Tuesday, December 18, 2012

Our Graying World and Wisdom on Living in It

By Jeffrey Weisbord, Adelphi sophomore

In the days of the Soviet Union, my grandmother was the assistant principal of a prominent English language school in Moscow. Many of her students became leaders in business, politics and medicine, and one—Mikhail Prokhorov—even went on to rank among the wealthiest people in the world and own the NBA’s Brooklyn Nets.

My father was one of her students, and grew up seeing his own mother as an authority figure for hundreds of Moscow’s most gifted youths. This image has changed drastically over the last few years, as my grandmother—now in her late 80s—relies on her immediate family simply to survive. Despite various ailments (dementia being the most noticeable), she still lives by herself, albeit with a house attendant who stays with her until 9:00 every night. I make a nightly trip to her apartment to ensure that she’s ready for bed, and my father visits her every day during his lunch break. Her day-to-day life has become very difficult, but it may be even harder for my father to witness his hero fade to a shell of her former self.

My story is just one among millions. Within the next five years, the number of people who are 65 or older will, for the first time, exceed the number of children on our planet. Aging is an issue that touches all of us. Fittingly, faculty members from Adelphi’s Gordon F. Derner Institute of Advanced Psychological Studies are using their expertise to address the issues surrounding aging and caring for the aged. Their work and that of other Adelphi professors and alumni is covered in the feature story of the Fall 2012 issue of Adelphi University Magazine, “Everyday People, Extraordinary Challenges—A Look at Growing Older in the New Millennium.”

From the Derner Institute, Professor Robert Bornstein, Ph.D., who co-wrote When Someone You Love Needs Nursing Home, Assisted Living, or In-Home Care: The Complete Guide with his wife, psychologist Mary Languirand, offers guidance on not only finding a good nursing home for yourself or a loved one, but also budgeting for elder care before it’s too late.

Assistant Professor Katherine Fiori, Ph.D., has researched the effects social networks have on seniors’ mental and physical health. She comments on the differing effects of networks—with family and with friends. She has found that friend-focused networks are particularly beneficial for mental health, while family-focused ones tend to be better for physical health than mental health.

Associate Professor Francine Conway, M.S. ’92, Ph.D. ’99, has studied grandparents who care for their grandchildren—a growing trend. She has found that the grandparents’ disposition and outlook play crucial roles in their health outcomes. “If they’re able to see this as a benefit to them, then it will be,” she told Adelphi University Magazine.

Whatever your age or outlook on aging, you’ll find credible and valuable faculty and alumni expertise in this Adelphi University Magazine article. 

Jeffrey Weisbord, a biology major, is part of Adelphi’s Early Assurance Program with NYU College of Dentistry. He is an avid writer and contributes to various University publications, including Adelphi University Magazine. He has always stayed active by exercising and playing sports, but has recently taken the next step by severely limiting the amount of unhealthy food that he consumes.

Monday, December 17, 2012

Hold the Applause

by Philip Alcabes, Ph.D.

Last week, the Think About It blog’s Weekly Health Roundup (14 Dec.) moved too fast. 

Our bloggers applauded the behavioral policing of NYC’s Bloomberg administration as a factor in two pieces of news:  the decline in New York City’s child obesity prevalence and an increase in life expectancy.

The Dec. 14th TAI blog post specifically mentioned four Bloomberg-era innovations:  bans on smoking in restaurants, bars, and parks; the ban on trans fats in restaurants; the requirement to post calorie counts at chain restaurants; and the new ban on the sale of sugar-sweetened beverages in large-size cups.
Our bloggers didn’t consider two big problems, though. 

First, there has been no convincing evidence that any one of the Bloombergian innovations has led to a reduced rate of disease.  The city’s Department of Health and Mental Hygiene has indeed made such claims – but they were based on circumstantial evidence.  For instance, evaluators found that people who order lower-calorie options at fast-food restaurants say they had read the posted calorie counts (the NYC health commissioner, Thomas Farley, might well believe that such correlations are evidence of cause-and-effect relations – but intelligent people know better).

Second, the data don’t support the conclusion that obesity prevalence has declined, nor the inference that the increased life expectancy demonstrates reduced risks of dying.

The obesity data are based on what are called “serial cross-sections.”  That is, investigators weigh and measure a bunch of children to determine the distribution of BMI, body-mass index.  Two years later, they do the same to a new bunch of children.  To find that the second batch contains fewer high-BMI kids than did the earlier group tells us nothing about whether the children who were obese the first time around have now slimmed down.  Because we don’t know if the children in the first batch even appeared in the second batch, and no individual child is observed at multiple times to track BMI increase or decrease. 

These data don’t allow us to conclude anything at all about whether children are getting fatter or slimmer.

And life expectancy, it’s important to know, is just an average age at death.  Life expectancy in a population will go up if people live longer, which is the point of measuring life expectancy in the first place.  But L.E. will also go up if more wealthy people move into a region (because wealthy people live longer than poor people).  And it will go up simply if more older people move in (because adding 70- and 80-year-olds to the population makes the average age at death go up – even though nobody’s chances of dying have changed at all).

In fact, over a short term and with the high rates of in- and out-migration that NYC has, the most likely expectation for the longer life expectancy in NYC isn’t lower risk of dying – it’s that the wealthy have bought up properties that the lower and middle classes can no longer afford. 

So there’s no reason to think that the trans fat ban, smoking bans, or big-cups-of-soda ban have made New Yorkers healthier.  It’s more likely that Mayor Bloomberg has simply made the city more hospitable to the rich.

Which doesn’t seem to merit applause at all.

Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.

Friday, December 14, 2012

Weekly Health Roundup

Three cheers for New York City!

The Bloomberg administration’s longterm focus on public health appears to be paying off, as a pair of reports released this week suggests. The childhood obesity rate in New York declined more than 5% in recent years, and made significant strides in other U.S. cities, including Miami and Philadelphia, as well. The positive news comes with a caveat, as the decrease in New York was less significant among minority and low-income children.

Mayor Bloomberg’s office announced all-time high life expectancy and all-time low infant mortality figures in conjunction with the Health Department this week. Babies born in 2010 have a life expectancy of 80.9 years—more than two years longer than the national average. And New York City’s infant mortality rate fell in 2011 to an all-time low of 4.7 deaths per 1,000 live births, this time with improvements seen across all ethnic groups.

The mayor’s office is quick to claim the positive news as a result of their commitment to public health. Over the span of Bloomberg’s decade-long mayorship, the Big Apple has benefited from several much-imitated health initiatives, including:
  • Smoking ban in most restaurants and bars, and in outdoor public places
  • Trans-fat ban in restaurants
  • Calorie count posting requirement at chain eateries
  • Ban on sugary beverages over 16 oz.

While New York City has made significant strides toward healthier living under Bloomberg’s mayorship, a new report from the ocean conservatory group Oceana details fish mislabeling in restaurants and stores in NYC and other cities across the country.  Aside from the “bait and switch” economic issue of patrons paying for higher-priced fish than they are consuming, the mislabeling can create significant health hazards for pregnant women, those with food allergies, or for anyone seeking to lower their consumption of mercury and other toxins.

Friday, December 7, 2012

Weekly Health Roundup

This week saw significant changes announced to the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) , the comprehensive guide produced by the American Psychiatric Association.  The headline-grabber involved the elimination of a separate Asperger’s syndrome and its envelopment into a broader autism spectrum diagnosis. While this was the noisiest change generated, other note-worthy shifts announced include:
  • expansion of post-traumatic stress definition
  • inclusion of binge-eating disorder and hoarding
  • addition of disruptive mood dysregulation disorder for children
  • elimination of gender identity disorder, to be replaced by gender dysphoria
  • dropping the bereavement exclusion from major depressive disorder, or more simply, permitting grief to be categorized with depression.
Controversy surrounds many of these changes, and for those that expand the current guidelines for diagnosis, there is apprehension surrounding the potential for overmedicating of what some would consider “normal” life chapters (i.e. grief as part of the bereavement process; temper tantrums as part of a child’s development).

And while overmedication is certainly a hazard, a new study published in The Lancet this week reveals that the breast cancer drug tamoxifen has been largely underutilized in post-breast cancer treatment. The study finds that prolonged (ten-year) use of tamoxifen further reduces the risk of breast cancer recurrence, as opposed to the current five-year tamoxifen protocol.

For royal bump watchers, good news from Buckingham Palace came this week in the form of an official announcement of the Duchess of Cambridge’s pregnancy. The happy news came with the more sobering footnote of Kate’s severe morning sickness for which she had been hospitalized, shining light on a rare pregnancy side effect that is generally benign but can produce serious health risks.

And finally, as we close out National Influenza Vaccination Week, we urge you to get the flu shot if you have not done so already. The CDC warned just days ago that this year’s flu season may be a particularly nasty one, having started earlier than usual. If you missed this week’s Flu Clinic, you can still get your flu shot through Health Services (Monday through Thursday from 5:00-7:00 p.m., and Tuesday through Friday from 8:30-10:30 a.m.).