Homelessness Among Elderly Persons

We picture the elderly as independent and self sufficient, but that is not always the case. Most of the elderly living in America today are dependent on pension and social security checks.  Neither of these are able to provide a very comfortable lifestyle, never mind a luxurious one.  Although most of the elderly have some source of income and a roof over their head, nearly 4 million do not.

It is not surprising that the number of elderly adults who have become homeless has increased around the county. An example of this increase has occurred in Massachusetts, where from 1999 to 2002, the number of people over 55 using shelters increased by 60%.

Increased homelessness among elderly people is largely the result of poverty and the declining availability of affordable housing among certain segments of the aging. Throughout the nation, there are at least 9 seniors waiting for every occupied unit of affordable elderly housing. Among households with very low incomes, households headed by an elderly person have almost a one-in-three chance of having worst case needs, despite the fact that housing assistance has been heavily directed toward elderly people.

Studies show that elderly homeless persons are more prone to victimization and more likely to be ignored by law enforcement. In 2006, 27% of the homeless victims of violent crimes were between 50-59 years of age. Individuals 62 and older constituted only 2% of the country’s sheltered homeless population from February to April 2005, compared with 15% of the housed population. In addition to the worsening of physical health caused by homelessness, the homeless elderly are also more likely to suffer from depression or dementia.

References:

http://www.nationalhomeless.org/factsheets/Elderly.pdf

http://library.thinkquest.org/10374/html/the_elderly.html

http://homeless.samhsa.gov/Channel/View.aspx?id=534&AspxAutoDetectCookieSupport=1

http://www.hearth-home.org/

To Win, We Have to Lose

A new campaign on television brought the issue of obesity to my attention. Obesity has become an epidemic in the United States. Around 15 million adults over the age of 52 suffer from this condition, representing nearly one in four older adults. While obesity itself is not a chronic condition, it leads to other trivial risk factors including coronary heart disease, type II diabetes, stroke and several forms of cancer. Obesity not only affects the health of older adults, it also affects their daily lives. Older people who are obese report more feelings of sadness and hopelessness than those who are not obese.

Another shocking statistic is the fact that obesity is on the rise with the increase in accessible technology and lack of exercise. Since 1991, rates of obesity have increased dramatically. Substantial increases among adults of all ages suggest that obesity among older Americans is likely to become a greater problem in the future. Among the obese population age 51 and older, a disproportionate percentage is aged between 51 to 69.

While obesity rates have increased for everyone, some groups have much higher rates, Rates are also higher for older adults with lower incomes and those with less education. Non-Hispanic whites age 51 and older have the lowest rates of obesity compared to adults of the same age of other racial and ethnic backgrounds. Older men and women have similar rates of obesity.

References:

http://seattletimes.nwsource.com/html/nationworld/2002335131_obesity14.html

http://hpi.georgetown.edu/agingsociety/pubhtml/obesity2/obesity2.html

http://www.newscientist.com/article/dn7514-obesity-may-accelerate-the-ageing-process.html

http://www.utsandiego.com/news/2012/mar/23/urban-studies-students-tackle-obesity-aging-milita/

More Than What Meets the Eye

Since my birthday’s coming up soon, one thing that has been bothering me is getting older. I’m not going to deny it. Gone are the times when I could be completely carefree. For me, this fear of aging stems from my impression that the elderly have monotonous lives. I decided to further research on the topic and came across surprising facts that agree with my thoughts. But at the same time I found solutions to the problem.

Nearly 20% of the older population experience depression. Even more troubling, only half of seniors with mental health problems get treatment of any kind, and less than 3% get treated by a psychologist. There are several health complications related to depression. However, suicide is the most feared complication, and it hits older adults harder than any other age group. In 2004, people aged 65 years and older accounted for 16% of all suicide deaths in the United States even though they comprised only 12% of the population. The reasons for delay or denial of treatment of depression could be numerous. First of all, depression symptoms are mistaken for a variety of other common health disorders in this age group. Secondly many seniors may exhibit symptoms of depression differently than the general population.

There are ways to counter this problem. Anti-depressive medications are quite helpful in many cases. However, exercising three times a week could be more effective than medication in relieving the symptoms of major depression in elderly people and may also decrease the chances that the condition will return over time. Seniors should be encouraged to lead an active and physical social life and intermingle actively amongst family and community members. Social interaction can go a long way in avoiding many cases of depression and emotional troubles resulting from loneliness.

References:

Andrew Rosenzweig, MD, MPH, Holly Prigerson, PhD, Mark D. Miller, MD, and Charles F. Reynolds III, MD, “BEREAVEMENT AND LATE-LIFE DEPRESSION: Grief and Its Complications in the Elderly”, Vol. 48: 421-428 (Volume publication date February 1997)

http://www.annualreviews.org/doi/abs/10.1146/annurev.med.48.1.421

Jaakko Valvanne, Kati Juva, Timo Erkinjuntti and Reijo Tilvis, “International Psychogeriatrics”, International Psychogeriatrics (1996), 8 : pp 437-443

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=272394

E Murphy, “Social origins of depression in old age”

http://bjp.rcpsych.org/content/141/2/135.short

Mark La Gory “The Effects of Environmental Context on Elderly Depression”, Journal of Aging and Health

http://jah.sagepub.com/content/4/4/459.short

AA: Aged Alcoholism

More than 10,000 baby boomers a day are turning 65 years old. Although alcohol problems are often underreported, alcohol use remains common among older persons. As the older population grows, increasing numbers of older alcoholics will require health care.  In a study of community-dwelling persons 60 to 94 years of age, 62 percent of the subjects were found to drink alcohol, and heavy drinking was reported in 13 percent of men and 2 percent of women.

Older adults who have alcohol dependence problems drink significantly more than younger adults who have similar problems. The findings suggest that older problem drinkers may have developed a tolerance for alcohol and need to drink even more than younger abusers to achieve the effects they seek. When considering this, an important factor that comes into play is the fact that alcohol's effects vary with age.  As the body ages, how it interacts with and reacts to alcohol also changes. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol's effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. According to the National Institutes of Health, alcohol is a factor in 60 percent of fatal burn injuries, drownings and homicides and in 40 percent of fatal motor vehicle crashes, suicides and fatal falls.

Aged people also tend to take more medications than younger people. Mixing alcohol with over-the-counter or prescription medications can be very dangerous, even fatal. At the same time, alcohol may worsen the effectiveness of medications and even worsen symptoms.


References:

Lawrence Schonfeld, Larry W. Dupree, “Antecedents of Drinking for Early- and Late-Onset Elderly Alcohol Abusers”, Volume 52, 1991 > Issue 6: November 1991

http://www.jsad.com/jsad/article/Antecedents_of_Drinking_for_Early_and_LateOnset_Elderly_Alcohol_Abusers_/1757.html

Larry W. Dupree, “Aging and Alcohol Use Disorders: Diagnostic Issues in the Elderly”, Table of Contents - 1990 - Volume 2, Issue 01  

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=271886

A Gurnack and Jeanne L. Thomas, Behavioral Factors Related to Elderly Alcohol Abuse: Research and Policy Issues, 1989, Vol. 24, No. 7 , Pages 641-654
http://informahealthcare.com/doi/abs/10.3109/10826088909047304

SALLY K. RIGLER, “Alcoholism in the Elderly”, Am Fam Physician. 2000 Mar 15;61(6):1710-1716

http://www.aafp.org/afp/2000/0315/p1710.html

The Hispanic Paradox

While living in Los Angeles, especially in South Central, one sees a large number of underprivileged Hispanics compared to other races. In accordance, 26.7% of the U.S Hispanic population lives below the poverty level compared to only 10% of their white counterparts. (U.S. Census Bureau)  A trait common amongst them, especially the older ones, is their lack of fitness and deteriorating health. However, despite their low socioeconomic status, Hispanic people have much lower mortality rates compared to those of African-Americans and Caucasians, as shown below. This epidemiological finding is commonly known as the Hispanic Paradox.

The biggest factor in health is a person’s socioeconomic status. Hispanics face poor educational status, employment, health status, and use of health and social services because they have retained their native language, where about 33% of elder Latinos only speak Spanish. (Hooyman & Kiyak) Those without citizenship face the issue of not being able to apply for Social Security, SSI, Medicare, or Medicaid. These statistics should mean that Hispanics should be particularly vulnerable to chronic illnesses and should have an overall worse health compared to other races. 

One hypothesis for the Hispanic Paradox, known as the “Barrio Advantage” states that living in the same neighborhood as people with similar ethnic backgrounds proves greatly advantageous for one’s health. In a study of elderly Mexican Americans, those living in areas with a higher percentage of Mexican-Americans had lower seven year mortality as well as a decreased prevalence of other medical conditions. (Karl Eschbach). Another hypothesis referred to as the “healthy migrant effect” states that the selection of healthy Hispanic immigrants into the United States is reason for the paradox. International immigration statistics demonstrate that the mortality rate of immigrants is lower than in their country of origin. In the United States, foreign-born individuals have better self-reported health than American-born respondents. 

Nonetheless a long-term solution for the poverty situation of this particular race needs to be formulated so that a positive impact can be made on the health and socioeconomic status as Hispanics age.

References:

Eschbach, Karl. "Neighborhood Context and Mortality Among Older Mexican Americans: Is There a Barrio Advantage?". American Journal of Public Health.

Abraido-Lanza, A., Dohrenwend, B. P., & Ng-Mak, D. (1999). “The latino mortality paradox: A test of the ‘salmon bias’ and healthy migrant hypotheses”. American Journal of Public Health.

http://www.census.gov/hhes/www/poverty/about/overview/index.html

Hooyman & Kiyak (.pdf)

The Silent Epidemic

I recently visited my Uncle and my Aunt in Seattle, whom I had not seen in a while. One night, my Uncle, who serves as a physician in several hospitals in Seattle, had an interesting conversation with me. I initiated the topic about superiority amongst races when genetics are concerned and if he has seen common trends amongst different races that made them weaker or stronger. I was always under the impression that people of African origins were better built physically and similarly had greater endurance to diseases. However he revealed the opposite to me that African-Americans are more prone to certain diseases due to their genes, such as sickle cell anemia, hypertension, prostate cancer and diabetes. Researching on the matter revealed much more, especially about the silent epidemic of increased Alzheimer’s disease amongst black people.

Alzheimer’s is the most common form of dementia and is usually diagnosed in people over the age of 65. (Alzheimer’s Research Foundation). ‘Alzheimer’s disease is more prevalent among African-Americans than among whites - with estimates ranging from 14% to almost 100% higher.’ (Cynthia Post) This is a surprisingly high statistic. What is even more shocking is the fact that there is a greater familial risk of Alzheimer’s in African-Americans. (Alzheimer’s Association) While the immediate causes of the disease remain unknown, I noticed that one of the common suspected cause included hypertension. This was supported by an article, which mentioned that ‘Data from longitudinal studies suggest that high cholesterol and high blood pressure may be significant risk factors for Alzheimer’s’. (Alzheimer’s Association) These are trivial findings for African populations, among whom vascular disease and its risk factors are already disproportionately present.

Africa is believed to be the ancestral homeland of all modern humans. (Sarah A. Tishkof) Perhaps these prevalent diseases are caused by susceptible alleles that are likely present in older races, and hence present more so in people of African origin. Hence, it is important to study African populations for not only their benefit but for the benefit of other races as well. It is equally important to increase awareness of Alzheimer’s among African populations, and to get services and treatments to those who are affected by the disease.

References:

Sarah A. Tishkoff and Scott M. Williams, “GENETIC ANALYSIS OF AFRICAN POPULATIONS: HUMAN EVOLUTION AND COMPLEX DISEASE”, Aug 2002. http://www.uvm.edu/~rsingle/stat395/S04/papers/Tishkoff%2BWilliams-NatRevGenetics-02.pdf

Cynthia Post, “Georgia: Alzheimer's Disease in the African American Community”, Atlanta Daily. http://www.dnafiles.org/outreach/ethnic-media-fellows/atlanta-ga-cynthia-post

Alzheimer’s Association, “African-Americans and Alzheimer’s disease” http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf

"Alzheimer's Research on Causes and Risk Factors." Fisher Center for Alzheimer's Research Foundation. May 1, 2003. http://www.alzinfo.org/research/alzheimers-research-on-causes-and-risk-factors

Pakistan’s Evolving Joint Family System

I previously talked about the American family structure. For this post, I wanted readers to picture the lives of the elderly in Pakistan, my home country. Researching on this topic expanded my knowledge, as I became aware of viewpoints that were not obvious to me before.

          In the 1990s, Pakistan reported the highest percentage of households at 72.4 % with 5 or more members. (Demographic and Social Trends Affecting Families in the South and Central Asian Region) An obvious reason that comes to mind is the widespread prevalence of the joint family system in the country. The joint family system serves as the basic family unit in Pakistani society. In a joint family, the parents, grandparents and children live in the same household. Older males are the breadwinners of the house while women play a significant role in taking care of the family. The members try to uphold each other's priorities and hence form a closely knit circle. People in Pakistan dearly followed the joint family but conversely in recent years, urbanization has directed to alterations and amendments to this existing system as each individual strives to keep up with today’s society. 

         The retirement age in Pakistan is 60 years after which most elders are unable to find alternative sources of income and thus become largely dependent on their families for financial support. (Family System in Pakistan 2011) With a rapid conversion of extended family systems to nuclear families, the elderly suffer the most in a third world country with bare amenities. This has lead to increased disease burden. The Population census of Pakistan of 2008 cites a 28% disability rate of people aged 60 and older, which is significantly greater than most developing and developed countries. (Sabzwari 2009) What are the elderly of Pakistan going to do with these currently changing scenarios? 

References:

UN Survey, “ Demographic and Social Trends Affecting Families in the South and Central Asian Region ”

http://www.un.org/esa/socdev/family/Publications/mtdesilva.pdf

http://www.asian-women-magazine.com/families/family-system.php

Saniya R. Sabzwar, “Ageing in Pakistan—A New Challenge”

http://memberfiles.freewebs.com/84/90/65819084/documents/Aging%20in%20Pakistan.pdf