Sunday, June 28, 2015

Age awareness

June is Alzheimer’s and Brain Awareness Month:  About 95% of people with Alzheimer’s have the late-onset form, in which symptoms become apparent in their mid-60s.
At this month’s UCSF Dementia Research Education Symposium, UCSF Memory and Aging Center Director Bruce Miller said that California has 500,000 persons with Alzheimer’s Disease, the most in U.S.  While “normal aging” involves changes in brain structure, there is great variability in cognitive aging depending on modifiable factors: adiposity and obesity, chronic inflammation, physical exercise, vascular risk.  He also reminded us of the potential strengths of aging, including “increased generosity, creativity and wisdom.”
 
UCSF nurse Robin Ketelle emphasized dementia is a loss of brain function that affects memory, thinking, language, judgment and behavior (symptoms), and that occurs with certain diseases (causes), and “dementia does not mean a person is mentally ill.”  However, Alzheimer’s Disease, which accounts for more than half of all dementia cases, has been recognized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); the term “dementia” has been replaced with neurocognitive disorder in DSM-5 
  
June 15 marked the 10th anniversary of World Elder Abuse Awareness Day (WEAAD).  In San Francisco, WEAAD was more like a month-long observation. 
This month’s Senior & Disability Action (SDA) meeting featured Avoiding Elder Abuse panel discussion:
  • Jill Nielsen of Adult Protective Services (APS) has staff of 37 MSW workers, 3 nurses and case aides to respond to reports of suspected elder abuse; state law requires APS visit within 10 days, interview client alone; self-neglect represents 50% of APS cases; emotional abuse is hardest to investigate as law enforcement is not involved (reporting is encouraged, but not required).  APS can act only with consent of the victim, unless there is Penal Code violation.
  • Hyun-Mi Kim and Ana Luz Vazquez of API Legal Outreach: Hyun-Mi said that legal remedy alone does not solve client’s life situation, so they take a holistic approach by partnering with Asian Women’s Shelter for more comprehensive services (case management) and Office of Citizen Complaints to train police (appropriately respond to immigrant victims).   In response to SDA Housing Organizer Tony Robles, who argued that Ellis Act evictions are a form of elder abuse that causes trauma, Ana mentioned she filed a restraining order against a landlord for harassing a monolingual Tagalog elder.   
  • Prescott Cole of California Advocates for Nursing Home Reform (CANHR) discussed how predators use a familiar TV celebrity like Henry “Fonz” Winkler to repeat a reward message like “let your home pay you cash” to target vulnerable seniors, who do not investigate the risks of reverse mortgages.  Prescott noted that 10% of reverse mortgages go in default, which amounts to an expensive loan because predators skip telling seniors about the obligations of paying ongoing taxes, insurance, maintenance of home, etc.  He provided copies of CANHR’s Senior Scams Alert.
  • Lisa Nerenberg of California Elder Justice Coalition (CEJC) provided an international perspective on elder abuse: World Health Organization (WHO) and International Network for the Prevention of Elder Abuse (INPEA) study, Missing Voices: Views of Older Persons on Elder Abuse (2002), identified disrespect as the most painful form of mistreatment by older adults in all countries.  Lisa provided examples of how Asian countries, influenced by Confucian filial piety, use policy to strengthen families:  Singapore has a special court for older persons to compel financial support from their adult children, and China has an elderly rights law that requires adult children to visit their elderly parents.
At our Main Library, San Francisco Department of Aging and Adult Services (DAAS) hosted WEAAD with speakers and film screening.  Administration for Community Living (ACL) Regional Administrator David Ishida said APS now has a federal home in ACL’s Office of Elder Justice for data collection. Other federal level highlights: The Elder Justice Act, which marked its 5th anniversary in March, received $4 million in funding for the first time in fiscal year 2015.  This year’s White House Conference on Aging also included elder justice as one of its four priority issues. 
DAAS Director Anne Hinton welcomed San Francisco District Attorney George Gascon, who said his staff scheduled presentations at four local senior centers in recognition of WEAAD.

These welcoming remarks were followed by a screening of Alive Inside and discussion, which I skipped since I had another appointment elsewhere and I had already seen this documentary when it was released last year with filmmaker in-person. ...and then I just wanted to listen to my own playlist like glam rocker Todd Rundgren (who turned 67 this month): Hello, It’s Me (“It's important to me that you know you are free ‘cause I never want to make you change for me”). ((^_^))

The Forum at Grace Cathedral hosted Safeguarding the Golden Generation: Understanding Financial Exploitation, which featured a screening of Last Will and Embezzlement (2012) documentary.  Seniors lose an estimated $2.9 billion annually to financial abuse and exploitation.  Perpetrators exploit the vulnerabilities of seniors who may have dementia and/or depression.  In addition, older adults from the Depression era may be more trusting and socially isolated.  Abuse is underreported due to embarrassment or fear of losing independence (like being placed under conservatorship or nursing home if they’re found to have diminished capacity). 

A lively panel discussion followed the film:
·         Filmmaker Pamela Glasner made her documentary based on her father who had Alzheimer’s Disease.  While in a Florida nursing home, her father was deceived by a stranger who added his name to her father’s bank account and will, allegedly during a “lucid moment” that was witnessed by a beneficiary.  When she reported this financial elder abuse to the Florida police, nothing could be done (police told her “nice guy said he didn’t do it”) so Pamela made this film to create awareness of this issue.
·         Evans Law Firm attorney Ingrid Evans provided tips on elder abuse fraud protection
·         Communities Against Senior Exploitation (CASE) program manager and California Senior Legislature assembly member Shirley Krohn has proposed increasing fines from $1,000 to $25,000 for financial institutions that fail to report financial abuse.

What else can be done to prevent elder abuse? 

“Unfortunately, regulations are really not preventing the abuses.  Why On Lok has never had an abuse problem, either by an employee or the organization, is because it is based in the community, and it’s open to everybody.  We have no visiting hours. ... The advantage of that is that there is an outsider that goes in or visits. ... So there is constant in and out.  People, the community is very aware of what happens. … You’re not a nursing home on the outskirts where nobody sees you and knows what happens.  So the problems of abuse are much more difficult to detect and combat.” -- Marie-Louise Ansak, Founding and Directing on On Lok Senior Health Services, 1971-1996 (pp. 127-128)

To support this transparency and reduce social isolation so we can age safely, it helps to design our environments so we can live out and about in the community with good public transportation options for all ages and abilities.  

At last month’s Aging and Tech conference, I couldn’t get enough of IDEO designer Barbara Beskind so I was hoping to see her again (but didn’t) at IDEO’s San Francisco office, which hosted At Home With Growing Older (AHWGO) forum, Embolden Bodies – Human Centered Design For Independent Living.
Susi Stadler, AHWGO cofounder and architect who specializes in the design of age-friendly and intergenerational environments, welcomed an intergenerational audience to discuss “approaches, strategies and products that assist people to gracefully age at home.”  She called aging an extreme sport—both delightful and scary, that takes focus and work. 
Ideas from interdisciplinary panel:
  • Will Carey, Industrial Designer at IDEO, showed slides of products based on user experiences that fit into everyday like a tendon machine, guide for blind to navigate using vibration and sound, walkers with tennis ball material guides
  • Jennifer Carton Wade, Senior Occupational Therapist at Laguna Honda – advocates for occupational justice (ability to do what’s needed to live fully in the community) because aging is marginalized, especially in transportation and mobility; she is less gadget-oriented, preferring to empower people to do on their own so they do not feel deficient; she also provided Handy Tips for Remaining Home as You Age  
  • Tasneem Babul Rayani, Contributing Industrial Designer at AHWGO, emphasized addressing the real (versus perceived) problem and designing to use our bodies naturally like squatty potty 
One older woman in the audience asked that they “not design for, but with us, old people because you don’t know until you get there.”
Director Sheila Malkind invited the intergenerational audience to this year’s Legacy Film Festival on Aging: September 18-20, 2015 at New People Cinema! (I suggested that Sheila screen Dancing with Maria documentary about 90-year-old ballerina Maria Fux who challenges students of all abilities so they are "made to dance.")
Dr. Margaret (Peg) Miller and Lonnie Hinckley of St. Francis Episcopal Church hosted a Transportation Fair for Seniors and Persons with Disabilities, which included all-male representatives from local public and private options:
  • BART:  FREE BART field trips for 10 to 20 seniors (age 65+) in group to get familiar with BART (includes roundtrip fare, Senior Clipper Card, travel tote, lunch, station and car tour, outing of choice); 62.5% BART fare discount for seniors and persons with disabilities
  • SFMTA:  Muni fares will increase July 1, 2015 (senior fare from 75 cents to $1), but there is still FREE Muni for low-to-moderate income (up to $71,350 Bay Area annual median income level) seniors and persons with disabilities, FREE Shop-a-Round for seniors, persons with disabilities, or eligible for ADA Paratransit; FREE Van Gogh Shuttle for groups of seniors and persons with disabilities; check out Muni Access Guide 
  • Flywheel: mobile app or phone call dispatch to request taxis with ramp van, wheelchair accessible, can specify vehicle
  • Taxis (Luxor, Yellow Cab):  will serve every neighborhood
  • Ride “sharing” platforms: did not address access for blind iphone users, riders with service dogs and wheelchair users, which is ongoing concern especially with City’s proposal to privatize paratransit and subject of discrimination lawsuits under Americans with Disabilities Act
  • Private door-to-door transport 
  



DeSoto Cab rebranded as Flywheel Taxi & inside paratransit van