Resilience

The 19^th biennial Hawaii Pacific Gerontological Society (HPGS) conference theme, Converging Paths, Building Resilience, kicked off with a keynote address, Rethinking Older Adult Volunteer Engagement – From Nice to Necessary, by Mikel Herrington, Office of Field Liaison Director at Corporation for National and Community Service (CNCS) and Acting Director of Senior Corps.  

In his first trip to Hawaii, Herrington donned an Aloha shirt and talked story about growing up in rural South Carolina with a single mother and great aunt Dixie who moved in to help with childrearing.  This experience instilled the value of an intergenerational household and older adult engagement.  

Senior Corps engages older adults age 55+ through three programs: Foster Grandparent (FGP), RSVP (Retired and Senior Volunteer), and Senior Companion (SCP).  Most volunteers are younger than age 65, average 9 years of volunteering, and enjoy increased life satisfaction and better health.  

CNCS Hawaii Program Director Derrick Ariyoshi moderated Panel Discussion—Unleashing the Potential, after showing an inspiring and heartwarming video of Senior Corps volunteers, Foster “Grandma Pearl" Rodriguez and RSVP teacher Lynette Kumalae who mentor children from homeless families in Waianae, and MC Rankin who is Senior Companion to an older man who is blind.  The connections fostered are mutually rewarding.

Communication and Barriers to Senior Home Modifications, presented by Michael Dowell, owner of Stay At Home Modifications and star of Fall Prevention (aka “Get this HAOLE out of my house!”).  Senior resistance to home modifications include not wanting home to look like a hospital and visual reminders of getting old.  He provided the following tips:

·         communication: ask open-ended questions to engage/get answers to understand older people, exercise patience and compassion, offer choices whenever possible; do not order/assume

·         awareness and acceptance of home modifications: explain impact of modifications, start with small changes like daylight bulbs, ask if know of friends who have fallen (if none or don’t think it will happen to them, respond that you want to keep it that way by making home safer)

·         funding: many no/low-cost “common sense” modifications like remove rugs, improve lighting, non-slip socks ($6), nightlight, declutter (better to give away while alive to see appreciation of recipients), rearrange furniture, move cords, Project Dana covers costs of grab bars/hand rails

Dowell noted the Greatest Generation, who experienced economic deprivation during World War II, and especially immigrants, tend to make do with what they have—saving for kids instead of spending for self—which he finds “heartbreaking.”  Here, I wondered whether home safety modifications could increase home value to benefit current (elder) and future owners (elder's kids)?

Hawaii State Department of Health released a couple of senior fall prevention videos describing 4 fall prevention tips:

1. review your medications with doctor/pharmacist yearly – especially if you take 4+ meds as side effects can cause dizziness that leads to falls
2. check your eyes annually – cataracts (cloud)/glaucoma (floater)
3. make your home safer by removing fall hazards, improving your lighting
4. exercise regularly to increase balance and flexibility

 

Mahalo to all-volunteer HPGS Conference Committee members!

Rethinking and Reframing Our Communication with Older Adults: A Lesson on Microaggressions for Service Providers, presented by University of Hawaii (UH) Professor Loriena Yancura.  Microaggressions = new prejudice, targeted toward socially marginalized groups, often invisible to perpetrator and victim because they are subtle; examples of 3 types of microaggressions applied to ageism:

1.     micro-assaults: violent verbal/nonverbal attacks meant to hurt intended victim; e.g., old man, gramps, geezer

2.     micro-insults: convey rudeness, insensitivity and demean recipient; e.g., commercials suggest older people are out-of-touch

3.     micro-invalidation: exclude, negate or nullify thoughts, feelings or reality of recipient—e.g., “things must have been really different back in your day!”

These have negative effects on target’s self-concept, health and well-being.  How we can protect ourselves:

·         Perpetrators: be conscious of your words and their underlying assumptions; apologize if necessary and appropriate; learn from your mistakes

·         Targets learn to be “recipients” v. “victims”: be self-aware of your feelings (mindfulness helps); educate your perpetrator (only if it’s worth your time); don’t take it to heart 

Yancura invited us to check out her research brief, Recognizing Microaggressions: A Framework for Helping Grandfamilies. 

Hawaii’s Older Adults and Their Families: A Demographic Profile, Eldercare and Paid Family Leave Policy, presented by UH researcher Hua Zan. Compared to mainland U.S., Hawaii’s age 60+ population:

·         larger %age of older adult population: 21.5% versus 19.5% in U.S.

·         increasing life expectancy

·         53.5% Asian + 28.2% White (versus 3.7% Asian + 83.7% White in U.S.)

·         higher %age of foreign-born population: 24.3% (versus 13.3% U.S.)

·         higher %age not speak English well or at all: 16.3% (versus 6.3% U.S.)

·         more college educated: 28.4% (versus 25.3% U.S.)

·         more in labor force:  31.2% (versus 28% U.S.)

·         lower home ownership: 77.7% (versus 81.3% U.S.)

Hawaii's challenges such as high cost of living, dearth of long-term care (LTC) services and multigenerational households (e.g., Gen X working families face combined pressure of caring for their children and aging parents/relatives) make unpaid leave for caregiving not financially sustainable.  Hawaii can join other states (California, Rhode Island, New Jersey) that have enacted successful paid family leave laws (also broadening definition of family to include an employee's aging parents).

Advance Care Planning in Hawaii: Where We Are and Where We’re Going featured presentations by health insurance providers (Kaiser's "know me first, treat me second"; Hawaii Pacific Health's "what matters most") and Jeannette Koijane of Kokua Mau's "Let's Talk Story."  As of January 1, 2016, Medicare began reimbursing healthcare providers for advance care planning discussions face-to-face with Medicare beneficiaries.

Ibasho: Elders as Agents of Change by Emi Kiyota, President and Environmental Gerontologist of Ibasho.  Kiyota founded Ibasho (“a place where one feels at home being oneself”) in response to the challenges of caring for unprecedented numbers of elderly in our society, and reducing the vulnerability of elderly populations affected by climate-related natural disasters to strengthen community resilience.  It promotes the social integration of elders by partnering with local communities where elders find opportunities to contribute their wisdom; for example, Ibasho cafes have formed to respond to 2014 typhoon in Philippines and 2015 earthquake in Nepal.

Sustainability and Resilience for a Super-Aging Society: 21^st Century Strategies in Japan moderated by Cullen Hayashida, who noted Japan is the most rapidly aging society on earth, facing growing workforce shortages with implications on economic growth and sustainability; Korea is just behind Japan in population aging.  Strategies to address worker shortages:

1.     postpone retirement age

2.     increase women in workforce

3.     increase births – anyone interested? (audience laughter)

4.     increase immigration

5.     promote emigration

6.     technology

7.     active aging initiatives

8.     community development – Ibasho

9.     enhanced training of healthcare workers

The Best Friends Approach to Dementia Care: Finding Success as a Care Partner by David Troxel, who mentioned his book was featured in Still Alice film starring Julianne Moore. The Best Friends Approach is about hugs v. drugs:

·         rethink relationship as best friends=equals

·         develop empathy

·         know and use life story

·         communicate: compliments, simple choices, ask opinions, slow down, speak up, be present

·         activity: do things together

·         develop the knack: art of doing things with ease, build self-esteem

·         30 second rule: save time if person likes and trusts you, person will cooperate; be less task-oriented, more person-oriented

In Developing a Dementia-Capable Healthcare System – Not an Aspiration but a Necessity, Dr. Joshua Chodosh mentioned the work of dementia care management = 80% psychosocial + 20% medical.

Hawaii’s fastest growing population is seniors age 85+, and about half of this population is at risk of developing dementia.  UH Center on Aging’s Hawaii Alzheimer’s Disease Initiative (HADI) has trained Memory Care Navigators to offer guidance and support for persons living with memory loss, their caregivers and families.  In addition, HADI has partnered with Kokua Mau for Let’sTalk Story Program to present topics on dementia issues. 

HPGS President Percy Ihara moderated Panel of HPGS Original Founders: 

·         Anthony Lenzer, first director of UH Center on Aging (which produced 13 one-hour video series, Growing Old in a New Age), talked about Healthy Aging (which State decided not to continue funding last year) and palliative care

·         Kathryn Braun, UH Public Health Professor who is lead evaluator for Hawai‘i Healthy Aging Partnership and co-author of Adversity and Resiliency in the Lives of Native Hawaiian Elders, recalled Gray Panther founder Maggie Kuhn at 1982 HPGS conference, inventing awards (which she wanted to call the “Gerries”--instead of mouthful Na Lima Kokua Ma Waena O Makua Awards)

·         Barbara Kim Stanton, AARP Hawaii State Director, talked about need for advocacy to respond to worse funding in aging field over last 2 years, and need to look at life transitions beyond age 50+ because one can become disabled at any age

·         Cullen Hayashida, founder of Kupuna Education Center at Kapiolani Community College (which saw its demise in the past year) talked about need for different groups reaching consensus in asking legislature 

It’s Just Aging: A Story About Growing Up! (December 2015) co-author Colby Takeda.  Book touches on sensory impairments so could easily be titled, It’s Just Disability!

Conference ended with Life & Happiness 101 by astrologer Alice Inoue, who presented 3 “positive mindset” principles:

·         get stuck in positive Tetris effect: at end of each day, think of 3 “good” things that happened to you; over time, you will rewire your brain to notice more opportunities

·         use Losada Line to inspire: 3 positive interactions needed to cancel out 1 negative interaction, so offer more appreciation so people will respond differently

·         use “counterfacts” that make you feel fortunate (rather than helpless) when you encounter challenges for greatest success
Inoue seemed to define happiness = positive mindset (perception).

Instead of constantly tweeting excerpts from a conference in progress, I prefer to pause + reflect before sharing my post-conference thoughts:

·         Though I have lived most of my life outside Hawaii (after running away as teenager to attend mainland college), and always felt like an outsider (as child of immigrant parents) among locals, I am grateful for the influence of my formative years growing up in multicultural, multigenerational Hawaii and its aloha spirit and respect for kupuna (elders).

·         Aloha = "the joyful (oha) sharing (alo) of life energy (ha) in the present (alo)”  This emphasis on sharing means caring (or “Sharon is Karen,” as Andy Bumatai says in closing on The Daily Pidgin series), or looking out for others (sometimes self-sacrificing, like Dowell describing parents saving for kids) and honoring reciprocity in relationships (kids have their turn providing for parents in old age).  62-year-old Bumatai lives aloha when he didn’t react to his cancer diagnosis by asking why “me”? Instead, when faced with adversity, he changes perspective – pretending instead of “me” has cancer, what if wife/kids have cancer? He also asks viewers that instead of typing messages on social media site, actually help someone – do stuff and put goodness in world to share! 

·         In contrast to the Caucasian perspective dominant in mainland U.S., Hawaii offers multicultural perspectives found in local humor (however politically incorrect) intended to humble everyone with an equalizing effect and promote respect for "everyday people ...we got to live together": part-Hawaiian comedians like Bumatai poke fun at ethnicities ("Hawaii Pidgin 101 – Ethnicities") and Frank De Lima at haoles (Caucasians) who are minorities (“Haoles Anonymous”); food (“haole food blues”); and aging (on turning age 66 – start “That’s the way things are” video at 1:28).  Since Asians are the majority in Hawaii, the influence of Asian culture's reverence for elders is strong.

·         As a gerontologist, it’s exciting to study aging in Hawaii with its diverse population of older adults who enjoy the longest life expectancy in the nation. Even with reports about women’s lagging life expectancy, Hawaii had the lowest overall mortality for women as well as the best scores for social support and economic (equality) context.  Hawai'i no ka oi!

·         Hawaii was in the vanguard with its Hawaii Prepaid Health Care Act of 1974 (stricter than Obamacare’s employer mandate), and could lead the nation if it adopts mandatory LTC insurance.  Hawaii’s Aging Network continues its public awareness campaign to build support for LTC social insurance program: 70% of seniors age 65+ are expected to require some form of LTC; limits on capacity of family members who currently provide 80% of care for frail elderly; constraints of Medicaid funding, etc. (Read UH Political Science Professor Laurence Nitz’s The Feasibility of a Long-Term Services and Supports Social Insurance Program for Hawaii: A Report to the Hawaii State Legislature.) 

·         During my visit in Hawaii, an elderly couple, married for 68 years, were temporarily reunited in the same care home, after filing a lawsuit challenging Hawaii state law that favors Medicaid clients over private-pay clients like 95-year-old Noboru Kawamoto and his 89-year-old wife Elaine.  Hawaii will need to figure out whether set-asides to ensure Medicaid patients have a bed in a care home trump civil rights of married couples who are private-pay. 

Happiness is appreciation for...

Indigenous system of caring, reciprocal relationship between people, places and resources from mauka (mountain) to makai (sea). Check out TED talk, Lessons from a thousand years of island sustainability, by Sam ‘Ohu Gon III, PhD.  

ICU World Conservation Congress in Hawaii's eco-friendly cardboard furniture.  At the conference, Hawaii Governor David Ige pledged to double local food production by 2030.  In Hawaii, the average age of a farmer is 60, and 85% to 90% of food is imported 2,300+ miles away.

PlasticFantastic? art installation of woman diving amid sea turtles, constructed of ocean debris collected from beaches, by Sustainable Coastlines Hawaii over last 2 years.

Hawaiian slack key guitar

Kalo (taro) identification & tasting in Waimea Valley 

    

Ahi limu poke & Saloon Pilot cracker (made with lard)

According to gerontologist Mara Mather and her research colleagues, older = happier due to “mellowing” of the amygdala (the brain’s emotional processing center): "with age, the amygdala may show decreased reactivity to negative information while maintaining or increasing its reactivity to positive information."  Related research found that older adults’ perceptions about trustworthiness might be skewed in a “positive” direction and thus make them more vulnerable to fraud. British journalist Ruth Whippman, author of America the Anxious: How Our Pursuit of Happiness Is Creating a Nation of Nervous Wrecks, is critical about Americans' pursuit of happiness and the role of social media in perpetuating this obsession. (Kudos to HPGS, which has a website but no Facebook, LinkedIn, Twitter etc. accounts, for maintaining liberation from social media that can disrupt learning process at conferences.)

 “It’s OK not to be positive all the time, and it’s unrealistic to believe that you can be happy every moment…That’s not a character failing; that’s a full emotional life.” –Julie Norem, psychology professor at Wellesley College, on The Tyranny of Positive Thinking Can Threaten Your Health and Happiness

Better to listen to The Guardian’s podcast of UTOPIA 2016/Guardian Live panel on How to Live a Happy Life for different definitions of happiness. And check out TED talk on My Philosophy for a Happy Life, by 17-year-old Sam Berns, who had progeria (accelerated aging) until his death in 2014: 

1.     Be OK with what you ultimately can’t do because there is so much that you can do …by making adjustments.

2.     Surround yourself with people you want to be around…appreciate your family, your friends, and your mentors.

3.     Keep moving forward.  Don’t waste energy feeling bad for yourself, acknowledge and do what you need to move on.

After HPGS conference ended, UH Sociology Department hosted a 2-day International Conference on Healthy and Resilient Aging: Exploring the Roles of Culture and Place.  I missed this to return to San Francisco...

Architecture and The City Festival: Resilient City by Design included screening of Concrete Love: The Böhm Family (2014), a documentary about a family of architects, including Pritzker Prize-winning architect Gottfried Böhm (now age 96) who continues his passion for creating “connections” in his designs.

Yes on I for Dignity

“Proposition I and the Dignity Fund it creates will ensure San Francisco seniors and adults with disabilities are able to live with dignity, independence, and choice in their homes and communities through policy change and sustained funding of services and support.” --The Dignity Fund Coalition 

Community Living Campaign Connector Marcia Peterzell greeted nearly 300 attendees to the kickoff for Yes on Prop I campaign at Western Addition Senior Center.  In July, SF Board of Supervisors voted 9-2 to place the Dignity Fund on the November ballot for voter support. If Prop I passes in November, it will provide a permanent source of funding (set-aside from General Fund, so no new taxes!) for seniors and adults with disabilities--modeled after successful implementation of the Children’s Fund (1991). 

Senior activist Jane Yamada, SF Aging and Adult Services Commission President Edna James, and Stepping Stone Adult Day Health Care Program Director Nicole Clause. 

 

Canon Kip Senior Center participants wear orange caps and staff seated at far right.  By 2030, the number of seniors in San Francisco is expected to increase by 100,000, or 25% of the population! To plan for this demographic shift, Dignity Fund would commit a steady increase in City funding to build a safety net to allow seniors a greater opportunity to age with dignity in their homes. 

SF Mayor Ed Lee, 64 years old, helped rally the crowd to support Prop I, while Bayview-Hunters Point Multipurpose Senior Services Director Cathy Davis stood in solidarity. 

Senior & Disability Action Executive Director Jessica Lehman reminded us that adults with disabilities combined with seniors age 60+ are projected to grow to 30% by 2030, and the need to be more inclusive like installing a ramp so speakers using wheelchairs can access the stage platform. 

SF Board of Supervisors President London Breed, who was raised by a grandmother in Western Addition public housing, voiced her support for Prop I and talked about her recent victory in persuading HUD officials to allow the City to pilot a preference policy in the subsidized housing lottery that would address displacement of residents in rapidly gentrified neighborhoods (such as out-migration of African-Americans in Western Addition who cannot afford to age in place).  Exciting development for applicants to 98-unit Willie B. Kennedy Apartments, affordable senior housing in Western Addition!

(Last month, HUD ruled that SF’s Neighborhood Preference law, co-authored by Breed last year, to prioritize neighborhood residents for affordable housing built in their neighborhood, could limit equal access to housing and perpetuate segregation in violation of Fair Housing Act.  In response, Breed and a delegation of City officials asked HUD to reconsider its decision, launching weeks of negotiations.  HUD wrote in its reconsideration: “HUD can support an 'anti-displacement' preference for 40 percent of the units, where residents from throughout the city are eligible for the preferences and where race is not considered in the selection process.")

Meals On Wheels of SF CEO Ashley McCumber engaged everyone to volunteer support for Yes on I, by displaying window signs, calling voters, distributing signs to businesses, distributing literature, being social media ambassadors, etc.

 

Karl Robillard, MOWSF Director of Marketing and Communications, spoke for shut-in clients in The San Francisco Chronicle article, “Prop. I seeks to help SF services keep pace with aging population”: 

“This is an issue we see as a hidden epidemic.  You can’t see the sheer number of seniors relying on city services because they are stuck in their homes. It opens up a really important conversation about the hidden epidemic of poverty and need among seniors.”