Toolkit: State Strategies to Support Older Adults Aging in Place in Rural Areas

This toolkit from the National Academy for State Health Policy highlights state initiatives to help older rural adults age in place by increasing services that help people remain in their homes, expanding and professionalizing the caregiver workforce, and making delivery system reforms within Medicaid programs.  According to research referenced in the toolkit, more than 85 percent of older adults prefer to remain in their own homes and communities, and serving older adults in their homes is usually less expensive than housing people in facilities. This resource was funded by the Geriatrics Program in the Bureau of Health Workforce at the Health Resources and Services Administration.   The Toolkit can be accessed here.

Comments Requested: The 2020 National Vaccine Plan

The U.S. Department of Health & Human Services is seeking input from the public on a 10-year national strategy for addressing vaccine-preventable diseases.  The plan will update all aspects of vaccine research and development, supply, financing, distribution, and safety, and address causes of an increased reluctance to vaccinate that led to recent outbreaks of pertussis, hepatitis B and measles.  Last year, the Centers for Disease Control and Prevention released research showing a lower rate of vaccination for rural teenagers and made recommendations for making it a routine part of clinical care.   Click here to access the Federal Register notice.  Comments are due on October 24, 2019.

October is Domestic Violence Awareness Month

In 2017, the Health Resources and Services Administration (HRSA) launched its Strategy to Address Intimate Partner Violence, with targets and projects that involve each of the agency’s bureaus and offices.  This month, HRSA’s Office of Women’s Health released the first progress report for that initiative, describing its achievements between 2017 and 2018.  Victims in rural areas may be reluctant to report intimate partner violent abuse, and unaddressed abuse has an impact that goes beyond the individual and into communities.

NIHCM: Population Shifts Impacting Rural Health

As urbanization increases, an older, sicker and poorer population remains in rural America. New infographics from the National Institute for Health Care Management (NIHCM) Foundation depict the population shifts driving these changes, the corresponding health care challenges, and promising tools to improve rural health. In rural areas, 18.4 percent of the population is over 65 years of age compared to 14.5 percent in urban areas, and rates of obesity, diabetes and smoking are higher.   The infographics can be accessed here.

Psychiatrist Shortage Causing Suffering, Risk of Jail and Suicide in Central Pennsylvania

Depression is on the rise. So is suicide, particularly among young people and military veterans. And Pennsylvania recently concluded that addressing mental health needs is the best defense against school shootings.

Yet, because of a shortage of psychiatrists, people commonly wait six months for an appointment in central Pennsylvania. That means some people badly in need of help continue suffering, and may become dangerous to themselves or others, before they can begin getting better.

“It’s terrible,” says Marge Chapman, executive director of the Dauphin County chapter of the National Alliance on Mental Illness, or NAMI.

Kathleen Zwierzyna, head of the NAMI chapter for Cumberland and Perry counties, tells of a relative who waited more than five months for an appointment with a psychiatrist. “We know many families who have lived through it,” she says.

Long waits extend to young people who show signs of mental illness at school and are referred by school staff, says Dan Daniels, executive director of the NAMI organization serving York and Adams counties.

Nearly half of Pennsylvania counties have no psychiatrist, says Christine Michaels, CEO of NAMI Keystone Pennsylvania.

“Yet there’s a crisis with suicide,” she says, noting areas that lack psychiatrists tend to be economically-depressed and have higher rates of depression among residents.

Psychiatrists, who are medical doctors, play a key role in diagnosing mental illness and deciding what treatment and medication should be used. Sometimes, symptoms return in patients who have been doing well, putting them in need of a psychiatrist to change or adjust their medication.

When people experiencing mental illness have to wait to be diagnosed, or begin medication or have it adjusted, it can disrupt their ability to work, attend school or care for their family, says Dr. Erika Saunders, chair of psychiatry at Penn State Health Milton S. Hershey Medical Center. Worse, it can put them at high risk of having to be hospitalized, ending up in jail or committing suicide, she says

Beyond that, delays can trigger other health problems and cause harrowing and destabilizing times for families. “There is a huge burden on families who are trying to care for their loved one,” Saunders says.

One central Pennsylvania resident who doesn’t want his name published experienced a return of a condition that had been well-controlled for years with medication. He learned his Harrisburg-area psychiatrist had retired. He says he contacted the area’s three major health systems: Penn State Health, UPMC Pinnacle and Geisinger Holy Spirit.

None could offer a near-term appointment, he says. One provided a list of private psychiatrists, but none were available. One suggested he try again in fall.  “We have a severe shortage of mental health professionals,” Saunders says. “We’re doing our best to care for [the sickest] patients, but we need to expand access for all patients.”

The shortage is severe not only in Pennsylvania but in much of the United States.

Read the entire article here.

Suicide is Growing Health Crisis for African American Youth

She started having suicidal thoughts at 11 or 12. She didn’t know the words to name it. She had no idea what it was, but she consistently had these urges to end her life.  “I just wanted to be dead,” she says.

One night when she was 24, and already long diagnosed with clinical depression, she succumbed to the feelings.  “I couldn’t suppress these thoughts anymore,” she recalls. “I had thought about ending my life for eight straight months.  “I texted a friend and said, ‘It would be better if I wasn’t here.’ That friend did not know that I had already taken substances in the hope that I would go to sleep and not wake up. And while I was waiting to die, the police showed up.”

T-Kea Blackman, now 29, survived that attempt and dedicated her life to helping others navigate the darkness of depression and mental health crises.

Read the entire article here.

Pennsylvania Health Secretary Calls for Declaration of Public Health Emergency

Pennsylvania’s secretary of health is asking state lawmakers to declare a public health emergency as she announced that Pennsylvania had recorded its first death from a vaping-related lung disease.

Dr. Rachel Levine said the state has nine confirmed cases of the lung ailment, 12 more probable cases and more than 60 they are still investigating. She urged Pennsylvanians to not vape, saying little is known about the illness except that it can be fatal.

Levine said she and Gov. Tom Wolf would like lawmakers to pass legislation declaring a public health emergency, which she said would allow her department to take specific action to keep this public health crisis from becoming an epidemic.

Without going into specifics, she said if legislation were approved for an emergency declaration, she and Wolf would have the ability make “targeted” changes to existing regulations. Nate Wardle, state health department press secretary, said her authority would be temporary.

Pennsylvania reported its first instances of vaping-associated lung disease to the federal Centers for Disease Control in September. Levine said she couldn’t provide details about the age, race or gender of the person who did. She did say that the cases that have reported appear evenly spread around the state.

Experts have said the lung disease resembles chemical exposure injuries. Pinpointing the culprit in vaping-associated lung disease isn’t simple. “We don’t know the chemicals in these products,” Levine said. “Whether they are bought commercially or bought on the street illegally.” Even the federal Centers for Disease Control, which is investigating vaping-associated lung disease, doesn’t know what’s causing the illness, Levine said.

“The fact that we have seen a death in addition to patients with very serious lung disease underscores the importance that people be aware of the symptoms associated with this illness,” Levine said. “The signs and symptoms of potential lung injury associated with vaping include cough, shortness of breath, chest pain, nausea, vomiting or diarrhea, fatigue, fever, or weight loss.”

The common factor among those who are reporting the same symptoms is that they have used a vaping device. Many of the cases involve people who vape using illegal cartridges, some with THC.

“The investigation into these cases in Pennsylvania and nationally is very complex,” said Levine. “And, it is evolving and changing every day. Unfortunately, right now, we still cannot say definitively what is making people sick. And whether it is related to the products being used, or the delivery of those products.”

Levine said she urged anyone who is vaping to stop, and anyone who is part of Pennsylvania’s medical marijuana program to discuss with their physician or dispensary if vaping their medicine may be harmful to their health.

Understanding Social Determinants of Health

The Josiah Macy Jr. Foundation has released a blog on Social Determinants of Health: A required Curriculum. The blog discusses the importance of understanding all the social factors that can affect a patient’s health and how medical professionals need to understand the conditions in their communities if they are going to help their patients live their healthiest lives. This blog can be applied to all health professionals.

Click here to read the blog.

New Online Resource Addresses Oral Health Needs

The American Academy of Pediatrics has published the “Oral Health Prevention Primer,” an online resource for pediatricians and providers who want to do more to address the oral health needs of children. The resource will help providers working with children understand the roles of various oral health allies, how they can collaborate, ways to provide oral health services, and how to advocate to achieve optimal oral health for their community with the goal of preventing dental disease before it starts.

Click here to view the resource.