Perspectives - January/February 2014 - (Page 38)

agency resources Insidious Factors In Elder Mortality HANK GEORGE, FALU, CLU, FLMI W hen we think about geriatric mortality, our attention runs to such things as burden of disease, build, blood pressure, cognitive status, objective evidence of frailty, and so on. There are also a number of insidious risk factors that are typically overlooked by underwriters even though they can often be directly or indirectly accounted for in the risk assessment process. "The size of an individual's social network is inversely related to mortality..." Nielsen, Mard, et al Clinical Epidemiology 2(2010):91 Established markers for inadequate socialization include social isolation, loneliness, and living alone. Social Isolation Social isolation encompasses being unmarried/not cohabitating, having little interaction with friends/ relatives, and not being a member of a religious or social group. Studies have shown that the mortality risk in social isolation equates to that linked to smoking cigarettes twelve months after a heart attack and imparts a 3-fold increased likelihood of a coronary event. It also substantially hikes the risks of major depression and suicide. Researchers have found that social isolation confers up to a four times greater all-cause mortality risk as compared to those with "... more ties to friends, relatives, and the community." Loneliness The three most common causes of loneliness in elders are spouse death, illness, and lack of friends. Lonely individuals are predisposed to a range of conventional risk considerations including accelerated cognitive decline, ADL and mobility limitations, and a higher probability of fair/poor self-rated health. 38 perspectives JANUARY/FEBRUARY 2013 The mortality risk attributable to loneliness is increased as much as 2-fold. Living Alone Anyone my age (I turned 67 in July) does not have to be told about the disadvantages of living alone... especially if their cooking skills are limited to frozen pizza! In addition to a markedly greater risk of developing clinical depression, this unnatural state correlates with underweight, poor nutrition, heavy drinking, daily pain medication use plus higher prevalences of COPD and heart failure. At age 80 and older, the highest suicide risk clusters among males living alone. They also experience greatly increased post-MI mortality. Long-Term Caregiving Until one has provided extended caregiving to a chronically ill family member-or witnessed its effects wear down someone else- it is difficult to appreciate how this debilitating task can culminate in 65% increased mortality. The first clues to caregiver distress, often written off as predictable consequences, are typically anxiety and depression symptoms. In due course, these self-sacrificing individuals run heightened risks of alcohol abuse, unintended weight loss, multiple medical disorders and, perhaps most alarmingly, they put off seeking medical help for their own symptoms. Increased rates of hypertension, cardiac disease, and diabetes are all well documented in elders caring for a spouse with Alzheimer disease. There is another aspect here that also merits mention. In fact, it is a major risk assessment red flag! In one study, the odds of incipient dementia, disability and poorer general health were all substantially increased in those who were accompanied by a companion; that is, if that companion was present in the room where the patient was seen by a physician. Grief and Bereavement The loss of a loved one-most notably a spouse/significant other or child-leads to a variable interval of grieving. By convention, psychiatrists distinguish between normal bereavement and "complicated grief." The latter occurs in 10-20% and is characterized by persistent intense longing for the decedent, anger over the loved one's demise, and a pernicious preoccupation with the person who passed on. Complicated grief results in a chronic pattern of undesirable consequences including avoidant behavior, severe loneliness, anhedonia (lack of pleasure from previously joyous undertakings) and chronic depression. Smokers will escalate their consumption, ex-smokers are prone to restart the habit, and those who use alcohol are apt to increase their daily intake. The incidence of suicidal ideation exceeds 50% and at least one in five victims of prolonged complicated grief makes a suicide attempt. The highest risk is in those with depression, lack of social support, or where the loss has triggered posttraumatic stress disorder (PTSD). The high-risk interval for excess mortality is within six months of the onset of complicated grief.

Table of Contents for the Digital Edition of Perspectives - January/February 2014

NAILBA Perspectives - January/February 2014
Contents
Chairman’s Corner
CEO Insights What’s New at NAILBA?
The New HIPAA Information Requirements
NAILBA 32 Highlights
Reading Ahead
In Vogue: Life, LTC & Annuity Product Trends
NAILBA Charitable Foundation What a Great Year it Was!
Member Profiles
Agency Successor Networking Group
The Power of LIFE Behind You
Agency Resources
Legislative Update
Index of Advertisers
Calendar of Events

Perspectives - January/February 2014