the importance of preserving nature and providing safe access to nature in urban development.

Previously: Green roofs are not just good for the environment, they boost productivity, study shows, Nature is good for you, right? and Out-of-office autoreply: Reaping the benefits of nature
Photo by Garry Knight

Addiction, Aging, Chronic Disease, Pain

National survey reveals extent of Americans living with pain

National survey reveals extent of Americans living with pain

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Yesterday, the NIH announced a new analysis of data that examined how much pain people in America suffer. The findings, published in The Journal of Pain, were based on data from the 2012 National Health Interview Survey (NHIS), an annual survey that asks a random sample of U.S. residents a wide variety of questions about their health.

The survey results are staggering: More than half of the adults in the country (126 million) had some kind of pain, minor to severe, in the three months before the survey. About 25 million had pain every day for that time frame and about 40 million suffer from severe pain. Those with the worst pain were also most likely to have worse health in general, use more health services and have more disabilities.

The survey also looked at complementary medicine approaches people take to dealing with their pain. Natural dietary supplements topped the list, followed by deep breathing and physical exercise such as yoga, tai chi or qi gong.

Joseph Briggs, director of the National Center for Complementary and Integrative Health was quoted in an article about the new study in the Washington Post:

The number of people who suffer from severe and lasting pain is striking. . . This analysis adds valuable new scope to our understanding of pain … It may help shape future research, development and targeting of effective pain interventions, including complementary health approaches.

Another topic the WaPo article touched on, which we’ve written about here at Scope, is the link between chronic pain and prescription painkiller abuse:

The prevalence of chronic pain in America also lies at the root of an ongoing epidemic of prescription painkiller abuse. Since 1999, according to the Centers for Disease Control and Prevention, the amount of painkillers such as oxycodone and hydrocodone sold in the United States has nearly quadrupled.

Here at Stanford, the Division of Pain Medicine is sponsoring a free back pain education day on Saturday September 13. You can find out more details here.

Previously: Assessing the opioid overdose epidemicChronic pain: Getting your head around itFinding relief from lower back pain and Stanford researchers address the complexities of chronic pain
Photo by Steven Depolo

Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Aging, Health Costs, Health Policy, Patient Care

A look back at Medicare’s 50 years

Hand in HandOn Friday, KQED’s Forum offered a look at Medicare and Medicaid to mark the programs’ 50-year anniversary. Stanford health policy researcher Laurence Baker, PhD, participated in the discussion, which covered issues such as how the programs drive the way prices for care are negotiated with medical providers, how the large population of Baby Boomers will affect the system, and how reimbursement rates affect the kind of care Medicare and Medicaid patients receive.

The panel also discussed the gaps in coverage — services like dental care are not covered by Medicare — and the challenges they create. Medicare coverage has grown from the narrow set of conditions it first covered, and Baker thinks the conditions are right to begin a new national conversation about expanding coverage:

One of the things that’s really ripe for discussion is how this country is going to handle the long-term care issues. Medicare’s got to be at the center of that. And it almost feels like the time is coming that we’re going to have to think about that much more seriously.

And when host Mina Kim asked Baker the question that’s on a lot of people’s mind — Is Medicare sustainable for the long term? — Baker noted:

The program is pretty important; it’s clearly something the country values across the political spectrum. Lots of people want to see it sustained. It may not be a pretty process. It might not be fun to watch the politics of how we work all this out, but there are lots of ways to keep the program solvent, so I’m optimistic.

Previously: Competition keeps health-care costs low, Stanford study findsWhat’s the going rate? Examining variations in private payments to physiciansCheck the map – medical procedure rates vary widely across CaliforniaMedicare payment reform shown to cut costs and improve patient care and KQED health program focuses on baby boomers and the future of Medicare
Photo by Garry Knight

Aging, In the News, Public Health, Sleep

Nothing to snort over: Why snoring should be taken seriously

Nothing to snort over: Why snoring should be taken seriously

6258904896_ec4a6f155a_zIt’s the middle of the night—or maybe the middle of the day—and all seems well. Then, you hear it: a low, rumbling, animalistic sound. It could be a snort or a growl or even a snarl. But it’s not an animal at all. It’s a person who is snoring far too loudly for your liking, and the sound only seems to be getting worse.

It’s safe to say we all know someone who snores – or we may even do it ourselves. A Huffington Post article puts a spotlight on snoring and features Stanford’s Rafael Pelayo, MD, who explains why it occurs, why it becomes increasingly worse with age, and, most importantly, why it could signal a potentially serious health problem.

“Think of fire and a fire alarm,” Pelayo says. “The snoring is the alarm. If there’s a fire and the fire alarm goes off and I disconnect the alarm, it doesn’t mean I put out the fire. The fire could still be burning.”

Snoring could be a symptom of sleep apnea, a disorder in which a person’s breathing repeatedly stops and starts during sleep. Apnea is a legitimate medical issue that can be harmful if gone unchecked, and Pelayo encourages anyone who snores to get tested for it.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.

Previously: New recommendation: Adults need at least 7 hours of sleep each night, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and How insufficient sleep can lead to weight gain 
Photo by Marc Lewis

Aging, BigDataMed15, Videos

A look at aging and longevity in this “unprecedented” time in history

A look at aging and longevity in this "unprecedented" time in history

Keynote talks and presentations from the 2015 Big Data in Biomedicine conference at Stanford are now available on the Stanford YouTube channel. To continue the discussion of how big data can be harnessed to improve the practice of medicine and enhance human health, we’re featuring a selection of the videos on Scope.

Life expectancy dramatically increased in the 20th century and has reached an all-time high in the United States. At this year’s Big Data in Biomedicine conference, Laura Carstensen, PhD, director of the Stanford Center on Longevity, called this point in history “unprecedented” in terms of longevity. She told attendees, “Our ancestors in the 20th century added more years to life expectancy than all years added across all prior millennia of human evolution combined.” She also noted that for the first time in the history of our species, “the vast majority of babies born in the developing world have the opportunity to grow old.”

In the above talk, she explains the changes that led to this “stunning achievement” and presents data to explore what aging now looks like – and what it might look like in the future.

Previously: Parents turn to data after son is diagnosed with ultra-rare disease, Nobel Laureate Michael Levitt explains why “biology is information rich” at Big Data in Biomedicine, At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health, Experts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patients and On the move: Big Data in Biomedicine goes mobile with discussion on mHealth

Aging, Cancer, Dermatology, Genetics, Research, Stanford News

Genetic secrets of youthful skin

Genetic secrets of youthful skin

new hatEvery year, upwards of $140 billion a year gets spent on cosmetics. In the United States alone, says an authoritative report, a recent year saw upwards of 5.6 million Botox procedures, 1.1 million chemical peels, almost a half-million laser skin procedures, 196,286 eyelid surgeries and a whole bunch of face lifts.

If you’ve got the courage to compare your present-tense face with the one you were wearing 20 or even 10 years ago, you’ll see why. As I wrote in a just-published Stanford Medicine article, “Wither youth?”:

The terrain of aging skin grows all too familiar with the passing years: bags under the eyes, crow’s feet, jowls, tiny tangles of blood vessels, ever more pronounced pores and pits and pigmentation irregularities. Then there are wrinkles — long, deep “frown lines” radiating upward from the inside edges of the eyebrows and “laugh lines” that trace a furrow from our nostrils to the edges of our lips in our 40s, and finer lines that start crisscrossing our faces in our 50s. Sagging skin gets more prominent in our later years as we lose bone and fat.

“And,” I added wistfully, “it’s all right there on the very outside of us, where everyone else can see it.”

Stanford dermatologist Anne Chang, MD, who sees a whole lot of skin, got to wondering: Why does skin grow old? Armed with a sophisticated understanding of genetics, she went beyond lamenting lost youth and resolved to address the question scientifically, asking: “Can you turn back time? Can aging effects be reversed? Can you rejuvenate skin, make it young again?”

The answers she’s come up with so far – from hereditary factors to a possible underlying genetic basis for how some treatments now in common commercial cosmetic use (such as broadband light therapy) could potentially slow or even reverse the aging of skin – are described in my magazine article.

Previously: This summer’s Stanford Medicine magazine shows some skinResearchers identify genetic basis for rosacea, New study: Genes may affect skin youthfulness and Aging research comes of age
Photo by thepeachpeddler

Aging, Medicine and Society, Pain, Palliative Care, Patient Care, Stanford News, Videos

“Everybody dies – just discuss it and agree on what you want”

"Everybody dies - just discuss it and agree on what you want"

Earlier this week, my colleague pointed to a New York Times essay penned by VJ Periyakoil, MD. In it, Periyakoil calls for a role-reversal in talking about end-of-life issues and encourages patients to take the lead in starting such conversations with their doctors. “Without these conversations, doctors don’t know what the patients’ goals are for living their last days,” she writes. “What are their hopes, wants, needs and fears? Do they want to die at the hospital connected to a machine? Do they want to die at home? The current default is for doctors to give patients every possible treatment for their condition, regardless of its impact on the patient’s quality of life, the cost or the patient’s goals.”

Periyakoil goes on to describe a letter that she and her colleagues created to help facilitate these patient-doctor conversations. The video above expands upon the Stanford Letter Project, which helps patients map out what matters most to them at the end of life, and includes the candid thoughts of numerous older adults.

“If I’m brain-dead, unplug me,” one woman says matter-of-factly. “And I want to die painless. No pain – just put me to sleep and don’t let me wake up.”

In the doctor’s office, one man shares his reason for writing a letter and expressing his wishes: “One of the worst things in the world that you can have happen [is you’re on] your deathbed and you’re putting the burden of life-altering decisions on a family member that has no clue of what you really want or don’t want.”

Advises another older man: “Don’t be ashamed of it – everybody dies. Just discuss it and agree on what you want.”

Previously: How would you like to die? Tell your doctor in a letter, In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues, Study: Doctors would choose less aggressive end-of-life care for themselves, On a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions

Stanford Medicine Resources: