Lucky you (seniors) live Hawaii!

"Lucky you live Hawaii” was an expression I heard a lot while growing up in Hawaii.  Though born and raised in Honolulu, I always felt like an outsider.  Brought up by my Chinese immigrant parents and grandparents, I inherited their intense work ethic instead of the laid-back, island lifestyle (fun in da sun). 

As a teenager, I ran away to attend college in the Mainland where I then stayed to work.  My parents, both seniors but not retiring types, remain in Honolulu where they continue to run our family business.  In doing so, they remain active and fairly secure that they will not outlive their savings.  When I visit them, it’s usually a working vacation—unpaid, but room and board provided.  

This time as a budding gerontologist, I decided my field visit would be an opportunity to study healthy aging in Honolulu.  After all, I could observe kupuna (elders) in my own ohana (family), as the Pake (Chinese) in Hawaii have the nation’s longest average life span at 86 years (http://www.healthtrends.org/status_life_expect.aspx).  Note:  Part-Chinese Sen. Daniel Akaka (born September 11, 1924) outlived Japanese Sen. Dan Inouye (September 7, 1924 – December 17, 2012). 

Palolo Chinese Home’s Senior Day Care resembles a college campus, with menu reflecting foodways of American (SPAM), Chinese, Filipino, Hawaiian, Italian, Japanese, Korean, Thai, etc. cuisines (http://www.palolohome.org/services/food-service.html).  

Lunch menu for Kupuna Wellness Centers, with meals prepared in a centralized kitchen and then delivered by Lanakila Meals on Wheels (http://www.lanakilapacific.org/programs/lanakila-meals-on-wheels/kwc/) for donation of $2 per kupuna—a real bargain considering Hawaii’s high cost of living.  (Recognizing the high cost of food, Hawaii’s Senior Farmers Market Nutrition Program distributes vouchers worth $50 to low-income seniors, while California’s distributes vouchers worth only $20.) 

E Loa Ke Ola (May Life Be Long)

One of my first stops to obtain information was at the State Department of Health’s Executive Office on Aging (http://hawaii.gov/health/eoa/index.html), which is conveniently located in the same building as the Hawaii State Art Museum (http://www.state.hi.us/sfca/).

Then it’s a pleasant half-mile stroll past these elegant banyan trees along Iolani Palace, State Capitol and Main Library (my childhood hangout) to the City and County’s Department of Community Services’ Elderly Affairs Division, the designated Area Agency on Aging that publishes the Honolulu Senior Information and Assistance Handbook (http://www.elderlyaffairs.com/site/449/publications.aspx). 

Successful aging

At the Center on Aging at University of Hawaii (UH) (http://www.hawaii.edu/aging/), Program Assistant Justine Nihipali alerted me to the latest Profile of Successful Aging Among Hawaii’s Older Adults (http://www.hawaiiadrc.org/Portals/_AgencySite/2013Aging.pdf).  Some highlights:

• Hawaii’s population is aging much faster than the U.S. national average, with a higher life expectancy of 81, and the fastest growing population being those 85 years and older, increasing at a rate of 72.2% between 2000 and 2010, compared with a national increase of 29.6%. 
• Keep active: Hawaii’s older adults report more time in leisure/exercise and labor force participation; and lower rates of disability, smoking, obesity/overweight, and diabetes.  However, they report higher rates of asthma.

Fusion cuisine: Zesty taro hummus (KCC Farmers' Market) and taro pie (Mickey D's)

• Go along to get along:  Hawaii is the most diverse state in the nation, with its mixed ethnic population at 23.8% compared to 2.7% nationally.  Hawaii also leads the nation in multigenerational living (7.2% of households), and 31.7% of older adults live alone compared to 40.6% nationally.

What I liked about Hawaii’s so-called Kupuna Wellness Centers is that they’re housed in larger community centers that serve all ages so it's like one big ohana with keiki (kids) and kupuna.  Since my parents were preoccupied with business, I attended a couple of classes intended for seniors, thinking I’d share information with my parents and ended up learning tips useful for everyone who wants to age in community.

Falls Prevention

Mo’ili'ili Community Center (http://moiliilicc.org/moiliili-senior-center) charges annual dues to participate in its Senior Center, but I was able check out the place by attending a free Falls Prevention class presented by Eileen Phillips, RN at Attention Plus Care (http://www.attentionplus.com/contact-us/events-and-classes).  She shared the following scary local stats:

• Every five hours a kupuna is injured severely in a fall that must be treated at a hospital
• 85 kupuna die each year due to falls, a leading cause of injury-related death

After discussing risk factors, she asked for volunteers to do a “get up and go” test for fall risk, which involved getting up from seat, walking around a cone and then sitting down within 8.5 seconds.  Most participants were small-boned Asians, who went about this exercise in typical, island pace so they exceeded 8.5 seconds.  We then did several exercises intended to challenge our balance sensors—eyes, inner ear and ankles—by letting go one at a time.  (More about falls prevention at http://www.hawaiiadrc.org/Portals/_AgencySite/2013Falls.pdf).

Disaster Preparedness

 

In the bimonthly Generations magazine (http://generations808.com/), I learned about this half-day course on Natural Disaster Awareness for Caregivers of Senior Citizens, presented by Natural Disaster Preparedness Training Center at UH (https://ndptc.hawaii.edu/).  During our workshop, we were treated to manapua (BBQ pork bun) and pork dumpling from Chinatown’s Char Hung Sut (which makes super-sized local versions of dim sum) and instructor Letha DeCaires’ home-baked chocolate chip cookie.

This course focused on tsunami, hurricane and tornado scenarios—though Hawaii is also affected by other disasters (volcanic eruption, flood, earthquake, fire, windstorms, coastal sea storms, terrorism, avalanche/landslide, oil/fuel spills, and community power/utility failure), which makes it an ideal HQ for disaster preparedness training.  Except for the Big Island, Hawaii isn’t affected by heavy snowfall or extreme/prolonged cold spells—lucky you live Hawaii!

FEMA uses the 72-hour rule (prepare to be on our own for at least that duration after a disaster; SF site at http://72hours.org/).  But Hawaii residents should plan for longer periods, like up to nine days, since most food is shipped in from Matson.  For communication, cell phones will be down but landline phones and texting should be up.

While the State Department of Health emphasized stocking up on low-sodium foods in A Natural Disasters Safety and Readiness Guide for Seniors (http://www.emprints.hawaii.edu/training/sp.pdf), the City and County listed local favorites like Vienna sausage, SPAM, and corned beef hash (http://www1.honolulu.gov/dem/57dayfoodlist8x14mar09pdf.pdf).  This high-sodium, sat fat diet sounds like a man-made disaster! To avoid BPA poisoning in canned foods, see http://www.treehugger.com/green-food/7-companies-you-can-trust-to-use-bpa-free-cans.html.)

Life without SPAM

I found my parents ill-prepared due to their pantry’s lack of canned foods because my Mum insists on eating fresh foods.  Non-GMO papaya and mango are homegrown: when ripe, just pick and eat.  

SPAM on sale (Longs Drugs), but banned in my parents’ home.  Note:  My failure to eat SPAM confirmed my outsider status growing up. 

Hawaii kama'aina (long-time residents) are the nation’s top consumers of SPAM, but my grandparents who lived well into their 90s didn’t eat SPAM.  Why do Hawaii residents live longer than Mainlanders? (Residents of Minnesota, home of Hormel SPAM, have the nation's second highest life expectancy; http://www.manhattan-institute.org/html/mpr_04.htm.)

Generations: Chinese Families in Hawaii 1850-2000 exhibit at Hawaii Heritage Center.  Chinese immigrants to Hawaii came with their Confucian values (respect, honesty, education, kindness, filial piety) and Taoist longevity principles (balanced living with nature). 

·       Ohana support: based on Confucian filial piety among Asians that make up 40% of Hawaii’s population.

·       Hawaiian time: things happen when they do, so no rush, no stress—even in traffic, just go with the flow (http://www.staradvertiser.com/news/breaking/20130108_Honolulu_traffic_congestion_among_the_worst.html & http://www.hawaiinewsnow.com/story/18599683/honolulu-ranked-worst-in-country-for-traffic)

·       Year-round sunshine: helps grow local produce, make vitamin D for bone health, and encourage more physical activity; NIH study finds leisure-time physical activity extends life expectancy as much as 4.5 years (http://www.nih.gov/news/health/nov2012/nci-06.htm)

        

·       Wild caught seafood from Pacific Ocean: provides local source of heart-healthy and anti-inflammatory long-chain omega-3 fatty acids, so Hawaii residents consume three times more seafood than Mainlanders (http://www.sfgate.com/hawaii/alohafriday/article/Sustaining-Hawaii-s-seafood-3776481.php)

·       Hawaii Prepaid Health Care Act (http://www.healthcoveragehawaii.org/target/prepaid.html) requires employers to offer coverage to employees working at least 20 hours per week.  (In contrast, the federal Affordable Care Act, aka local boy ObamaCare, requires employers to offer coverage to employees working at least 30 hours per week, effective January 1, 2014.)

·       Low rate of obesity:  Hawaii has the second lowest adult obesity rate in the U.S. (http://healthyamericans.org/report/98/obseityratesbystate) due to large Asian population, but Pacific Islanders are at risk (http://honoluluweekly.com/story-continued/2013/01/defeating-obesity/). UH President MRC Greenwood said, “While Hawai‘i has had some of the best health statistics in the nation, in the last 15 years we have seen our rate of obesity increase from 11 percent in 1995 to 23 percent in 2010 (http://www.bigislandvideonews.com/2012/05/08/hawaiis-role-in-solving-the-weight-of-the-nation/; yet, she fails to explain how the obesity epidemic was created on June 17, 1998, when NIH lowered the “normal” BMI upper limit from 27 to 25, so suddenly over 30 million Americans went from “normal” to “overweight” –representing a 50% increase in overweight Americans overnight, per http://www.cnn.com/HEALTH/9806/17/weight.guidelines/. Further, there are no BMI guidelines specific to older adults, and BMI may not be a reliable indicator of obesity because it uses weight as a measure of risk, when it is actually a high percentage of body fat and waist size that makes a person obese.)

·       Short height:  At the last GSA annual meeting, Honolulu-based geriatric Dr. Bradley Willcox, Co-Principal Investigator of the Okinawa Centenarian Study (http://www.okicent.org/team.html) and Hawaii Lifespan Study, noted that short height is associated with longevity.

Broke da mout’ food, but where da greens?

Several physicians who practiced in Hawaii, like John McDougall (http://www.drmcdougall.com/misc/2012nl/nov/honor.htm), Michael Klaper (http://doctorklaper.com/), William Harris (http://www.vegsource.com/harris/) and Terry Shintani (http://www.bizjournals.com/pacific/blog/2013/01/hawaii-diet-author-shintani-says.html) advocate plant-based diets for health and longevity, but it’s rare to see greens on local plates.

Instead, plate lunches (aka heart attack on a plate) loaded with animal meats and starches (white rice, mac salad), a carryover from plantation days, are ubiquitous (http://www.nytimes.com/2008/11/12/dining/12plate.html).  KCC Farmers’ Market (http://hfbf.org/markets/markets/kcc/) offers mostly local food on styrofoam plates.

Local fast food chain Zippy’s serves breakfast from 11 pm to 10:30 am, like this bento with white rice, scrambled egg and choice of two meats (Portuguese sausage, corned beef hash, or SPAM).  Zippy’s founders are Okinawan but they don’t serve Okinawan food, except for white rice.

I love eating Korean banchan, or appetizers (mainly vegetarian).  At Korean take-out places, I skip the meats, rice and mac salad (sometimes) in favor of creating my own veggie banchan plate: wakame (seaweed), chapchae (sweet potato noodles, carrots, cabbage), radish, mung bean sprouts, zucchini jun, and mandoo (dumplings)(Korean Hibiscus BBQ).

More banchan (Yummy’s Korean)

Longevity diets

Dr. Willcox’s Okinawa Diet Plan (http://okinawa-diet.com/index.html) attempts to offer a “practical diet program rooted in Okinawan traditions” of the “longest-lived people on earth,” yet he recommends industrial processed soy-based products (which aren’t healthy whole foods) and dairy (which is mucus-promoting).  Okinawan cooking is heavily influenced by southern Chinese cooking, emphasizing vegetables, soybean, rice, wheat noodle, fish, pork and tea (http://211.76.170.15/server/APJCN/Volume10/vol10.2/Sho.pdf & http://www.westonaprice.org/traditional-diets/food-in-china). 

Bitter melon and sweet potato tempura appetizer (Hide-Chan Restaurant)

Goya chanpuru (bitter melon stir-fried with tofu, eggs and pork) served with white rice and miso tofu soup (Hide-Chan).

Okinawan soba with pork, fishcake, green onions and ginger (Hide-Chan)

Okinawan sweet potatoes (Whole Paycheck)

When I join my parents for weekly dim sum brunch, we eat steamed dumplings and stir-fry noodles but nothing deep-fried and never bother using condiments like Aloha soy sauce (Happy Days Restaurant).  Traditional Chinese will drink hot or room temperature tea before and after a meal to preheat and lubricate the digestive tract.  Drinking too much liquid while eating is discouraged because it dilutes gastric juices; however, southern Chinese (Cantonese) began a rebellion when they combined yum cha (drink tea) + dim sum! Eating is a leisurely affair while we talk story, averaging two hours of bliss :-)

Iced drinks are a no-no because cold constricts digestion.  Since our body's internal temperature is 98.6F, drinking anything more than 60F colder will shock the system, causing stomach cramping and slowing metabolism.  Other no-nos in Chinese-American restaurants: MSG (Japanese invention), forks (use chopsticks) and fortune cookies (eat fresh fruit instead; see http://www.fortunecookiechronicles.com/ for origin of fortune cookie).

Mum’s lo han jai (vegetable stew dish for Chinese New Year’s) features mung bean noodles for long life.  (Recipe and symbolism of ingredients at http://archives.starbulletin.com/98/01/14/features/story1.html.)

When Mum noticed gray hairs sprouting out of my head, she immediately brewed up he shou wu ("He with a Head of Black Hair"), a Chinese tonic herb to prevent premature aging.  I actually like my graying head (wanna-be Maxine Hong Kingston), but also liked the earthy taste of he shou wu so I drank it up!

In Hawaii, we live (long) to eat!