LIVABLE COMMUNITIES: Aging in Marin: A Public Health Perspective

In 2007, the Marin County Grand Jury used the phrase “silver tsunami” to describe the county’s growing population of older adults. While it is true that aging of the county’s population will have a dramatic impact over the coming decades, local communities are welcoming the challenge. At Marin Health and Human Services (HHS), we are focusing on strengthening existing community infrastructure to serve older adults while also taking action to improve the quality of life for all citizens. Creating an environment where people of all ages can “live long and live well” is an emerging public health priority.

According to the 2010 U.S. Census, the median age in Marin County is 44.5 years--the highest in the Bay Area and nine years older that the state average. Seniors are also the fastest growing age group in Marin. In 2030, an estimated one in three Marin residents will be over age 60, compared to one in four today. This is not surprising, given that many of Marin’s residents are living longer than those in other counties.

Last year a nationally publicized report compared life expectancy across the nation’s 3,143 counties.[1] Marin women had the longest life expectancy nationally at 85.0 years, five years longer than the national average. Marin men ranked fifth for male life expectancy, at 81.4 years.

While there is plenty to celebrate, not all Marin residents enjoy a long life. When comparing certain census tracts, we find a 17-year difference in life expectancy between our healthiest and our least healthy neighborhoods. Not surprisingly, the leading cause of death in communities where people live shorter lives is preventable cardiovascular events--primarily heart attack and stroke. We also see a strong correlation between childhood obesity rates, a known contributor to cardiovascular risk, and shorter life expectancy in these same communities. In the communities where people are living longer, the leading cause of death shifts toward less preventable cancers.

For healthy aging, prevention of chronic cardiovascular disease across the age spectrum is a priority, especially among baby boomers. While Marin is fortunate to have a relatively high number of medical providers per capita, no health system is equipped to manage an epidemic of preventable chronic disease within this largest generational cohort in recent history.

This circumstance places an even greater premium on primary prevention, including opportunities to promote healthy eating through a person’s entire lifespan, as well as age-appropriate fitness programs and recreational facilities that offer convenient, free and safe options for physical activity. One in four Marin County adults is obese, and one in 10 is a smoker. There is plenty of opportunity to ensure that more people can “live long and live well.” The county-wide Healthy Eating and Active Living Initiative (www.marinHEAL.org) is currently bringing together residents and community partners to create a roadmap for improving community health.

For medical providers, perhaps the most important trend to consider is increasing rates of dementia. Among Marin residents over age 85, Alzheimer’s is now the third leading cause of death. A general shortage of geriatric providers and too few students entering geriatrics as a profession are causes for concern. It will be critical for non-geriatric clinicians to understand issues of dementia, including early detection and how to support patients and their families.

According to the Alzheimer’s Association and the CDC, one in eight adults age 60 and older reported experiencing “confusion or memory loss that is happening more often or is getting worse” over the past year.[2] Among these individuals, only 19% reported discussing these changes with a healthcare provider. Other studies have found that half of those who meet the diagnostic criteria for dementia have not received that diagnosis from a physician.[3,4]

Fortunately, medical providers can find support for their aging patients from several local programs and efforts.

Project Independence, operated by HHS, is a nationally recognized program that provides a bridge of support for people transitioning from hospital discharge to independence at home. Outreach and home visits have helped reduce the rate of recurring hospitalizations to 6% in Marin, compared to 20% statewide.

Financial Abuse Specialist Team (FAST) is available to assess elders who may be at risk for being taken advantage of financially. For more information about FAST, and any other services for older adults, visit the HHS website at www.marinhhs.org/aging-adult-services. To make a referral, call 415-457-4636.

Marin County Prescription Drug Misuse and Abuse Initiative is currently engaging stakeholders county-wide to address prescription drug misuse for all age groups, including seniors. The number of narcotic pain medications being prescribed in Marin County has more than doubled in the past 10 years, and there has been a corresponding increase in overdose deaths. In addition, opiate pain medications and benzodiazepines increase fall risk in the elderly.

Skilled nursing facilities will become a larger fraction of the healthcare system for those who may not be able to live safely at home. HHS is strengthening relationships with Marin’s 14 facilities to prevent disease, especially through infection control. The facilities now report staff and client influenza vaccination rates; in-service training is offered to facilities with low rates. This intervention helped increase staff vaccination rates from 58% in the 2012-13 flu season to 90% in 2013-14.

Senior Villages have emerged in Marin. These virtual communities respond to the changing needs of the growing older adult population. They are typically nonprofit organizations that assist older adults in performing daily life tasks they can no longer do themselves. To learn more, visit www.marinvillages.org.

The increase in older adults presents an exciting challenge for Marin County. Medical care is one component of a “livable community” that includes appropriate and affordable housing, adequate mobility options, safe and open spaces, opportunities for civic engagement, and access to health and social services.

Service assessment and development is a continuous process, and medical providers have an important voice in shaping policies and programs to meet the needs of our older residents and their families. Community input is essential. Marin County welcomes citizen involvement on the Commission on Aging, which advises the Board of Supervisors and HHS on issues related to older adults in Marin. For more information, or to volunteer, visit www.marinhhs.org/boards/commission-aging

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Dr. Willis is the Public Health Officer for Marin County.
Email: mwillis@marincounty.org

References

1. Wang H, et al, “Left behind: widening disparities for males and females in US county life expectancy, 1985-2010,” Population Health Metrics, 11:8 (2013).
2. Alzheimer’s Association & CDC, “The Healthy Brain Initiative,” Alzheimer’s Association (2013).
3. Boustani M, et al, “Screening for dementia in primary care,” Ann Int Med, 138:927-937 (2003).
4. Bradford A, et al, “Missed and delayed diagnosis of dementia in primary care,” Alzheimer Dis Assoc Disord, 23:306-314 (2009)