Healthy and happy old age

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Dr. Jodi Friedman.
Dr. Jodi Friedman.

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People no longer experience life as a succession of roles which shift like clockwork purely on the basis on their age. What it means to be 40, 50 and 60 has changed. People are living longer than ever before, and as the first wave of baby boomers enters retirement the process of aging is evolving, beset by unique challenges as well as opportunities.

Many new types of facilities are sprouting up that not only treat seniors medically, but also help them maintain quality of life in extreme old age. The Center for Healthy Aging, a facility on the grounds of Northern Dutchess Hospital, in Rhinebeck, is an example. It offers geriatric assessments and works collaboratively with patients, caregivers and primary-care providers to deliver inpatient, outpatient, and transitional care to people age 65 and older.

The center opened in 2011 with a full-time medical director, Dr. Jodi Friedman. A year later she was joined by part-time social worker Allison Gould. The center caters to seniors in several counties, providing assistance in developing a customized, comprehensive wellness plan.

Friedman treats “mostly the oldest and most complicated medically patients,” usually referrals from other doctors. Gould sees younger seniors as well — people in their mid-seventies — who are dealing with emotional issues related to aging, such as bereavement or fears about dementia.

To further reach out to the growing community of retirees, the center has begun partnering with [email protected], a not-for-profit networking organization that’s located in the same building and dedicated to helping its 56 members stay at home and maintain their independence.

The center, which accepts private insurance and Medicare, can refer its clients to community services such as [email protected] It can come up with a program of therapy, including alternative modalities such as massage and acupuncture. It offers use of a medically based fitness center and educational programs. In the fall and spring, it hosts a lecture series, in which past topics have included financial wellness, relaxation and meditation workshops, and aging gracefully.

Isn’t “healthy aging” a bit of an oxymoron? “There’s more chronic illnesses, and people are on a lot of medications,” said Friedman, who has a background in family practice. “We try to look at their medications in the context of different medical problems. Part of being a healthy older person is managing these multiple problems.”

How to improve

Making Ulster County the healthiest county in New York State has got to be County Executive Mike Hein’s most well-publicized goal in the area of public health. But Hein, who first set the goal in 2009, has never specifically said how long it will take to achieve that worthy goal.

Ulster County Health and Mental Health Commissioner Dr. Carol Smith supports Hein’s goal. It’s the correct goal, she argues. Being number one should be Ulster County’s aspiration.

The nationwide county health rankings first published by the University of Wisconsin’s Population Health Institute four years ago is widely accepted as the standard for comparing county performance. In 2010 Ulster County ranked 33rd of New York’s 62 counties. In 2011 it dropped to 35th. In 2012 it improved to 29th, and this year its rank slid back down to 31st — the statistical middle of the state pack.

Both at last month’s board of health meeting and at the May 21 meeting for health professionals at Ulster County Community College in Stone Ridge, Smith complained about how this year’s results were skewed by the inclusion of a new category, “drinking water safety,” in which Ulster County was ranked very poorly — probably wrongly, according to her. She also expressed concern about the survey sample size — 500 Ulster County residents had been surveyed.

The ranking system, its research supported financially by the Robert Wood Johnson Foundation, may have its methodological weaknesses, but in the field of American public health it is fast becoming the equivalent of what the Dow Jones Average is on Wall Street — that is, it’s widely followed, and it’s based on the best capsules of comparative data available.

The rankings of surrounding counties suggest the same up-and-down-within-a-narrow-range pattern as Ulster County’s. Neighboring Dutchess County was ranked 11 in health outcomes among the counties in 2010, 13 in 2011, 9 in 2012 and 9 again in 2013. Orange County ranked 21, 19, 20 and 22. Greene County was 59, 60, 52 and 55. Putnam County was ranked 1, 1, 1 and 4 among the counties, and Sullivan County a consistent 61 in all four years. Columbia County was ranked 45 in all years except 2011, when it temporarily moved up to 43.

As can be surmised from these numbers, results vary widely in the mid-Hudson region. What is more important than the rankings derived from the combination of various socio-demographic and medical variables is what they tell us about the pattern of public health care in our counties. What can be most easily improved? Where are structural changes most needed in our fragmented healthcare system? What are the relationships among the institutional players? What investments will yield the highest rate of return in terms of the improvement of overall public health?

The role of the hospitals in the rapidly changing community health systems is one of the big items the state health department is seeking to tackle this year. The county health departments are being required to prepare a four-year community health plan for submission to the state in November.

This is a tough time for people in health care who are comfortable with changing only one thing at a time. Americans are proud of having what we consider to be the best healthcare system in the world. Unfortunately it is by far the most inefficient, fragmented, disorganized and expensive healthcare system in the world as well, leading to our trailing many other nations in terms of outcomes and other results.

Can Ulster measure up?

[wide]Ulster[/wide]With state and federal support in question and Ulster County facing an obesity epidemic, the county health department has its challenges. At a meeting of nearly 100 health professionals entitled “A New Era of Prevention: Assess, Plan and Connect for a Healthier Ulster County” at SUNY Ulster on May 21, Dr. Carol Smith, Ulster’s commissioner of both health and mental health, said her department remained committed to the goal of making Ulster County the healthiest county in the state, as promised by County Executive Michael Hein in 2009.

Education in the schools and workplaces is key to creating “a culture of health and wellness,” she said. The goal is long-term and aspirational: “We may not change everyone in the current generation, but it’s important and achievable for the future.”

In his introductory remarks, Hein applauded the county’s emerging network of rail trails as not only an economic development tool but also as “a huge public-health initiative.” It provides the opportunity to get out and recreate, which will have an impact on obesity and gives inner-city youth access to nature, he said. Gov. Andrew Cuomo has committed $2 million to the trail network, which is already “65 percent built out.” It will eventually connect the Ashokan Reservoir to the Walkway Over the Hudson, the Hurley rail-trail and the Kingston waterfront.

Hein alluded to the planned closing of one of HealthAlliance’s hospitals. “The building is immaterial” to ensuring the quality of health care in the county, he said. Ulster County benefits from access to high-quality care in Albany and New York City.

Smith was appointed commissioner in April 2012. She is a medical internist who holds a master’s degree in public health and has resided in Ulster County for 20 years.

The state health department is requiring county health departments to collaborate with hospitals in preparing community health implementation plans to address county needs through 2017. The plans must be submitted to the state in November.

The state agenda focuses on five areas: preventing chronic diseases: promoting a safe and healthy environment; promoting better health for women, children, and infants; preventing HIV and other infectious diseases; and promoting mental health, including prevention of substance abuse.

Ulster County is focusing on two areas, preventing chronic diseases and promoting mental health. Heart disease, cancer and lung disease are the leading causes of death in Ulster County. (Heart disease is number one for women, followed by cancer and lung disease, while cancer is number one for men, followed by heart disease and lung disease.)

Better health outcomes

[wide]VBMC[/wide]Vassar Brothers Medical Center (VBMC) is expanding and says it is drawing more patients from other area hospitals, a trend it attributes to its high ratings and comprehensive services.

That was among the messages communicated by President Janet Ready at the hospital’s eighth annual “State of the Hospital” address on April 5 at the Grandview in Poughkeepsie. Ready provided a brief overview of the hospital’s achievements in the past year, which she said reflected its three primary objectives: enhancing patient care, enhancing access to care, and partnering with physicians. Three physicians also spoke at the well-attended early-morning event.

Ready said the hospital has enhanced patient care by expanding staff. In the past year, the hospital has hired 60 new physicians, for a total of 650 doctors, and 37 allied heath practitioners. The new hires include a gynecological oncologist who is an expert in robotic surgery and specialists in vascular medicine and breast surgical reconstruction.

Ready noted that VBMC was ranked in the top five percent of all hospitals in the nation for overall cardiac services, cardiac surgery, coronary interventional procedures, and maternity services. It has among the best outcomes in the state for coronary bypass surgery, according to an August 2012 state health department report. “Our cardiac surgery program ranks number one for coronary bypass grafts and valves in the state,” she said.

Ready noted the numerous partnerships with the medical community in the areas of primary care, pulmonology, thoracic surgery and neurosurgery. She said that 1,000 more patients were referred in 2012 to VBMC from other regional hospitals, nearly 70 percent higher than the previous year.

VBMC’s new Center for Ambulatory Services, opened in mid-July, served 760 patients in its first six months. The center has enabled the hospital to perform more surgeries.

Hire a coach?

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Many people who know they should eat better, exercise more, and enjoy themselves more just can’t seem to make it happen. It’s not easy to break lifelong, unhealthy habits fostered by a culture that in many ways opposes wellness. That difficulty has created a niche for a new type of support, the health and wellness coach.For the past year, at least two certified health coaches, both based in New Paltz, have been plying their trade in the region.

Sherrill Silver, a registered nurse who had been a school nurse in the Marlborough and Hyde Park school districts, holds a master’s degree in health education, and has taught health in the women’s studies department at SUNY New Paltz. She was certified by Wellcoaches, a program based in Boston that says it is “building the new profession of health and wellness coach … [to] facilitate the psychological processes of change that generate sustainable healthy lifestyles and optimal health and well-being.”

Only participants in the program who have medical training are certified as health coaches. Others, such as a colleague who previously was a yoga instructor, are certified as wellness coaches, according to Silver.

“I’m helping people discover it’s possible to change,” Silver said. “I call it positive doing rather than thinking.” Being non-judgmental is another key to success, she added. “If the person doesn’t achieve his or her goals, it’s not a failure but a learning experience.”

Julie Robbins is a holistic health coach who works with children and adults with ADD and ADHD (Attention Deficit Hyperactivity Disorder) as well as with women entrepreneurs. She was certified by Integrative Nutrition, based in Manhattan, whose holistic approach, emphasizing not just the body but also the spirit, she found appealing. Robbins owns a travel agency, All About Travel, and earned degrees in accounting and economics.

Before plunking money down for a health coach, people should research the person’s credentials and make sure they’re certified by a legitimate organization. As it is, there is no standard certification and “pretty much anybody could hang up a shingle,” Silver said.

Definitely meet with a prospective health coach, advised Robbins. On September 1, a new website, www.hudsonvalleyhealthcoaches.com, goes online. Also check out www.wellcoaches.com; www.ideafit.com/organization/Wellcoaches; and www.integrativenutrition.com.

Silver has long been interested in food, having grown up in the restaurant business and become a certified herbalist. She said that she was drawn to the profession by her desire to promote well-being rather than merely focus on disease treatment and prevention. Although highly motivated to be healthy, she herself, a professional with a family, had struggled to maintain healthy eating habits. She learned how difficult this battle can be. It was discouraging for her to find that many companies have cut back on their wellness and prevention efforts.

Silver, who also works as community liaison for Four Winds, a psychiatric hospital in Westchester County, offers a three-month counseling program, with rates ranging from $50 to $150 an hour, depending on geographic area. So far she has treated a dozen clients, conducting the 45-minute weekly consultations by phone, for the most part, in her home office. Silver said a few of her clients were located in other parts of the country, including Chicago and Atlanta.

She said she starts with a comprehensive evaluation that looks not only at the person’s weight, fitness level and medical history, but also at their mental and emotional health, including level of satisfaction in relationships and life in general. In the succeeding weeks, “we learn a lot about each other,” Silver said. Trust is absolutely essential to the process. After evaluating each person’s strengths and challenges, she helps her clients create a vision of wellness and health for the future.