Shannon Brownlee, an investigative health writer, published “Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer” in 2008. It was pretty controversial but was expertly documented. Other writers such as John Abramson (Overdosed America), Norton Hadler (Rethinking Aging: Growing Old and Living Well in an Overtreated Society), and H. Gilbert Welch (Overdiagnosed: Making People Sick in the Pursuit of Health) have written similarly comprehensive, and damning, exposes of the state of modern medicine in America. Now some of the major medical journals and medical societies have taken up the call to expose medical treatments and diagnostic tests that ought to be stopped. This movement is long overdue and is a potential solution to the exorbitant rise in health care costs that continues, even in spite of the slow-down seen since the Affordable Care Act was passed.
First, the good news with respect to crashes: It’s getting better. Over the past 20 years we’ve seen reductions in fatal crash rates, with declines greater for older drivers. This is due in part to the improved crashworthiness of vehicles which differentially benefits older drivers due to age-related increases in fragility. Declines may also be related to increases in the health of older adults, allowing older drivers to better survive crash forces and recover from crash injuries. The fact that older adult crash rates are declining even for property-damage only crashes, however, suggests that declines in crash risk represent more than just a decrease in injury severity, but that the crash involvement of older drivers may be declining as well. The bad news, however, is that even if there is only a small increase in crash risk associated with advancing age, we can expect age-related crashes and injuries to persist as the number of older road users increases dramatically in the United States and around the world. By the year 2050 it’s predicted that 1 in 5 individuals in the U.S. will be 65 years of age or older, with the 85+ age group being one of the fastest growing population segments of the United States. This makes increases in crash risk faced by older road users an important and urgent problem.
The term “Wicked Problems” arose in the 1970s to distinguish major challenges of public policy from those of the hard sciences. Most famously articulated in a 1973 paper by Rittel and Webber in Policy Sciences, Wicked Problems are issues that are very difficult, if not impossible, to solve because they are 1) highly complex, with no readily apparent solution, 2) intricately interconnected with other problems, 3) entrenched in the landscape and/or the political arena, and 4) volatile, presenting constantly moving targets to policy makers. These problems defy conventional solutions because the typical set of policy responses are insufficient to address these problems in any meaningful way.
In my last blog entry I discussed some of the challenges associated with intervention studies to improve cognition. However, I didn’t really spend much time defining cognition and cognitive aging. A very recent publication by the Institute of Medicine/National Academy of Sciences (NAS) provides a book-length treatment of cognitive aging.
One of ISL’s goals involves finding effective “holistic” interventions to improve functional, and particularly, cognitive capabilities as people age. Surveys have shown that fear of loss of cognition, and particularly development of dementia, ranks as a top concern for seniors. (It is more feared than loss of vision.)
As a first post, I want to muse a bit about what constitutes successful longevity. Many writers have speculated about terms such as successful aging, functional aging, healthy aging, and the like.