‘Dying Before Their Time’ report calls for comprehensive response to disproportionate mortality rates among Detroit-area seniors
Sabrina Robinson remembers spending days as a young girl with her grandmother, who would care for other seniors in her Detroit neighborhood, some more than 80 years old.
Robinson, a Detroiter who celebrated her 65th birthday Saturday, said “people used to live so much older, but now, they aren’t even living as long to take care of.”
In parts of Wayne County, including Detroit and eight surrounding suburbs, older adults are dying at twice the rate of those who live elsewhere in Michigan, according to a report, “Dying Before their Time,” a 19-year analysis between the Detroit Area Agency on Aging and Wayne State University Medical School.
The agency attributed much of the cause to be a “result of deep-rooted negative social and economic policies and significant inequities in resource distribution.” Chronic illnesses, living conditions, accessibility to health care and lack of health insurance, food and transportation are specifically cited as reasons for the shortened lifespans, the study found.
The study, released Monday, focuses on mortality in the communities the agency services: Detroit, Hamtramck, Harper Woods, Highland Park and the five Grosse Pointes from 1999-2017.
The elderly population in this area had significant decreases in life expectancy between 1970 and 2000, and the decline of mortality was already accelerating, researchers say. There was a 23% higher loss of Detroiters age 60 and older between 1990 and 2000 compared to senior citizens in the rest of Michigan.
According to the study’s latest findings, the death rate is 122% higher for people ages 50-59 in Detroit and the neighboring suburbs in comparison to those of the same age in the rest of Michigan, and it’s 48% higher for ages 60-74.
“What’s happening is startling,” said Ronald Taylor, president and CEO of Detroit Area Agency on Aging. “The fact is we’re losing a lot of our population because of excess mortality, and it’s shocking to see that it still continues and that the trend has not gone down.”
Taylor leads the Detroit Area Agency on Aging’s 125 employees who serve more than 100,000 seniors with disabilities and their caregivers. Since the report began in 1997, its focus has broadened to address the disproportionate mortality rates, he said. The first reports addressed increasing death rates.
Multiple chronic illnesses, excessive hospitalizations and poor access to health care are among the reasons for mortality of those ages 60 and older. However, these are just symptoms of the major underlying cause, which, according to the study, are the social determinants of health including nutrition, housing, transportation, water supply, income, education, job availability and overall neighborhood conditions.
“It’s important for us to continue that study to see if things are improving but also to help guide us in our advocacy and then policymaking,” Taylor said.
All data was collected by time and geography from publicly available sources, the researchers said. The study looked at populations versus mortality, years of potential life lost, hospitalizations, medical shortages in designated areas, nursing home availability and quality, and comparison of Detroit to other cities.
Study co-author Dr. Herbert Smitherman Jr. of Wayne State University School of Medicine and Detroit Medical Center said it was shocking to discover how many people aren’t making it to 60 years old.
“I’m a physician but also a scientist, so when they approached me, my first recommendation was that an analysis needed to be done since there was never data collected by the state,” Smitherman said. “To see we lost not 1 or 2%, but 23% of the entire population, it seemed unrealistic. The Detroit region had 1.3 million people and lost more than 150,000 people, that’s just what the (nation) lost with coronavirus.
“That’s when we realized something was happening to seniors that wasn’t happening with any other population, and it got my full attention. Next, we realized if they’re dying before age 60, what’s happening before?”
Data collected in the study area shows that 89% of older adults have at least one chronic illness, and 39% of older adults have three or more chronic illnesses, including high cholesterol, high blood pressure, obesity, arthritis and diabetes.
Lack of health insurance was found to be a major factor contributing to younger residents developing chronic illnesses that go unaddressed and contribute to early death.
Almost the entire study population (94.3%) lives in areas designated as having a shortage of health professionals, and lacking in access to primary care services. Two-thirds of the older adults live in dire, medically underserved areas compared to just 16.5% of older adults in the rest of Michigan, a difference that has increased over time, according to the study.
The racial disparities in health care cost Michigan $2.2 billion each year, the study says. The effect on families who care for their seniors is a much larger price tag. Michigan has 1.3 million family caregivers, and the estimated economic value of unpaid family care is $14.5 billion, according to the study.
The death rates have persisted for at least two decades and possibly more than 50 years, Taylor said.
“First, we need to recognize that racism is a public health issue and that the majority of our population, especially in Detroit, is 80% African American, and within our total service area, about 75%. That’s a significant issue into changing the social determinants of health.”
Ending the ‘old-aged’ stigma
Robinson takes her two small service dogs to St. Patrick Senior Center in Detroit’s Midtown for residents to interact with. Now a senior, she’s waiting for the pandemic to end to join the center’s community.
“I’m still emotional from just losing a friend at age 55 to a brain aneurysm and was thinking about how people are dying so rapidly,” she said. “I have my own issues, and I think it’s all the medication we’re taking in. I’d rather spend my time being a part of this community where there are lots of activities.”
The research found the average life expectancy of Midtown Detroit residents is 69, which is 13 years shorter than residents of the Grosse Pointe area, a few miles away.
The numbers stunned Raymond Burton, a 71-year-old resident of the Midtown senior center. He worked in property management for 50 years and said he was “totally in the dark” when it came time to find help.
“I had a brain tumor removed early on, it led to seizures and (a traumatic brain injury), then vertigo and strokes,” said Burton, who uses a wheelchair. “I think I’ve lived so long because I had mentors who took me very far, but still didn’t know what was available and could barely think for myself at the time.”
Burton wished there was more training required for professionals helping seniors and for others to understand their needs.
“Seniors want to know what’s happening. What makes us so apprehensive is when people decide for us and assume we’ll go along with it,” Burton said. “We’re not treated like people.”
About one in five older adults in Metro Detroit live in poverty, more than double the state rate. An additional 11,000 seniors are food insecure, according to the study.
John Moore, a 70-year-old Detroit native, rotated between his McDonald’s pop and a cigarette as he glared at the view of parking structures across his Midtown living complex. He said the area has always lacked resources, and that has created resilience among people.
“If you ask anyone here if they’re rich, a couple will say yes. If you ask if they are middle class, all will say yes, but if you ask if they’re poor, they will all say no,” Moore said. “At our age, no one wants to be at the bottom, and even if they are, they make the best of it.”
Moore said he enjoys riding his bike to McDonald’s, seeing all the students from nearby Wayne State, smoking his two packs a day, and wishing the community would be more involved with seniors.
“There’s a stigma with the ‘old aged’ term that indicates you might be kicking the bucket anytime, but we need to change that because I really feel like a 17-year-old with a great sense of humor,” he said.
The work was startling, Smitherman said, and the answer is improving social factors of health that account for nearly 70% of a person’s overall health.
“What we put in the report is how we felt as researchers and clinicians,” he said. “What it showed us is that the health status of people in Detroit is so poor that we’re seeing downstream effects of this. My wife is a pediatrician and she’s seeing obesity, high blood pressure and illnesses that are typical with adults that are occurring in younger and younger people.”
As time goes on, residents aged 60 or older in southeast Michigan will outnumber children by 2026, according to the study.
The report is no surprise to geriatric doctors, including Gwendolyn Graddy-Dansdy, chief medical officer of Program of All-inclusive Care for the Elderly, or PACE.
“It’s disappointing to see mortality rates declining, especially knowing the pandemic will only add to those statistics,” said Graddy-Dansdy, who was involved in the original 1997 study.
PACE offers a closed system of care through 13 sites in the state and 123 in the nation through Medicaid. She said the holistic approach of providing everything in-house has made a difference for disabled seniors and their families.
“It’s unfortunate right now that we have limited service during the pandemic,” she said. “The holistic approach starts with awareness, and I hope people are appalled by these numbers. We have to look at people differently than we did in the past and change our ways.
“We have work to do to make certain that our older adults are receiving the quality care they desire.”
The report’s authors are advocating for access and delivery of ambulatory and primary health care services, training and availability of highly skilled health care personnel and access to a quality hospital, nursing homes and long-term care facilities.
In the long-term, the report calls for a collaborative approach by health and human service providers.
“In the short term, we’re looking to provide services across the lifespan in which we can educate individuals and start to teach folks before they become 60 about how they can improve their lifestyle, and then how can we improve our services to caregivers,” Taylor said.
“We need to focus on policies that can be changed to address how funds are allocated. And so that they won’t be just allocated based upon population, but they also include factors such as needs.”
For months, nursing homes have been at the center of a debate in Michigan during the COVID-19 pandemic. About one-third of the deaths linked to the virus in the state have been nursing home residents.
At the height of the pandemic in April, The Detroit News spoke with health care workers inside the city’s Sinai-Grace hospital, which is surrounded by 14 nursing homes. Seniors lined the hallways with an overflow due to lack of resources, workers said.
“We have a crisis that is upon a crisis, that is upon of crisis on top of a crisis,” Taylor said. “The COVID-19 pandemic on top of the fact that we got a high population of folks that have chronic illnesses, and then on top of the issue of systemic injustices whether is racial, economic, health, in the length of time we’re dealing with.”
Smitherman worries the trend will continue without a coordinated push to reverse it.
“What we’ve seen over 19 years is that it’s the same,” Smitherman said. “Unless we have some sustained effort where they allocate funding and collaboratively work to improve health and reverse centuries of racial poverty, this trend will persist over many decades to come.
“If we do nothing, nothings going to change.”
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