STRESS! (Positive) cures for modern anxiety from Andy Warhol (1928-1987) exhibit at SF Museum of Modern
Art
As
a paid participant in the UCSF Stress and Resilience study this month, I was
assigned to Method of Breathing and Shower (MOBS) condition. (Other conditions were exercise and
meditation.) This stress resilience
method involved daily morning breathing and hot showers for 21 consecutive days. I was fine with hot showers, but
did not like breathing as instructed by a 15-minute audio recording of a
monotonous male voice that made me want to return to sleep:
“Inhale, exhale, in, out, breathe
light and slow, slow inhale, slow exhale, in, out, no need to inhale all the
way or exhale all the way, breathe naturally, softly and relax.
Inhale, exhale, in and out, focus
on the breath with your full attention, breathing through the nose for both the
inhale and the exhale.
Inhale, exhale, focus just on this
even guiding breath, listen to the sound of your breath, and make it peaceful, soft
and relaxed as possible…"
Conscious breathing
exercises had to be done in the morning to “make the habit regular,” and on an
empty stomach...before breakfast, so stomach rumbling in hunger was distracting.
At Anza Branch Library, Dr.
Yangdron Kalzang of Kunde Institute-Center for Tibetan Wellness and Healing
presented talk on Tibetan Medicine: Self-Care, which has influences from India
(Ayurvedic), China (5 Elements) and Persia.
Tibetan Medicine focuses on digestive fire (immune system and internal
disorders) and emotional/mental health (stress). She outlined 3 "poisons of emotion":
desire/attachment, hatred/jealousy, and ignorance/delusion.
Dr.
Kalzang explained symbolism in Tibetan flag colors (similar to Traditional
Chinese Medicine’s Five Elements): blue=space, white=air, red=fire, green=water,
and yellow=earth. Youth is associated with earth and water. At older age 55+, fire is diminished, air
picks up, water is unstable so there is dryness; instead of drinking lots of
water that can overwork kidneys, Dr. Kalzang recommended consuming 1 tablespoon
of oil (ghee) to quench thirst.
Dr. Kalzang reviewed Progression of
Mental Imbalance in Tibetan Medicine:
imbalanced lifestyle+dietà stressà anxietyà panic attackà depressionà maniaà madness/crazinessà bipolarà forgetfulness. Signs and symptoms of stress:
·
Physical: restless limbs/body, feeling
light/ungrounded, wanting to stretch, constant yawning, insomnia, shaking with
hunger
·
Mental: feeling overwhelmed,
agitated/anxious, difficulty focusing/concentrating, jumping/monkey mind,
short-tempered, paranoid
For stress relief, Dr. Kalzang recommended
take a break and breathe. She also demonstrated the art and craft of making
sachets of freshly ground nutmeg and caraway seeds wrapped in muslin fabric and
secured with string. To focus on breath,
inhale aroma of herbs. Add warmed ghee
to ground herbs to make poultice for application to acupressure points on body;
this Hormey treatment helps relax mind and body, reduces physical and mental
stress, boosts immune system, clears the mind and improves concentration. These “external accessory therapies” are
cost-effective, safe and without harmful side effects.
About
70% to 90% of adults age 65+ have been exposed to a potentially traumatic event in their lifetime. Sometimes conducting life review
with older adults brings up past trauma, so taking deep breaths can help bring
us back to the present.
Deep breathing’s role
to keep us present was reinforced during SF Department of Public Health (DPH)
training on Trauma Informed Systems (TIS) Initiative—Transforming Stress and
Trauma: Fostering Wellness and Resilience. Other take-aways:
·
“Connection
is the healing balm of trauma.”
·
Shift
perspective from “What is wrong with you?” to “What has happened to
you?” to provide context, foster compassion, help us see strengths
in face of adversity.
· Chronic stress can trigger brain into survival mode, so emotion brain (limbic system) takes over thinking brain (prefrontal cortex); aggravating
behavior is a “cause for a pause”: before react, pause & take a breath,
ask “What has happened to you? What is happening here? What is the need
behind this behavior? How can I respond to this need?”
·
Health
disparities: what’s wrong? Race+Place=Health; what happened? Trauma
(insidious, historical, institutional)Ã Community
violence=Health
·
Context
matters: oppression,
racism, sexism, classism, xenophobia, inequity, homophobia
·
Understanding
community level traumaà promoting
community resilience: opportunity (intergenerational poverty,
divestmentà economic empowerment, quality
education, restorative justice); people (fragmented social relationships,
destructive social normsà rebuild relationships, strengthen
healthy social norms); place (unsafe public spaces, deteriorated
environments, unhealthy productsà safer
public places, invest in environments, available healthy products)
·
TIS principles in action:
understand trauma & stress (find out ACE score and resiliency score https://acestoohigh.com/got-your-ace-score/); cultural humility &
responsiveness (take implicit bias test https://implicit.harvard.edu/implicit/); safety (physical, social,
emotional) & stability; compassion & dependability; collaboration &
empowerment (foster voice & choice: Ask, Respond, Clarify,
Confirm “Does this work for you?”); resilience & recovery (practice
gratitude)
·
Relationships
are central to healing:
healthy relationships involve attunement (being sensitive, responsive, in
harmony with feelings & needs of ourselves & others)
·
Relationship
building tool—Connect,
then Re-Direct PEARLS: Partnership (“Let’s work together”), Empathy
(“That sounds frustrating”), Apology (“I’m sorry that happened”), Respect
(“You have gone through a lot”), Legitimation (“It makes sense that you
feel this way”), Support (“Let’s see what we can do”)
SIYLI micro-practices, appropriated from Buddhism, focused on more breathing for
mindfulness-based emotional intelligence:
·
Mindfulness: listening (with attentiveness,
kindness, and curiosity); 3 breaths (1st attention to breathing, 2nd
relax body, 3rd ask “What’s important right now?”); focused
attention; minute to arrive (start meeting with 1 minute of silence to help
everyone be fully present); open awareness; noting (when you feel stuck: notice
it, name it, let it be, and just breathe)
·
Self-awareness: body scan; head, body, heart check-in with 3 breaths (1st breath scan head=thoughts, 2nd scan body=emotions +
sensations, 3rd scan heart=values/intentions); journaling; mindful eating
·
Self-management: SNBRR (Stop, Breathe, Notice,
Reflect, Respond—when triggered); mindful conversation (listen,
repeat back to check understanding with speaker); self-compassion; acceptance
(take breaths in & out, “Breathing in, I do my best; breathing out, I let
go of the rest”—when distressed)
·
Motivation
& resilience:
values & envisioning journaling; hands on chair (let feeling of chair
fabric be “mental cue to remember your intention for how you show up”);
resilience (breathe in & out with feelings and recognize them as temporary
to create mental space for “wise response & growth”)
·
Empathy
& compassion: "just like me" & offering kindness (bring
to mind people you know & work with, consider your common humanity, wish
them well); shift to connection (take 3 breaths to build connection with others
in the moment—1st breath to settle the mind, 2nd breath
to see similarity, 3rd breath to offer kindness); walking meditation
(savor process of walking, attention to sensations including transfer of weight
from one foot to next and feet on ground); empathetic listening (to feelings
and words)
·
Leadership: difficult conversations preparation by
thinking through 3 levels (content, feelings, identity) from each person’s
point of view; impact is not intention (when you notice feeling irritated/frustrated
with someone, consider 3 levels that may be driving other person’s behavior);
compassion practice (when encountering someone in distress, pause & reflect
on situation, attention to what they are experiencing, invite positive wishes
for them); ask “what would be of service?” (get to core of what’s important)
Our
self-motivation comes from flow channel (diagram pictured above) which occurs
when challenge matches your skill level, similar to person-environment
fit. Meng covered this “art of
self-motivation” in his book’s chapter 6 on “Making Profits,” citing male TED
Talk authorities like tech bro Tony Hsieh (author of Delivering Happiness: A
Path to Profits, Passion, and Purpose), Daniel Goleman (Emotional
Intelligence), Mihaly Csikszentmihalyi (Flow: The Psychology of Optimal
Experience), and Daniel Pink (Drive: The Surprising Truth About What
Motivates Us). Later in this chapter's envisioning practice section, Meng mentioned a few female authorities, like his friend Roz Savage (first woman to
complete Atlantic Rowing Race solo, so motivated after writing her
obituary reflecting on the life she aspired to live that she gave up her “old
life” to pursue her dream of rowing across oceans) and Barbara Fittipaldi (CEO
of Center for New Futures); more breathing in resilience section citing Matthieu Ricard (co-author with Goleman of Happiness: A Guide to
Developing Life’s Most Important Skill); and then discussing optimism, Meng cited positive psychologists Martin Seligman (Learned Optimism: How to Change Your
Mind and Your Life) and Barbara Fredrickson (Positivity: Top-notch
Research Reveals the 3 to 1 Ratio That Will Change Your Life).
SIYLI training cost $1,250 but I attended through SF DPH at no cost, other than 2 days of my time and skepticism. Much of this mindfulness material (minus videos of male talking heads) is covered in Stanford Chronic Disease Self-Management Program (
which I delivered as workshop facilitator while employed at On Lok, and supplemented self-efficacy approach with linkages to community resources to address social determinants of health in supporting participants' weekly behavioral action plans).
Jenée Johnson, SF DPH Program Innovation Leader for
Mindfulness, Trauma and Racial Equity (would be helpful to add Gender Equity), invited SIYLI graduates to Mindfulness
Meet-Up so we could continue “integrating self-awareness,
self-management, empathy, resilience and compassion into our lives and work.”
Mindful magazine staff showed up to take photos to accompany upcoming
article about DPH’s mindfulness efforts.
Ron Purser, SFSU Professor of Management, described his participation
in SIYLI:
“The
workshop was an amalgam of childish icebreakers, turn-to-your partner
exercises, three-minute breathing meditations, and a hodgepodge of superficial
materials on emotional intelligence as a pathway to career success, along with
the usual neurobabble that meditation changes your brain…
What’s happening with corporate mindfulness is a complete
denigration of critical thinking into the causes of stress, which are all
privatized into the individual. There is also an implicit denigration of
collective action and building solidarity. This trope is so common—“Change
always starts from within. We first have to change ourselves, take
self-responsibility, do self-care.”… The fact that these corporate initiatives
are also [do it yourself] undercuts social change. It’s sending individuals a
message that they are the problem, they need to be calm, and they need to
regulate.
We’re always in a mode of trying to remake ourselves, refashion
ourselves. We’re entrepreneurs of the self. Just look at the boom in meditation
and mindfulness apps. The products are being hawked. Everything is about
mustering our internal resources in an enterprise culture where subjectivity is
monetized as mental capital and we’re human capital.
But we don’t look at how external resources in the social and
political environment are really what helps us become more resilient. Do we
have sick days at work? Do we have money in a savings account? Do we have
neighbors who can help us out? Do we have health care? All of these things are
much more conducive to building resilience than these gadgets and techniques
being marketed...
Mindfulness is a very unregulated industry…where anyone can hang
out a shingle...
It seems innocuous. What’s wrong with a three-minute breathing
exercise? What’s wrong with that, you know? Well, nothing particularly. But can
we aim a little bit higher?”—Ron Purser, author of McMindfulness:
How Mindfulness Became the New Capitalist Spirituality, interviewed by Zachary
Siegel, “Why Corporations Want You to Shut Up and Meditate,” The Nation
(July 25, 2019)
Could deep breathing fresh air have the same effect of relaxing people who use smoking/vaping (breathing carcinogens) as a form of stress relief? Last month, headed over to Oakland Museum to attend
Alameda County Behavioral Health’s Tobacco Conference, Vaping Nicotine: How Safe
is it for Our Communities? where
I was greeted by these posters showing smoking prevalence among vulnerable
populations (chronically homeless, incarcerated, HIV infected, low-income,
mentally ill/SUD) and behavioral health/psychiatric co-morbidities (OUD,
schizophrenia, bipolar, alcohol use, SUD, anxiety). Centers for Disease Control and Prevention
recommended that mental health facilities go smoke-free and stop providing
cigarettes to patients as an incentive/reward.
Gurinder
Singh Wadhwa, DO, shared research showing that despite intentions for harm
reduction, many smokers do not transition fully from smoking to vaping;
instead, they become dual users increasing nicotine consumption. People with behavioral health conditions
consume 42% of all cigarettes, while research suggests quitting tobacco
decreases depression and anxiety. Further,
integrating tobacco treatment into behavioral health treatment can help clients
with tobacco addiction.
Phil
Gardiner, DrPH, Senior Program Officer at UC Tobacco Related Disease Research Program
(TRDRP) and Co-Chair of African-American
Tobacco Control Leadership Council (AATCLC), likened vaping as another addictive
tobacco product to menthol cigarettes marketed to African-Americans over the
past half-century. Tobacco-related
diseases are #1 cause of death in African-American community, killing over
45,000 a year. (See 15-minute documentary, “Black Lives/Black Lungs.”)
Yet, 90% of black organizations, including Congressional Black Caucus,
accept tobacco money so they don’t speak against tobacco industry that is killing
black lives.
After the power
point presentations, we enjoyed working lunch over discussion circles: Stanford Tobacco Toolkit (targeting schoolkids);
Power of Marketing (SF-based Juul
has 76% of vaping market share, $1.6 million marketing budget targeting young
users); Vaping Devices Deconstructed (1 Juul pod=20 cigarettes worth of
nicotine!); Advocacy Work (community participation is driving force behind adoption
of Tobacco Retail Licensing ordinances that prohibit sale of flavored tobacco,
establish minimum price floors and package size requirements for tobacco
products and limit tobacco retailers per capita); and Tobacco Dependence
Treatment Providers and Resources (pictured above, Project Eden provides outpatient
services to adults with substance use disorders, using harm reduction though
term not used because funding based on abstinence model).
SF passed an
ordinance banning the sale and distribution of e-cigarettes, pending a Food and
Drug Administration (FDA) review of their safety, including inhaling secondhand
vapor, presumably to protect children. Never
mind FDA already requires health warning labels on all tobacco products, SF did not go so far as to ban
conventional cigarettes that kill more than 400,000 Americans each year. Instead, Beverly Hills became first U.S. city
to ban sale of tobacco products except cigars, effective 2021.
Surviving
SF DPH’s Supporting
Health by Empowering & Lifting Leaders (SHELL) hosted an interactive seminar,
HIV Long-Term Survivors with Tez Anderson, founder of Let’s Kick ASS (AIDS
Survivor Syndrome) and HIV Long-Term Survivors Awareness Day (June 5, when CDC reported first
cases). Tez came out of the closet at age 17 (in
1977), diagnosed HIV+ in 1983, had “mid-life” crisis at 26 (in 1986) when he
was told he had only two years to live, which made him think short-term so he
had no plans for college or saving money.
He moved to SF Castro gay mecca, where death and the expectation of
dying was prevalent. He experienced anger,
severe anxiety and depression; he sought help from therapists, but the ones he
could afford did not know how to help because they were trainees and too young
to understand. After Highly Active
Antiretroviral Therapy (HAART) was introduced in 1996, HIV was transformed
from a death sentence to a chronic, but manageable condition.
Today more
than 60% of people living with HIV are age 50+, and these long-term HIV
survivors face unique challenges entering old age: poverty, social isolation/withdrawal,
survivor guilt (ASS v. PTSD), and harmful side effects from early medications
(neuropathy, enteropathy, arthritis, diarrhea, etc. which impair mobility and
engagement when they “need community more than ever”). Now age 60 and married for 12 years, Tez
views aging as inevitable and a privilege because people have value in
experience, so he embraces wrinkles and graying hair. He also discussed ageism, like not bothering
to test old people for sexually transmitted diseases, and PrEP marketing to
young.
At SF Main Library, journalist Keli Dailey hosted Surviving San Francisco: The Free Advice Show with
panelists:
·
Karen (Central City SRO
organizer): museum free days, free cycle, free films via SFPL’s Kanopy (video
streaming)
·
Dro (stand-up comic): work in
food industry for free meals
·
Peggy (social worker turned
start-up tech activist): survived on social worker salary $30K-60K by living in
rent control unit and being frugal
During July 4th
weekend, joined American Independence was all about land: walking tour with
David Giesen. Starting at the Hostel in Union Square and
walking east to Chinatown and Financial District, David talked about various
social movements: charity (Glide Church’s fight against poverty, more about
changing individual v. transforming society), utopian communist (back-to-the
land Diggers, Mormons, American Indian occupation of Alcatraz, Jim Jones and
People’s Temple, Occupy), revolutionary socialist (Black Panthers, who lived in
building across from 701 Sutter Street building for sale with vacant
ground floor retail space for lease below Legal Assistance to the Elderly’s 2nd
floor offices, pictured above in right corner), and geonomic (Judaism, Henry George).
Sun Yat-Sen (1866-1925; 12-foot
statue in St. Mary’s Square, Chinatown), “Father of Modern China,” got
inspiration for his Three Principles of the People (nationalism, democracy, and
social welfare) for China while in SF in 1905.
After reading Progress and Poverty (1879) by American journalist
Henry George (1839-1897), Sun adopted the Georgist idea of equalization of land ownership based on a single tax on land values to generate government revenue for social welfare needs like clothing, food,
housing, and transportation.
As State Assemblyman,
Willie L. Brown, Jr. twice introduced land value tax legislation but was
defeated; instead, California voters passed Proposition 13, People’s Initiative
to Limit Property Taxation, in 1978, partly motivated by the idea that older
Californians should not be taxed out of their homes. Yet, after walking through many vacant lots, empty
storefronts, and streets with unhoused people in the City, Georgism is appealing
to encourage productive land use v. land speculation.
Margot Kushel, MD,
Director of UCSF Center for Vulnerable Populations and Benioff
Homelessness & Housing Initiative, presented a standing room only Grand
Rounds talk, Aging Among Homeless Populations: An Emerging Crisis, at UCSF Mission Bay.
She talked about homelessness in SF and California, then shared findings
from HOPE HOME
(Health Outcomes in Populations Experiencing Homelessness in Older Middle agE), an ongoing longitudinal cohort study examining homelessness in adults
aged 50+ in Oakland.
·
Homeless population is aging: proportion of single homeless older
adults age 50+ in SF has grown to 50%, from 11% in 1990 and 37% in 2003
·
Cohort born 1955-1965 have elevated risk of homelessness during
their lifetime because they came of age during recession and not able to
make-up lost income, Reagan made massive cuts in federal affordable housing that
were never restored—California is 2nd worst, with only 22 units of
affordable and available for every 100 extremely low-income households; only 34% of low-income, at-risk elderly households receive Section 8 rental assistance
·
Racial justice issue: Blacks are less than 6% of SF population, yet
have 3-4x risk of being homeless. Housing
is primary means of wealth, yet there is discrimination in home ownership (segregation,
redlining, predatory lending) and rental market.
·
HOPE HOME study: 450 participants, 77% men, 80% African-American
·
Pathways into homelessness: 44% of homeless studied experienced
their 1st episode of homelessness after age 50—most married; many
worked multiple, minimum wage, non-union, physically demanding jobs; 3 triggers—job
loss & unable to compete with high school education, sick & unable to continue physically demanding job, death of spouse/parent. (Contrast early
onset homeless: traumatic adverse child experiences, mental health/substance
use started in teen years, prison, TBI, etc.)
·
Health status: “50 is the new 75” (premature aging, prevalence of
geriatric syndromes); self-reported multiple chronic conditions (hypertension,
arthritis, hepatitis, asthma); higher proportion with functional impairment (1/3 have executive function impairment that interferes with following sequential steps to
secure housing), substance use problems common to numb fear (65% drug
use-cocaine, cannabis, opioids; 26% alcohol use); mental health (over 1/3 depression,
1/3 PTSD, 18% psychiatric hospitalization); high rates of acute care
utilization, high mortality rate & institutional care (nursing home stays);
majority obtain housing within 18 months
· Interventions/solutions:
deeply affordable housing (expand & preserve, target those who make <30%
AMI; follow legislative efforts at National Low Income Housing Coalition),
eviction prevention (just cause in SF, Oakland, San Jose; AB 1482 proposes
state-wide just cause laws with limits on large rental increases), legal
assistance, emergency housing assistance, rapid re-housing, permanent
supportive housing (Housing First model, need to adapt for needs of older
adults to age in place); advocate “housing is the best medicine” (push back
against individual narrative—know how to treat serious mental illness, real solutions
point to affordable housing)!
Dr. Kushel joins discussion with graduate
student Andy Kim and UCSF Institute for
Global Health Sciences (IGHS) Executive Director
Jaime Sepulveda. Dr. Kushel said homelessness is vastly undercounted due
to surveys in English and federal definition of homelessness does not include
Asians who might have 8 people crowded in SRO.
Community Living
Campaign’s Outer Sunset Connector Margaret Graf organized this month’s Senior
Power presentations at Taraval Police Station with speakers from SF DPH’s Community Health Equity & Promotion (CHEP) and Safe Streets for Seniors.
For older adults age 60+
living in SF, Community and Home Injury Prevention Program (CHIPPS) provides
free home safety assessments and minor home safety modifications (if income eligible)
because “seniors are happier and healthier living at home.” Yet, people at home can risk injury from
falls, scalds (hot liquid), burns (dry heat) and fires; and seniors may recover
more slowly, leading to loss of mobility and independence, hospitalization and
risk of death. Injuries at home are
preventable if we prioritize safety:
·
Changes in behavior: see doctor (get balance
check, review meds that may cause instability/dizziness); get vision and hearing check (wear glasses with correct prescription, wear hearing
aid if needed); regular physical activity (tai chi helps balance); wear right
shoes (non-slip sole, breathable material, high back, flat/low heel,
wide-mouth, no laces, soft and padded; if diabetic, podiatrist can write
prescription for shoes paid by Medicare); careful if smoke (well-ventilated
area, large ashtrays for butts, never in bed or lying down on couch; better to
quit with help from 1-800-NOBUTTS)
·
Climate change: in SF,
“extreme heat” is above 85F, can lead to dehydration, heat exhaustion and heat stroke; and will worsen
conditions like heart disease, diabetes and respiratory illnesses. Some tips during extreme heat: call family/friend
to check in; avoid being outdoors 10 am–4 pm; drink plenty of water; take cool
showers/baths; avoid alcohol; eat small meals that are low in protein; wear
loose, breathable fabrics. To find a
cool place, check SF72.org or call 311.
·
Changes in home environment: get free home safety assessment; good
lighting, reduce clutter and trip hazards; CHIPPS can provide surge protectors
(do not run electrical cords under carpets to avoid sparks), install carbon
monoxide detectors, annually test smoke and CO2 detectors, etc.
SF Hazards & Climate Resilience
(HCR): People with Disabilities + Older Adults was an opportunity to provide feedback on draft HCR Plan strategies for existing buildings, new
development, public awareness, housing, utilities, waterfront, transportation,
etc. and build community while enjoying 100% plant-based breakfast and lunch provided by Nourish
Café!
David Munoz Ventura, Senior Project
Coordinator with the Seismic Safety Outreach Program (SSOP) (pictured above
with his colleague Jia) presented Personal
Preparedness: A Seismic-Safety Plan for Older & Disabled Adults at Institute on Aging. SSOP is a partnership between SF Department of Building
Inspection and Community Youth Center (CYC). (CYC Program Director Michael Wong was former
Asian Community Preparedness Manager of the American Red Cross Bay Area Chapter, running its Youth for Chinese Elderly Program, which partnered bilingual youth volunteers with
monolingual Chinese elderly in emergency and disaster preparedness; since 2015,
Michael brought this intergenerational model to CYC.)
All training participants received SSOP for Senior
Preparedness booklet and Dynamo Radio
Light. David reminded us that we survive through social cohesion, our interdependence,
so get connected: use digital networks to stay informed via SFDEM, SF72org, 511 and 311; WhatsApp messaging; sign-up to meet
neighbors on Nextdoor; upload important documents in cloud
or Google drive. For people with disabilities
who are not able to Drop, Cover and Hold On during earthquake, David modified instructions to protect head and neck
with arms/pillows, and do not head for doorway (unless you’re in 19th
century adobe home).
Brain
Awareness (last month)
At JCCSF’s
3rd Annual Brain Fitness Forum, comedic monolinguist Josh Kornbluth performed Josh’s
Brain Improv describing his experience as an Atlantic Fellow at Global Brain Health Institute of UCSF Memory and Aging Center.
With his credentials as a graduate of Bronx High School of Science and
theatrical performer, he set out to learn as much about brain science to educate
audiences about brain disease
research and to help remove the stigma relating to people with dementia and
their caregivers. Josh’s Citizen Brain series can be
viewed on his youtube channel.
Forum ended
with a documentary screening of Too Soon to Forget: The Journey of Younger Onset Alzheimer’s Disease (YOAD). Up to 5% of the more
than 5 million Americans with Alzheimer's are living with YOAD (diagnosed before
age 65), which can be diagnosed as young as age 30. Congress
has introduced YOAD Parity Health Act of 2019 (H.R.
1903/S. 901), which would allow individuals living with YOAD to access programs
under the Older Americans Act (OAA). Former New York Times reporter Phil Gutis, diagnosed with YOAD at age 54, has been chronicling his journey online.
Elder Care Alliance, a non-profit senior living organization, hosted
afternoon Celebration of Dementia-Inclusive Art & Community at SOMa
Cultural Arts Center: a drop-in “open classroom” where participants, who
received Dementia-Inclusive tote bags, were free to enjoy refreshments, make art,
view posters, sit at tables to respond (drawing, collage, writing, etc.) to
prompts from issue cards stamped “Dementia-Inclusive Communities Initiative” about
creating an “age-friendly” environment: care, culture, physical space and built
environment.
Interactive Let’s Redefine Age … woops, hard to read small print!
Cards read: What are things you fear when you think about getting older? What are things you love about your
own aging process? For collection of responses, visit #Elevate Aging.
On Lok 30th
Street Senior Center, which is celebrating 40 years, hosted 4-part How You Age Matters series. Center Director Valorie Villela
introduced UCSF geriatrician Louise Aronson, who presented Many Faces of
Dementia. For Dr. Aronson,
dementia is personal as her late father had Alzheimer’s and her mother has mild
cognitive impairment. Her
recommendations:
·
Keep
healthy and active: eat a healthy/Mediterranean diet; exercise
regularly; keep your mind active (consider brain training); don’t smoke; keep
your weight, blood pressure, and blood sugar under good control; maintain at
least a few close, personal relationships
·
Some
things to do that improve life and your future, whether or not your have
dementia: Get evaluated; think about what matters most
to you; get a hearing aid if you need one; stay active and social; make or
update your advance directive; start doing all the fun things you can afford.
·
Communicating
with someone with dementia: NEVER reason, shame, say “remember?” or “I
told you” or “You can’t”, condescend, force, abandon; INSTEAD, distract,
reassure, divert, reminisce, repeat, offer simple instructions, be kind, provide
choices, demonstrate, try a different approach, encourage and support
Good Life before
Good Death
“…there is more of a romance to death than to aging currently…a good
death is good, but hopefully it's pretty short and quick, right? Whereas we're
talking decades of life and one of the things I like to say is do I know enough
palliative care to give you a good death? Yes, but more importantly, I know
enough geriatrics to give you a good life.
…if you
look at a lot of health systems or other places, you'll see, oh here's
pediatrics, here's adults, here's death. Oh, what happened in between? Oh we
became invisible, we don't matter. And that's why we need elderhood because
there are three phases whenever you're talking about kids and adults or
childhood and adulthood, you need to invoke the elders and elderhood as well.”—Louise
Aronson, MD, geriatrician and author of Elderhood: Redefining Aging,
Transforming Medicine, Reimagining Life, as guest at Geripal (May
30, 2019)
At Dr. Aronson’s presentation at City Lights
bookstore, sat behind Paul Kleyman, editor of Generations Beat Online. Dr. Aronson explained that she originally
called her book, Oldhood, because she wanted to reclaim the word “old.” However, after someone pointed out that title
would be grammatically incorrect, she changed the title to Elderhood. (This contrasts with old-naysayer
geriatricians like Juergen Bludau’s Aging, But Never Old: The Realities, Myths & Misrepresentations of the Anti-Aging Movement
(2010) and Marc Agronin’s The End of Old Age: Living a Longer, More Purposeful Life (2018) which opens with an introduction called, “Old is the Problem and
Aging is the Solution," and leave it to Big
Pharma to embrace “Get Old.”)
Nancy
Belza (financial services sales executive) and Paul Puccinelli, LMFT of Dyalogues (for-profit
co-founded by Dawn Gross, MD in palliative care,) began with a cards exercise
that was eerily similar to Go Wish (non-profit) intended to reduce
stress and stigma around end-of-life discussions, while practicing our
listening, empathy and curiosity skills for stronger connections. (Stanley Terman, a psychiatrist, created My Way for Natural Dying cards through his non-profit, Caring Advocates.)
Nancy and Paul instructed us to
organize cards based on relative importance, and then invite our partners into
this “gift of conversation” using these prompts because curiosity leads to
discovery: Tell me more, What does that look like, How could I support you,
How would I know, and Help me understand.
Take-aways:
·
This is about NOW: don’t
have to wait to have these conversations.
·
Don’t assume to know
what others want, without first having a conversation.
·
More than one
conversation: life is dynamic, what matters most to us changes over time.
·
Talking about what
matters at end of life, with those who matter, can ensure that our vision is
respected and honored.
Catherine
A. Madison, MD Director at Ray Dolby Brain Health Center, introduced Advance Directive for Dementia, developed by Barak Gaster, primary
care MD at University of Washington, and profiled in The New York Times
article published last year. Dementia
Directive is recommended for all patients at age 65, when they become at risk
for cognitive impairment that could lead to dementia.
·
Because tough conversations rarely go as planned, provide prompts (for
example, use Go Wish cards developed by geriatrician Elizabeth Menkin, MD) and then focus on listening,
reflecting, learning and working on a common objective.
·
Become comfortable with your talking points, focusing on goals, function
and quality of life.
·
Be flexible: “You look uncertain about this…We don’t need to decide
today—at this moment. Let’s talk more at
our next meeting.”
·
Try mindfulness: Pay attention in
a non-judgmental manner, on purpose, to what matters most and bringing your
whole self to the experience.
Dr. Gaster singled out dementia from multiple health conditions for an
advance health care directive due to its nature as a slowly progressive
neurodegenerative disease that leaves people with a long-time frame of
diminishing cognitive function and loss of ability to self-care; many Americans
who value autonomy may view living with advanced dementia as an unacceptable
loss of dignity. In contrast, the
standard advance directive focuses on rare conditions like persistent vegetative
state, permanent coma, or imminently terminal condition that do not apply to
dementia.
Steve Heilig, MPH, Director of Public Health and Education
at San Francisco Medical Society, echoed Dr. Madison’s views.
