Sunday, March 31, 2013

US Social Security Must be Protected

Today, March 31, 2013, the New York Times Editorial Board argued why President Obama must keep hands off US Social Security in any deficit reduction strategy.  Here are extracts of the Editorial Board's argument.
"In last year’s “fiscal cliff” debate, President Obama offered to reduce the annual cost-of-living adjustment, or COLA, for Social Security benefits, a spending cut favored by Republicans and scorned by Democrats. Republicans rejected the offer because Mr. Obama wanted tax increases in exchange, while Democrats said it would be too harmful. More recently, Senate Democrats did not include Social Security reforms in their budget and specifically rejected a COLA cut. The House Republican budget also steered clear of explicit cuts to Social Security, a move partly aimed at isolating Mr. Obama.
The question now is whether Mr. Obama will again propose to cut the COLA when he unveils his budget next week. We think he should not do so. The president might want to seem like he is willing to compromise by renewing his call for a COLA cut. But Republicans already spurned his offer and are unlikely to take him up on it now. They are more likely to paint him as a foe of Social Security, which would be reinforced by Democrats’ opposition to the cut.
Even if Mr. Obama avoided those pitfalls, a COLA cut is a bad idea, as we will explain in this editorial. It also is a distraction from the real problems of Social Security.
WHAT IS THE PROBLEM WITH SOCIAL SECURITY? The answer is a long-term shortfall. Social Security plans for solvency over 75 years, but because of demographic pressures and the weak economy, it is currently solvent only until 2033. After that, without reforms, it would pay about 75 percent of promised benefits.
Meanwhile, the nation is having a retirement crisis. Even before the recession, people had not saved enough to make up for the loss of traditional pensions. The downturn and slow recovery have made things worse. Less than half of households ages 55 to 64 have retirement savings, and of those, half have less than $120,000. Many near-retirees also have lost home equity or a job.
All that will leave most retirees heavily reliant on Social Security, which currently pays a modest benefit, on average, of $1,265 a month. Already, the majority of retirees — with annual incomes up to $32,600 — get two-thirds to all of their income from Social Security.
Even at higher incomes, up to $57,960, Social Security is the single biggest source, accounting for almost half. Only the top fifth of seniors, with incomes above $57,960, do not rely on Social Security as their largest source of income; most of them are still working.
Going forward, there is no escaping the reality that Social Security will be more vital than ever. To save it, we need consensus on direction and principles, among Democrats and across the aisle, along these lines:
SHOULD IT BE USED FOR DEFICIT REDUCTION? This is part of a larger question about whether any deficit reduction is appropriate when the economy is weak and unemployment high. The short answer to both questions is no. But as long as the deficit occupies center stage, the best approach would be for politicians to debate, and even agree, on spending cuts and tax increases to take effect as the economy strengthens.
Social Security reforms should be decided separately because the program is not driving the deficit. That distinction goes to chronic revenue shortfalls and rising health costs that propel spending on Medicare and Medicaid. Social Security did not cause today’s deficits, because the payroll taxes that support it have been more than adequate; and it will not contribute to future debt, because it is barred from spending more than it takes in.
The reason Social Security is wrapped up in the political budget debate is that government deficit projections assume Social Security will always pay promised benefits in full, even though the system is expected to run short in 20 years. That shortfall is reflected in deficit projections, so reducing it would improve the budget outlook.
The answer is to address Social Security’s problems, not to conflate reforms with the broader deficit reduction efforts.
HOW SHOULD SOCIAL SECURITY BE REFORMED? The drive to cut the COLA is based on the premise that the inflation gauge used to compute the adjustment overstates the rising cost of living. That is a flawed premise. A good case can be made that the gauge is an inaccurate way to track inflation for working-age people, but there is no empirical evidence that it overstates inflation among retirees, who tend to spend more on health care and other necessities for which there are few, if any, cheaper substitutes.
To ensure that the system is paying proper COLAs, Congress should instruct the Bureau of Labor Statistics to develop a statistically rigorous index of inflation among retirees. Until that is done, cutting the COLA on grounds that it is too large would be unjustified and disingenuous.
In the meantime, the debate over reforming Social Security will come down to tax increases versus benefit cuts. With retirements at risk, reducing benefits is dangerous, though trimming benefits for upper-income recipients, who live longer and draw larger benefits, could close about 10 percent of the system’s long-term funding gap.
Another overdue reform, which would close about a third of the gap, is to raise the level of wages subject to Social Security payroll tax to about $200,000 from the current $113,700. That would bring the taxable wage base in line with rising incomes among top earners.
A sensible change is to raise the payroll tax rate, currently 6.2 percent for both workers and employers. The rate has not been raised since 1990. A one percentage point increase could be phased in over 20 years and still raise enough revenue to close about half of the funding gap."

Global Action on Aging would also urge the US Government to pay interest on the funds that it has borrowed over the years from the Social Security system.  Surely that's fair!  
As the NYTimes concludes: "It is imperative that the frenzy that passes these days for deficit debate not engulf Social Security. There are rational and acceptable fixes to the program that could preserve it for generations to come, if political will can be found to enact them."      

Saturday, March 30, 2013

Geneva Association's Pension Proposals

Participants at Geneva Association Conference Strongly Endorse the Four Pillars Concept 

by Krzysztof Ostaszewski+

Global Action on Aging urges you to consider some responses from p
articipants at the December 2012 Geneva Association conference on the Four Pillar System.  Recipients received a short questionnaire asking their views on some key issues concerning the current and future situation of global retirement systems. Here are some questions and answers that will interest you.

A.  Are there any challenges to global retirement systems that are still going unnoticed?
B. Where will the solutions to the global retirement crisis come from?

C.  What are necessary changes in the workplace to make employment of silver (older)  workers effective, productive and beneficial to both employers and employees?
D. If you were to give advice to political decision-makers, insurance firms, pension plans and individuals (current and future retirees) in order to address the global retirement systems' challenges, what would you advise each to these groups?
In response to Question A, the participants chose “global ageing and increasing longevity” as the top challenge but a close second was "public finance and financial repression."
Other concerns listed were "low interest rates and low economic growth," "increasingly intrusive and productive regulation," "individual myopia," and "decreased willingness to engage in solidarity systems."
In response to Question B, the top choice was “breakup of the European Union or other significant political dislocation,” with “liability issues” as a close second; “insufficient disclosure of information to citizens” was also mentioned.

The clear winner among the answers to Question C was: “continued employment of the elderly and a flexible labour market,” i.e. the fourth pillar, as proposed by The Geneva Association and its Life and Pensions programme.  . . . . . "

We hope that political decision-makers will hear this message. Participants also, though far less strongly, endorsed financial innovation from insurance firms and private pensions, as well as programmes created by governments, as possible solutions to the retirement challenge.
In response to Question D, again, the winner was very clear: “tax and regulatory incentives to employers for the employment of silver workers.” The second most common answer was: “removal of regulatory and tax barriers to employment of silver workers,” another endorsement of the role of the fourth pillar. 

Here are some examples of advice given in response to Question D:
Carefully balance concerns about financial sustainability and adequacy of benefits;
More transparency, financial education, and information about the value of benefits and cost of retirement;
Proper ethical standards for financial advisers; A new social contract;
Honesty in communicating the nature of the problem to citizens; address the long-term care problem;
Careful monitoring of longevity improvement by insurance firms;
Political decision-makers should show more flexibility, and pay attention to financial sustainability; 
Pay attention to health issues, as not all workers can work more and more years; Raise retirement age, but also protect low-income workers;
Governments should help grow the second, third and fourth pillars;
Pension plans should work on effective risk-sharing.

If you are interested in more information, contact the Research Director, Life and Pensions, The Geneva Association.

Susanne Paul, Global Action on Aging.




Thursday, March 28, 2013

Most US Women lack a plan for their Retirement

Dear GAA Friend,

Have you wondered how you will pay for your retirement?  Do you have a plan?  If so, great!  You are in the minority.

According to a Huff Post 50 item, retiring women (26 percent) are worried that they won't be able to meet the financial needs of their family.  More than one in four women (28 percent) expect to take time or have already taken time out of the workforce to act as caregiver for a child or aging parent. Of these caregivers, 73 percent believe that this time out will impact their ability to save for retirement. Further, many reported that their retirement may involve financial caregiving; one in three women (31 percent) expects that when they are retired, they will need to provide financial support for a family member other than their spouse, according to the study's results.

Here are some of the other findings:
-- Only 14 percent of baby boomer women have a written retirement strategy. Some 45 percent do not have a plan at all while 41 percent have a plan that's not written down.
-- About 36 percent of baby boomer women expect to rely on Social Security as their primary form of income in retirement. Another 36 percent expect to rely on 401K plans while the rest expect to draw on a mixed bag of savings and assets.
-- Of the women who expect to rely on Social Security, only 34 percent say they know "a great deal" or "quite a bit" about their Social Security benefits.
-- About 61 percent of baby boomer women expect to work after 65 or simply do not plan to retire.
-- Only one in five baby boomer women who expect to keep working have a backup plan if retirement comes sooner than expected.

Few women have a backup plan if things don't work.

What can you do now?

Learn more about the details of your Social Security benefits, adopt and pay into a savings goal immediately, understand what a savings shortfall may look like and figure out what you'll do "if" such a shortfall occurs. As the author says, "There's no doubt that every woman needs her own retirement strategy."

Susanne Paul for Global Action on Aging

Wednesday, March 27, 2013

How is your Mental Health Today?

Dear Friend of Global Action on Aging,
How is your mental health today?  You and I often recognize most of the health challenges facing older adults.  But we continue to overlook – under-report and under-treat the mental health issues that we older people face.  Why? 
Some experts say that we confuse what is “normal” aging behavior and what is “psychiatric” conditions.  Of course, some people face mental health problems throughout their lives and others develop conditions in their later years that can be treated fairly easily. 
What does the data show?  Today, about 25% of older adults has a significant mental disorder.  It could be depression or anxiety.  Another 7% has a form of dementia, such as Alzheimer’s.  Many other mental conditions go un-reported. 

Nationally in the US over the next 25 years, the number of older adults with major psychiatric illnesses is expected to more than double from 7 to 15 million individuals as the Baby Boom generation ages. In Hawaii, by the year 2020, every fourth person will be 60 years or older.  Without good treatment, these conditions can lead to increased disability, additional caregiver stress, poor health, increased mortality and even greater risk of suicide.
Apparently, older persons are less likely than younger persons to recognize their own mental health problems.  Only about 3% see a mental health professional for help, a rate far lower than persons of younger ages.  Nearly one elder in seven suffers from depression. . . .but yet 70 to 90 % don’t seek or get any treatment.

If you are feeling “blue,” or persistently discouraged or sad, seek help.  Get to a doctor or a sympathetic person that you trust to ask for help.  Get the help you need to recover your positive take on life.  Life is short; enjoy the day!

Susanne Paul for Global Action on Aging

Monday, March 25, 2013

Japan Confronts Fire Safety Issues for Elders with Dementia

Twenty 25% of small facilities for dementia patients in Japan unequipped for fires

More than 500 small group homes for dementia patients (including elders) or about a quarter of such facilities across Japan, are not equipped with sprinklers, a survey conducted by The Yomiuri Shimbun has found.   Because  small homes with less than 275 square meters of total floor space are not legally required to install sprinklers, the government has urged those facilities to install them by providing subsidies according to size.

A nationwide survey was conducted in February and March following a fatal fire at a small group home for dementia patients in Nagasaki. Five patients died in the incident.  According to a survey, some 524 facilities, including the Nagasaki home, were not equipped with sprinklers. The survey covered 2,047 facilities in 44 prefectures. The three remaining prefectures--Akita, Yamanashi and Tottori--said they did not have the total numbers of small group home facilities.

It is estimated that about a quarter of small group homes are unequipped with sprinklers.
Most group homes with 275 square meters or more of floor space are equipped with sprinklers, the Yomiuri survey found.   In 2009, the ministry made it mandatory for such facilities to install sprinklers. The measure was taken after seven people were killed in a fire at a group home with about 280 square meters of floor space in Omura, Nagasaki Prefecture, in 2006. Smaller facilities became eligible for subsidies from 2010.An official said the ministry is also investigating the actual conditions for sprinkler installment. "Based on results [of the investigation], we hope to consider improvement measures, including how financial assistance should be provided," the official said.

Prof. Yasumichi Kurata of Nishikyushu University, an expert in social welfare affairs, said: "As various types of buildings including private homes are used as small group homes, it isn't always possible to install sprinklers at low costs. The subsidy system must be improved, for example, by having it cover a certain portion of actual costs spent [for installation], rather than providing subsidies according to the amount of floor space."

What is the situation in your country?  Are older and/or handicapped persons protected against fire in their living facilities? 

Susanne Paul for Global Action on Aging

Saturday, March 23, 2013

Can you afford to Retire in the USA?

Dear GAA Friend,
Although many US citizens are living longer and fewer are in physically demanding jobs, those who plan to work longer may be unrealistic. A recent survey found that 47 percent of retirees left the workforce unexpectedly, largely because of disabilities, other health issues or problems at work.
At present, the largest group of workers leaves the workforce at age 62. That is when they initially qualify for reduced Social Security retirement benefits, which represents a smaller monthly amount for those who take it before hitting their full retirement age. Just 14 percent of the retirees leave the workforce after age 65.  Only one in four of them works for pay in retirement.

The risk is that many workers as they get older cannot work for reasons beyond their control, including disability, ill health, and loss of a job and inability to get another.
US workers have to plan to work as long as possible. One-third of workers say they or their spouse have not saved anything for retirement. And only 57 percent says they are actively saving for retirement.

The result?  Many are unprepared to stop working. Nearly three in five workers have assets, beyond their homes, of $25,000 or less. A third of those withdrew savings to pay for expenses in the last year, a survey found.
A big problem, researchers have said, is that too few workers are covered by retirement plans on the job. Those that are covered most frequently have a 401(k) or another defined contribution plan. But as many as one in four of people with those plans dip into them for non-retirement purposes.

Although US citizens are aware that retirement requires substantial savings, they are often unable to put away enough as they wrestle with expenses and burdensome debt.

While it appears that workers are not being smart about their retirement needs, what is the responsibility of their employers and the US government that makes the rules about Social Security? Why are their any exceptions to paying into Social Security for US workers?  What about the "minimum wage"?   Isn't it too little to support oneself?  How can people in the US have a "good old age" if their government and bosses have held their wages down? 

What do you think?   What was/is your experience? Please send GAA a comment on this important topic.

Thanks and have a good week, Susanne Paul for Global Action on Aging



Thursday, March 21, 2013

How do you want to die? Do you know?

Dear GAA Friend,

Finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars, UCLA researchers said Tuesday.
“You can improve care while reducing costs by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,” Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, said in a statement.

But have your loved ones been consulted about their wishes?  Have you considered what you would desire in this circumstance?

Many families express guilt and regret that they had never asked their loved ones about their preferences, about pain issues, about blessings, about pain relief, and more in the closing hours of their parents' or grandparents' lives.

In some countries, a written statement or advance directive that stipulates wishes can be helpful. . . .but not if its existence is unknown to family members.

What are your experiences?  Please share them with Global Action on Aging's reading community.

With thanks,

Susanne Paul for Global Action on Aging

Monday, March 18, 2013

Debate over Euthanasia in Tasmania

AUSTRALIA NEWS: "(Tasmania state proposed) Euthanasia laws spark debate," by Matt Smith (_Mercury_ [Hobart], Mar. 13, 2013).

A proposed new law in Tasmania would give this Australian State the opportunity to give advanced terminally ill patients an opportunity to take their own lives. Prime Minister Lara Giddings says that public opinion is "in favor of some form of voluntary assisted dying." Apparently legislative safeguards would be put in place to assure no heightened risk for people who may be vulnerable because of their age, disabilty or mental illness.

Do you have euthanasia opportunities in your country?  If so, will you please describe them?  Do you support this legislation?  Or not?  Please share your perspective with Global Action on Aging.

Susanne Paul
Global Action on Aging

Thursday, March 14, 2013

US Retirement Age getting Older and Older

Steven Greenhouse, a New York Times reporter, published a very provocative article on March12, 2013, detailing how US citizens are delaying retirement until older and older ages.

Why?  Greenhouse says that some "older persons" still feel young and want to work or devote themselves to a new project or compelling interest. Others stay on the job, worried that they may have serious medical bills in the future, and seek additonal resources in the event that Social Security and Medicare prove insufficient.

Another group thinks that their savings are inadequate or anticipate having to support their parents in their old age, thus reducing resources for adult children.  Costs of higher education for children has increased  drastically over the past decades and pulled down their savings. Some potential retirees have helped their own parents to live in a nursing home and thereby reduced their personal savings for retirement.  Still others have footed the bill to send children to college, depleting their "retirement savings."     
What is happening now?  Many more older US citizens are living into their late 80s and 90s and outliving their retirement savings.  What does this mean?     
Greenhouse cites a Boston College study that found that "53 percent of Americans were 'at risk' of being unable to maintain their pre-retirement standard of living once they retire, up from 30 percent in 1989. A study last May by the Employee Benefit Research Institute found that 44 percent may not have enough money to meet their basic needs in retirement."
Today, one-third of retirees in the United States rely solely on Social Security, with benefits averaging just over $15,000 a year for an individual and $30,000 for a couple.  Can you live on this income? It can't be easy.
A generation ago, most workers with employer-based retirement plans were enrolled in traditional pension plans promising a monthly stipend for life after retirement.  But that's changed drastically.  The BLS (Bureau of Labor Statistics) data shows that only a quarter of all workers now enjoy a "traditional pension plan."  Only 26 percent of all workers are in such pension plans, including 17 percent of private-sector workers, according to the Bureau of Labor Statistics. Most people whose employers do offer retirement plans are enrolled in 401(k)’s instead, and 58 percent of workers are not participating in an employer-based retirement plan, according to the Center for Retirement Research at Boston College.
What's the future of those who will "come of old age" in the years and decades ahead?  Will we/they live in poverty and misery with fore-shortened lives?  Will the US economic system support or sustain its elder citizens?  Or will the 1% who control so much US wealth today ignore their fellow citizens?  What do you think?  Please share your views in our comments section.
Susanne Paul for Global Action on Aging 

Monday, March 11, 2013

Are you a Prime Candidate for Financial Exploitation?

Dear GAA Friend,  Today we are posting Eileen Beal's revealing New American Media News feature published on Mar 10, 2013.  The writer makes clear that older persons between 70 and 90 years of age are "prime targets for financial exploitation and abuse."  Read this important article printed below.

CLEVELAND, Ohio--Despite the hit their savings and investments took during the Great Recession, Americans between 70 and 90 are still the wealthiest age group in the United States. Not surprisingly, they are also prime targets for financial exploitation and abuse.

“It’s all their assets – a mortgage-free home, steady income from Social Security or a pension, investments – that make them a target,” said attorney Page Ulrey, a senior deputy prosecuting attorney for the King County Prosecutor’s Office in Washington.

Prime Targets

According to experts, prime targets are:

Women, most often between ages 80 and 89;
• Men who have recently lost a spouse or partner;
• Living alone and may require some help with either health care or home maintenance;
• Lonely and vulnerable;
• Especially at risk during the holidays.

In addition, financial exploiters target those with diminished mental capacity and decision-making ability, stressed Lori Stevic-Rust, director of Senior Services at Lake Health System, in northeast Ohio.

Stevic-Rust, author of four books and a nationally recognized psychologist, is often called in to evaluate the mental capacity and competency of at-risk seniors.

“They target them,” Stevic-Rust added, “because their ability to pay attention, process information, analyze situations or figure out what the long-term consequences will be for a given action is significantly impaired.”

She went on, “Even when they know the day and year and can perform simple activities in the home – prepare a meal for instance – they aren’t able to make important decisions or judgments or carry out complicated activities that involve many steps.”

Spotting the Signs

The majority of exploiters and abusers are strangers: telemarketing scammers going after credit card or Social Security numbers, paid caregivers or “sweethearts” -- con artists, who prey on lonely elders.

Signs of Financial Abuse

According to a recent report from the MetLife Mature Market Institute, The Essentials: Preventing Elder Abuse, the following are flags that mean it could occur, or is occurring:

• Lack of care when the person has sufficient funds available
• Changes in banking or spending habits
• Excessive use of the ATM or credit cards, especially for non-care-related items
• Abrupt changes in a will, power of attorney, or financial documents
• Unpaid bills and utilities
• Lack of knowledge of financial status
• New “best friends”
• Unexplained disappearance of valuables or money – or both
• Unexplained transfer of money or assets to a family member or someone outside of the family – such as a new “best friend”
• Discovery of the person’s signature forged on checks, financial transaction documents, or documents or titles related to his or her possessions
• Unusual degree of fear of or submissiveness to a caregiver
• Bruises, trips to the ER, broken bones – where there is financial abuse there is often physical abuse
• Isolation – by aide or new “best friends” – from family, friends, community, or other stable relationships
• Signs of intimidation and/or anxiety when questioned about new “best friend”
• Missed appointments or uncharacteristic nonpayment of bills
• Anxiety about personal finances

Among other blazing red flags are: changes in long-standing living arrangements (especially those involving the new “friend”); changes in long-standing inheritance plans; and creation of a durable power of attorney – a powerful legal document giving a suspected abuser the means to control both the elder’s person and assets.

--Eileen Beal
After that, it’s friends, neighbors or family members – most often a son or son-in-law. Then it’s unscrupulous professionals – accountants, financial planners, bankers, lawyers, physicians, contractors, etc. Many have histories of drug or alcohol abuse and/or have gambling or other financial problems.  Studies have also shown that ethnic elders are especially vulnerable to financial abuse.

Those fighting financial exploitation and abuse say it’s all about MOM: Motive (money, jewelry, property--sometimes even sibling rivalry); Opportunity (unrestricted – and unobserved – access to a victim); and Means (the ability to use their trusting or family relationship to charm, cajole, coerce or outright steal from their victim).

Financial abuse of older adults has become so rampant that when the U.S. government created the Consumer Financial Protection Bureau (CFPB), it designated a special Office of Older Americans to deal with the issue.

The CFPB office’s goals: Track down and expose scams; ensure laws currently on the books are enforced; and educate seniors, and those who care about them, to identify, avoid and report financial scams. (See the sidebar to this article, “Spotting the Signs of Financial Abuse.”)

Prevention: Always the Best Remedy

Financial abuse is a crime, so it’s surprising that while more cases are being reported few abusers stand trial and go to jail.

According to Page Ulrey, of Seattle’s King County Prosecutor’s Office, “Those who are being abused are often dependent on their abuser for their care and don’t want to [take them to court] because of the repercussions it would cause. Or they fear they will be sent to a nursing home. Or they fear – or love – the offender.”

Frequently, too, she said, “Or they are ashamed to admit that they have been taken advantage of.”

Ulrey stressed that it is often difficult to prosecute exploiters. That’s not only because of the reasons mentioned above, but also because the victim has died or is so cognitively impaired he or she cannot testify. To keep a vulnerable relative or loved one out of harms way concerned friends or family members must be proactive. The earlier deterrents and roadblocks are set in place, the better, she said.

One time-tested strategy for keeping financial abusers at bay, Ulrey said, is for an elder’s friends and family members to stay connected. “Financial abuse and exploitation occurs in the shadows, where people are isolated from those who could spot the signs that something isn’t right,” she said.

Psychologist Lori Stevic-Rust emphasized that it’s important to become hyper-vigilant in observing a vulnerable senior’s physical health and cognitive state. “Declines in both can make them vulnerable to manipulation and exploitation,” she explained.

Those assisting the at-risk person should help him or her get information about exploitative situations, schemes or scams they may encounter and to become better educated about their finances.

It would also be valuable to help the senior consult with legal or financial professionals who can draw up such documents as trusts, limited powers of attorney, or conservatorships. “These can – and for the most part do, deter financial exploiters,” Ulrey said.

If you suspect someone is being financially abused, it is important to report your concerns to local authorities. The National Adult Protective Services Association’s website ( lists adult protective services departments in every state. “This site doesn’t just have the telephone numbers for reporting financial abuse, they take anonymous tips too,” said the Association’s executive director, Kathleen Quinn.

If all else fails, you may be able to file for a protection order. “This will limit the contact the abuser has with their victim--and perhaps protect assets, too,” Ulrey said.

Sources and Resources

Consumer Financial Protection Bureau

Elder Financial Protection Network (Note: While this is a California-based site, the information applies to everyone.)

Family Caregiver Alliance

National Adult Protective Services Association

National Committee for the Prevention of Elder Abuse

“Preventing Elder Financial Abuse for Older Adults”

“The Essentials: Preventing Elder Abuse”

Eileen Beal, a Cleveland-based writer on issues in aging, wrote this article for Today’s Caregiver Magazine with the support of a MetLife Foundation Journalists in Aging Fellows program, a program of New America Media and the Gerontological Society of America.

Please send your comments,  Did you learn helpful information to protect yourself or loved ones in this article? Global Action on Aging welcomes your comments.

Thanks, Susanne Paul for Global Action on Aging

Monday, March 4, 2013

How to Prevent Amputation among Diabetic Elders

Global Action on Aging

Chiquita Smith is the most beloved volunteer in our GAA family. Blind due to diabetes, she is a strong advocate for impoverished older persons living in public nursing homes in the New York City area.  She led GAA interns on investigative visits to such homes and asked interns to describe what they saw.  For example, "Are older persons parked in hallways one behind another in wheehchairs?  Is anyone speaking to them?  Are they asleep?"   She wanted interns to describe the clothing that the older residents were wearing-- "Did it match, top and bottom?  Was their bed clean?  Did they have any visitors?"  And she instructed the young people to inquire of residents if they had had the opportunity to vote in the last public election.  GAA interns benefted from her advocacy and helped prepare her "talking points" with the institutions' administrators. If Chiquita did not get satisfactory answers and action from administrators, she wrote to City and State Health officials informing them of the situation.  What a role model for the young. . . and a very strong advocate for poor old people.

Today Chiquita is in Beth Israel Hosptial in New York having had two legs amputated due to diabetes. Will you hold her in your thoughts during these difficult days for her?   We are posting an article by Laurie Umeh (National Health Service Corps, July 2006) in her honor.

"Preventing Amputation in Older Adults with Diabetes, Proper Foot Care Is No. 1 Strategy
 Lower extremity limb loss is a dreaded complication of diabetes at any age. For the older adult, limb amputation often has particularly far-reaching consequences: loss of mobility and independence. Amputation may be the one event that ultimately and prematurely forces someone into nursing home placement. Diabetes mellitus (DM) increases the risk of lower extremity amputation 15-fold.1 Older adults in general are particularly vulnerable; approximately 96% of amputations occur in people older than 45.2 Survival statistics about amputation are bleak. The 5-year survival rate after amputation is only 27%.3For the older adult who has had an amputation, rehabilitation may be limited by cardiovascular disease or other medical conditions. Many older amputees find a prosthetic limb heavy and uncomfortable and lack the stamina to ambulate with it.4 In one study, only 53% of patients older than 65 could be fitted with a prosthetic limb.5The direct and indirect costs of amputations represent a major burden for the health care system. Yet 85% of lower extremity amputations can be prevented through programs for preventing and treating foot ulcers, preventing ulcer recurrence and educating patients about proper foot care.7The cascade of events that ultimately culminates in limb amputation often begins with an innocuous-appearing ulcer on the foot. The mechanism of injury may seem trivial — a wrinkled sock, an improperly trimmed toenail or a foot that swelled in its shoe and led to skin breakdown. A tiny blister or shallow ulceration becomes a draining, infected wound. After months of immobility and heroic efforts to save the ailing limb, osteomyelitis sets in, and amputation often results.As providers of primary health care in clinic and nursing home settings, nurse practitioners are perfectly positioned to champion primary and secondary prevention of diabetic ulcers and lower extremity amputation. The ability to perform foot care has limits in the older person with DM. Understanding the disease process, acquiring a repertoire of effective wound treatments, and knowing when to refer may prevent the progression of injury to ulceration and ulceration to amputation.

Please share this information with your friends, particularly those who suffer from Diabetes. 

Susanne Paul for Global Action on Aging