Medical: A strong economy may be a danger to fragile seniors

Almost instinctively, we know that recessions can't be much good for our health.

The stress of unemployment, unpaid bills, lost wealth and lost medical insurance all contribute to worsening health in various ways, researchers have found in recent years.

A 2010 poll by the Harvard School of Public Health showed that many people with major illnesses like heart disease, diabetes or cancer felt that the economic downturn was worsening their health and expected further problems in the future. About a third of the patients with heart disease or diabetes said they were having difficulty paying medical bills and managing their conditions due to economic setbacks, and about a fifth of cancer patients reported similar difficulties.

While people of all ages may skimp on health care during lean times, the impact of a recession particularly affects the very young and the elderly.

One study published last fall in the journal Pediatrics noted increases in both shaken-baby syndrome among infants and head trauma to children under age 5, with the rate of trauma injuries nearly doubling to 15 per 100,000 children between 2004 and 2009, according to researchers at Children's Hospital in Pittsburgh.

In a study of the older people, researchers from the University of Michigan and the College of William and Mary found that seniors who were invested in the stock market reported after the 2008-09 crash that their health was significantly worse than similar respondents who were asked the same questions before the economic meltown. And the stock-owning seniors exhibited more symptoms of depression than the control group.

Yet the most dangerous economy for the most fragile seniors may be a strong one.

Researchers have noticed that despite many poor health indicators during recession, the overall number of deaths in the population actually decreases slightly during downturns, and rises again when the economy turns robust.

A new analysis published last month by the Center for Retirement Research at Boston College took a close look at who actually dies during good times, and concludes the difference lies in elderly nursing-home patients.

Specifically, they documented that people aged 65 and older made up 75 percent of the additional deaths recorded during economic expansions. Older women, in particular, accounted for 55 percent of the additional deaths.

"An expanding economy generates a greater scarcity of front-line caregivers in nursing homes, which may cause more deaths among the elderly,'' reported a team made up of four economists from the University of California, Davis.

They noted that past research has shown that employment levels in the health-care sector "decline during economic expansions as low-paid, low-skill health workers (such as nursing aides in nursing facilities) find better jobs elswhere."

Pay for nursing-home aides, low to start with, is likely to lag in any recovery because it is largely tied to federal and state government reimbursement rates.

Elderly women are more at risk because more women outlive their husbands and are more likely to live in a nursing facility near the end of their lives. And the researchers saw that mortality rates increased more in states that have higher percentages of their elderly populations living in nursing homes.

They calculated that a 1 point decline in the unemployment rate was related to a statistically significant 0.56 percent increase in nursing-home deaths.

(Contact SHNS health and science correspondent Lee Bowman at BowmanL(at)shns.com.)