Saturday, July 9, 2011

Aging boomers strain cities built for the young (AP)

NEW YORK � America's cities are beginning to grapple with a fact of life: People are getting old, fast, and they're doing it in communities designed for the sprightly.

To envision how this silver tsunami will challenge a youth-oriented society, just consider that seniors soon will outnumber schoolchildren in hip, fast-paced New York City.

It will take some creative steps to make New York and other cities age-friendly enough to help the coming crush of older adults stay active and independent in their own homes.

"It's about changing the way we think about the way we're growing old in our community," said New York Deputy Mayor Linda Gibbs. "The phrase `end of life' does not apply anymore."

With initiatives such as using otherwise idle school buses to take seniors grocery shopping, the World Health Organization recognizes New York as a leader in this movement.

But it's not alone.

Atlanta is creating what it calls "lifelong communities." Philadelphia is testing whether living in a truly walkable community really makes older adults healthier. In Portland, Ore., there's a push to fit senior concerns such as accessible housing into the city's new planning and zoning policies.

Such work is getting a late start considering how long demographers have warned that the population is about to get a lot grayer.

"It's shocking how far behind we are, especially when you think about this fact � that if you make something age-friendly, that means it is going to be friendly for people of all ages, not just older adults," said Margaret Neal of Portland State University's Institute on Aging.

While this fledgling movement is being driven by nonprofit and government programs, New York aims to get private businesses to ante up, too.

Last year, East Harlem became the city's first "aging improvement district." Sixty stores, identified with window signs, agreed to put out folding chairs to let older customers rest as they do their errands. The stores also try to keep aisles free of tripping hazards and use larger type so signs are easier to read. A community pool set aside senior-only hours so older swimmers could get in their laps without faster kids and teens in the way.

On one long block, accountant Henry Calderon welcomes older passers-by to rest in his air-conditioned lobby even if they're not customers. They might be, one day.

"It's good for business but it's good for society," too, he said.

The size of the aging boom is staggering. Every day for the next few decades, thousands of baby boomers will turn 65. That's in addition to the oldest-old, the 85- to 90-somethings whose numbers have grown by nearly one-third in the past decade, with no signs of slowing.

By 2050, 1 in 5 Americans will be seniors. Worldwide, almost 2 billion people will be 60 or older, 400 million of them over 80.

That's almost always viewed as a health issue, preparing for the coming wave of Alzheimer's, or as a political liability, meaning how soon will Social Security go bust?

"We think this is something we should be celebrating," says Dr. John Beard, who oversees the World Health Organization's Global Network of Age-Friendly Cities. "They need to live in an environment that allows them to participate."

In East Harlem, a yellow school bus pulls up to a curb and 69-year-old Jenny Rodriguez climbs off. The bus had already dropped a load of kids at school. Now, before the afternoon trip home, it is shuttling older adults to a market where they flock to fresh fruits and vegetables.

Rodriguez usually goes shopping on foot, pulling along a small cart. It can be a hike. Supermarkets aren't too common in this lower-income part of the city, and there's less to choose at tiny, pricier corner bodegas.

"You can only buy so much. Some streets, the cracks are so bad, you're pushing the shopping cart and almost go flying," Rodriguez said, examining sweet potatoes that she pronounced fresher and cheaper than at her usual store. "This is so much easier."

More than 200 times, school buses have taken older adults from senior centers to supermarkets in different neighborhoods. It's just one of a variety of initiatives begun in 2009 by the New York Academy of Medicine and the city's government to address the needs of older residents. Already, they're showing results.

A city report found the number of crashes has dropped at busy intersections in senior-heavy communities where traffic signals now allow pedestrians a few more seconds to cross the street.

Benches have been placed in nearly 2,700 bus shelters to give waiting seniors a place to rest.

The city's aging taxi fleet is scheduled to be replaced by a boxier model designed to be easier for older riders and people with disabilities to open the doors and slide in and out.

On the Upper West Side, seniors snapped up a report card of grocery stores deemed age-friendly because they offer deliveries, have public bathrooms � a rarity in the city � and sell single portions of fresh meat, poultry or fish, important for people who live alone.

Artists volunteer to teach at senior centers in return for space to work on or display their own creations.

And a "Time Bank" is letting hundreds of people of different ages and with different skills essentially barter services. A retired English teacher may do some tutoring, for example, and use the credit she earns to get computer help from another volunteer.

Aging expert Andrew Scharlach of the University of California, Berkeley, sees a common thread in these changes and the work of other cities. Combat the social isolation that too easily sneaks up on older adults and it has a huge impact not just on how many years they will live, but how well they live them.

Cities and suburbs were designed for younger people, full of stairs and cars, he explained. As they become increasingly difficult to navigate, older people gradually retreat.

Revamping a lot of infrastructure may not happen in a tough economy. But some communities are building age-friendly changes into planned upgrades or maintenance, such as New York's street crossings, or into requirements for future development.

The WHO's Beard says some changes aren't that costly, noting that seniors around the world say more benches and access to bathrooms will help them get out and about.

Among other cities' work:

_The Atlanta Regional Commission's Lifelong Communities Initiative is pushing communities that help people age in place. Efforts are under way in six metro areas, including work to adapt zoning codes to allow more of a walkable mix of housing and retail. The Mableton community of suburban Cobb County is planning that kind of a town square, and has opened a farmers market � on a weekday morning when seniors preferred to shop � and intergenerational community garden. To the east, DeKalb County is building a library near a senior center, planned senior housing and a bus stop. One town pilot-tested a shuttle for seniors to supplement bare-bones public transit.

The Atlanta Housing Authority is working with the commission to retrofit high-rise apartments that house a lot of older residents, with the goal to improve access to the surrounding community. At one site under construction, changes include a ramp entrance, safer sidewalk to the bus stop and more time for pedestrians to cross the street.

The overall move isn't without controversy.

Sometimes younger residents misunderstand and say they don't want to live in a retirement community, said commission urban planner Laura Keyes.

She said boomers, who are classified as being born from 1946 to 1964, and millenials, the children of baby boomers who came of age in the new millennium, ultimately want the same things: access to shopping, green space, more freedom from the car. The idea is a mix of ages but where older residents don't need to move if their health fails.

Keyes became interested in age-friendly communities when visiting friends in nursing homes built in commercial districts � and saw that they had nowhere to take a walk.

_Philadelphia is the oldest of the nation's 10 largest cities, with 19 percent of its residents over age 60 � and lots of multi-story rowhouses where seniors are stuck on one floor. "They become prisoners in their homes," said Kate Clark of the nonprofit Philadelphia Corporation for Aging.

In redesigning the city's zoning code, proposals are being debated that would allow seniors to rent out their upper floors, and to require that a certain amount of new housing be what's called "visitable" � with such things as ramp entrances, wide hallways and at least a half-bathroom on the main floor, she said.

With funding from the National Institutes of Health, the aging group's Allen Glicksman is studying if seniors who live in a walkable neighborhood really are healthier as a result. He has found that social capital � think friendly neighbors, low crime and good sidewalks that encourage getting out � is as important to older residents as access to supermarkets, public transportation and good housing.

Also, there are calls for age-friendlier parks, with safer steps and places to walk apart from bikers.

To sustain momentum, Clark created GenPhilly, a network of 20- and 30-somethings interested in shaping the city they'll age in by raising senior issues in varying professions.

_Portland was part of WHO's initial study of what makes a city age-friendly, an initiative that helped bring about more handicapped-accessible cars for the city's light-rail system, Neal said.

Now, aging experts are among the advisers as the city develops a master plan for the next 25 years. One issue, Neal said, is how to develop more accessible housing when the city's anti-sprawl policy means a lot of narrow, multistory houses are being squeezed into empty city lots � near transportation but still not age-friendly with all the stairs.

Integrating senior-friendly changes into everyday city policies is less visible than, say, a new retirement home but it's ultimately the goal, says Scharlach, the aging expert.

New York also hopes for some economic return.

Consider La Marqueta in East Harlem. Fifty years ago, it was a bustling, five-block market, a weekly gathering spot for families. But economic downturn left the city-owned building mostly empty for years. Now, as part of a $1.5 million economic revitalization project, an industrial kitchen in the building will train low-income women to start their own food businesses. It joins the fish and butcher shop, a farmer's market, and a high-end food importer � and busing in the seniors once a month boosts the still thin customer traffic.

But it's more than a shopping day. A quick check from a health department nurse reassured 73-year-old Maria Ilarraza that her blood pressure was OK, and she sat to catch up with friends over coffee. In another corner, a crowd listened as a university nutritionist explained how to safely freeze and thaw meat.

Art teacher Piedad Gerena showed off some of the bold landscapes and modern images her students at a nearby senior center learned to paint, and, to her delight, sometimes sell for up to $200 apiece. "Many of these people have no families," Gerena said. "The art makes them feel happy."

___

Online:

World Health Organization's Global Network of Age-Friendly Cities: http://tinyurl.com/3kdkp6q

Portland State University's Institute on Aging: http://www.pdx.edu/ioa

New York City's Aging Improvement Districts: http://tinyurl.com/3h5fo7a

New York Academy of Medicine: http://www.nyam.org/urban-health/healthy-aging

Atlanta Regional Commission's Lifelong Communities Initiative: http://tinyurl.com/3gz9lfv

Philadelphia Corporation for Aging: http://www.pcacares.org

GenPhilly: http://www.genphilly.org



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Thursday, July 7, 2011

Calif. hospital system settles celeb records cases (AP)

LOS ANGELES � Years after hospital employees were accused of snooping into the medical records of celebrity patients, UCLA Health System agreed to pay an $865,000 settlement for potential violations of federal privacy laws.

The settlement that UCLA reached with federal regulators Wednesday did not name the stars involved and did not require the hospital system to admit liability.

The investigation by the U.S. Department of Health and Human Services revealed that workers repeatedly accessed patients' electronic health records between 2005 and 2008.

The hospitals have agreed to report to a federal monitor on the implementation of its corrective plan over the next three years.

In a statement Thursday, UCLA said it has taken steps over the past three years to retrain staff and strengthen its computer systems.

UCLA Hospital System CEO Dr. David T. Feinberg said the university's facilities will "remain vigilant and proactive to ensure that our patients' rights continue to be protected at all times."

In 2008, California Department of Public Health officials announced results of their own investigation into the privacy breaches and found that UCLA hospital workers inappropriately accessed records of 1,041 patients since 2003.

The hospital later disciplined 165 employees through firings, suspensions and warnings.

At least two former UCLA employees have faced criminal charges for medical privacy violations.

Former administrative specialist Lawanda Jackson, 50, pleaded guilty to selling information to the National Enquirer from the files of Britney Spears, Farrah Fawcett and other high-profile celebrities. She died from complications of breast cancer before she could be sentenced.

Former medical school researcher Huping Zhou was sentenced to four months in federal prison and fined $2,000 for reading the confidential medical files of co-workers and celebrities such as Drew Barrymore, Arnold Schwarzenegger and Tom Hanks.

Zhou was not accused of selling the information and claimed that, as a Chinese national, he didn't know it was a violation of U.S. law to peep into the files.

The headline-grabbing breaches led California legislators to pass a bill boosting the maximum fine for privacy breaches at health facilities from $25,000 to $250,000.

Then-Gov. Arnold Schwarzenegger signed the legislation into law after his wife Maria Shriver had her records breached at UCLA Medical Center. Shriver filed for divorce last week.

The UCLA Health System includes Ronald Reagan UCLA Medical Center, Santa Monica-UCLA Medical Center and Orthopedic Hospital, and the UCLA Medical Group, a network of primary and specialty care satellite offices.



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German parliament OKs genetic embryo tests (AP)

BERLIN � After an emotional debate, German lawmakers voted Thursday to allow a procedure that looks for genetic disorders in embryos before they are implanted in the womb.

Lawmakers voted 326-260 to permit the procedure known as pre-implantation genetic diagnosis under strict conditions after a debate that cut across party lines. Eight abstained.

The procedure is sometimes used after in-vitro fertilization, when parents whose families have a history of genetic disorders want to avoid having a child with a lethal or severely debilitating birth defect.

Elsewhere in Europe and in the U.S., the test is often used in infertile couples who have failed in previous attempts to have children while using IVF in hopes that the test will boost their chances of implanting the best embryo.

The procedure's legality had been a gray area in Germany. Parliament took up the issue after a federal court last year ruled that a doctor who had performed the procedure hadn't committed any offense.

Under the law approved Thursday, an ethics commission will have to decide on a case-by-case basis whether couples can use the procedure. An expert would have to certify that a couple's child faced a high risk of a serious genetic disorder or that a miscarriage or stillbirth was likely.

A large minority of lawmakers favored a total ban, with some saying that even limited permission for genetic selection set a bad precedent.

"This is about variety: Do we want to allow it in our society?" asked Katrin Goering-Eckardt of the opposition Greens, one of those advocating a ban.

But lawmakers who backed allowing the practice said it would be an option only in a few cases, and argued that parents who worry about possible genetic defects should be trusted to decide.

"I am firmly convinced that we should not choose to close our eyes to how we can use modern medicine appropriately to support and help these long-suffering families," said Labor Minister Ursula von der Leyen.

Opposition lawmaker Soeren Bartol said he wanted to give couples at risk of passing on genetic disorders the option of deciding to have a child.

"I would also like these parents to be spared, as far as possible, the terrible experience of a miscarriage or a still birth," he added.

Debates on procedures that involve genetic selection tend to be tinged in Germany by memories of the country's Nazi past including experiments on humans, but lawmakers didn't refer to that explicitly on Thursday.

Church leaders, however, criticized the decision. The country's top Roman Catholic bishop, Archbishop Robert Zoellitsch, said that "the selection of human embryos violates the precept of respect for human dignity" and Lutheran church leader Nikolaus Schneider said he would have liked greater restrictions.

Thursday's debate centered squarely on the morality of the procedure, a test done to pick the best embryos, rather than its medical merits � which researchers say have largely been a disappointment.

Doctors had assumed the test would improve pregnancy rates, but studies showed that women who had their embryos tested were actually less likely to become pregnant, probably because scientists still can't accurately predict which embryos will succeed.

A study in its early stages presented this week at a European fertility conference in Stockholm suggested that embryos which look problematic three days after fertilization can fix themselves by day five. Many embryos created by IVF are implanted after three days, although doctors are increasingly waiting until day five if possible.

The German motion refers to tests removing one to two cells out of an embryo about three days after its fertilization � when it typically has about eight cells � to see whether it looks abnormal. Some experts say that is too early and jeopardizes the embryo's future development.

___

AP medical writer Maria Cheng contributed to this report from London.



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Obesity rates still rising in many states (AP)

WASHINGTON � In 1995, no state had an obesity rate above 20 percent. Now, all but one does.

An annual obesity report by two public health groups looked for the first time at state-by-state statistics over the last two decades. The state that has the lowest obesity rate now � Colorado, with 19.8 percent of adults considered obese � would have had the highest rate in 1995.

"When you look at it year by year, the changes are incremental," says Jeffrey Levi, executive director of the Trust for America's Health, which writes the annual report with the Robert Wood Johnson Foundation. "When you look at it by a generation you see how we got into this problem."

The study, based on 2010 data, says a dozen states top 30 percent obesity, most of them in the South. Mississippi topped the list for the seventh year in a row, with Alabama, West Virginia, Tennessee and Louisiana close behind. Just five years ago, in 2006, Mississippi was the only state above 30 percent.

No state decreased its level of obesity, which is defined as a body mass index of 30 or more. The body mass index is a measurement based on weight and height.

There was a bit of good news in the report: Sixteen states reported increases in their obesity rates, down from 28 states that reported increases last year. Levi says those increases have been gradually slowing, most likely due to greater public awareness of health issues and government attempts to give schools and shoppers better access to healthier foods.

"We're leveling off to some degree at an unacceptably high level," Levi said.

First lady Michelle Obama has tackled the issue with her "Let's Move" campaign, pushing for healthier school lunches, more access to fruits and vegetables and more physical activity. Republicans in Congress have pushed back somewhat against some of those programs, however, saying a rewrite of school lunch rules is too costly and questioning an Obama administration effort to curb junk food marketing aimed at children.

As in previous years, the study showed that racial and ethnic minorities, along with those who have less education and make less money, have the highest obesity rates. Adult obesity rates for African-Americans topped 40 percent in 15 states, while whites topped 30 percent in only four states. About a third of adults who did not graduate from high school are obese; about a fifth of those who graduated from college are considered obese.

Dr. Mary Currier, Mississippi's state health officer, says her state has struggled to drop its No. 1 status and it has been challenging because much of the state is poor and rural.

"We live in an area of the country where eating is one of the things we do, and we eat a lot of fried foods," she said. "Trying to change that culture is pretty difficult."

She says the state has had some success by making school lunches healthier, taking high-calorie foods and drinks out of school vending machines and trying to find more low-cost exercise facilities for residents of rural areas.

"It is frustrating, but we've had some progress," Currier said. "We just have to continue to work at this. It's not something that's going to change overnight."

___

Online:

Calculate your body mass index: http://www.nhlbisupport.com/bmi



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Tuesday, July 5, 2011

Colon cancer deaths down except in Mississippi (AP)

ATLANTA � Health officials say colon cancer deaths continue to drop across America � except in the state of Mississippi.

The Centers for Disease Control and Prevention issued a report Tuesday that echoes earlier findings of a national decline in colon cancer deaths. Death rates fell by as much as 5 and 6 percent in some New England states. Mississippi was the only state that saw no real decline.

Screening exams can catch colon cancer before it grows deadly. Mississippi has one of the nation's lowest screening rates. Also, blacks die of colon cancer at higher rates, and more than a third of Mississippi's residents are black.

The report is based on information for the years 2003 through 2007.



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Seeds blamed for Europe E. coli still on sale (AP)

LONDON � Egyptian sprout seeds blamed for a massive and deadly E. coli outbreak are still on the market and were shipped to more European countries than was previously believed, officials said Tuesday, as the EU announced a ban on further imports.

The European Food Safety Authority confirmed in a report that one lot of contaminated fenugreek seeds from Egypt was probably the source of the recent food poisoning outbreaks in Germany and France. But the number of European countries that received parts of the suspected lot is "much larger than previously known," and includes Austria, Britain and Spain, it said.

The European Union said in a statement it was banning the import of Egyptian fenugreek seeds until Oct. 31, adding that its members must destroy all seeds from "one Egyptian exporter" received between 2009 and 2011. Officials have not released the name of the exporter.

The move, however, may be largely symbolic, since tainted seeds have already been widely distributed in Europe and it's unclear officials will be able to identify them because the amount of bacteria may be too small to detect.

Fenugreek seeds from the suspect Egyptian lot � about 15,000 kilograms � were imported to one large German distributor, the agency said. Those seeds were then sold to 70 different companies, 54 of them in Germany, the center of the outbreak, and to 16 companies in 11 other European countries.

Fenugreek is a clover-shaped plant whose leaves are commonly used as an herb and also in Indian curries. The seeds are often sold dried, and if they are contaminated with E. coli, the bacteria can survive for years.

Tracing exactly where the seeds from the suspected lot were sold could take weeks, food safety officials said. In Germany, the fenugreek seeds were sold in mixed spice packages with lentil seeds.

European food safety officials could not rule out that other lots of seeds from the same exporter weren't also tainted. Last year, Europe imported about 49,000 tons of fenugreek seeds from Egypt, worth more than euro56 million ($81 million)

Officials previously believed that sales had centered primarily on Germany and France but until now had little detailed information on where the seeds were shipped.

So far, the strain has killed 51 people, including 49 deaths in Germany and one each in Sweden and the U.S.

More than 4,000 people in Germany have fallen sick since the outbreak was detected in May, including 851 who have developed a serious complication that can lead to kidney failure. The same bacteria was also responsible for a much smaller outbreak in France last month.

Scientists said it was possible only a small part of the lot were infected, which might explain why there weren't more cases given how widely they were sold. "You could have some seeds contaminated but not necessarily the whole batch," said Ian Henderson, a professor of microbial biology at the University of Birmingham.

He said it would be difficult to find the culprit bacteria on the seeds since large quantities only appear once the sprouts begin to grow. "It could be like searching for a needle in a haystack," he said.

Experts said many of the infected seeds may already have been used but that some were still in the food chain.

Some suspect there have been numerous undetected E. coli cases across Europe. "Most people who get this won't get that ill and it won't be diagnosed," said Paul Hunter, a professor of health protection at the University of East Anglia.

He said that the outbreaks were caught because there were large numbers of people getting sick at the same time, in unusual circumstances. But if people bought and ate infected sprouts on their own � like from a 50-gram (1.76-ounce) packet from a garden center, as was the case in the French outbreak � their illness would probably be missed.

Health officials warn there could be further outbreaks of the lethal E. coli strain since the tainted fenugreek seeds are still for sale. Experts say people should not grow or eat their own sprouts and that all sprouts should be thoroughly cooked before being eaten.

"If people do not eat raw sprouts, we might not see many new infections," Hunter said. "But people are very good at ignoring public health advice," he said. "I wouldn't bet against more outbreaks."

_______

Associated Press writers David Rising in Berlin and Gabriele Steinhauser in Brussels contributed to this report.

(This version corrects amount of fenugreek seeds imported into EU to 49,000 tons instead of 3,000.)



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