The Longevity Project | Part 3: Despite nation-leading longevity, Colorado mountain communities face significant health challenges
February 28, 2018
Editor's note: This is the third installment in a four-part series from the Summit Daily News. Read Part 1: What's the secret behind Colorado mountain towns' peerless longevity? Part 2: Is Summit County a Blue Zone, a designation for areas around the world that have a high number of centenarians? Part 4 will print Feb. 23: We live longer here, but when it comes to caring for our aging population, many mountain communities fall short.
Frisco resident Gretchen Tilden is 85 years old, and she spends much of her time these days painting. Tilden is engaging in art therapy to cope with the lingering effects of a serious brain injury she suffered back in 2013. Before the injury, Tilden was a physical force of nature. She was a ski instructor in Keystone for 15 years after moving to Summit in 1990, and never had any noticeable health issues.
But then came the fateful day in 2013 when she was hit by an out-of-control snowboarder at Copper Mountain Resort.
"I went flying in the air and came down directly on my head," Tilden recalls. "I had an internal brain hemorrhage. They took me to Denver on Flight for Life, and the doctors didn't think I would survive the night."
However, Tilden beat the odds and survived. "The doctors kept saying, 'I can't believe she's alive, she's 80!'"
Unfortunately, Tilden's survival came at a sharp cost. "I lost my sense of smell and taste, and I have constant vertigo. It's cost me a lot."
Brain injuries are one significant risk factor for the fearless, active seniors in Summit, but there are other concerns as well.
At first glance, Colorado's central mountain towns seem to have most of the ingredients for a long, happy life: breathtaking scenery, clean air, healthy people and a bounty of outdoor recreational activity that draws hundreds of thousands of people from around the world. It's no wonder we have the highest life expectancy in the country.
Dig below the surface, though, and you're likely to find some sobering truths.
According to the Robert Wood Johnson Foundation's Annual Report, the mountain counties of Eagle, Pitkin, Routt and Summit ranked in the top 10 among all Colorado counties in health outcomes. However, Eagle and Summit also tied for having the highest rate of excessive drinking in the state. Mountain counties also scored poorly when it came to physical environment because of a severe housing shortage.
For the working people in our mountain communities, those truths are evident every day. Some residents rely on free community dinners because they spend what little they have on rent. They might not be able to afford health insurance or afford the specialist who can diagnose and treat their hidden heart condition. To pay for a roof overhead, one might need to hold two or three jobs. To cope with the stress, they might turn to heavy drinking or other self-destructive vices. During the shoulder seasons, when most homes sit empty and when friends move away, they get lonely.
These are people whose quiet suffering is rarely reflected in the cheery statistics about mountain life.
In the past two installments of The Longevity Project, the Summit Daily explored reasons why Summit and Eagle counties have the highest life expectancy in the country. In this installment, we look at the areas where we fall short.
Watch: The 38th annual Summit County 50+ Winter Games took place earlier this week. Summit’s super seniors competed in everything from giant slalom, figure skating, an obstacle course, a biathlon, a snowshoe race and more. (All videos by Hugh Carey and Heather Jarvis)
High living, high costs
An obvious bit of news for anyone who has tried to find a place to live or gone grocery shopping in the mountains: It's really expensive to live up here.
Just ask Dillon Mayor Kevin Burns. Back in December he announced he would not seek another four-year term as mayor this April, citing the high cost of living.
"Dillon is a very tough place for young professionals and young married couples trying to establish their lives, and that certainly affects me," Burns said at the time. "The chances of me staying in Dillon are pretty remote, and I think it's only fair to give someone who is more confident they can serve an entire term a chance."
To understand the housing problem, take a look at home sale listings on Zillow or any other real estate listing page. The median price for a single family home currently on the market is $789,000. Only 12 apartments or condos are currently available for rent on Zillow, with the average rent at $1,900 per month.
A person earning $40,000 a year may wind up spending half their paycheck on rent alone. A household is considered "cost-burdened" by spending just over 30 percent of gross income on rent. The 2015 Self Sufficiency Standard for Colorado report issued by the Colorado Center on Law & Policy found that families in Summit have to make much more to afford basic necessities such as housing, child care and food.
"A Summit County family with one adult and one preschooler, for example, needs an annual income of $59,595 to make ends meet, more than three and a half times the federal benchmark (for poverty)," the report concluded.
Craig "Corky" Woodring, a local artist and former construction company owner who spent much of the past three decades living in Summit, doesn't see the county doing enough to support the people who actually live here.
"People can't afford to live here," Woodring said. "They come to work here, but when they start a family they need to move away to buy a house. You have to work three jobs to survive. The employers don't want to pay a living wage."
Woodring also believes that the bedrock of a stable community — a foundation made up of long time residents and middle-class families — doesn't really exist in Summit.
"Summit doesn't have the solid base. The jobs are seasonal, the pay is (low), you can't afford insurance to carry yourself through. There's a whole segment of society that is missing."
Tamara Drangstveit, executive director of the Family and Intercultural Resource Center in Silverthorne, regularly helps people who struggle to afford living in the mountains.
"It doesn't matter if you're looking at housing, health care or child care, costs are higher in Summit County," Drangstveit said. Her clients often pay 40 to 50 percent of their income on housing, and 15 to 20 percent each on health care and child care.
"That doesn't leave a lot of money at the end for things like food, clothing and other necessities."
Dr. Ali Mokdad is a co-author of the study by the Institute of Health Metrics of Evaluation that placed Summit County at the top for life expectancy. He said that while socioeconomic factors do have a large impact on life expectancy, they aren't necessarily the most important.
"While health is correlated to socioeconomic issues primarily, you can be poor and still be healthy if you engage in the right behaviors." Mokdad points to places like Yuma County, Arizona, which has a relatively low average income but managed to raise their life expectancy by eight years since the last study. Poor life expectancy, Mokdad explained, is primarily driven by behavioral issues, such as obesity, poor nutrition and excess drinking.
The Human Environment
But part of the problem for making those lifestyle changes is living in an environment that does not encourage them. In his Blue Zones books, author and explorer Dan Buettner proposed that the most sustainable way to improve a community's life expectancy is to "reshape the environment" to steer people toward better habits and better lifestyles.
He identified one key common trait across all Blue Zones communities: walkability. While counties like Summit have an exceptional trail and recreation path network, they don't necessarily link to all the places people need to go. Many of those places are only accessible by car.
"Parts of Summit County are walkable," Drangstveit said, "but places like the Dillon Valley are not. The county has done walkability studies, and there's been a lot of work done, but there's a long way to go. There needs to be better linking of middle-class neighborhoods to the trail and path network, as well as to the needed services like grocery stores and health care."
Another issue in Summit is a relative lack of food accessibility. The public can look up local food accessibility statistics through the Food Research Atlas, an interactive map tool provided by the U.S. Department of Agriculture to find areas that are considered "food deserts" because of their lack of access to a variety of healthy food.
While healthy fruits, vegetables, grains and beans are usually available at grocery stores, over 1 in 20 Summit households are in a situation where they don't have access to a vehicle and live more than half a mile from the nearest grocery source. That means they have to take long, burdensome trips by foot to the supermarket, or rely on public transportation and be at the mercy of its schedule.
Physical Health Factors
Living at altitude isn't for everybody, especially people who have difficulty breathing or other cardiovascular issues. Sometimes those issues are not readily apparent and pose serious threats to long-term health. Cardiac failure continues to be the leading cause of death in Summit County and nationwide.
Dr. Peter Lemis said that one of the biggest health concerns at altitude are hypoxia, a lack of oxygen reaching tissues and pulmonary edema — a cardiac condition that can cause fluid buildup in the lungs.
"We have 20 percent less oxygen up here," Lemis said, "and for people with pre-existing cardiovascular issues, those are exacerbated. People who have pre-existing medical conditions don't usually move here."
Lemis added that people with those conditions who do move up here often have to move away, as do people who have to move away due to other serious illnesses or injuries. That, he believes, is part of the reason life expectancy is so high in the mountains.
"When people get critically ill, and in danger of dying, they often need to move to a tertiary care center down in Denver. That's why we don't have many people die here."
Dr. Jules Rosen, chief medical officer at Mind Springs Health in Frisco and former chief of geriatric psychology at the University of Pittsburgh, added that because most people living in Summit weren't born here, they aren't acclimated to the conditions.
"Take the sherpas in the Himalayas," Dr. Rosen offers as an example. "Some genetic studies show that sherpas are genetically different from most of us us."
Dr. Rosen explained the body's usual response to living in a place with less oxygen than what the organs need is to produce higher hematocrit levels, or red blood cells to carry that oxygen. The risks of having high hematocrit levels include blood clots and other serious conditions.
However, despite the lack of oxygen in the Himalayas, those sherpas test for lower hematocrit levels.
"People who live in the Himalayas, whose genetic line stretches hundreds of thousands of years, have become genetically attuned to the conditions," Rosen said, "but most who come to live here are not genetically selected to live here."
Dr. Rosen added that there are significant risk factors for seniors, like bone change. Being healthy and active doesn't slow that down.
"Being active is a protective factor, but it doesn't prevent bone degeneration," Rosen said. "Even if they are active, they may have osteoporosis. If you slip on ice and break a hip, you have the same risks and complications as everyone else does."
Rosen also said that falls are one of the biggest safety concerns for seniors.
"As people get older, the risk of serious injury from falls and deaths far surpasses the risk of car accidents. Once you pass the age of 60 your risk of serious injury or death goes up exponentially compared to car accidents."
Paul Chodkowski is CEO of St. Anthony Summit Medical Center in Frisco, a Level III trauma center and the largest health services provider in Summit. Early in his tenure, Chodkowski recognized the need for more study about health effects at altitude, especially as we age.
"For every 1,000 feet, there's an expotential effect on the body," Chodkowski said. "It's much harder on the cardiovascular system to live at 9,000 feet than at 7,000 feet."
Chodkowski found that there was a rising senior population in the area, and realized the importance of addressing their needs. He wound up hiring Summit's first local full-time cardiologist, Dr. Warren Johnson.
"Dr. Johnson started seeing patients who had cardiology issues, and they are significant at altitude," Chodkowski said. "He began to see that there is a higher prevalence of pulmonary hypertension in our population."
Though little research exists about the physical health effects of living at altitude, Chodkowski said that Johnson's work produced positive developments.
"Dr. Johnson started collecting patient information and data, and eventually that led to the development of a High Altitude Research Center that we're in the process of working on."
Chodkowski said that he hopes the research will help find better solutions and care for altitude-related illnesses and chronic diseases.
In 2017, Eagle County recorded 13 suicides, the most anyone in the county can remember for a single year. In 2016, Summit County also had a near-record number of suicides, but in 2017 that number dropped significantly, a dose of good news that underscores the strides that mental health advocates have made locally in the last year.
However, the struggle to bolster mental wellness in the mountains is far from over.
In working with her clients at FIRC, Drangstveit believes stress continues to be major contributing factor. "When regular people are struggling to keep three jobs while trying to support their family, it builds up a lot of toxic stress – stress that you can't really get rid of. It leads to depression, anxiety and general unhappiness."
Corky Woodring had his life shattered by mental illness. He once had a family, his own construction company and a relatively comfortable life in Summit. But depression and bipolar disorder made him lose it all, and he was forced to move to Pennsylvania for a time. There, he was briefly institutionalized to treat his mental illness.
"In Pennsylvania, I started to get better. They have a much better mental health support system out there. But back then, there was nothing for mental health in Summit."
Carlos Santos is an independent living coordinator and peer counselor at the Northwest Colorado Center for Independence, a nonprofit that helps persons with disabilities and others obtain the help and resources they need to live independently. He regularly comes across individuals with mental health concerns.
"What I've seen is that a lot of these folks come up to the mountains to get away from their problems, but obviously it doesn't always work," Santos said. "They look at it as a bit of escapism, but then reality sets in. They struggle to afford the cost of living, and they don't know how to navigate the system out here to get the resources they need."
Santos added that while Summit and Eagle have done a good job improving accessibility to mental health resources, there are a lot of people who work here but live in Park and Lake counties.
"Out in Park and Lake, the bedroom communities, there isn't a lot of outreach to help them where they live," he said. "They can't always access the resources that are available in Eagle and Summit."
The Building Hope initiative is a grassroots community mental health initiative that is trying to address gaps in Summit County's support network. Program Manager Betsy Casey believes that along with cost of living, the very nature of mountain communities make residents susceptible to depression.
"We have long, cold winters that are nine months long instead of six months," Casey said, "and combined with the isolation for young people who come here without a support network, it creates a perfect storm."
That isolation is compounded, Casey said, by the fact that mountain resort towns are transient communities, where people come and go and stable relationships are hard to maintain. Many turn to drinking or substance abuse to self-medicate as a result.
Dr. Rosen believes that there may also be some physical reasons for poor mental health in the mountains. One concern he highlights is "nocturnal oxygen desaturation," or low oxygen levels during sleep because of conditions such as central sleep apnea. That lack of oxygen and poor sleep may lead to psychological issues down the line.
"Sleep apnea is a hidden danger, and a real risk factor for people living at altitude," Dr. Rosen said. "It causes fatigue, low energy levels and can also lead to depression, anxiety and other emotional problems. But we don't know enough about it, and we really need to."
Dr. Rosen added that those mental health issues, whether environmental or biological in nature, might lead to dangerous behaviors such as binge drinking.
"Alcohol is a depressogenic, it causes depression. Excess drinking alters your brain chemistry and hormone levels, and might make existing mental health conditions worse."
Dr. Rosen added that excess inebriation creates a secondary concern — falls. "You're more likely to die from a fall on ice or snow around here if you're drunk than getting into a drunk driving accident. It can also seriously affect your sleep, which can cause issues with blood pressure and feeds into the cycle of stress and poor health."
Dr. Rosen said that he and Dr. Lemis have been hoping to do a serious study about sleep apnea at altitude. Chodkowski said that St. Anthony Summit has also been looking into researching sleep apnea and oxygen desaturation.
Dr. Rosen maintains that the physical and mental health issues he mentioned eventually push people out of the mountains, and that is the real reason life expectancy is so high here.
"We have everything going for us here, except time," Rosen said. "No matter how successfully you're aging, time will still march on, and as time gets the better of us, we have to move out."
Rosen concludes that the high life expectancy in Summit is a bit of a mirage. "People don't live longer in Summit, they just don't die in Summit. They move to Denver."
To greener pastures
Gretchen Tilden's brain injury cost her dearly. Because of the chronic vertigo, she had to give up downhill skiing, her true passion. She can't even do cross country anymore.
Now that she can't do much of what she loves, Tilden said she is going to wind up moving to the Front Range. "There's not much more left for me to do up here," she said. She believes she will be taken care of down in Denver, where senior care services are much more readily available.
Tilden managed to live to a ripe old age by avoiding excess drink, staying active and healthy and keeping a positive mindset. However, the accident left her needing the kind of care she can't get in the mountains. She is one of many seniors having to abandon their perch at 9,000 feet because of a lack of senior services. In our next installment, The Longevity Project will look at whether our mountain communities are doing enough to care for the burgeoning senior population, which has nearly doubled over the past decade.
The Summit Daily asked our readers to tell us about their favorite people over 80 years of age. Click here to view the county's "Super Seniors."
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