Tuesday, March 31, 2015

Aging in America 2015 conference highlights

Last week I attended American Society on Aging (ASA)’s Aging in America (AiA) conference, held in Chicago for the second time in three years. I was happy to return to Chicago, former headquarters of Andersen (brand name was revived last fall—almost ten years after the Supreme Court overturned the firm’s 2002 criminal conviction) and where I attended annual training during my Arthur Android (“think straight, talk straight”) years...so I associate Chicago with learning, nowadays through ASA, which will be back in Chicago for 2017 AiA conference.  

Kudos to ASA for making this annual conference accessible by offering free registration to student volunteers (new!) and discounted registration to other volunteers (very helpful to those of us who work in nonprofits with limited training budgets)!
Day 1
For 2015 AiA conference, I took a red-eye flight (using frequent flyer miles), returned to stay at Hostelling International ($32 per night)...and then trekked a mile through snow, rain and sleet to the conference site at Hyatt (avoided $219 per night) for Monday morning’s mandatory volunteer orientation to reacquaint myself with the floor levels by colors:  silver, blue, green, bronze and gold.  New this year was scanning name badges (instead of sign-in sheets) for continuing education credit so session attendees received credit only if they entered session room within 15 minutes after start time to be scanned in, and then remained to be scanned at end of session. Also new was at least one men's restroom temporarily converted for gender-neutral use (with black curtain hiding urinal stall), which was very practical because more women attend conference. 
Rock and Roll Legends Reflect on Aging, Making Music and Living Life: With youtube clips, Roy Earnest (Corporation for National and Community Service, Oakland) talked about intergenerational connectedness (Adele’s cover of Bonnie Raitt’s “I Can’t Make You Love Me”; Grateful Dead bassist Phil Lesh performing with his two sons in his San Rafael restaurant; Carlos Santana functioning from center of his heart “so he’s never out of style"); Janice Blanchard (Aging Better Together, Denver) discussed ageism and female rockers (contrasting 56-year-old Madonna and 60-year-old Annie Lennox “acting your age” at last month’s Grammy Awards, which reminded me of continuity theory of aging; 82-year-old Yoko Ono responding to critics, “Please don’t stop me being the way I am.  I don’t want to be old and sick like many others of my age”); and Pamela Braverman Schmidt (Bunker Hill Community College, Boston) explored rock musicians branching out into other creative genres (Patti Smith’s photography, David Bowie’s acting, Neil Young’s environmentalism, Bob Dylan’s poetry). 
Shame in Aging: psychiatrist Angela Smith reviewed aging in a developmental context, noting the most intense psychosocial drivers are avoid shame (appearing old, asking for and receiving help, and feeling useless as a result of marginality) and desire for connection; social worker Paula Seefeldt and volunteer support director Denyse Kapelus talked about Irene Zola’s founding of Morningside Village (New York) enlisting volunteers to offer friendship and informal help to elderly neighbors free of charge (unlike other village models that charge membership fees).  Their Lifeforce in Late Years (LiLY) website includes a wonderful resource on How to Build an Eldercare Village.
Chicago-based Mather’s More than a Café Chorus performed at the opening general session. ASA Chair Lynn Friss Feinberg welcomed 3,000 registrants from all 50 states plus Puerto Rico, and 15 countries. 
Jennie Chin Hansen received ASA Hall of Fame Award for her advocacy and leadership to improve the lives of older adults—notably her almost 25 years at On Lok in San Francisco, where she led push to enact 1997 federal law that incorporated On Lok’s long-term care model into the Program for All-Inclusive Care for the Elderly (PACE), a Medicare and Medicaid program now operating in more than 30 states!
In Disruptive Aging, AARP CEO Jo Ann Jenkins said instead of aging, focus on living—sounding much like Ilya Mechnikov, who said “We must continue living, not age-ing.” 
In Maturity Re-Imagined, Age Wave CEO Ken Dychtwald said maturity is about more than aging, but purpose and legacy (giving back).  His survey indicated that health is the most important ingredient to achieve a happy retirement. 

Day 2
My volunteer assignment as room monitor on Day 2 helped reduce overchoice dilemma and broaden my horizons to attend sessions that I had not previously considered.
Vital Involvement in Affordable Senior Housing: The Creative Approach:  after meeting at an ASA conference, Linda Duncan of AHEPA Management Company (Indiana) and Helen Kivnick (Minnesota), co-author of Vital Involvement in Old Age (1986)began a collaboration to enhance creative wellness among 4700 residents of HUD 202 housing based on the minimax principle: minimize obstacles by maximizing supports for and emphasize resident’s strengths to focus on what the person has and can do. AHEPA Services Coordinator Betty Montgomery provided an example of this strengths-based problem-solving: 
  1. identify personal need/problem: lack of movement among residents with arthritis and their lack of exercise that increased pain when moving
  2. identify gaps/obstacles in environment: misinformation about managing arthritis pain 
  3. identify supports in environment: Service Coordinator invited arthritis pain speaker who provided solid information to dispel myth that people with arthritis should avoid exercise
  4. identify personal skills/interests/values: residents wanted to be more active and involved in daily life so they learned movements and exercise strategies to maximize muscle strength and to minimize pain
Use of Online Dementia Care Training in a Live Classroom Setting based on Alzheimer's Association essentiALZ® certification through CARES online (available 24/7 on staff’s own time with compensation) and in-classroom (not more than 30 minutes, face-to-face interactions, group problem-solving, Q&A).
Open Windows: Older Adults Sharing Life Experiences presented by Senior Learning Network founders Ellen Ervin and Lynne Beachner incorporating Zoom video meetings with Sheila Finkelstein, author of Technology for Seniors Made Easy, Melva Stein (former Peace Corps volunteer in Malawi), and Bibi (“Belgium Anne Frank”). 
Took a quick break to see Ai-jen Poo, author of The Age of Dignity: Caring for a Changing America (2015), since I missed her book tour in San Francisco last month.
How to Use Technology for a Positive Aging Experience:  Arthur (former CPA) and Bonnie Kupperman (former journalist) demonstrated their website, My Senior Portal, originally developed for Arthur’s 95-year-old father, to engage (create and maintain personal records and information), enjoy (participate in online games, read jokes), and educate (learn health information, housing and caring services).
The Upside of Aging: A New Culture of Health, Productivity and Purpose: Paul Irving was an attorney who launched his encore career as Harvard Fellow and then became Chairman of Milken Institute Center for the Future of Aging and author of The Upside of Aging: How Long Life Is Changing the World of Health, Work, Innovation, Policy and Purpose (2014).  
Pinchas Cohen, a pediatrician before he became Dean of USC Davis School of Gerontology, discussed making personal and societal changes to improve health: smoking (stop), sedentary lifestyles (“sitting is the new smoking”), diet (legislate labeling, though don’t know best diet), and Alzheimer’s risk (avoid by diet, exercise and staying engaged).  
His healthy aging advice was not “one-size-fits-all,” but personalized aging, and suggested a longevity calculator to calculate biological age.  Fernando Torres-Gil, Director of the Center for Policy Research on Aging at UCLA, commended session’s pharmacy sponsor for going tobacco-free last year. 

Day 3
National Perspectives on Mental Health and Aging Policy:  SAMHSA Project Officer Marian Scheinholtz, ACL Administrator Kathy Greenlee, Rush University Director of Health and Aging Robyn Golden, and Leaders Engaged on Alzheimer’s Disease (AD) Executive Director Ian Kremer.  SAMHSA and ACL have partnered to provide resources addressing behavioral health needs of older adults.  Robyn noted that historically AD was not part of mental health discussions; according to Alzheimer's Association, AD is not a mental illness but can cause symptoms related to mental health.  
Spirit of ’45 recognized the Greatest Generation including 95-year-old Elinor Otto, a “Rosie the Riveter,” who built the planes flown by these three Tuskegee Airmen.  She said work gave her a reason to wake up, and only recently retired when Boeing plant closed.
In Disabilities in Aging: A Future Redesigned, Fernando Torres-Gil said most of us are “temporarily abled” who may soon face the vicissitudes of the aging experience that include impairment.  Chicago-based Access Living CEO Marca Bristo talked about her own experience when she became paralyzed at age 23 after diving into Lake Michigan, and changing from the medical to social model so disability is a normal part of the human condition.  UC Berkeley Visiting Scholar Wanda Lieberman presented show and tell of universal design architecture examples. 
Legacy Film Festival on Aging founder and director Sheila Malkind of San Francisco at poster session. 
Gerijoy’s Victor and Brittany Wang of San Francisco married after meeting at last year’s ASA conference. 

Helping Lower-Income Seniors Maintain Financial Independence: Consumer bankruptcy attorney Eric Olsen founded HELPS http://www.helpsishere.org/ (Help Eliminate Legal Problems for Seniors) Nonprofit Law Firm to provide seniors who are judgment proof and with protected income (social security, disability, veterans benefits, ERISA retirement) an attorney who communicates with debt collectors to prevent collector harassment. 
Using Information and Technology to Improve Healthcare for Older Adults in the transition from episodic care to population health, presented by Jaewon Ryu of session sponsor Humana.  General sessions were opportunities for attendees to win a free ipad or AARP RealPad.
Gray Panthers’ Intergenerational Action Model: A Strategy for Social Movements and Change featured intergenerational panelists Jarmin Yeh (UCSF doctoral student), Brooke Hollister (UCSF Institute for Health and Aging), Carroll Estes (Board Chair of National Committee to Preserve Social Security and Medicare Foundation), and Paul Nathanson (Justice in Aging Special Counsel).  
In solidarity, we formed circle for Gray Panthers’ Growl: stand and raise both arms (reach toward peaceful world), open eyes wide (envision suffering and need), open mouths and stick out tongue (cry out against injustice), and growl three times!!! 
Martha Holstein, who attended Gray Panthers' session, provided promo code 4M15HLSTN, for 30% discount on U.S. orders of her new book, Women in Late Life: Critical Perspectives on Gender and Age (2015).
California Association for Adult Day Services received 2014 Rosalinde Gilbert Innovations in Alzheimer’s Disease Caregiving Legacy Award for Policy and Advocacy, based on its Success Through a Unified Vision: the Fight to Preserve Alzheimer's Care in California, which saved Adult Day Health Care (ADHC) from elimination as a Medi-Cal benefit in 2011 through a concentrated effort utilizing public interest litigation, grassroots advocacy and persuasive media stories.  

Day 4
In On the Rise: Prescription Drugs and Substance Abuse Addiction Among Elders, Certified Master Addictions Counselor Steven Moore (Houston) said that baby boomers have had more exposure to alcohol, tobacco and illegal drugs in their youth; prescription drug abuse is present in 12-15% of elderly who seek medical attention; more patients age 60+ are admitted to hospitals for alcohol connected problems than for heart attacks; 85% of older adults take prescription medication.
Let’s Talk Senior Poverty: What Are We Doing About It? same title, description and speakers as last year’s session.  Presenters Paul Nathanson (Washington, DC) and Kevin Prindiville (Oakland) from Justice in Aging use the power of law to strengthen government safety net programs like Medicare, Social Security, Medicaid and SSI to fight senior poverty.
In Transforming Communities for an Aging Society, Debra Whitman talked about creating "great neighborhoods for all ages," including age-friendly NYC's example of designating seniors-only swimming pool hours, in response to seniors who weren't comfortable splashing with younger ones.  She and Rodney Harrell introduced AARP Network of Age Friendly Communities and AARP Livability Index coming April 20th! 
In The Hidden Male, Friendship Senior Options Director of Lifestyles Michael McCann (Schaumburg, IL) explained The Male Journey, based on Joseph Campbell's Hero Myth Cycle and Richard Rohr's male spiritual journey, with three outcomes: Foolish, Angry or Wise.  When given freedom during retirement, men who "suck it up to be a man" seek opportunities to "explore, hunt and continue to grow." Activity programmers might get these men in the door by offering beer, steak and sports, and then engage them to get deeper in the aging process like naming highlights/celebrations and detours/disappointments in life journey, etc.
San Francisco Long-Term Care Coordinating Council member Cathy Spensley presented on Making San Francisco Age and Disability Friendly: A Collaboration Across Sectors  
Community Gardens in Senior Living with Kavod Senior Life Resident Care Coordinators Elizabeth Dubinsky and Dre Dufford showed us a video of their Denver retirement community garden and later engaged us in hands-on gardening activity. Though Kavod's vision was an intergenerational horticultural therapy program, its older gardeners did not want to share with children.  They primarily grow foodstuffs to use for congregate meals. 
Seed ball recipe: 1¼ cup dry terracotta clay + ¾ cup dry organic compost + ¼ cup assorted seeds + enough water so mixture binds together but doesn’t stick to hands; roll into penny-sized round balls & completely dry in sun, then throw seed balls into garden, water to allow seeds to germinate. Seed balls were a traditional method of planting for many Native American tribes.
Facing the Challenges of Oral Health Care for Seniors with Leonard Brennan, dentist and Co-Director of Harvard Geriatric Dental Fellowship Program, and his daughter Kathleen, a family practitioner (Maine), discussed age-prevalent oral conditions such as candidiasis (fungal infection) and xerostomia (dry mouth), which are associated with medication side effects.

Day 5 
National ForumSocial and Health Disparities in Aging Authors from the latest (Winter 2014-15) Generations journal appeared in person! 
UCLA Public Health Professor Steven Wallace on Equity and Social Determinants of Health Among Older Adults, and Health Foundation of South Florida's Martha Pelaez on Ending Health and Social Disparities (legislate access and resources to ensure tools and culturally appropriate support to manage health).
SAGE Executive Director Michael Adams on its National Resource Center on LGBT Aging, University of Washington Social Work Dean Emeritus Nancy Hooyman on Gender Inequities in LTC (caregiving's low status perpetuates gender-based health disparities across the life course; poverty and poor quality of life in old age is the price women pay for other people's dependence on them for caregiving, which is seen as a private duty rather than a service with "public value"; take Fair Care Pledge), and UW Social Work Professor Karen Fredriksen-Goldsen on Promoting Health Equity Among LGBT (still need protection from discrimination in employment, housing and public accommodations).
University of Hawaii Social Work Professor Colette Browne on culturally competent community programs (Ha Kupuna National Resource Center for Native Hawaiian Elders received ASA's Award for Excellence in Multicultural Aging), Willy Valencia on Diabetes in Older Hispanic/Latino Americans, Tim McNeill on African-Americans, and SFSU Gerontology Professor Darlene Yee-Melichar on Perspectives from Asian-American Communities.

March is National Nutrition Month:  Chicago Meat-In 
Cold weather burns calories, so I ate often to replenish calories lost due to Chicago cold.  Chicago-style food (hot dog, deep-dish or stuffed pizza, Italian beef) is hearty, though lacking in fresh local fruits and vegetables during December to April.
Hostel's DIY Chicago Dog Dinner: sport peppers and dash of celery salt
Farmer’s Fridge North Napa Salad ($7 for jar containing napa cabbage, mixed greens, avocado, organic red grapes, pistachios, dried tart cherries & balsamic vinaigrette) and “Fried Rice” (not pictured, but $3.75 for cauliflower, local peas, carrot, garlic, egg whites).
Exhibit Hall Reception 
Gilbert Award Reception 
Good Stuff’s Michelle Melt Free Range Turkey Burger ($6.98 included caramelized onions, swiss cheese, ruby tomato, lettuce on wheat bun with southlawn herb garden mayo) 
Al’s Italian Beef dipped in au jus ($4.55): Chicago food legend since 1938
Garrett Mix of sweet CaramelCrisp and savory CheeseCorn (free sample): Chicago tradition since 1949

Art in Bloom

Foliage loss due to snowy weather in Chicago had me yearning for horticultural therapy, so I headed over to a department store's flower show on its 9th floor ...perhaps closest I could get to being Up on the Roof ("it's peaceful as can be, and there the world below can't bother me," as Carole King sang).  

My love of gardening comes from my grandfather, a strong, silent type who seemed to express affection through gardening activities and eating together.  Being close to nature (plants) makes me reflective, so I reflected on conference remarks about seniors wanting their own time and space in NYC’s swimming pool and Kavod’s community garden.  I thought how different my grandparents were because we lived in an intergenerational household with no age discrimination.  I vividly recall accompanying my grandmother as her underage guest to a wedding and being told “no kids allowed” but my grandmother prevailed, and I found the wedding to be PG-rated except for alcohol. 

Five years ago, I re-lived that “no kids allowed” experience when I set foot in a senior center for the first time: when I walked through the entrance door with a sign stating that the facility was for seniors age 55+, several seniors approached me at the door asking for the purpose of my visit.  After I explained that I was visiting the nutrition class offered through City College, they approved.

Because I chose to attend the conference’s Health Disparities Forum, I missed the Senior Centers Summit scheduled at the same time.  However, for my gerontology class, I wrote a paper about reinventing senior centers for baby boomers, who are more involved with their children to stay young, and less comfortable with the age segregation of their parents’ generation.  Offering different models that include multigenerational community or wellness centers so there is something for everyone is vital.
Landmark Chicago Theater, Beaux-Arts style building from 1921.

Thanks to Marie-Louise Ansak scholarship, I completed an independent study on horticultural therapy to share with On Lok's adult day care program participants. Earlier this month in sunny and dry San Francisco, I presented my hands-on horticultural therapy project: container garden (intended for windowsill), infusion and sachet activities using organic herbs from the mint family to promote memory (lemon balm, rosemary, sage), relaxation (lavender, lemon balm) and digestion. Aromatherapy uses essential oils from herbs that can be inhaled and absorbed into lungs and nasal passages, entering the bloodstream and activating centers in the brain that affect mood, emotions and immune function.

Selected herbs originate from Mediterranean region, which has climate similar to San Francisco Bay Area: dry summer, mild winter.  Plant care is relatively low-maintenance SWAN:
  • Sunlight:  5 hours per day
  • Water:  once a week
  • Air:  ventilated to avoid powdery mildew
  • Nutrition:  feed fertilizer once every 6 weeks


  1. These Charts Show the Baby Boomers’ Coming Health Crisis
    Dave Johnson
    May 11, 2015
    Despite increasing life expectancy, the aging cohort is less healthy than the previous generation
    American Baby Boomers are more stressed, less healthy and have slightly less health care coverage than people in the same age group did a decade ago, according to data from a new report released by the U.S. Centers for Disease Control and Prevention (CDC).
    Exacerbating the potential for a crisis, those aged 55 to 64—the core of the Boomers—are living longer than their predecessors did 10 years ago…
    Percent of adults aged 55-64 with select chronic conditions
    Monitoring chronic conditions is essential for those aged 55-64 since diabetes, obesity and high cholesterol can increase the risk of illnesses like heart disease, the leading cause of death in the U.S.
    Percent of adults aged 55-64 reporting mild to serious psychological distress by income group
    Boomers at every income level reported an increase in moderate to severe psychological distress, except those making 400% more than those in poverty.
    Percent of adults aged 55-64 with health care coverage by income group
    Among those aged 55-64, the percentage with health care coverage slightly decreased in 2013 compared with the same age group in 2003.
    Despite increasing public coverage through the Affordable Care Act, the percentage of those uninsured increased for all income groups — except those in the highest-earning group — due to losses in private coverage. Only the wealthiest saw an overall increase in coverage during this interval.
    Top 5 causes of death, ages 55–64
    For every 100,000 adults aged 55-64, there were 77 fewer deaths than the same age group 10 years ago. That’s an 8% decrease—despite increases in chronic conditions and stress.
    While heart disease and cancer remain the two leading causes of death, they both claimed far fewer lives among adults aged 55-64 than 10 years ago. Chronic restrictive lung disease (CRLD) and diabetes saw smaller declines. Of the top five causes of death for Boomers, unintentional injury was the only to rise since 2003.
    The seeming paradox of a decrease in the number of deaths and the worsening of health is explained in part by Americans’ increased use of prescription drugs. Adults aged 55-64 are taking more drugs than ever before, with a 29% spike in the use of anti-diabetic pills and a 54% increase in cholesterol-lowering drugs.
    The trend toward prolonged treatment of chronic conditions signals how health-care workers and policymakers must prepare, in the coming years, for the largest-ever cohort to enroll in Medicare over the next ten years.
    Data is from the CDC special feature on adults aged 55-64, of the 2014 Health Report.

  2. More Than Three-Quarters of a Million Older Californians Are “Unofficially” Poor
    August 31, 2015
    Venetia Lai
    Nearly 1 in 5 adults over 65 in California — more than three-quarters of a million people — live in an economic no-man’s land, unable to afford basic needs but often ineligible for government assistance, according to a new study by the UCLA Center for Health Policy Research.
    The study, funded by the California Wellness Foundation, highlights the plight of the “hidden poor” — those who live in the gap between the federal poverty level and the Elder Index's poverty measure, which is considered a more accurate estimate of what it takes to have a decent standard of living. The Elder Index accounts for geographic differences in costs for housing, medical care, food and transportation. The national federal poverty level guidelines say a single elderly adult living alone should be able to live on $10,890 a year, while the Elder Index estimates that person in California on average requires $23,364.
    “Many of our older adults are forced to choose between eating, taking their medications or paying rent,” said D. Imelda Padilla-Frausto, a UCLA graduate student researcher at the center and lead author of the study. “The state might be emerging from a recession, but for many of our elder households, the downturn seems permanent.”
    According to the study, about 772,000 elderly adults in California who are heads of households belong to this group of hidden poor, which is more than double the number of elderly (342,000) who meet federal poverty level guidelines. Unlike the “official” poor, the hidden poor often do not qualify for public assistance.
    The study, which used 2009-2011 American Community Survey data and the 2011 Elder Index data, showed that in terms of sheer numbers, whites make up more than half of elders in the financially pinched group (482,000). Proportionately, grandparents raising grandchildren, older adults who rent, Latinos, women, and the oldest age group (75 and over) were the groups most affected.
    The invisible poor are throughout California
    Geographically, the researchers found that in all counties, between 30 and 40 percent of elderly adults who are single and 20 to 30 percent of older couples are among the hidden poor.
    The county groups with the highest proportion (40 percent or more) of hidden poor among households headed by single elders are rural: Nevada/Plumas/Sierra,Mendocino/Lake and Colusa/Glenn/Tehama/Trinity…
    Groups with large proportions and populations of hidden poor:
    • Grandparents raising grandchildren. Although a small subset of elder households, grandparents raising grandchildren are a particularly vulnerable group as neither the grandparents nor child is able to generate additional income to cover basic living expenses… • Older adults housing adult children. …
    • Single women who head households. …
    • Single elders head of households, age 75 and older …
    • Single elders who are renters or homeowners: Housing is one of the biggest drivers of economic insecurity, particularly for single elders. Almost 70 percent of single older renters have incomes below the Elder Index and more than half of those are among the hidden poor…
    The highest proportion of hidden poor among single elders who head households was found among African-Americans and Latinos (37.4 percent and 36.8 percent, respectively).
    The authors have recommended ways to address the needs of those living in the gap between the federal poverty level and the Elder Index, including: increasing and protecting income as is proposed in Assembly Bill 474 and the Supplemental Security Income Restoration Act; raising income eligibility limits for housing assistance and using former redevelopment funds for construction of affordable housing; helping seniors with the cost of health care by raising income eligibility to 200 percent of the federal poverty level, from 100 percent; and expanding and updating food benefits.

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  5. Horticulture therapy brightens the days of dementia patients on Sunshine Coast
    ABC Sunshine Coast
    By Kylie Bartholomew
    Posted 4 May 2016, 3:03pm
    Five older folk sit huddled around a patio table on a sunny Thursday morning. From the outside they look like any group of keen gardeners.
    But they are not. They have dementia. And this is horticulture therapy.
    Horticultural therapist Cath Manuel is using gardening to enrich the lives of patients living with dementia on Queensland's Sunshine Coast.
    Once a week she leads a group of up to six patients and two volunteers to plant seedlings or tend to a sensory garden at Carramar aged care facility at Tewantin.
    "If they've gardened a lot in the past, we give them pots and tools and they know exactly what to do," Ms Manuel said.
    "But some of the others in the group just need that help because from step one to two, they can sometimes forget what step one was."
    Ms Manuel said having a carer to patient ratio of 3:2 ensured the gardeners were not overwhelmed, stayed on task and had a tangible item at the end of the session.
    Volunteer Denise said gardening offered more than just therapeutic benefits.
    "There's a social element too if people want that to happen, but there's also the ability to sit quietly and work on something," she said…
    Ms Manuel said having the patients involved enabled a valuable sensory experience.
    "I can see them really just enjoying being in the moment of digging in the dirt. We could stand there for five minutes and just dig," she said.
    "I can see the change in them in their face, their smiles, and if there's a bird we'll stop and look at the birds or listen to the birds, or a plane will fly over so we'll talk about that.
    "It creates opportunities then for other conversations, and I can really see the physical change in them.
    "That's where I think that gardening is so beneficial. It's that connecting with nature."
    Step-by-step the key to reducing stress
    Ms Manuel said a step-by-step visual instruction card helped to mitigate any stress and was a handy reference tool for the gardeners.
    The activity is carefully planned and strategic.
    "Once all the pots are filled [with potting mix], we'll clean up the potting mix and then bring out the flowers, so that just helps to stop any confusion around any of the activities we're doing," Ms Manuel said.
    "We just don't want to overwhelm our gardeners with giving them too much to do."
    Increasing demand for therapy benefits
    A horticulturalist of more than 17 years, Ms Manuel said seeing the benefits gardening had in her own life had led her to explore the role it could play in helping others, specifically dementia patients.
    She completed an online course in Australia and pursued further professional development in the United Kingdom at the horticultural therapy organisation, Thrive.
    Ms Manuel said the potential for how horticultural therapy could be used in the community was exciting.
    "Gardening for dementia patients is a new, but a growing area because the number of memory support units is on the increase," she said.
    Ms Manuel said the scope for horticultural therapy in the community was exciting, with potential vocational, social and therapeutic, and rehabilitation benefits.

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  8. ‘To Age Is a Sin’: In Blunt Speech, Madonna Confronts Bias in Various Forms
    DEC. 10, 2016
    In the world of pop music, women are enjoying a moment of dominance. Beyoncé, with her towering album and short film “Lemonade,” rewrote the playbook (again) in April. Adele’s album “25” has soared since its release about a year ago, selling more than 10 million copies in the United States alone.
    The two artists will square off in the top categories at the Grammy Awards in February.
    But in a lacerating speech on Friday, Madonna — the highest-grossing female touring artist of all time, who in March wrapped up a tour that took in $170 million — resisted the notion that all was well and fair for women entertainers, particularly as they get older. Accepting a Woman of the Year award at the Billboard Women in Music 2016 event, the 58-year-old musician brought a hush over the crowd as she spoke in deeply personal terms.
    In the speech, Madonna said she had faced sexism, misogyny and “constant bullying and relentless abuse” over the more than 30 years of her career. She spoke about being raped on a rooftop with a “knife digging into my throat” when she first moved to New York many years ago, an experience she first discussed publicly in 2013.
    She also took pride in her ability to persevere in an industry that she said did not look kindly on older women singers. “People say that I’m so controversial,” she said to the crowd. “But I think the most controversial thing that I’ve done is to stick around.”
    In the world of music, she said, “to age is a sin.”
    “You will be criticized, you will be vilified, and you will definitely not be played on the radio,” she added. (Beyoncé is 35 years old; Adele is 28.)
    In substance, the speech was not, of course, entirely new for Madonna. She has challenged sexual norms through her music, image and writing since the start of her career, pushing for, as Camille Paglia — a cultural critic who has both supported and rebuked Madonna over the years — wrote in 1990, “young women to be fully female and sexual while still exercising total control over their lives.”
    Candor has always been one of Madonna’s hallmarks. In recent years, she has become something of a warrior against age discrimination, publicly rebelling, with few subtleties, against the notion that age should slow her down.
    …On Friday, in her speech, Madonna spoke about the rules of “the game” — the established ideas that she said women are pushed to abide by.
    “You are allowed to be pretty and cute and sexy, but don’t act too smart. Don’t have an opinion,” she said. “You are allowed to be objected by men and dress like a slut, but don’t own your sluttiness and do not — do not, I repeat — share your own sexual fantasies with the world.”
    Another unspoken rule for women, she said, even more important than satisfying the expectations of the men in their lives, was to “be what women feel comfortable with you being around other men.”
    Toward the end of her speech, she mentioned other groundbreaking musicians, including Prince and David Bowie, both of whom died this year. “But I’m still standing,” she said. “I’m one of the lucky ones.”

  9. With Age Comes a Mouthful of Trouble
    Paula Span
    THE NEW OLD AGE MARCH 23, 2017
    …Medicare has never provided dental care, except for certain medical conditions, and California’s Medicaid program covers only some services, at reimbursement rates so low that most of the state’s dentists do not accept Medicaid patients at all.
    …Many Americans find it difficult to obtain adequate dental care, but the problem is particularly acute among older Americans… Fewer than half of Medicare beneficiaries have visited a dentist in the past year, a rate that sinks to 26 to 28 percent at lower income levels.
    At the West Center, where the average patient lives on $850 a month, “they often haven’t seen a dentist in 10 or 20 years,” Dr. Becerra said. “They’d end up in the E.R. when the pain got unbearable.” She has seen patients who have pulled their own teeth.
    About 20 percent of Americans over age 65 have untreated cavities, the National Center for Health Statistics has reported, with cavities much more prevalent among blacks, Hispanics and Asians. Among those over age 75, a quarter have lost all their teeth.
    Still, better hygiene and fluoridation means more older people have more teeth to preserve, over lengthened life spans, than in the past. Decades back, “losing your teeth and getting dentures was the expectation,” said Dr. Stephen Shuman, who leads the Gerontological Society of America’s oral health group.
    Yet dental health gets more challenging at older ages. Gums recede, exposing roots to decay, and bone loss makes teeth less stable. Older people produce less saliva — particularly because they often take drugs that produce dry mouth — which also leaves teeth vulnerable to decay.
    Decades-old fillings and bridgework can crack or crumble. Regular brushing and flossing sometimes pose physical and cognitive challenges. “People who have worked a lifetime to maintain their teeth find them falling apart,” Dr. Shuman said.
    These difficulties arise precisely when most Americans are leaving the work force and losing employer dental insurance, if they had it. Medicare offers no help, and Medicaid, varying by state, generally pays skimpily for limited procedures.
    Preventive care actually lowers costs in the long run, researchers at the University of Maryland Dental School have reported. Though older people who receive preventive care like cleanings make more office visits, their care costs significantly less overall because they are less likely to develop problems requiring expensive treatments like root canals, said Dr. Richard Manski, a study co-author.
    Even patients with dementia can maintain their teeth, a University of Minnesota study has found. With treatment, education and follow-up care, older adults with dementia are no more likely to lose teeth than those without dementia.
    So efforts to bring more dental care to older adults are advancing on several fronts. “There are lots of pots bubbling right now,” said Dr. Shuman. “Oral health is an essential element of healthy aging.”
    • The West Center, which expects to treat 1,000 people at sliding-scale fees its first year, demonstrates the possibilities for public/philanthropic alliances….
    •…dental hygienists and dental therapists operate in a variety of settings, at lower costs, when state legislatures allow them sufficient autonomy...In 39 “direct access” states... But the permitted practice locations vary: Hygienists can work in nursing homes in Washington and Utah, but in Wisconsin, they cannot — yet. Some states allow them to visit homebound patients; others do not.
    • Dental school programs can help fill the gap…monthly screenings in senior centers in low-income neighborhoods.
    • Technology could also play a role….

  10. For those people whose relative are suffering from Alzheimer’s Disease and maybe reading this, I find it hard that people are still ignorant of herbal medicine when it comes to treating Alzheimer’s Disease.
    I have been through many phases over the last couple of years since my father's diagnosis, he was 53 years old and had Early Onset Alzheimer’s Disease and his diagnosis changed my life in many ways, I spend most of the time in denial and I keep thinking the tests were wrong. But deep down I knew they were correct. Though sharing his story is very difficult. He was always very successful in being able to accomplish anything he set his mind on doing. Alzheimer’s is a bitch of a disease. It began by robbing his recent memory, but it didn't stop there. It continues to steal, taking the most recent memories until it has pilfered all but the oldest memories, he experienced a decline in his ability to think, remember and make decisions. I feel a need to express my thoughts and feelings about how it affected his day to day living and how its deteriorated since despite the help of some wonderful medics and medicine.
    I remind myself how lucky to come across Charanjit rychtova's herbal medicine which is able to control this disease without any side effect, I felt a moment of relief hoping that he is free from this ailment, and nothing compares to the healing power of nature. Now I believe almost every health problem can be addressed in one natural way or another. The only thing I wanted was for him to feel better. I’m proud to say my Dad is Alzheimer’s free. You can also contact him for advice and more info. charantova@gmail.com