Update on Aging


aging discussion 3-15-14Recently, Tony DiNuzzo, Rebecca Galloway, Bronia Michejenko and myself presented a panel discussion on issues in aging as part of a UTMB President’s Cabinet Award project called the HomeTown Science 3D Seminar Series. The discussion was called Aging and Wellness: Ways Science Can Help.

One interesting aspect of the seminar was that we were in a virtual world when we did it. We used the UTMB island in the virtual world of Second Life®. See the picture on the right.

The panel discussion was recorded and is now available as a one hour video program. You can see it at either of these two locations:

Not only did the four of us interact together but we took comments and questions from the audience. The end result is a rich dialog that we hope you can use with other groups. It is available freely for you to use.

The discussion ranged over these five questions:

  1. Who wants to live forever? – The question of quality of life and when does quality of life trump healthcare interventions?
  2. Why does everyone seem to die from a broken hip? – Strength, balance and rehabilitation and what can elders and their families do to reduce the consequences of loss of strength and balance?
  3. Nobody is taking my car keys away! – Mobility, access and depending on others and what are the options for getting around when driving one’s self is no longer an option?
  4. I don’t want to die in a nursing home. – Where and how to live throughout ones lifespan and what are the options for aging in place?
  5. Why do I have to repeat this every time? – Coordination of care and teamwork and why can’t health providers share information and test results so it does not have to be repeated over and over

Join us for a real-time discussion about the questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Many of us have 4-legged friends who we consider members of our families.  I for one can’t imagine life without a dog, when I was born my parents already had 4-legged children and I have had a dog ever since.  Some of you may have dogs, cats, horses, or pigs that you love, and the idea of living without them would definitely be a big adjustment.

Animals especially dogs have been used to help humans in so many ways: as guides for the blind and deaf, search and rescue, to notify owners of health incidents (blood sugar or seizures), psychotherapy for children, etc.  Now researchers are looking at the possible long-term benefits of animal-assisted therapy for those with Alzheimer’s and other dementias. Animal-assisted therapy (AAT) with dogs can provide people a companion and a non-judgmental listener, it also may help to reduce agitated behaviors and increase social interaction.

A pilot study by Dr. Nancy Richeson (2003) looked at the effects of AAT on agitated behaviors in those with dementia.  For three weeks participants spent one hour a day in small groups with a therapeutic recreation professional, a therapy dog, and a handler.  Richeson found that there was a significant decrease in agitated behaviors among participants; however, these effects were no long apparent at follow-up three weeks after the intervention was complete.  Social interactions also increased, some family members and caregivers even commented on participants talking endlessly about the dogs.

Animal interaction can definitely be a comforting activity for animal lovers regardless of age or cognitive ability.  There are now organizations across the country that provide these types of therapeutic opportunities some that serve Texas include: Therapy Pet Pals of Texas, Therapy Dogs International and Faithful Paws, .  If this is something you or a loved one may benefit from it is definitely worth looking into.

Our Guest Blogger this week is Danielle Rohr, Special Projects Coordinator, Texas AHEC East, North Central Region.

Reference:

Richeson, N. E. (2003). Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia.  American Journal of Alzheimer’s Disease and Other Dementias, 18(6).

Image Source:

http://rainhummingbird.com/blog/wp-content/uploads/2013/04/therapy-dog-is-pet-by-an-elderly-man-in-a-wheelchair-and-a-younger-woman-horizontal-shot.jpg

Join us for a real-time discussion about the rather grave question raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

From the  ending of John Steinbeck’s novel The Grapes of Wrath where Rose breastfeeds a starving stranger.

From the ending of John Steinbeck’s novel The Grapes of Wrath where Rose breastfeeds a starving stranger.

I’ll never forget January 2010, the month that my maternal grandmother passed away.  Not only was she the matriarch of our family, she was my last living grandparent.  This was the only grandparent death I’d experienced as an adult, so it was different.  As we sat there in the church building during her funeral services and I looked around at the family and friends gathered, I could not help but think about the last few years of her life.  I thought about how after my grandfather passed, she had taken care of herself and her household, but as she aged, she needed help.  My mom, her siblings, and her caretaker were her support the last few years of her life when she became feeble.  I began to wonder, who is going to take care of me when I become elderly?  If nothing changes and I do not have children, what will happen to me when I age?

When we are young, we are under the impression that we must follow the perceived societal norm: go to college, get married, have children, and live happily ever after.  However as of late, the norm is shifting. More women are delaying childbirth for educational pursuits and for economic reasons. In the United States, women, ages 35-39, having their first child has increased 50% over the last 20 years. (Peterson, Pirritanom, Tucker & Lampic, 2012)  As a result a woman may unexpectedly be faced with infertility, due to reduction in fertility that comes with age.   In addition, there are some who individuals who purposely choose not to be parents.  As this generation ages, we could possibly see more people in the childless and elderly demographic.  When those in this demographic become ill, they may face a different set of issues than those with children, as noted by DeOllos and Kapinus.  Their work asserts that childless elderly individuals are more likely to be institutionalized if they became ill and once released, their network of friends and family were not extremely supportive (DeOllos & Kapinus, 2002).

Although it is not guaranteed that someone with children will have better care than someone who does not, it is more likely that a child will feel obligated to care for an ill parent.  There are many factors that can contribute to how this scenario may turn out for someone and many questions that have to be answered, especially as societal norms continue to transform.  I am not sure of what the future holds for me, I am certain that as my parents age, my siblings and I will be there, just as they were for my grandparents.

Our Guest Blogger this week is Leah Jacobs, Coordinator, East Texas Area Health Education Center

References

  1. DeOllos, I. Y., & Kapinus, C. A. (2002). Aging childless individuals and couples: suggestions for new directions in research. Sociological Inquiry, 72, 72-80.
  2. Peterson, B. D., Pirritano, M., Tucker, L., & Lampic, C. (1012). Fertility awareness and parenting attitudes among American male and female undergraduate university students. Human Reproduction, 27, 1375-1382.

Image from Seen and Heard International Opera Review (http://www.musicweb-international.com/SandH/2007/Jan-Jun07/wrath1702.htm). This image was first used here in the post: A Compassionate RoboCop?http://wp.me/pH3Dx-1b

Join us for a real-time discussion about the rather grave question raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

A family begins to talk... See the whole film at http://smithcreekstudios.com/wider_view/ella_mays.asp

A family begins to talk… See the whole film at
http://smithcreekstudios.com/wider_view/ella_mays.asp

Those of us working in healthcare, independent on our roles, need to look deep into our personal values and preferences as it relates to end-of-life and get the dialogue and conversations started within our own families and direct contacts.  Not enough people in our county are willing to have these conversations, yet everyone wants to complain about it or have legislative rulings made on the topic.  Why not just start talking? We have power in numbers.

We talk about graduation plans, wedding plans and many other life changing events.  We prepare our children to drive an automobile through training.  We plan our financial future with expert guidance that we generally seek out in advance.  Why not talk about end-of-life fears, concerns, wishes and all of it throughout our life span?  You think we don’t fear for our children’s lives as they drive off for their first solo trip?  Of course we do, we just don’t dwell on it.  Let’s get in the habit of taking it a step further, let’s talk about the “what-ifs.”

We don’t have to make up scenarios about dying; there are enough out there in the media.  Watch the news not just for the purpose of knowing what is going on, but let it guide our conversations.  Let our spouses, our kids, our sisters and brothers know what we think about certain situations; the ethical considerations, our point of view.  Go ahead, talk.  Talk about it all.  Talk about the disappearing plane, how we feel about it, what our perspective is based on each different passenger’s journey and where they were in the journey.  Talk about the high speed crash, the overdose, the cancer fighters and those that choose not to fight very hard or long.  Just talk about it!  We all think about it.

Maybe if we all start talking about it, we can make the transitions a little easier for someone.  That someone may be a daughter, a son, a parent, a sibling or it may even be the healthcare worker that is trying to sort out their own thoughts, beliefs and feelings while they deal with the family and patient that is going through an end-of-life process.  Maybe, if we talk, we can become stronger as a society, more proactive and more open in dealing with the subject of dying that is uncomfortable for many.  So next time the opportunity rears its head, take it, and start the conversation.

Our Guest Blogger this week is Barbara Orantes R.N., Nurse Manager, Citizens Medical Center, Victoria, Texas. Interesting in that I had another person suggest end-of-life planning as a blog topic this week.

Join us for a real-time discussion about the rather grave question raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

older womanGrowing up in a rural area of Texas I was taught as a child that living to a ripe old age was a true blessing.  From my perspective, having my great-grandparents, grandparents and many great aunts and uncles around to enrich my childhood verified this fact.  Although not highly educated in the formal sense, they imparted an incredible amount of wisdom and life skills that impact my life to this day.  As an adult, watching these same individuals age, and in some cases pass away, I realize that many of the characteristics that have made them such wonderful role models make their later years more challenging.  The best way I know to explain this statement is to tell you my “tale of two grandmothers.”

My grandmothers were raised in rural Texas communities on family farms.  This fostered a fierce sense of independence and self-sufficiency.  For the most part in those days, you grew or made what you needed.  They married men from similar backgrounds and started their families.  Both of my grandmothers have seen more in their lifetimes than I can ever imagine. They survived a world war, the great depression and natural disasters galore.  Now their focus has turned to surviving the later years of their life.

Over the years they have already addressed some of the challenges many rural elderly encounter.

The loss of the ability to drive is the thing that my 96 year old grandmother mourns the most.  She reluctantly relinquished her keys after she had totaled her second car. The loss of independence was a tremendous psychological blow.  Living in a rural area limited her transportation choices to basically friends and family.  She avoided going to medical appointments, the grocery store or other errands, sometimes to the point of doing without, because she felt she was being a burden on others.

Both grandmothers have been forced to move out of the homes they have lived for the majority of their lives to other locations due to health issues.  The stress from having to “move to town” cost my 93 year old grandmother the hearing in one ear.

Now in the final years of their journey they are working through new challenges.  They are now trying to address the increased need for medical care and the resources required to finance this level of care.  This is especially challenging for the grandmother who married a farmer.  Without a pension and very little social security income, she is once again forced to rely on her family to help navigate the expenses of residential care.  The grandmother whose husband fully paid into social security and has a pension, is still trying to figure out how long her resources will last as she has moved to a point where a higher level of care is required.

All of these challenges, along with health concerns, have both grandmothers starting to question the “blessing” of longevity.

Our Guest Blogger this week is Leslie Hargrove, MCHES, Executive Director, Texas AHEC East Coastal Region

Join us for a real-time discussion about the rather grave question raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

This is a vintage fruit crate label and has nothing to do with the content of the blog.

This is a vintage fruit crate label and has nothing to do with the content of the blog. I just am aware of these as an art form from the past.

There is a stigma about aging in our society. The elderly are often expected to follow a particular pattern of behavior and these behaviors are accepted. Perhaps our perceptions are built from stories in the media, personal experience, or cultural norms. When we think of grandpa or grandma in their late years, movies have helped us envision the little old man feeding pigeons at the park, grandma sitting on the front porch in her rocking chair playing a crossword puzzle, or both heading out to the weekly bingo game. Does growing old mean we have to fall into a particular, expected pattern of activity or inactivity? Are the typical, expected behaviors healthy for the elderly? Can the aged still make meaningful contributions to society?

I recently visited with Dianna Smith, a sixty-seven year old woman who has been retired for three years and recently lost both of her elderly parents. Smith shared her thoughts on aging from her personal experience and offered some advice to others.

According to Smith, “There seems to be a general perception amongst young adults and the elderly that once you grow older, you no longer have to contribute to society, you don’t really have to do anything, you have reached the point where you can relax and just be taken care of.”

Is this all that there is when we get older? Smith says “No, absolutely not!” Her motto is “live until you die.” She believes that staying active is the most important thing you can do as you age. In fact, research suggests physical activity contributes to the reduction of psychological distress among the elderly because it promotes psychosocial interaction, improves self-esteem, helps in the maintenance and improvement of cognitive functions, and serves to reduce the frequency of relapses of depression and anxiety (Stella, 2002).

When it comes to aging and staying active, first consider taking on new challenges. “You have spent your life learning who you are, finding your interests, and perfecting your skills. Growing older does not mean you have to leave those things behind. Rather, find new challenges that relate to your interests and skills,” said Smith. For example, Smith started learning to play the violin at age fifty-seven. “The social norm seems to be that learning to play the violin from scratch is not within a retired person’s scope of activity or ability. It is reserved for young children,” said Smith. However, at the age of sixty-seven, Smith now plays with string ensembles and symphony orchestras. In fact, playing the violin has opened up new opportunities and experiences such as accompanying a string ensemble to Ireland where they played at numerous sites. She was able to visit a different culture and meet new people because of her desire to accept new challenges and interests.

Second, as we age, we may become limited in the extent of activities we can perform due to physical or mental constraints; however, we can still adapt to the changes that occur with aging. Perhaps you used to enjoy jogging, but can no longer handle the stress on your knees. Adapt and start walking. If you can no longer walk, try riding a stationary bicycle. There are always alternatives.

Finally, get involved and form new social networks. As we progress through life, we find friends through work, church, or family. As we age, these groups can change. Our family and friends pass on or our church members move away. It is important to accept invitations to new social groups for support and longevity. Staying socially active helps relieve stress while also building new supportive relationships.

Overall, Smith believes that staying active physically, socially, and spiritually helps us live a longer, more productive life. You can still contribute to society and also find enlightenment through your experiences as an older adult. After our discussion, I was reminded of a quote authored by Stephen King used in his movie, Shawshank Redemption. In this movie one of the lead characters is released from prison at an elderly age. After coping with the stress of life in the free world as an older man, he must make a decision. “Get busy living, or get busy dying.”

Aging is a part of life. It is up to each of us to decide how we want to approach aging. Staying active physically, socially, and spiritually can actually make you healthier and prolong your life. If you are living longer and healthier, then the next question might be when do you actually consider yourself old? As for Mrs. Smith, she is going to continue to stay active taking on new challenges, finding new physical activities she can perform, and meeting new groups of people. She will continue to “live until she dies.”

Our Guest Blogger is Mark Scott, M.B.A., C.P.M., Director, Texas AHEC East-Piney Woods Region

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Mark suggests these questions for the Tuesday discussion:

  • What is your outlook on life from an elderly perspective?
  • What are common social stigma about the aged?
  • Do we have to conform to those accepted behaviors?
  • What other activities can we do or adapt to as we age?

Reference

Stella, F., Gobbi, S., Corazza, D., & Costa, J. (2002). Depressa˜o no idoso: Diagno´stico, tratamento ebenefı´cios da atividade fı´sica. Motriz, 8(3), 91–98.

“I will never be an old man. To me, old age is always 15 years older than I am.”   –  Francis Bacon

When do we become old? Is it when we have gray hair? Is it when we retire from work? Or is it a specific age; are we old when we reach 55? 65? 100?  The Pew Research asked this question back in 2009 to nearly 3,000 adults. This was the response:

  • 13% said you are old when you have gray hairturtles
  • 23% said you are old when you retire from work
  • 32% said you are old when you turn 65
  • 45% said you are old when you have trouble walking up stairs
  • 76% said you are old when you can’t live independently
  • 79% said you are old when you turn 85

So, when are we old? I remember being in the 7th grade and thinking that 30 year olds were old adults who had their lives all together.  Now, that I am hovering around 30 myself, I realize my middle school-self had no idea what she was talking about!  Besides feeling old every time I see a new gray hair, I usually feel like I’m still in my early 20s (until I am around young people of that age!)  It is all a matter of perspective.   If you don’t feel old, then you must not be old, right?  This seems to be consistent with the Pew study which states that, “Among 18-29 year-olds, about half say they feel their age, while about quarter say they feel older than their age and another quarter say they feel younger. By contrast, among adults 65 and older, fully 60% say they feel younger than their age, compared with 32% who say they feel exactly their age and just 3% who say they feel older than their age.”

I guess the wise old cliché “you are only as old as you feel” must be true, since “being old” is clearly not defined. After all, age is only a number.  There seem to be many more career changing adults now than ever.  This could be attributed to many factors including: opportunity, financial assistance, job market, economy, etc., but it’s also older adults not letting their age get in the way of wanting to learn something new and pursuing what makes them happy.  Age alone does not decide when your mind and body are old. Why do we need others to define what is or is not appropriate for our age? Take for example the list of people below:

Did you know that?

  • At 100, Grandma Moses was painting.
  • At 93, George Bernard Shaw wrote the play Farfetched Fables.
  • At 91, Adolph Zukor was chairman of Paramount Pictures.
  • At 90, Pablo Picasso was producing drawings and engravings.
  • At 89, Albert Schweitzer headed a hospital in Africa.
  • At 88, Michelangelo did architectural plans for the church of Santa Maria degli Angeli.
  • At 85, Coco Chanel was the head of a fashion design firm.
  • At 82, Leo Tolstoy wrote I Cannot Be Silent.
  • At 73, Peter Mark Roget published the Roget Thesaurus.
  • At 76, Nelson Mandela was elected president of South Africa.
  • At 65, Pulitzer Prize and National Book Critics Circle Award winner, Frank McCourt first began writing.
  • At 64 Laura Ingalls Wilder published her first book Little House in the Big Woods.
  • At 48, Susan Boyle first appeared on Britain’s Got Talent and launched her singing career.

I guess somebody forgot to tell them that they were “old.”

Our Guest Blogger this week is Karen Brown, MAEd. Program Coordinator, Texas AHEC East – Waco Region

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

no exitNo Exit is a play by Jean-Paul Sartre in which three dead characters, assigned to Hell, find themselves in a room with no exit (1). I sometimes think life has no exit too. Not that life does not end but that we have no real cultural expectations for how to die. We rely on an accident or disease to kill us or just allow “old age” to let us fizzle out, but we rarely have a real exit strategy.

Partly that lack of an exit strategy is related to our cultural disapproval of suicide. Generally it seems that our culture and religions say it’s OK to die when external forces choose the moment but if we choose the moment ourselves, that’s morally “wrong.”

And anytime we consider making an active choice to die, we turn to suicide as the methodology (2). I’m not a fan of suicide (I might choose the wrong moment and miss something good) but I do wonder if there is a way to die with grace and in an appropriate fashion at exactly the right moment.

Along that line, the other day I was having breakfast with friends, when one of them said, “My brother, who is 75, just joined the Exit Club.” What pray tell is that? Well, it’s apparently not called the Exit Club, but there exists the Final Exit Network (http://finalexitnetwork.org) which seems like a close fit to what my friend was mentioning.

I also came across the Hemlock Society which ceased to exist some years ago, apparently due to the association of its name with Socrates. See http://www.assistedsuicide.org/farewell-to-hemlock.html

But taking an active role in ending one’s life is not quite my concern here, so I looked for, dying without suicide. I found a few related links but they all ended up talking about suicide, not a natural death at one’s choice.

I know of stories of people who went about their day quietly, said good night to their family, and simply transitioned to the next place. We never consider that to be suicide and I’m sure it is not. It is an example of “going gently into the night” (3).

This latter process is something we need to know more about and to teach to successive generations.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Notes

  1. The title in French is Huis Clos which means a private conversation behind closed doors as opposed to “we can’t get out of the room” but there are many reasons why we cannot get from one place to another and that’s enough for this analogy.
  2. I don’t want to consider euthanasia  at all this week. Maybe we’ll look at that later.
  3. Paraphrased inappropriately from Dylan Thomas.

fight ageismHave you ever forgotten something, and excused yourself as having a “senior moment?”   If we examine the implications of this statement we can identify that we believe older adults have memory problems or are senile.

Ageism is defined as the intentional and/or subconscious discrimination against elderly people that has both direct and indirect detrimental effects on the older population,

Age stereotypes are often internalized at a young age.  By the age of four, children are familiar with age stereotypes, which are reinforced over their lifetimes.

Our Western society values youth and beauty.  The media’s portrayal of older adults is portrayed as dependent, helpless, unproductive and demanding.  Television advertisements depict bladder incontinence, dentures, and inability to get up after a fall when addressing the older adult, whereas the young are vacationing, dancing, and enjoying life.   The value that the media and society place on youth may be reflected in the number of cosmetic surgeries among older adults.

The relationship between ageism and civil rights is long standing and is reflected in Butler’s association between ageism and other forms of social injustice. “Ageism,” he says, “can be seen as a process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this for skin color and gender. Ageism allows the younger generations to see older people as different from themselves, thus they subtly cease to identify with their elders as human beings” (Butler, 1975).

The truth is that the majority of seniors are self-sufficient, middle-class consumers with more assets than most young people and with more time and talent to offer society.

A survey by Duke University (2001) of 84 people ages 60 and older, showed that nearly 80 percent of respondents reported experiencing ageism, such as other people assuming they had memory or physical impairments due to their age. The survey revealed that the most frequent type of ageism, reported by 58 percent of respondents, was being told a joke that pokes fun at older people. Thirty-one percent reported being ignored or not taken seriously because of their age.  Older patients are often viewed by health professionals as set in their ways and unable to change their behavior.

If older adults are treated as dependent, incompetent, helpless then they may begin to take on that role, because it is an expectation.

Healthcare practitioners must examine their beliefs and educate themselves so that they do not have biases that can compromise clinical objectivity and patient care. Examples of provider beliefs are: seeing the patient as chronically ill and frail, decreasing the opportunity to ambulate or engage in self-care; fear of narcotic dependence, which gets in the way of pain management; under treatment of depression, believing all elders are depressed; promotion of bed rest, with subsequent loss of function. Currently, hospitals perpetuate dependency which erodes the patient’s self-esteem, identity, and individuality.

old people

References

  1. Butler, R. N. (1975). Why Survive?: Being Old in America. New York: Harper and Row.
  2. Cornwell. J.  (2012). The Care of Frail Older People with Complex Needs: Time for a Revolution. King’s Fund, London.
  3. Perry. D. (2012). “Entrenched Ageism in healthcare Isolates, Ignores and Imperils Elders.” Aging Today: March/April.
  4. Kydd.  A.,  Wild D. (2013). Attitudes towards caring for older people: Literature review and methodology.
  5. Palmore. E. (2001).  The Ageism Survey: First findings. The Gerontologist. Vol 41. No 1.

Our Guest Blogger this week is Bronia Michejenko, RN, MSN, GNP, BC.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

aging seminar 1This is the 137th blog and we have explored many issues affecting older people, especially those in rural areas. The topics have been very diverse and I wonder if we have covered all the essential areas? I want to ask y’all out there to help in identifying the BIG areas where getting older presents us with challenges.

On March 15th, Tony DiNuzzo, Rebecca Galloway, Bronia Michejenko and myself will present a panel discussion on issues in aging for our HomeTown Science 3D Seminar Series (http://www.utmb.edu/hometownscience). The discussion is called Aging and Wellness: Ways Science Can Help and we will spend time talking about five questions. To me these five questions embody the BIG issues that face everyone who moves into and beyond their seventh decade.

aging seminar 3Each question is below with a brief expansion of the issues involved.

  1. Who wants to live forever? – The question of quality of life – When does quality of life trump healthcare interventions?
  2. Why does everyone seem to die from a broken hip? – Strength, balance and rehabilitation – What can elders and their families do to reduce the consequences of loss of strength and balance?
  3. Nobody is taking my car keys away! – Mobility, access and depending on others – What are the options for getting around when driving one’s self is no longer an option?
  4. aging seminar 2I don’t want to die in a nursing home. – Where and how to live throughout ones lifespan – What are the options for aging in place?
  5. Why do I have to repeat this every time? – Coordination of care and teamwork – Why can’t health providers share information and test results so it does not have to be repeated over and over.

I did leave off particular diseases even though aging does make us more prone to a number of conditions. In a way disease is unpredictable but I think everyone has to face the issues above, illness or no. Finally, one’s particular illness will probably make some of the issues more challenging.

aging seminar 4So, here’s my question for today. Are these five item an exhaustive list of the issues around aging? Can you suggest another? Comment below or come to the Weekly Discussion on Aging and we’ll brainstorm the question.

Join us for a real-time discussion about the questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.


aging seminar 5

HelloLovell Jones wrote in today’s Austin American Statesman about how cultural differences influence what medical researchers study. He tells how he came to UT’s MD Anderson Cancer Center in 1980 to study breast cancer and how he was especially concerned about the high rate of breast cancer in African-American women. Now retired, and after a lifetime of study and advocacy in this area, he reports that given all the advances in the treatment and prevention of breast cancer, the mortality rate “in African-American women in Texas remains almost four times that of white females.”

Jones further points out as an example, that with his retirement there remains “no African-American full-professor in the basic or behavioral sciences” at MD Anderson.

He attributes the lack of progress in cancer care for African-American women (the first fact) to this second fact. If there in no one in senior leadership positions who understands the needs of a particular group then that group suffers from “benign neglect, institutional discrimination and internal politics… [leaving us] with a system that has been unresponsive to both research and health-care needs.”

This is an most interesting observation. Over the last few decades, all of American society appears to have become more sensitive and attuned to the special needs of the many, many sub-groups that exist. It would seem however that regardless of our sensitivities we tend to disregard groups that are not like ourselves. Thus, if no (choose your group) people are involved in the leadership then the needs of the (that group) people may get overlooked.

Might this apply to the elderly too. So maybe, suppose we have a thirty-something with a Ph.D. in Gerontology, with a useful set of specialized skills, but he/she is not a group member (not old), therefore, however hard he/she tries, the needs of the elderly will remain an abstraction and essential needs may not be served. Do you think this might be true?

What implications does this bring up?

Reference

Jones, L. Factor our cultural differences into scientific health discovery. Austin American Statesman, February 28, 2014, section A, page 11.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

virtual abilityEach week’s blog is followed by a discussion session that I host in the virtual world of Second Life. While we use Second Life (SL) as a convenient, small-group communication platform, instead of using Skype or another videoconferencing service, others have found it provides a valuable virtual access to the outside world for many people who cannot get out into the physical outside world.

An article by W. J. Au caught my eye the other day. He said, “SL enthusiasts have tried promoting it as a platform for any number of real-world applications, such as remote conferencing and architecture visualization, but only one [use] consistently shows substantial and unique value: [it is] a real-time, immersive social space for people with physical or mental disabilities that impair their first lives, [and] who often find comfort and security interacting through anonymous avatars… As the developed world experiences a spike in senior citizens, SL very well could find a new audience.”

And this last reference was what seemed to relate to us in the rural elderly category. As people age there are often health conditions that develop that in turn limit physical activity. Many older people, like their younger counterparts with disabilities, find themselves trapped at home with few social outlets.

From our weekly discussions on aging, I have come to know several people involved in a unique group in Second Life. This group is called Virtual Ability and one of their core concepts is to assist disabled people to come into virtual worlds like SL and to function normally there. They assert that there are tremendous benefits to disabled people in doing so. Here is a quote from one of the participants in the SL Virtual Ability group, “Virtual Ability, Inc. and SL have given me hope again. I had pretty much given up on hope, so this is important to me.” Please take a look at their web site for further information: http://www.virtualability.org and especially the Benefits page: http://www.virtualability.org/benefits.

Older persons who find themselves in need of a social group could most certainly find something of value by visiting the Virtual Ability group in SL. And should you feel that older people cannot manage the technical and cognitive skills needed to function in a computer-based 3D simulation like SL, I am reminded of a 93 year old woman that Tony and I interviewed a few years ago. She lives in a small rural community in East Texas and taught classes in computer skills at the senior center (See an earlier blog for a movie of that interview: http://wp.me/pH3Dx-7l).

Age like disability need not be an impediment to life.

Reference

Au, WJ. Second Life turns 10: what it did wrong, and why it may have its own second life. Gigacom, June 23, 2013. (http://gigaom.com/2013/06/23/second-life-turns-10-what-it-did-wrong-and-why-it-will-have-its-own-second-life).

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

CoffeeBreakYesterday, I was a co-presenter and the topic had to do with caregiving and finding the joy and humor in a very stressful activity.  Each presenter talked about the organization they worked with and how the organization meets the needs of their clients and caregivers.

Caregivers are heroes in my book.  Basically they have put their life on hold for a period of time to assist someone who is having difficulty negotiating everyday activities of life.  Sometimes the care recipient needs assistance for a short period, six weeks rehabilitating after surgery or traumatic life event, other care recipients require assistance for years with increasing level of assistance needs due to a medical condition that is characterized by deterioration.

I frequently find that long-term caregivers get lost in caregiving, their day never ends and to make things easier they neglect themselves.  Studies have reported that caregivers experience reduction in their immune system response and this suppression continues after that caregiving situation resolves.  In the Geriatric Clinics the Physicians, Nurse Practitioners, and I encourage caregivers to be selfish and engage in activities that refresh them, whether it is getting a manicure, having lunch with a friend, playing a round of golf, etc.

Frequently caregivers will report they cannot leave  their care recipient with someone else because: someone else cannot do the job as well as the caregiver does, the care recipient will not agree, there is no one they can contact for assistance, they do not have the finances to pay someone, etc.  Another issue is what happens if the caregiver becomes unable to provide care, what is the backup plan?

If there is a caregiver in your family or circle of friends and community, please recognize the them and arrange for a short break from their caregiving activities. If you know the care recipient maybe you can spend a couple of hours reading to, playing games with, looking through photo albums, baking cookies these are a few ideas that may help distract the care recipient from awareness that caregiver is away for a short while.

If you decide to do something with the caregiver arrange for a sitter to be present with the care recipient.  The sitter needs to be prepared to distract the care recipient with some of the ideas above, or maybe a student who needs to work on assignments or read while the care recipient naps.  The sitter is present to appropriately address any emergency that might arise.

You can also help them prepare a backup plan.  The plan should address immediate then longer time frames.  Example:  Caregiver is hospitalized with no notice, a call is placed to the person who knows who to notify for immediate needs, then the person who will need a couple of hours to make appropriate arrangements to be able to provide a few days of care and then the longer time frame person who may live in another state and might require a couple of days to make necessary arrangements.  Knowing that there is a plan to activate when something unexpected arises relieves stress.

Today’s Guest Blogger is Adele Herzfeld, LMSW. She is a Senior Social Worker at UTMB in Internal Medicine – Geriatrics.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Image borrowed from https://www.library.ucsf.edu/content/december-10-coffee-break-ucsf-students

Big new ideaBack in the early 1970’s, when I was a graduate student at the University of Kentucky with my wife and two small sons, we found ourselves without health insurance. Our previous experiences with health care were as children on our parents health insurance and the kindly services of the US Air Force. Uncle Sam paid for our two son’s births and early years.

One of our neighbors, as it turned out, was the first medical director of a new health maintenance organization. It was called the Hunter Foundation for Healthcare and was Kentucky’s first HMO.

They had rates based on ability-to-pay. With me as a graduate student on the GI Bill our ability to pay was extremely limited but again Uncle Sam was funding the HMO so he came to our aid again. This was a classic all-under-one-roof HMO that used a stage model for care. One’s first contact was by phone with triage by a nurse practitioner or physician assistant who decided who you would see. Then, when you came in you saw a nurse or PA, with a physician running in as needed and referrals to specialists or hospitalization. It was a good model. We enjoyed good care from them.

The Hunter Foundation HMO provided coordinated care across providers and reduced duplicative efforts. It was a model that deserved to succeed. It did not however draw enough paying clients to keep that model and thus has faded into history.

Good ideas always circle around and are rediscovered by the next generation as the “next great, new idea.” An article in the Austin American Statesman, describes a new plan by congress to create an new version of the HMO for Medicare recipients. It’s called the Better Care program and has the classic HMO structure of fixed monthly fees plus providers all-under-one-roof for better coordination across multiple chronic conditions and less duplication.

What’s your health care model and is it better?

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

References

  1. Alonzo-Zaldivar, R. Medicare proposal envisions flexible teams for chronic care. Austin American Statesman, January 16, 2014, A5.
  2. Health Maintenance Organization. Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/Health_maintenance_organization
  3. Bentley-Smith, A. HMO-Founder Calls System a Failure, Calls for Medicare for All. http://www.pnhp.org/news/2006/december/hmofounder_calls_sy.php
  4. Thomas, D. The Rise of HMOs. RAND Corporation, 2003.                     http://www.rand.org/pubs/rgs_dissertations/RGSD172.html

 

self careMuch education is available on Alzheimer’s Disease care, and rightly so. More than five million Americans have it. Often overlooked, however, is care for the 15.4 million caregivers who provide more than 17 billion hours of assistance each year. For them, the health risks posed by caregiving can be just as devastating as the disease. A 1999 study by Shultz and Beach reveals a disturbing statistic. The spouse of a person with dementia between the ages of 66 and 96 who is experiencing mental or emotional strain has a 63 percent higher risk of death than a person of the same age who is not a caregiver (Shultz & Beach, 1999).

There is no instruction manual for the husbands, wives, sons, and daughters to care for themselves while caring for a person suffering from dementia. Everyone knows during an airline emergency you must place an oxygen mask on yourself before helping others. So why don’t caregivers follow the same advice?

The recognition of caregiver stress is the first step towards reducing it. Caregivers must honestly ask themselves. Do I get enough rest? Do I verbally or physically lash out at my loved one? Do I sometimes feel sad or guilty about my care?  Has my use of alcohol or tobacco increased?

A caregiver must learn they cannot change the behavior of a person suffering from dementia. They must be able to distinguish between what is within their power to change and what is not. Frustration is a warning sign the caregiver is trying to change things that will not change.

It’s important for the caregiver to set realistic goals like making doctor’s appointments, taking steps to keep their loved one from wandering, or helping a family member write memoirs. A caregiver can ensure their own health by accepting what they can change, finding peaceful ways to enjoy time with their loved one, and providing as safe an environment as possible.

Our Guest Blogger this week is Tom Knight, Center Director, Texas AHEC East – North Central Region.

Reference

Shultz, R. & Beach, S. (1999). Caregiving as A Risk for Mortality: The Caregiver Health Effects Study. JAMA, 282, 23, 2259-60. Copy of text available at http://www.ucsur.pitt.edu/files/beach/JAMACaregiving1999_000.pdf

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Image source: Image appears on several web sites but unable to locate original source.

 

 

gypsyPatients and families are looking to you for information, guidance, reassurance and simple compassion. No doubt, you strive to meet all these needs as you juggle care for several patients, and administrative tasks as well. after discharge[1].

Today I am going to touch on three ideas to get the conversation started about how to engage patient care partners to be really active, trained participants in their loved ones’ care.

Let’s take the example of infections in the hospital.

Head – start with the facts

Get with the patient and the patient’s family members and share some facts prior to a hospital stay. Remind patients that hospitals and hotels are public places.  Infections are common, but preventable, especially with their help. Explain early signs of infection so that they are aware of what to look for.

Heart – connect with your patients

Have empathetic discussions with the patients and their care partners and open yourself up for help from them. Tell them it is OK to support your conscientious hand-washing practices by asking everyone who comes in the room to use gel or wash up. Tell them that they know the early signs of infection and that it is OK to call you anytime to alert you because it is better safe than sorry.

Hands – provide tools

You can start this process prior to a hospital stay by giving them advice to wash their bodies for several days before an admission/surgery with chlorhexidine soap. Once in the hospital, give them tools and jobs to do during the times when their loved one is resting and they could use something to control. Provide them with alcohol wipes and bleach wipes and tell them that throughout the stay it would be great for them to clean doorknobs, bedrails, the bed tray, the restroom bars. Your environmental services workers may do these things, but they can be done more. Tell them they can help their loved one by helping to wash the patient’s hands frequently, especially before meals. Remind them to continue these practices at home.

This is just one example of patient engagement that can assist hospital staff, give the patients some control, and prevent infections/readmissions. Want more ideas? See www.campaignzero.org.

Reference

[1] Curtiss, K; Foley, M; McWiliams, S. (2013) Safe & Sound Nursing Tools for Family Engagement and Patient-Centered Care. PartnerHealth. Lake Forest, IL.

Our Guest Blogger this week is Meredith Masel, PhD, MSW, UTMB Oliver Center for Patient Safety & Quality Healthcare.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Image Source: Together Wherever We Go. Published by Hal Leonard (HL.305330).

 

“And how we deal with death is at least as important as how we deal with life, wouldn’t you say?” – James T. Kirk, Star Trek II: The Wrath of Khan

The Knight discusses his future with Death

The Knight discusses his future with Death

Like Captain Kirk, many Americans think they can cheat death and avoid dealing with it – though most are happy to deal with life and many seek to live it as long as possible. And I daresay that most are hoping to live life to its fullest with passion and good health (just check out last week’s blog by Tony DiNuzzo –  http://wp.me/pH3Dx-fl).  Unfortunately, that is not the case for everyone and even if life is lived well – there is always an end. How do you want your life to end? Are you as passionate about how you want to die as you are about how you want to live?

Americans have the opportunity to declare how they would like to be cared for when they are dying or have a catastrophic illness that renders them incapable of making decisions. However, research studies have found the use of advance directives ranged from less than 50 percent of severely ill patients (AHRQ, 2003) to 67% in those over age 60 (NEJM, 2010). Studies do show that when an advance directive is available, patients generally receive the care they requested (NEJM, 2010). Advance directives come in a variety of formats – living wills, durable powers of attorney for health care, and ordinary written instructions.

I know I would rather make it clear to my spouse, my children, and my primary care provider what is important to me to continue life , what kind of life sustaining measures are acceptable, and when it’s OK to say “good-bye”. But this is frequently a difficult discussion – nobody wants to talk about dying. One method I found that gets the discussion started is an online resource called “The Conversation Project” (http://theconversationproject.org/ ). It contains “starter kits” that help people identify their values and their wishes for the end of life and helps start the conversation with family and health care providers.

So, deal with death in a way that is at least as important as how you deal with life and help yourself, your family, or your patients make their wishes clear.

References

And… thanks to my doctoral student, Carrie Simmons, for her research on advance directives.

Our Guest Blogger this week is Linda R. Rounds, PhD, RN, FNP, Professor, UTMB School of Nursing.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Image source: The Seventh Seal. Allan Ekelund (Producer), Svensk Filmindustri, 1957  (http://www.imdb.com/title/tt0050976)

“My friend is a wonderful example of this; he’s perpetually youthful in his thoughts, actions and interactions; he truly seems ageless. So many people have accepted that ‘aging’ is inevitable, and go about their lives living out the programs, beliefs and ideals that our parents, families, teachers, society socioeconomic background, etc., instilled in us. Too often, those programs are negative, and virtually ignore the unlimited source energy of our authentic self.” – Aleta St. James (http://www.aletastjames.com/forget-aging-lets-all-be-ageless)smokin at 100

I’m not exactly sure why this struck me at this particular time to say good-bye to the thought of aging.  Maybe it’s because I’m in post-holiday blues and want to find things to feel good about.  Maybe it’s because I just got married and want to live forever with the love of my life.  Or maybe … well maybe just because.   I agree with Ms. St. James and the idea of aging as being portrayed too often as negative and limiting.    How about the idea of having children at age 50 as Ms. St. James has done?  Some feel it is not fair to the child to have such ‘old parents.’  What of child maybe at age 10, introduces her mother and is asked, ‘so that is not your grandmother?’  If raised with insight, love and mindfulness, the child will respond in ways that show there is nothing unusual or strange about having an “older parent.” Will the “older parent” have the stamina and strength to cope with the demands of parenting if faced with inevitable declining health?  That is usually the issue raised.

Another way of saying this may be “what’s age got to do with it?” – to paraphrase a line about love.   And if that is too much for you, than how about toning it down and just “living to the fullest?” Passionately, regardless of age?  Heck, why even place a description on aging at all?  It’s funny that if you Google terms about the refusal to give in to “aging” they are usually written by people in their 40’s or 50’s.  Well folks, I hate to tell you this, but that ain’t aging.  Not in the way those in the field of caring for older patients may define it.  That is more about a midlife crisis.  The need for good health care provided by Geriatricians usually won’t even be considered unless you are 70 or older.  And providing a chronological age to the caring for an “older adult” is more about policy and the need for age-related guidelines and standardization of care.

One reason we are compelled to say something about how we grow older may be the need to be aware of living well with the time we have left.  I have noticed more of my friends, most in their 50’s and 60’s doing things that they would not have dreamed of doing years ago.  I also notice that I am attending more memorial services for friends who have passed away – many way to young.  So what did “age” mean if their lives were full or not?  If they achieved what they hoped to before their time was done?  It meant nothing except in ways that would define the age of retirement, becoming eligible for an annuity, social security or a discount at the local grocery store or Luby’s.  I was told I can get a 10% discount at Kroger’s since I’m over 55.  Well let me just run over there and get my discount.  Please!!  Before you know it, I’ll be hanging out at the local donut shop complaining about the government!  Oh oh!  I think I’m getting into that old habit of portraying some bad stereotypes of ‘old’ people’.  You see, it can’t be helped.  You start feeling ‘old’ (whatever that is) and then before you know it, you’re old.

Think I need to get my surfboard out and hang some 10 down at Galveston beach.  The waves are looking good! I love seeing the look on the teenagers’ faces!

Our Guest Blogger this week is Tony DiNuzzo, Ph.D., Director, East Texas Geriatric Education Center/Consortium, UTMB.

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

The WordPress.com stats helper monkeys prepared a 2013 annual report for this blog.

Here’s an excerpt:

A New York City subway train holds 1,200 people. This blog was viewed about 4,800 times in 2013. If it were a NYC subway train, it would take about 4 trips to carry that many people.

Click here to see the complete report.

Seen while on a film shoot in Jamaica. A Medical Clinic open only on Tuesdays and Thursdays.

Seen while on a film shoot in Jamaica. A Medical Clinic open only on Tuesdays and Thursdays.

Latin America, like every other region in the world, is experiencing the effects of population aging. However, aging in Latin America has unique characteristics and these characteristics point towards aspects of aging where most attention from healthcare providers and most attention from policy makers and advocates is required. In Latin American and the Caribbean, populations turning 60 years of age after the year 2000 will be particularly fragile because they survived unfavorable conditions in early childhood. Most countries in this region are developing and experienced rapid mortality decline beginning in 1930 or 1940 that was characterized by the spread of medical knowledge and technology and to a much lesser degree, by improvements in standards of living. This mortality decline, added to changes in life styles and exposure to substances, produced three outcomes: first, a decrease in the level of communicable diseases and a corresponding increase in the proportional contribution of non-communicable conditions; second, an increase in frailty of cohorts born right before, during and shortly after the implementation of medical advances; and third, a persistence of communicable diseases because root causes like limited access to clean water, poor education, and insufficient health coverage and health services that can provide preventive measures, still prevail.  These outcomes put vulnerable populations, such as older adults, at higher risk of disease, disability and mortality.

These demographic characteristics of aging in Latin America place older adults in a very difficult situation. Despite the protective role of extended families in the care of older adults, specialized care is limited and policies targeted at protecting vulnerable older adults are limited and take a long time to get implemented. The number of Geriatrics programs is limited and the shortage of Geriatricians is one of the largest compared to other regions in the world. Even worst, there are many countries in Latin America that don’t have Gerontology programs. The number of healthcare providers trained in the care of older adults is therefore very limited and unlikely to improve in the near future.

In a globalized era like the one we currently live in, regional problems like the one presented above have a toll not only on the region but worldwide. The US Census projects that Hispanics will be the largest population group in the United States in the near future. This group will bring all the problems previously presented and pose an important health challenge for developed countries where migration usually occurs.

As researchers and healthcare providers we need to study these problems and conduct cross-national comparisons that may help us design policies and interventions that can help older adults have better quality of life. As a society we are not ready for the Aging Revolution that is coming upon us. Even worse we are assuming that aging follows a single pattern around the world. We must understand the unique characteristics, different countries and regions have and develop our interventions based on these unique characteristics.

This week’s Guest Blogger is Rafael Samper-Ternent M.D., Ph.D. He is currently a researcher at the aging institute at Javeriana University in Bogota, Colombia. Previously he was a fellow at the Sealy Center on Aging at UTMB.

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

References

  • Palloni,A., & McEniry,M. (2007). Aging and health status of elderly in Latin America and the Caribbean: preliminary findings. J.Cross.Cult.Gerontol, 22(3), 263-285.
  • Palloni,A., Pinto-Aguirre,G., & Pelaez,M. (2002). Demographic and health conditions of ageing in Latin America and the Caribbean. International Journal of Epidemiology, 31(4), 762-771.
  • US CEnsus Bureau 2010
  • Wong,R., Espinoza,M., & Palloni,A. (2007). Mexican older adults with a wide socioeconomic perspective: health and aging. Salud Publica de Mexico, 49 Suppl 4 S436-S447.

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