Live from Age-Friendly San Francisco

Livestreaming has the potential to make the world more accessible, especially for homebound people.  Starting with the Great American Solar Eclipse last summer, I’ve organized a few livestreaming watch parties in an older adult residential community.  Last month’s Power to Change symposium included closed captioning and the ability to ask real-time questions.  Then earlier this month, I organized a watch party of Supreme Court Justice Ruth Bader Ginsburg (author of 1999 Olmstead decision) being interviewed by Forward editor Jane Eisler, with ASL interpreter and questions submitted by viewers in advance. Each livestream came with technical audio-visual difficulties, along with complaints from mainly oldest-old (age 85+) residents who preferred face-to-face interactions than virtual learning.

As a lifelong learner and old soul myself, I reach out to local experts who can speak live from age-friendly San Francisco on a variety of topics that engage mature adults.   

Nostalgia for comfort food

Rachel Gross, Professor of American Jewish Studies at SFSU, presented a talk on Referendum on the Deli Menu: American Jewish Nostalgia and the Deli Revival about adapting traditional American Jewish comfort foods for the 21^st century, with an emphasis on sustainability and local sourcing.

Medical cannabis 

Donald Abrams, MD, Professor of Clinical Medicine at UCSF, presented a timely talk on Medical Cannabis. With the growing number of states legalizing cannabis for medical or recreational purposes, cannabis use among older Americans has increased significantly, despite a lack of biomedical, clinical, and public health research.  Cannabis remains illegal under federal law.  Because the Drug Enforcement Administration (DEA) has listed cannabis as a Schedule 1 drug (“high potential for abuse” and “no currently accepted medical use”) and has designated National Institute on Drug Abuse (NIDA)—part of National Institutes of Health (NIH)—as the sole source of cannabis for scientists, NIDA will not fund cannabis studies on its health benefits but only harm.  Yet, with funding from NIH, Dr. Abrams has conducted pioneering research on the safety and pain relief properties of cannabis for patients with AIDS and cancer.

Dr. Abrams suggested that cannabis-induced euphoria is not such a bad thing: “Is it really an ‘adverse experience,’ particularly in a terminal patient? Is a single treatment that increases appetite, decreases nausea and vomiting, relieves pain and improves sleep and mood, a potentially useful tool in oncology and palliative medicine?”  

During Dennis Peron Memorial Tour in Castro District (aka LGBT mecca), Green Guide Tours founder Stuart Watts showed a photo of himself with Castro resident Peron aka “Father of Medical Marijuana” who died last month at age 71. Peron advocated for medical cannabis, which helped his partner ill with AIDS ease pain and nausea. 

“Brownie Mary” Rathbun (1921-1999) met Peron at Café Flore in 1974.  Brownie Mary was an IHOP waitress, with a grandmotherly visage, who earned extra money baking and selling cannabis-laced brownies from her home.  Her customers were mostly gay men with AIDS, who found that cannabis helped them with wasting syndrome.  Later people donated cannabis to Brownie Mary, who then began baking more brownies and distributing them free to sick people.  She was arrested several times for possession of cannabis brownies.  Brownie Mary also volunteered at SF General Hospital’s AIDS ward, where Dr. Abrams worked as physician and became inspired to conduct the first study about the effects of cannabinoids in people with HIV. 

Thanks to the efforts of Peron and Brownie Mary, San Francisco passed Prop P, the nation’s first medical cannabis bill in 1991.  In the following year, they opened the San Francisco Cannabis Buyers Club, the first medical cannabis dispensary in the U.S.  In 1996, California became the first state to legalize medical cannabis with voter-approved Proposition 215. According to Peron, “Every cannabis user is a medical patient whether they know it or not.” 

Effective January 1, 2018, Proposition 64 (passed in 2016) allows licensed medical cannabis dispensaries in California to open their doors to recreational customers age 21+ who can purchase a limited amount (1 ounce) of cannabis without a current physician’s recommendation or medical marijuana identification card (MMIC, which can cost up to $100).  MMIC holders must be age 18+, may purchase higher quantities of cannabis, and do not have to pay sales and use taxes on their cannabis purchases. 

Social insurance

At Home With Growing Older hosted a forum on Social Security, Medicare and the Campaign against Entitlements, presented by Justice in Aging Executive Director Kevin Prindiville and UCSF Sociology Professor Emerita Carroll Estes, at SF Public Library.

Lifelong mothering

At Reinhardt Alumnae House, Mills College President Elizabeth Hillman and former College President Jan Holmgren hosted It Never Ends: Mothering Middle-Aged Daughters (2017) book reading and discussion with authors, Sandra Butler (age 79) and Nan Fink Gefen (76), who explored older women’s reflections on motherhood when daughters are in their 40s and 50s. 

Reverse Aging? 

Sutter Health Institute for Health and Healing hosted The Science of Healthy Aging with 51-year-old Sara Gottfried, MD, at Sherith Israel.  As one of the first 350 to register for this free event, I received a free copy of Gottfried’s book Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years (2017).  As an old soul who aspires to greater maturity, I was almost repelled by the title of this anti-aging book and its overemphasis on a youthful physical appearance rather than health.

Creative Aging 

At Contemporary Jewish Museum, met up with SFSU Gerontology Professor and Program Chair Darlene Yee-Melichar to attend Creating A New Old San Francisco, a one-day “deep dive into contemporary aging” by Creative Aging International (CAI).  She stands between journalist Paul Kleyman and fellow Gerontology Professor Emiko Takagi.

Event included resource table and networking opportunities.  Connected with Caitlin Morgan of Institute on Aging and Hope Levy of City College of San Francisco’s Older Adults Program.

Dominic Campbell, CAI co-founder and Global Brain Health Institute (GBHI) Fellow, described this mini-fest of contemporary aging about conversation, connections and “joining the complex story in the middle.”

Session 1 Overview – Issues in Contemporary Aging: “Why? Everyone attending brings expertise. To avoid telling people what they already know while articulating what makes contemporary aging unique, we asked these speakers to share knowledge from their experience, so we might begin to think together.”

San Francisco Bay Area speakers seated from right to left in photo above, and presented in the following order:

•     Carroll Estes, PhD, of UCSF and Nicholas DiCarlo discussed concepts from their upcoming An Encyclopedia of Contemporary Aging (expected to be published by Routledge in late 2018/early 2019): inequality, power, resistance, abjection, trauma, destruction of the commons, right to self-development, intergenerational, interdependence, austerity, gentrification, watch-bitch v. watchdog.

•     Susan Hoffman, Director of Osher Lifelong Learning Institute (OLLI) at UC Berkeley, spoke about Radical Aging: BELIEF that we can all self-actualize, KNOW that there are obstacles and limitations, WISDOM and experience to expand possibilities; our roles (pioneers & activists; researchers & translators; poets & philosophers; inventors & designers; educators; artists & amateurs); 25% of OLLI members are age 80+, calling OLLI the “4^th Age Salon.”  She highlighted influences through the decades (1960s: Marian Diamond’s brain plasticity research, Free Speech activism, White House Conference on Aging; 1970s: gerontology programs, Gray Panthers, The Center for Independent Living, American Society on Aging, On Lok, California Arts Council; 1980s: Age Wave, SeniorNet, Genome Research Institute, Association for Cultural Equity; 1990s: Encore, Multimedia Gulch, UCSF Memory & Aging, Walter Bortz’s Dare to be 100, Xerox PARC; 2000s: Osher Lifelong Learning Institute, Stanford Center on Longevity, Village Movement, IDEO, Elizabeth Blackburn’s telomeres research; 2010s: Age-Friendly Cities, Aging 2.0, GBHI Fellows).  She said we need to transcend divisive generation labels because we are all perennials!

•     Gretchen Addi, Consultant and Designer-in-Residence at Aging 2.0, on Technology and Business – Insider Awareness: recalled Jetsons family in 1962 living in the future—"what we take for granted today was the science fiction of the previous generation”; mentioned superpowers, like IDEO colleague Barbara Beskind who is seeking to design glasses and earbud for facial recognition as adaptive technology for her macular degeneration; new technology can improve lives of people as we age; called for shift to design with (not for) older adults, about people (not age group), interdependence (not independence); keep older adults mobile, engaged, healthy, connected; accessibility to avoid risks of exclusion and isolation if not tech savvy, privacy and security concerns. 

•     Bruce Miller, MD, Director of UCSF Memory and Aging Center, on Challenges of Dementia: epidemic of age-related cognitive impairment, most costly health problem in U.S. that especially impacts poor; 70% preventable risk factors (cardiovascular disease, high cholesterol, lack of exercise, loneliness, isolation, depression, head trauma), 30% neurodegeneration by aggregate bad proteins.

Session 2 The San Franciscan View – Innovations at Home: “Why? Aging shrinks geography, all successes are, ultimately, local. Great innovations are happening. This celebration of SF projects already ‘creating a new old’ shares some of the innovation in this city.”  Choice of two breakout sessions:

Room 1 – Caring Systems – how we live where we live: “Cultures of caring community being nurtured in SF.”  This session was chaired by Tim Carpenter, founder of EngAGE, a 20-year-old nonprofit that builds and operates affordable senior and multigenerational apartment communities as “vibrant centers of learning, wellness, and creativity.” 

·     Jerry Brown, CEO of Bethany Center Senior Housing, talked about his affordable housing site’s collaboration with partners (OnLok PACE, IHSS, IOA, Openhouse, etc.) to provide a continuum of care to diverse elders representing 37 countries and 8 languages. Housed at Bethany Center and modeled after Mather LifeWays, Ruth’s Table is a multigenerational community center that provides art and wellness programs, integrating senior residents with visitors of all ages from the surrounding community. 

·     Kate Hoepke, Executive Director of San Francisco Village (SFV), talked about social networks diminishing as we get older and face marginalization; in response, the village grassroots movement began 12 years ago to create intentional communities that are intergenerational to dignify aging.  She noted the greatest barrier is reluctance to ask for help, yet one needs to ask to get help.

·     Karyn Skultety, Executive Director of Openhouse, introduced her organization as the 1^st LGBT-welcoming affordable senior housing, serving over 2,300 people not living in housing last year, and a resource for cultural humility training.

·     Rachel Lovett of Thriving in Place (advocacy for IHSS) and Re:Imagine (end-of-life exploration event on April 16-22, 2018).

Room 2 – Dignity and Empathy in Place: “Dignity and empathy as drivers of creativity, generations of innovation,” chaired by Rachel Main of Alzheimer’s Association.  (Photo only, attended session in Room 1 instead.)

·     Jessica McCracken – Ruth’s Table http://www.ruthstable.org/

·     Doniece Sandoval – LavaMae https://lavamae.org/

·     Jenn Chan – Senior Shower Project https://www.seniorshowerproject.com/

·     Cathy Davis – Bayview Senior Services https://bhpmss.org

·     Adam Waskow – Memory Dog http://www.memorydog.org/team

Vegetarian box lunch prepared on-site by Wise Sons Jewish Deli 

JCCSF Adult Programs Manager Shiva Schulz and Hope Levy

Session 3A – Creative Practice as Strategy – Examples from national and international understanding of creative practice leading change.

·     Anne Basting, Professor of Theater at University of Wisconsin-Milwaukee, and Founder, CEO of TimeSlips Creative Storytelling, asked us to text someone: "what gives you a feeling of awe?" She mentioned 3 sources of awe: nature, art and spirituality.  We can facilitate awe through creative engagement: Yes, and (inviting and affirming choices through play/improv); Beautiful Questions (open shared path of discovery); Proof of Listening (radical affirmation of choices); Rigor/Value (frame in context with social capital); Connect (individual and communal purpose)

·       Arti Prashar, Artistic Director/CEO of Spare Tyre in London, promotes collaborative participatory art with hard-to-reach people (age 60+, people with dementia/learning disabilities, women who have experienced violence).  This can be done using gardens as non-verbal theater that engages in the present moment, invites in space of senses, adjusts to slower pace, elicits play and imagination.

·       Dominic Campbell, co-founder of CAI and director of Bealtaine Festival in Ireland, the world’s first (1996) nationwide arts festival celebrating creativity and aging.  He talked about Celebration as Strategy, and the need for fun festivals, with elements of individual choice (because life is about risk), empathy exchange, disruption (stereotype-smashing creative arts day club, Meet Me at the Albany) and connection.

In The Vintage Years: Finding Your Inner Artist (Writer, Musician, Artist) After Sixty (2013), author and retired SF Bay Area clinical psychologist Francine Toder, PhD, notes that later life is an exceptionally good time to study art because our mature brain has improved judgment, focus of attention, patterning, and bilaterality. Nearing age 70 as she approached retirement, she took up playing the cello and practices daily. 

Hope Levy and Darlene Yee-Melichar, holding Legacy Film Festival on Aging (LFFoA) program, meet-up with LFFoA Director Sheila Malkind.

Dance and Tai Chi with Greacian Goeke, Director of Impromptu No Tutu, and her Bay Area dance ensemble express themselves in improvisational movement outside CJM, after emergency alarm triggered temporary evacuation.

Session 3B - Creative Practice as Strategy - Evolving Innovation: Where, how and why.

·     Anne Basting of Timeslips talked about transforming long-term care with the collaboration of nursing home residents through The Penelope Project: An Arts-Based Odyssey to Change Eldercare (2016)  

·     Kate de Medeiros of Miami University co-authored with Basting The Gerontologist article, "'Shall I Compare Thee to a Dose of Donepezil?': Cultural Arts Interventions in Dementia Care Research" about the challenges of measuring interventions in dementia care based on subjective experience.

Variety Pack! a capella community choir from Oakland, with Artistic Director Lauren Carley.

Session 4 – Sustained Systemic Innovation: Planned sustained change session chaired by William Cleveland from Center for the Study of Art and Community (Bainbridge Island, WA), which builds arts partnerships.

·       Maura O’Malley and Ed Friedman, founders of Lifetime Arts in New York, provide technical assistance to support arts programming for older adults based on Gene Cohen’s creative aging research focused on mastery and social engagement.  Lifetime Arts is also a leader in library-based creative aging programs, partnering with American Library Association. 

·       Kelly Dearman, Chair of Aging & Disability Friendly Task Force in San Francisco, presented on the implementation of San Francisco’s Age and Disability Friendly Plan

·       Gavin Barlow and Annabel Turpin of Meet Me in Albany & Future Arts Centres in UK

·       Tim Carpenter – EngAGE 

Bay Area monologuist and GBHI Fellow Josh Kornbluth performed a piece from “Brain Improvs” based on his experiences with people with dementia, a disease characterized by loss of empathy.  His idea is to start a revolution through storytelling, which mirrors what people have gone through so distance is broken down for a “worldwide peaceful revolution of peaceful empathy.”  His show at The Marsh has been extended through the end of this year. 

Session 5 - Tools for Change: Moving towards deeper strategy.

·       Penelope Douglas of Culture Bank in San Francisco talked about how art helps us see the poor as communities with assets of value and opportunity for investment.

·       William Cleveland, Director at Center for the Study of Art and Community in Washington State, talked about Arts Based Community Development (ABCD) ecosystem to advance dignity, health, productivity

·       Teresa Bonner, Director of Aroha Philanthropies in Minneapolis, shared website of resources at https://www.vitalityarts.org/ to champion participatory arts education programs for older adults.  

Session 6 - What Next? A question to start and end with. When you determine the kind of old you want to be, you shape the world you want to grow older in. What’s your next step? Sharing thoughts from the room gathered over this one day – nurture and heal, inspire and mobilize, educate and inform, build and improve.

Community Music Choir Solera Singers of Mission Neighborhood Center sing songs in Spanish from Latin America.

IAGG 2017 Global Aging and Health

Last week, Gerontological Society of America (GSA) hosted the quadrennial International Association of Gerontology and Geriatrics (IAGG) World Congress in San Francisco. The theme of this year’s Congress, “Global Aging and Health: Bridging Science, Policy and Practice,” brought together over 6,000 scholars and practitioners from more than 75 countries to learn the latest developments in the field with a focus on improving the lives of older people. 

Global population aging is a significant trend of the 21^st century, due to increased life expectancy and low birth rates.  According to the United Nations Population Fund, people aged 60+ comprise 12.3% of the global population, and will increase to 22% (or 2 billion) by 2050. 

Opening Ceremony and Lecture 

Outgoing IAGG President Heung Bong Cha presented IAGG flag to incoming IAGG President Jack Rowe, Professor of Health Policy and Aging at Columbia University and co-author of Successful Aging. 

GSA President Barbara Resnick announced that one-fifth of GSA’s membership comes from outside the USA; GSA had forgone its annual scientific meeting this year to plan for this World Congress, an eight year effort; and next year’s GSA meeting: The Purposes of Longer Lives, will be held in Boston, November 14-18, 2018.

Like GSA’s annual meeting, sessions at IAGG World Congress were identified by tracks: BS (Biological Sciences), BSS (Behavioral & Social Sciences), HS (Health Sciences/Geriatric Medicine), SRPP (Social Research, Policy & Practice) and ID (Inter-Disciplinary).

AARP CEO Jo Ann Jenkins presented her lecture, Disrupt Aging, based on her best-selling book of the same title.  She talked about our longer lives as opportunities to grow, thrive and contribute, rather than global aging as decline, burden and a crisis to be solved.  Disrupt aging is about choosing how we want to live and age.

Linda Fried, first female Dean of Columbia University’s Mailman School of Public Health, talked about Benefiting from the Third Demographic Dividend.   

After noting the 10^th anniversary of The Elders, a group of senior leaders brought together by Nelson Mandela to work on global solutions, she proposed creating a Third Demographic Dividend using the assets of an aging population for a better future that is win-win for all ages.  She offered Experience Corps (EC) as an evidence-based model for this win-win-win impact of an aging society.  In the early 1990s, she helped design and develop EC, an intergenerational program that placed trained older people as volunteer tutors to boost the academic performance of elementary school students while volunteers improved their own health through this meaningful activity and community engagement. EC is now an AARP program, in 22 U.S. cities. 

Chinese lion dance entertainment 

Welcome to Exhibit Hall Opening!

Dementia care

More than 47 million people worldwide have dementia, and there are 9.9 million cases every year, with age as the greatest risk factor for dementia.  By 2050, the number of people living with dementia worldwide is expected to triple to 132 million.  The prevalence of dementia is expected to place growing demands on health and long-term care providers as the world’s population ages.  Dementia is the primary medical condition associated with nursing home admissions.

Presidential Symposium: Dementia-Related Stigma – International Perspectives in Addressing the Stigma of Dementia (HS)

• Banghwa Casado’s study on Stigma of Alzheimer’s Disease (AD) and Care-Seeking Among Korean Americans suggested that increasing AD knowledge could influence seeking AD care.
• Sarang Kim’s research on Dementia-Related Stigma and Cultural Diversity found that dementia-related stigma in Australia is specific to age, gender and cultural background, and therefore dementia-stigma reduction strategies should be tailored specifically to these different groups.

The UK has developed interventions to address the stigma of dementia:

• Creating Dementia-Friendly Workforce: The Role of Personal Narratives in Online Training – Murna Downs, Professor of Dementia Studies at University of Bradford, presented Improving Dementia Education and Awareness (IDEA) online training to decrease stigma and increase quality of care.  She emphasized the need to listen to people living with dementia (see BBC documentary, “Terry Pratchett – Living with Alzheimer’s”) because it’s not enough to know a list of signs and symptoms.
• Intergenerational Approach to Addressing Stigma – Simon Evans, dementia researcher at University of Worcester, noted that growing awareness of dementia and its effects, along with poor prospects of a cure, has led to fears of getting this disease.  Dementia-related stigma is associated with feelings of shame, sense of dehumanization/social isolation, depression; it can lead to delayed diagnosis and treatment and increased institutionalization.  He shared how teachers introduced dementia awareness into schools through lessons in a range of subjects (assistive technology, brain, memory aging, living well with dementia), meeting people with dementia and their carers, debates, life histories, drama/art/music, singing/choir, tea parties, Dementia Ambassadors, etc.

In Stigma in Psychosocial Dementia Research, Myrra Vernooij-Dassen of Radboud University (Netherlands) observed that once diagnosed with dementia, stigma reduces the person to the disease, so the person is often seen through the filter of dementia focused on deficits rather than capacities.  As a result of stigma, losses in social functioning appear to be caused more by social dynamics than by brain injury alone.  Yet, life can continue to be meaningful after a dementia diagnosis, if people are treated with dignity—not being perceived as a burden to others, but continuing to be useful. 

Liberating the Arts from the Therapy Culture in Dementia Care (BSS) featured Cracked: A New Light on Dementia, a play from Canada-based Collective Disruption and inspired by Canadian poet-singer Leonard’s Cohen’s Anthem, suggesting that cracks make us human:

Ring the bells that still can ring

Forget your perfect offering

There is a crack in everythin’

That's how the light gets in

This theater production followed people with dementia and their families, informed by research involving people with the lived experience.  Sherry Dupuis, Professor of Recreation and Leisure Studies at the University of Waterloo and co-lead of the Partnerships in Dementia Care (PiDC) Alliance used art-based, interdisciplinary team research to challenge the dominant tragedy discourse focused on loss and deficit, which assumes a premature closure of life in dementia.  Based on actual stories told by people with dementia and their families, the play explores their real lives and possibilities for self-expression including fun and laughter.

Symposium: Ageing, Dementia and the Social Mind (BSS) 

• Social Location of Personhood in Dementia Care, Policy and Practice  – Professors Paul Higgs and Chris Gilleard of University College London affirmed personhood in dementia (considered a change, not loss, in identity) and the shared responsibility of care to support the dignity, identity and autonomy of the person with dementia. 
• Precarity in Late Life: Rethinking Dementia as a Frailed Old Age  - According to Amanda Grenier, Aging and Mental Health Chair at McMaster University (Canada), the idea of dementia as frailty and impairment, based on leading paradigms of activity and success, reinforce stigma. She concluded that we need to rethink dementia and frailty, in relation to “ourselves” v. “the other” (shared vulnerability), as part of the life course and human condition v. end of life experience, as part of a successful life and relational interdependence v. failure of dependence, and provision of care as shared responsibility.
• Dementia, Class and Social Relations  – Ian Rees Jones, Cardiff University Professor and investigator of Improving the experience of Dementia and Enhancing Active Life (IDEAL) called for a political economy approach, noting studies that show a higher risk of dementia in those with lower socio-economic status, the role of social class in diagnosis and treatment of dementia. 

• A Relational Model of Citizenship: Insights From a Study of Elder Clowning in Dementia Care in Toronto - University of Toronto researcher Pia Kontos talked about the role of red-nosed clowns  in increasing positive affect in older people, by using improvisation, humor and expressive arts (song, musical instruments, dance).  While children remain the target audience, clowning has been adapted for older people with dementia since the late 1990s.

Several years ago, I took the Massive Open Online Course (MOOC), Living with Dementia: Impact on Individuals,Caregivers, Communities and Societies, by Laura Gitlin, Director of the Center for Innovative Care in Aging at Johns Hopkins University. It was awesome to meet her in-person for updates during two symposia co-chaired by her, relating to activities for people with dementia.

Symposium: The Therapeutic Benefit of Activity in Dementia Care: Evidence Across Countries and Service Contexts (BSS) – Because challenging behavioral symptoms presented by persons with dementia often adversely affect caregivers’ well-being and there is no cure for dementia, non-pharmacological interventions like the purposeful use of activity can help maintain quality of life for the people with dementia as well as their caregivers.  One promising intervention is New Ways for Better Days: Tailored Activity Program (TAP) in Dementia Care: a home-based occupational therapy intervention that involves assessment of preserved capabilities, previous roles, habits, and interests of people with dementia; development of activities customized to individual profiles; and training families in using activities as part of their daily care routines.  TAP reduced behavioral symptoms and/or increased engagement.

• Marcia Novelli presented on the Brazilian version of TAP in Dementia Care
• Jose Aravena presented on Kintun, Chile's first public health strategy for dementia care that provides transportation to an adult day program with activities to improve cognitive functioning, physical abilities, social interaction and community involvement.

Symposium: Tailoring Activities for Persons With Dementia to Manage Behaviors: International Perspectives (BSS)

• Characteristics of Activities for Persons With Dementia at the Mild, Moderate, and Severe Stages – Natalie Regier’s research attempted to develop guidelines to tailor activities based on a person’s stage of dementia, or cognitive/functional profile (help with initiation, need for cues/redirection, engagement time).  (Examples: persons with 1) mild dementia prescribed complex arts and crafts and cognitive activities, 2) moderate dementia prescribed music/entertainment, and 3) severe dementia prescribed simple physical exercises and manipulation/sensory/sorting activities.)
• Jose Aravena and Lindy Clemson discussed use of TAP principles in Chile and Australia, respectively. 

An occupational therapist (OT) in attendance expressed his belief that activities need to be meaningful to the individual, adjusting for individual cognition.  Laura Gitlin acknowledged that tailoring activities to an individual’s preserved capacity is the gold standard, but barriers include lack of time and resources to consult with an OT, so they seek evidence to match activity with cognitive profile for struggling caregivers that might work and improve quality of life.  

Symposium: Farming for Health: Lessons Learned From Green Care Farms for Dementia Care (SRPP) featured presenters on this worldwide initiative toward small-scale, homelike care settings that focus on person-centered care, offering a combination of agricultural and care activities. Residents of green care farms (GCFs) are given the opportunity and freedom to engage in outdoor, work-related, domestic, and other kinds of activities implemented into normal daily living. GCFs exist mainly in Europe, especially in Norway and the Netherlands. 

• Keith Anderson of University of Montana School of Social Work on Experiences with Green Care Farming in the U.S. (Lifeside Care Farm in Montana, a GCF introduced to U.S. by Dutchman Martin Fischer) with opportunities based on growing acceptance of creative, non-medical interventions for person-centered dementia care.
• Ingeborg Pedersen of Norwegian University of Life Sciences on Key Components of Farm-Based Day Care Services for People with Dementia:  1) provide familiar cultural traditions and activities, 2) being in nature environments (animals, garden, freely accessible outdoor space), 3) experience everyday setting, 4) fulfill personal interests and needs, 5) promote physical activity and sleep, 6) sense of community, 7) relatives feel safe, 8) invite to intuitive activities.
• Simone de Bruin of National Institute of Public Health and the Environment (Netherlands), session chair on GCFs (see her video, "Implementing green care farms for people with dementia" in adult day service)
• Hilde Verbeek of Maastricht University (Netherlands) on The Physical Environment of Green Care Farms: A Comparison with Existing Nursing Homes, finding that GCFs allow residents to engage in more physical activities and social interactions than residents in traditional nursing home settings, allowing them to have better quality of life and improved health outcomes. 

The Age Stage

With sessions running from 8 am to at least 5:30 pm, I thought I’d experience death by power point … but fortunately, while moving between session venues during 30 minute breaks, I passed by The Age Stage, sectioned off by black curtains and located on the 2^nd floor of Moscone West Convention Center.  GSA collaborated with IAGG Humanities and Arts Work Group to present The Age Stage, a three-day program to showcase creativity in aging. 

“If you are doing creative work, you are absolutely ageless. There is no such thing as age in creativity. It is always something new.”

—Eileen Kramer, 102 year old dancer and artist, “’Always grasp the opportunity’: confronting ageism creatively,” The Guardian (27 June 2017)

The Age Stage celebrated improvisation by featuring Quicksilver (dance and music), Songwriting Works (songwriting) and Stagebridge (theater).  

Maryland-based Arts for the Aging, Inc. (AFTA) teaching artists Nancy Havlik and violinist Anthony Hyatt co-directed Quicksilver improvisational dance and music company of older adults. 

Judith-Kate Freedman and Ash Devine from Washington State demonstrated Songwriting Works, based on the oral tradition of collective music-making. UCSF's Theresa Allison, MD, who studied the impact of Songwriting Works, found that creating and performing original songs enabled institutionalized elders to remain vibrant and creative.

Never Too Late Musical Revue by Antic Witties troupe directed by Barbara Scott of Stagebridge, founded in 1978 in Oakland and the nation’s oldest theatre company of older adults. 

New Senior Life Fashion Show featured older Koreans modeling modern dress while sashaying the runway and then dancing in K-pop style, a workout for body and brain … so fun that one could temporarily forget that South Korea has the worst senior poverty rate and elderly suicide rate. 

Choreographer Eartha Robinson and Lisa Chevalier presented Colibri Arts: Lifelong Movement and Dance, through Debbie Allen Dance Academy,

benefits memory (choreography) and blood flow (movement).  Some program participants, who began tapping their feet while seated only, were standing and grooving seven months later!

Honoring Our Elders of northern Mexico displayed 6 feet high portraits (at left) by self-taught artist J. Michael Walker.  Art Saves Lives: AIDS Health Foundation Pop-Up Gallery (at right) by older persons living with HIV/AIDS.

Based on her 30+ years as a geriatric social worker, Wendy Lustbader shared The Power of Stories about older people. 

Dancing with Crow’s Feet is a pro-aging theater piece inspired by narratives of older women.

Written and directed by Debra Campbell of Arts & AGEing Kansas City, the play used ancient folklore about crows, known for their intelligence and adaptability, to celebrate old age and crow’s feet.  Caw, caw, caw!

When words become difficult, people with dementia can express themselves through art.  Frye Museum Creative Aging Program Manager Mary Jane Knecht and Elderwise Director Cara Lauer introduced Seattle-based arts programs, In the Moment: Living Well with Dementia:

• Elderwise arts-based adult day program (Beyond Forgetting poetry book edited by Holly Hughes)
• here:now arts engagement for people living with dementia at Frye Museum
• Momentia Seattle grassroots movement empowering persons with memory loss and their loved ones to remain connected and active in the community.

Seattle-based Art of Alzheimer's exhibited The Artist Within: A Different View of Dementia featuring artworks by individuals, ages 60 to 101 years old, living with dementia.  

In One Morning I Looked in the Mirror and Didn’t Recognize Myself, Helen Kivnick read from her friend Lucy Rose Fischer’s book I’m New at Being Old (2010).  After 25 years as a gerontology researcher and approaching age 60, Lucy embarked on a second career as an artist painting on glass and was featured in Twin Cities PBS documentaries, The Creative Power of Aging (2008) and Life Changing Art (2010).

Health Promotion

In Genes, Environment and Behaviors that Predict Healthy Longevity (ID)

University of Illinois Public Health Professor S. Jay Olshansky presented on The Future of Healthy Lifespan Has Arrived: “It doesn’t matter if maximum lifespan is 115, 118 or 120; the most important message is that we should not be trying to make ourselves live longer, we should only be trying to extend the period of healthy life.” 

Complimentary lunch (with sugary soft drinks!) included in session on Interprofessional Solutions for Improving Oral Health in Older Adults: Addressing Access Barriers, Creating Oral Health Champions. GSA Oral Health Workgroup Chair Stephen Shuman (pictured with screen shot of The New York Times article, “With Age Comes a Mouthful of Trouble”) discussed importance of caring about oral health due to its association with quality of life (comfort, speech, chewing/food selection/food enjoyment, appearance, self-esteem/socialization), systemic health problems (malnutrition, poor diabetes control, aspiration pneumonia, bisphosphonate-related osteonecrosis, infective endocarditis) and potential implications in other diseases (cardiovascular disease, dementia).  In May 2017, Administration for Community Living launched its Oral Health website to raise public awareness for starting or enhancing an oral health program for older adults.  Oral cavity examination needs to be added to old paradigm of Head, Ears, Eyes, Nose and Throat: HEENTà HEENOT.

Keynote: Dietary Determinants of Lifelong Health (ID) moderated by Fox Wetle, founding Dean of Brown University's School of Public Health.

Stefania Maggi presented on The Mediterranean Diet: New Evidence in the Lifelong Approach to Healthy Diet.  The protective effects of the Med diet are due to a combination of factors: olive oil (MUFA), fiber, omega-3, vitamins, minerals, phytochemicals.  There is good evidence that following a Med diet can reduce risk of heart disease, diabetes, cancer, dementia, osteoporosis, frailty, all-cause mortality.  She noted that in 2010, UNESCO recognized the Med diet as an intangible Cultural Heritage in Humanity: more than just food, as it promotes social interaction with communal meals, and respect for territory and biodiversity.  

Connie Bales disclosed interests with pork, beef and dairy industries, prior to her presentation on Interventions for Obesity in Frail Older Adults: Findings and Implications.  She reported that most of the world’s population live in countries where overweight and obesity kills more people than underweight.  She observed that exercise improves fitness, muscle mass and/or strength, but makes little change to body weight; reduced calorie diets produce beneficial decreases in body fat but also reduce lean mass; best outcomes combine diet and exercise, especially aerobic and resistance training. 

Jean Woo discussed Biopsychosocial and Cultural Factors Influencing Diet and Nutrition. She found the traditional Chinese diet is comparable to the Mediterranean diet, offering similar benefits. She also noted coronary heart disease mortality in Hong Kong Chinese is about one-quarter that in the U.S.A. 

Exhibit Hall’s Innovation Theater featured a demonstration of K-YangSaeng Exercise, which was developed by Yonsei Professor Young Shin Won, 

consisting of breathing exercises, acupressure, flexibility exercises, internal organ stimulation from palm and underfoot stimulation exercise—intended to infuse energy into body and mind.

Age-friendly San Francisco

For the most part, I skipped programs related to San Francisco, where I can easily access them as a resident.  Exceptions were Wednesday schedule that included all-day programs: Technology and Aging: Innovation for Independence and Inclusion at Marriott Hotel and Legacy Film Festival on Aging (LFFOA) at Moscone West Center. (The three-day LFFOA takes place at New People Cinema in San Francisco, September 15-17!)

Co-Designing Technologies for Older Adults: Working with Stakeholders – Sherwin Sheik, Founder & CEO of CareLinx (online caregiver marketplace), talked about taking a holistic approach to quality of life solutions that can be adapted to the life flow of the older person, instead of the older person adapting to multiple part solutions.

LFFOA Director Sheila Malkind, with At Home With Growing Older Board President Mikiko Huang and her son Cyrus, after screening of The Sandwich Generation (2008), a documentary by filmmaker Julie Winokur about caring for her father Herb who had dementia.  One powerful part of this documentary was when the filmmaker’s husband said Herb’s "spirit to live" made his parental instincts kick in and give "whatever was needed" to keep Herb aging at home, including 24/7 caregiving. 

According to a nationwide PEW Research Center survey, nearly half (47%) of middle-aged Americans are “sandwiched” between aging parents (age 65+) and children (more young adult children are struggling to achieve financial independence). Dementia patients live longer when families delay putting them in a nursing home, and enjoy a higher quality of life (i.e., significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications) than those in nursing homes.    

San Francisco Aging Commission President Edna James visited AARP in Exhibit Hall. 

SFSU Gerontology classmate Diane Houlton with attendees from Philadelphia stand in line for lunch hosted by Mendelsohn House, affordable senior housing near Moscone Convention Center. 

Bernal Heights Senior Program Coordinator Roland Soriano and Felton Senior Director Cathy Spensley at taco bar. 

Community Living Campaign Director Marie Jobling and Deputy Kate Kuckro.

SFSU Gerontology Professor Darlene Yee-Melichar with her poster, "Developing Academic-Community Partnerships in Gerontology: From Concept to Practice." 

SFSU Gerontology Professor Emeritus Brian de Vries and graduate Sumiyo Brennan. Brian presented in two symposia: Preparations for End of Life Among LGBT Older Canadians, and Appraisals of Adversity and Resilience in LGBT Elders.

From Moscone West Center, rode “T” train (aka tortoise) to UCSF’s Memory and Aging Center in Mission Bay for Global Brain Health Institute (GBHI) event.  GBHI Executive Director Victor Valcour introduced the Atlantic Fellows for Equity in Brain Health, who participated in a 12-month residence program to engage in projects focused on the psychosocial side of dementia care, addressing the triple threat: stigma of aging + stigma of dementia + higher risk in socioeconomic disadvantaged. 

Bay Area comedic monologuist Josh Kornbluth mentioned his stepfather had Alzheimer’s disease. During his year as a GBHI Fellow at UCSF’s Memory and Aging Center, Kornbluth is helping to tell the story of dementia to the public through a series of improvs, which he will develop into a one-man show and movie, called “Don’t stop me if you’ve heard this one,” starting in September.

Social Justice & Aging in Community

Symposium: Challenging Attitudes to Ageing and Ageism (SRPP) was the first session that I attended when the World Congress began on Sunday.

• Angela Kydd of Edinburgh Napier University spoke about Ageism in the Third Age: values associated with active and successful aging often do not extend to oldest-old (age 80+ or Fourth Age), who are associated with dependency and thus face increasing stigma and societal stereotypes.
• Discussant Liat Ayalon of Bar-Ilan University (Israel) noted the need to view ageism in context as part of other vulnerabilities (healthism, disablism, lookism, or sexism); older adults experience multiple jeopardies (impaired health status, dementia status, sensory decline, appearance); non-ageist approach would consider diversity, individually-tailored/patient-centered care, increased knowledge and awareness; see http://notoageism.com/.
• In Attitudes Toward Aging Among Geriatric Health Care Team: Don’t Forget the Caregiver, Mary Wyman of University of Wisconsin at Madison noted that 85% of care of older adults are provided by an informal, unpaid caregiver.
• University of Malta's Sandra Buttigieg spoke on Professional Ageism: belief that aging means inevitable decline, and futile to invest effort in person with limited life expectancy. This negative imagery can be normalized and internalized, resulting in self-fulfilling prophecy.  Consequences of professional ageism include new/worsened disability, higher probability of death, and under/overtreatment. What can be done: make geriatric care highly relevant in medical training, reconsider care options (home-based), make treatments more appropriate to older populations, review assumptions about financial impact of aging in healthcare, use technology to deliver key skills remotely and enable home-based care, reset public mindsets about older adults.
• In Discourse Matters in Ageism, Amanda Phelan of University College Dublin criticized the metaphor “silver tsunami” to describe population aging as impending disaster, noting language that makes older people feel like a burden.

It was disconcerting to see exhibitors of anti-aging products (mostly skin creams) at Exhibit Hall.

Symposium: We Are Now They: Old Gerontologists Living in Age-Segregated Housing (ID) – discussant Helen Kivnick and presenter Miriam Moss on Adaptation to Living in a Retirement Community (on stage), Harry Moody and Sidney Moss (seated in front row).

·         Life in a CCRC: On Not Being Invisible by Anne Wyatt Brown, author of The Big Move: Life Between the Turning Points (2016) - When caring for her ill husband in a three-level house in Florida became challenging, Anne and her husband Bertram decided to move to Roland Park Place, a continuing care retirement community (CCRC) in Baltimore—where her parents resided and not far from Johns Hopkins University, where they first met as graduate students almost 50 years earlier. She adjusted to walkers/wheelchairs and talked about advantages, such as companionship among understanding peers who provide moral support.

·         Aging Out of Place by Ruth Campbell, retired University of Michigan Social Work Professor, moved into Piedmont Gardens, a CCRC in Oakland, which she described as a stimulating and friendly community of high academic achievers, 72% female; she had a relative there, enjoys visits from her grandkids and volunteers as weekly peer counselor.

Creating Caring Communities: Social Capital Formation and Aging in Place (SRPP):  UC Berkeley Social Welfare Professor Andrew Scharlach presented on Fostering Social Capital Through the Village Model, research on the social impacts of membership in eight California villages.  During their first 36 months as Village members, respondents experienced increases in the amount of interpersonal contact, group participation, ability to get help when needed, but no change in feeling of belonging to a community.

Keynote: Social Inequality and Social Justice (BSS) - Chair Jan Baars of University of Humanistic Studies (Netherlands) with presenters:

• Christopher Phillipson of University of Manchester (UK) on Developing a Political Economy of Ageing: New Approaches to Social Justice and Inequality, discussed the crisis in social aging (decline of welfare state, replace retirement with idea of extending working life, abandon equality as goal), failure to develop a critical response (disastrous preoccupation with active/successful aging, challenge to social solidarity by unwillingness to fund services by upper and marginalized working class, impact of “microfication” so larger issues are invisible in social gerontology) and his proposal for developing an emancipatory social science (identify ways existing social institutions systematically impose harms on people, develop credible alternatives that would mitigate harms, build “everyday utopias” for a different kind of welfare state and different ways of experiencing later life).
• Dale Dannefer of Case Western University on Intersection of Age and Inequality: Enduring Tensions, Emerging Challenges, reminded us that the pattern of cumulative dis/advantage over the life course is not “cast in stone,” but can be addressed through deliberate social actions designed to mitigate effects at any level of society, from “micro” to “macro.” 

Symposium: Addressing the Intersectionality of Race, Gender and Immigration Status in Long-Term Care (SRPP) moderated by Chair Nancy Hooyman, University of Washington School of Social Work Dean Emeritus.  90% of Americans want to age at home, yet many rely on paid care workers because their families can’t provide the support they need.

• Kevin Prindiville, Justice in Aging Executive Director, on Increasing Care Inequities with Age Among Historically Marginalized Populations – 6.4 million seniors live in poverty  — mostly women and people of color; influenced by systemic causes including racism, sexism, changing economy, recession, rising costs, shrinking safety net (Medicaid, Medicare, ACA, Social Security, SSI/SSP, OAA, SNAP, etc.).
• Sarita Gupta, Jobs with Justice Executive Director and Caring Across Generations Co-Director, on Culture and System Change to Ensure Justice for Caregivers – reminded us of Mahatma Gandhi’s saying, “a nation’s culture resides in the hearts and in the soul of its people”; women’s work is invisible and undervalued, so storytelling will make eldercare visible in PBS documentary, “Care” to be broadcast in September 2017.  We need to protect what we have (safety net), create what we need (home care, universal family care in ME & MI, careforce support in NC & MN). 
• Rocio Avila, State Policy Director at National Domestic Workers Alliance (NDWA) and We Belong Together Campaign on Immigration Enforcement: Impact on Women & Home Care Workers.  Home care workers are disproportionately immigrant women and women of color; they perform critical work yet make poverty wages (25% living below federal poverty level, over 50% rely on some form of public assistance); and are more susceptible to needing health care themselves due to the toll of caregiving work.  Trump Administration’s proposals to expand immigration detention, removal and deportation threaten immigrant women and their work in caring for older people; to repeal ACA and convert Medicaid to block grants will result in worsening insurance inequality.
• Lourdes shared her experiences as a home care worker.

Ai-Jen Poo, NDWA Director, was listed on IAGG Program Book to present on Domestic Workers and Labor Protections, but she was a no-show with Rocio filling in her spot.

Ai-Jen Poo showed up in “Care” documentary film screening hosted by LaborFest, with panel discussion afterwards.  Panelists David Duckworth SEIU 1021, Brad Wiedmaier, SEIU Local 2015 California long term care; and Brett Miller, SEIU 1021, discussed how unions can help us take care of each other.