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Friday, May 13, 2011

URBAN LEGENDS ABOUT AGING


by Harry R. Moody, guest blogger

 “The problem isn’t the things that we don’t know,
it’s the things we ‘know’ that ain’t so.” (Mark Twain)
                                                                

 
“Retirement is bad for your health.” Or “People often die soon after they retire.”
(Proven false long ago by longitudinal studies of retirement; see the work of Gordon Streib and many others.  There are of course cases where people in ill-health opt to retire and do die soon afterward.  But retirement wasn’t the cause.  Maybe there are other reasons to encourage people to delay retirement but fear of bad health isn’t one of them.)

“Ageism is the work of the advertising industry.”
(Actually, ageism was invented by the ancient Greeks, as a glance at their youth-oriented art will show.  It was rediscovered by the Renaissance and then propagated in the 20th century for a variety of reasons.  Advertising and media mainly trade on stereotypes already widely accepted in society.)

“Anti-aging medicine today is making rapid progress.”
(Actually, no progress all; no intervention has ever been shown to slow the biological process of aging, other than caloric restriction (eating drastically less).  Herbal supplements sold in health food stores are totally unregulated; many are dangerous. None, including anti-oxidants, has ever been proven effective in slowing aging.)

“Advance Directives would have prevented the case of Terri Schiavo.”
(Not at all. Her husband Michael would almost surely have been appointed proxy decision-maker, since a spouse is already presumed as such by the courts.  As for Living Wills, they have been shown to be mostly underutilized and ineffective according to most  serious empirical studies on the subject: see Hastings Center Report in Summer, 2004 issue for details.)

“People are always worse off when they move to a nursing home.”
(Not true; many people actually thrive and blossom in the new social environment, as countless cases prove. See, for example, the recent memoir Making an Exit for an inspiring story on this point of a daughter who was astonished by her mother’s flowering after moving into a long-term care facility.  Any nursing home social worker can tell similar stories.)

“Cosmetic surgery is a sign of ageism.”
(Maybe in society at large but lots of people feel compelled to go for plastic surgery for defensive reasons: to get a face lift for dating or to avoid being discriminated against in the job market.  Hey, give ‘em break.  They’re not ageist, they're just trying to survive.)

“Home care is cheaper than nursing homes.”
(Would that it were so.  But economic studies for decades have shown just the opposite, whenever all relevant costs, such as rent and unpaid caregiving, are taken into account.)

“Respect for elders was higher in the past.”
(A common myth, debunked by historian Peter Laslett thirty years ago; see his classic The World We Have Lost.  Maybe there’s a reason why the Bible contains the Fifth Commandment, “Honor thy Mother and Thy Father.”  It’s the only Commandment that carries a reward for following it.)

“More people today are retiring to move to the Sunbelt.”
(Some do and always have.  But 90% of retirees stay right where they’ve always lived and most of the remainder move only within their state of residence.  See Charles Longino's work on “The Mobility Myth.”)

“Only 4 percent of older people live in nursing homes.”
(A half-truth propagated by well-intentioned advocates.  What is famously called the “4 percent fallacy” number applies only to a single point in time.  But on a life-span basis, 40%  or more of those who reach age 65 will spent time in a long-term care facility before they die.  One more example of the fallacy of cross-sectional versus longitudinal comparison.)

“We need more regulation of nursing homes to prevent elder abuse.”
(Actually, long-term care is already more highly regulated than any industry in America, except for nuclear power.  As for elder abuse, it’s more likely to happen—and remain undetected--- in a home care setting.  Citizens groups could certainly contribute by closer consumer scrutiny and advocacy of nursing homes.  But more regulations may not help since we’re not enforcing the ones we already have.)

“Older Americans have declining rates of disability.”
(Yes, Ken Manton proved this point—but only for the past.  Epidemiologists are now looking at accelerating rates of obesity or diabetes and there is reason to doubt that declines will hold true in the future.  See Jay Olshansky’s article in JAMA (Spring, 2005), and more recent research warning about projected ill-health of Boomers in retirement. Obesity rates are an ominous sign of things to come.)

“Religion is good for your health.”
(It’s true that people who attend church tend to live longer, but no one knows why. Some studies suggest that volunteerism, the arts, lifelong learning or even having a pet will give the same result.  It could be that religion has little to do with it; maybe bowling would do the same (but not bowling alone).  Here, as so often, correlation is not causation.)

“The 20th century witnessed dramatic gains in longevity in later life.”
(Another myth; life expectancy from birth did increase from 47 to 77 in the 20th century, but life expectancy for people at age 65 only went up a modest 5 years, not nearly so “dramatic”)

“The U.S. spends a lot on health care, but it also gets results.”
(Haven’t we heard that “We have the best health care system in the world!”  Yes, we’ve heard it but it isn’t true.  According to UN data, US life expectancy is lower than Costa Rica.  Recent studies suggest that, in state-by-state comparisons, higher spending is often associated with worse health outcomes, as suggested by the fact that up to 100,000 Americans die each year as a result of medical errors.)

“Prevention and health promotion is the way to save money in health care.”
(Sounds good, but it’s probably not true.  That’s what Prof. Louise Russell concluded more than two decades ago in her massive economic study, Is Prevention Better Than Cure?  The nonpartisan Congressional Budget Office in 2009 has agreed, finding that health promotion measures would in fact not save money in healthcare reform.  Prevention might be a good idea, but it won’t necessarily save money.)

“Geriatric medicine today is becoming more widely accepted.”
(Quite the opposite.  There are more M.D.’s who are members of the American Academy of Anti-Aging Medicine—a bogus field-- than there are Board-certified geriatricians.  The number of geriatricians is actually lower today than a decade ago and it continues to decline.)

“Older people are more likely to be victims of crime.”
(According to Justice Department data and the FBI, older people are less likely to be crime victims than any other age group in the population.  However, they're more afraid of crime, perhaps because they watch more television than other age-groups. Older people should probably be more afraid of falling, since falls injure more seniors than crime does.)

“Stem cell research will help us find a cure for Alzheimer’s.”
(Few neurologists believe this chestnut.  We don't even know the cause of Alzheimer's and most favored hypotheses have not been supported.  Stem cells may work for other conditions, but probably not Alzheimer's.  However, California voters probably believed it would when they passed their Stem Cell Initiative.  Parkinson’s maybe; Alzheimer’s, very unlikely.)

“People are retiring earlier than ever.”
(In fact, the trend to early retirement has been reversing for the past 10 years.  It’s may soon be a thing of the past.  The recent recession has only strengthened the trend.)

“The U.S. introduced age 65 for retirement, following German Chancellor Otto Bismarck, who picked that number because it was own age.” (It’s true that Germany was a model considered in planning Social Security. But Germany set age 70 as the retirement age at a time when Bismarck himself was 74.  It wasn’t until 27 years later that the age was lowered to 65, when Bismarck had been dead for 18 years.)

“Americans have less free time than they did previously.”
(True, Americans have less vacation time than people in other countries.  But “free time” overall is another matter, according to University of Maryland’s John Robinson’s definitive study of time use by Americans.  What people say about use of time doesn’t match their actual behavior when measured by reliable research methods.)

“The Gray Lobby holds a strangle-hold on aging policy in America.”
(A favorite myth of those who don’t like AARP or other advocacy groups.  But even Social Security is no longer the “third rail of politics,” as used to be said by pundits.  Apparently George Bush didn’t believe it in 2005, nor does the Obama White House, which convened Commission to figure out how to rein in entitlement spending.)

“America spends more on the military than on health care.”
(A hardy chestnut for liberals eager to cut military spending. Actually, health care spending is nearly three times bigger than defense spending.  The “health-industrial complex” is alive and well.)

“Poverty among the old remains a major problem.”
(Maybe in 1959 but not today; child poverty is vastly higher and older people as a group are less likely to be poor than other adult groups.  There are serious problems faced by the near-poor elderly and there are sub-groups, including minorities, who do have high rates of old-age poverty.)

“We lose a million neurons every day.”
(A familiar nugget of ageism, now long disproven by neuroscience.  Check out the latest findings on neuroplasticity by Marian Diamond and other investigators.)

“Aging is not a disease.”
(An article of faith among gerontologists, but it's actually not established at all.  In fact, a growing number of biologists reject this proposition and serious work on slowing the process of aging is underway in the laboratory.  Besides, no one has ever defined exactly what a ‘disease’ is, so it’s hard to prove the point one way or another.  For more on this point, see my article “Has Anyone Ever Died of Old Age?”)

“Until recently, families lived together, but now we’re isolated into nuclear families.” (A sentimental belief long discredited by historical demographers; see Peter Laslett and others on this one.  The nuclear family of residence became the preferred mode as long ago as the 18th century and was actually a distinctive characteristic of European societies long before that.)

“Older people are being abandoned because our society is becoming more mobile and families are living at greater and greater distance.”
(This myth of “abandoned elders” was dubbed a “hydra-headed monster” by gerontologist Ethel Shanas.  But the myth never dies not matter how many times you cut off the heads and prove it false.  As for the “Mobility Myth,” that’s been debunked by demographers.  There are other reasons to be concerned about elder care, but increased mobility isn’t one of them. See Wolf & Longino, The Gerontologist, 45:1, 2005)

"Health care costs are high because of the profits of health insurance companies."
(Not quite.  According to the 2009 Fortune study of America's largest corporations "Health care insurance and managed care" ranked only 35th in profitability, at a mere 2.2% profitability, when measured by return on shareholder equity.  It was far behind aerospace, oil production, and food services, for example.  But some health care sectors, like "Pharmaceuticals" and "Medical Products and Equipment" were very profitable indeed (19% and 16%).  Health care insurance companies pass along most of their revenues to providers, but insurance companies are the ones whose bills we see so we naturally blame them for our problems.)

"The 2010 Health Care Law introduced  'death panels' and rationing of Medicare."
(Evidently, more than a third of Americans believe this.  But there's nothing remotely like this is the Affordable Care Act that was passed.  Earlier in the legislative process, a Georgia Republican did introduce a provision permitting payment for Medicare patients to talk with their doctor about end-of-life choices, but it was stricken after controversy.  The health care law did not cut Medicare but it did slow the growth of future Medicare spending, thereby extending the life of the Medicare Trust Fund from 7 to 19 years.)

"Drinking red wine will make you live longer."
(A lot of people believe this one based on a TV story on "Sixty Minutes."  There is a substance, resveratrol, found in red wine and grapes that has been shown by some laboratory studies to promote longevity.  But you would have to drink amounts of wine far beyond what is humanly possible in order to have any of the hypothetical effects.  Studies of resveratrol on human longevity continue but alcoholics need to find a different excuse for drinking more wine.)

"Health care costs are high because we spend most of the money in the last year of life."
(This one can be dubbed 'The Last Year of Life Fallacy' because it confuses treatment for severe illness with unreasonable extension of life for people who are dying.  Actually, it's not easy to know when  'the last year of life' will turn out to be.  When we look at the data in retrospect, it turns out that Medicare spends about 25% of its money on people who are the sickest, i.e., in "the last year of life."  It's another illustration of the 20-80 rule: 20% of your customers account for 80% of your revenues.   Of course there are cases when dying people are unreasonably kept alive, just as there are many cases of undertreatment.   But we only know  "the last year of life" in retrospect."

"Social Security is going bankrupt and going broke; within a two decades, there won't be any money to pay promised benefits."
(People often assume that "going broke" means there will be no money in the Social Security Trust Fund to pay benefits.  It's true that, in coming decades, policy-makers will have address solvency, as they did in 1983, by making modest changes in benefits or revenues.  But even if they do absolutely nothing at all, by 2037 Social Security will still be able to pay 78% of benefits, which is hardly the same thing as "going broke."  With modest changes Social Security could remain solvent for decades beyond that.)


  
 ORIGINS OF URBAN LEGENDS ABOUT AGING

            We’ve all heard these urban legends before: for example, “Alligators are living in the sewers of big cities,” “Children have been poisoned by Halloween candy,” or “Isaac Newton discovered gravity when an apple fell on his head.”  (None are true.) But why do we continue to believe these popular urban legends about aging?  Is it just misinformation?  Maybe not.  The “lies we tell ourselves about aging” may serve a purpose—namely, propping up ideological views about the world that we find comfortable for a variety of reasons.  Here are a few of those reasons:

Sentimentality about the “Good Old Days”

-“Respect for elders was higher in the past.”
-“Until modern times, families lived together, but now we’re isolated into nuclear families.”
-“Older people are being abandoned because our society is becoming more mobile and families are living at greater and greater distance.”
-“Religion is good for your health.”

The Illusion of Progress

-“The 20th century witnessed dramatic gains in longevity in later life.”
-“People are retiring earlier than ever.”
-“Older Americans have declining rates of disability.”

Better Living through Chemistry (Science, Medicine, Rationality, etc.)

-“Geriatric medicine is becoming more widely accepted.”
-“Stem cell research will help us find a cure for Alzheimer’s.”
-“Anti-aging medicine is making rapid progress.”
-“Advance Directives would have prevented the case of Terri Schiavo.”

Horror of Nursing Homes

-“People are worse off when they move to a nursing home.”
-“Home care is cheaper than nursing homes.”
-“Only 4 percent of older people live in nursing homes.”
-“We need more regulation of nursing homes to prevent elder abuse.”

Older People as Victims

-“Older people are more likely to be victims of crime.”
-“Poverty among the old remains a major problem.”
-“We lose a million neurons every day.”

Right-thinking (bien-pensant) Aging Advocacy (“Gerontological Correctness”)

-“Aging is not a disease.”
-“Cosmetic surgery is a sign of ageism.”
-“Ageism is damage done by the advertising industry.”

The Idols of Politics (Liberal, Conservative or None of the Above)

-“America spends more on the military than on health care.”
-“The U.S. spends a lot on health care, but it also gets results.”
-“Prevention and health promotion is the way to save money in health care.”
-“The Gray Lobby holds a strangle-hold in aging policy in America.”
- "Social Security is bankrupt."

Retirement Dreams

-“More people today are retiring to move to the Sunbelt.”
-“Retirement is bad for your health.”
-“Americans have less free time than they did previously.”

See Jan Harold Brunvand, Encyclopedia of Urban Legends, Santa Barbara, Calif.: ABC-CLIO, 2001.


“Myths of the High Medical Cost of Old Age and Dying,” Cynthia X. Pan, Emily Chai, and Jeff Farber, International Journal of Health Services (38:2, 2008).

This report challenges commonly held beliefs about the financial and medical impact of older Americans during their last months of life. Written by physicians specializing in geriatrics, the report offers a wealth of data to refute seven misconceptions that currently influence U.S. health care policies: (1) that the growing number of older people has been the primary factor driving the rise in U.S. health care costs; (2) that as the population ages, health care costs for older Americans will necessarily overwhelm and bankrupt the nation; (3) that putting limits on health care for the very old at the end of life would save Medicare significant amounts of money; (4) that aggressive hospital care for the aged is futile and the money spent is wasted; (5) that it is common for older people to receive heroic, high-tech treatments at the end of life; (6) that Medicare covers everything that older adults need in terms of their health care; (7) that if older patients had living wills or other kinds of advance directives, it would resolve dilemmas of how aggressively to provide care.

MORE ON THE MOBILITY MYTH

       We can’t take care of the old folks because everyone’s moved away, right?  Or will "intimacy at a distance" make the heart grow fonder? 

      It turns out mobility is mostly a myth, argue two noted demographers specializing in migration.  According to recent data, Americans are actually less and less likely to move than in the past.  "The idea of an increasingly mobile society is widely held but untrue..." says Douglas Wolf, co-author (with Charles Longino) of a major study on the subject.  They argue that U.S. elder care is not being threatened by increasing mobility because of one simple fact: The United States is NOT an increasingly mobile society, if 'mobility' means the propensity to move house:

      "There are all kinds of social change that might inhibit family care—women's greater involvement in paid labor; more divorce, which tends to stand in the way of intergenerational relationships; the growing prevalence of childlessness," says Wolf. "There are lots of good reasons to be concerned about the future of elder care. But an increasingly mobile society? That isn't one of them."

    For more details (including data) see "Is 'Increasing Mobility' a Threat to U.S. Elder Care?" at:
http://www.prb.org/Template.cfm?Section=PRB&template=/ContentManagement/ContentDisplay.cfm&ContentID=12347

Hidden Dangers: Falls Injure More Seniors Than Violent Crime
(New America Media, Apr. 4, 2011)