Written Testimony on Interim Charge 1 on Aging Texans
House Human Services
Dec. 15, 2015
The Texas Medical Association, representing more than 48,000 physicians and medical students, appreciates the opportunity to submit our written comments on the charge to this committee — to study the economic and social impact of aging Texans, including a review of state services and programs, and their effectiveness in addressing the increased demands of aging Texans. We believe meeting the needs of this growing population of Texans is a significant public health challenge for our state, and TMA’s members recognize our role in working with you to find solutions.
One in five Texans will be age 60 or older in 15 years. Many people likely imagine these older Texans as living with chronic conditions and diseases that erode their health and their social and economic lifestyle. In fact, a significant proportion of Texans aged 65 and older, and even those 50-65, already live with chronic conditions such as arthritis, cancer, diabetes, or cardiovascular disease.
But while we commonly identify these as diseases of aging, they do not have to be a part of normal aging. The longest study of human aging reinforces our understanding that normal aging does not have to include costly, disabling diseases that limit a person’s lifestyle. With aging, one’s body grows less capable of maintaining energy levels, retaining all of one’s cognitive abilities, and even resisting disease. This decline, however, begins in the 30s and 40s, when people still can adopt lifestyle practices that will help them resist or prevent many disabling and costly diseases later in life.
While one’s health is largely influenced by genetics, physicians advise our patients that a healthy lifestyle is also key to healthy aging. A healthy lifestyle includes healthy eating with a focus on certain nutrients (calcium, vitamin D) along with avoiding some substances (sodium, sugars, certain fats); regular physical activity (to reduce muscle loss, physical balance for fall prevention); monitoring of behavioral health (alcohol and substance use and depression, adequate sleep); regular testing and health screenings (weight, blood pressure, glucose, cholesterol, cancers, vision, dental); and vaccinations (influenza, pneumococcal, zoster) to prevent or delay onset of disease.
Preventive and clinical care in a medical home by physicians must have the support of a strong public and community health system. This integration of medicine and population health presents the best opportunity to reduce and mitigate the chronic conditions and disabilities associated with aging. For this to work, state and local agencies need the ability and resources to perform these key public health functions:
- Stronger public health monitoring and surveillance of chronic diseases and working with communities to assess the prevalence of risk factors (such obesity, overweight, physical activity, and substance use);
- Surveillance and initiatives aimed at preventing the spread of infectious diseases in long-term care facilities;
- Monitoring and surveillance of injuries to expand and support evidence-based injury prevention programs;
- Evidence-based community/local population-based programming such as the Texas Department of State Health Services’ (DSHS’) potentially preventable hospitalization program;
- Improved physician and provider access to state and local data regarding chronic conditions and risk factors;
- Developing the public health workforce to enhance awareness of aging and evidence-based clinical guidelines for the aging population, and of prevention programming including home-centered services that support independence;
- Preparedness planning to support the aging population in the event of a disaster or infectious disease emergency; and
- Assessing how to address gaps in and strengthen our statewide child and adult vaccination programs, emphasizing strong policies to support vaccination of caregivers and health care workers in health facilities.
The DSHS report on preventable hospitalizations confirmed that many Texans are hospitalized for conditions that can be avoided (2008-13), the most costly of which — at more than $10 billion — was bacterial pneumonia that caused more than 280,000 hospitalizations. Bacterial pneumonia can be prevented largely with timely vaccination to protect against many contagions such as measles, pertussis (whooping cough), varicella (chickenpox), and pneumococcus. Texans older than 65 in particular are most vulnerable if either they or their family members are not properly vaccinated for these preventable diseases.
Finally, we call on you to consider the significant behavioral health needs of our aging population. Many aging Texans face the stress anxiety that comes with disability; loss of income; or the responsibilities of caring for children or grandchildren, or their own aging family members. These Texans also are at risk of suffering from an overdose from improper use or abuse of pain medications.
TMA looks forward to staying engaged in your work on healthy aging. Working with the medical community and local public health and community organizations, you can help Texans live longer and better so they can remain engaged in community life and continue to contribute to a healthy Texas.
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