No senior left behind

Springtime in lovely garden at 30^th Street Senior Center (http://www.onlok.org/30thStreetSeniorCenter/About30thStreet.aspx)

apple penny table

This month I began participation in UCSF’s Practicing Alternatives to Heal Depression (PATH-D) study, as I was selected to take part in the non-depressed group.  For the screening exam, I was given the Folstein Mini-Mental State Exam (MMSE), which involves repeating the words:  apple, penny, table.  Because these words have become so cliché (like an apple a day keeps the doctor away, a penny saved is a penny earned, etc.), I wondered about the effectiveness of repeating these same words to screen for cognitive impairment?

I read that “major depression in older people living in the community range from less than 1 percent to about 5 percent, but rises to 13.5 percent in those who require home healthcare and to 11.5 percent in elderly hospital patients” 

(http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml).  This confirmed my career choice to work in health promotion to support aging in community. 

“Only happy faces bloom there and there’s never any room there for worry, gloom or cares.  Seniors come here from everywhere to enjoy a day of cheer.”  By Precita Eyes Muralists in collaboration with the 30^th Street Senior Center.  If communing in this garden doesn’t lift someone out of depression, I find the karaoke singing (deep, abdominal breathing) inside the senior center brings a smile to my face and an occasional chuckle.

“nothing about us, without us!”

American Deaf Culture (http://www.americandeafculture.com/) author Thomas Holcomb presented a talk, Deaf Culture: An Obsolete Concept or A Timeless Solution? at SF Main Library.  When the medical model provides cochlear implants as a cure for deafness, does this mean full assimilation so there’s no need to be deaf anymore—something passé, a relic for a museum display case?  Alternatively, Holcomb offered Deaf Culture as a cultural/linguistic model to support healthy identity formation, self-determination, information-sharing and full access to communication. 

The Deaf community has opposed mainstreaming, which denies deaf children the opportunity to learn American Sign Language and isolates them among hearing classmates. When the Deaf seek opportunities for congregation, the hearing view them as segregation. 

Holcomb discussed the current fight for deaf-only retirement communities, which has raised concerns about discrimination against the hearing, but it’s really about a linguistic minority being able to live out their lives where they can enjoy the ease of freely communicating based on shared language and experience.  Holcomb explained that American Deaf Culture is characterized by information-sharing to the extent that not much is held back: access to communication is a way to understand how the world works (for example, buying a car at sticker price) because this was not picked up from their hearing parents or teachers. 

senior advocacy

SFSU Gerontology Program hosted Careers in Aging Fair, which included my invitees Department of Aging & Adult Services (http://www.sfhsa.org/DAAS.htm), Family Service Agency (http://fsasf.org/svc_senior.html), Gray Panthers (http://graypantherssf.igc.org/), Meals on Wheels (http://www.mowsf.org/) and Senior & Disability Action (http://www.sdaction.org).

Left photo:  Family Service Agency Senior Services Director Cathy Spensley with LTC Ombudsman Benson Nadell.  Right photo:  SDA Executive Director Jessica Lehman with Gray Panthers advocate Michael Lyon.

older women’s health

SFSU Gerontology Program Chair Darlene Yee-Melichar presented a talk, Women’s Health & Healthy Aging: Living Longer, Living Better.  Highlights:

• Ethnic minorities are becoming the majority
• If we seek to reduce death rate among women, focus on their top three causes of death: heart disease, cancers, cerebrovascular diseases (strokes)
• Multiple Chronic Conditions among age 45+ (“MCC zone”):  impact of caregiving among mid-life women of sandwich generation is often neglecting self-care
• Most common combination: hypertension + diabetes correlation, nutrition + physical activity factors
• 1/3 of older women exposed to disabilities, 2/3 of older women independent; activity limitations & disabilities increase by age, setback by sedentary lifestyle—need older person to retain autonomy or lose ability so weigh consequences of being helpful v. too helpful
• 1/3 of U.S. population has low health literacy—need accurate info. that’s easy-to-understand

home care & domestic workers’ rights

At this month's SDA meeting, we heard from domestic workers and their advocates to learn how supporting the Domestic Worker Bill of Rights (http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB241) can be win-win for domestic workers and older adults and persons with disabilities (PWD) who receive their services so we can age in community.

getting around

SDA’s Senior Survival School at I.T. Bookman Community Center included transportation panel:  Matthew West of SF Muni Accessible Services discussed priority seating (blue decals on windows above seats, blue-colored seats in new buses) for seniors and PWD (Muni driver may not drive bus if passenger safety at stake should someone refuse to yield front seats to seniors and PWD), and late-night stop policy allows riders to request stop near side of intersection v. designated bus stop from 8:30 pm to 6 am.  John Sanderson discussed applying for paratransit services (ADA shared-ride cost $2, ADA group ride cost paid by senior center, and non-ADA-mandated taxi service).  Roxana Lara talked about shop-a-round, a grocery shuttle service for seniors and PWD, with a special offering free rides through August 15, and then we received shop-a-round tote bags! More information in Muni Access Guide (http://www.sfmta.com/cms/raccess/mauindx.htm).

aging gracefully

Jewish Community Center of SF hosted The Art of Aging Gracefully: Stay Vital, Healthy and Fit, with presentations from UCSF MDs.  My favorites:

Dr. Bruce L. Miller of UCSF Memory and Aging Center presented Factors Associated with Cognitive Aging, which included showing “Great Works Done in Late-Life or with Neurological Disease”:  Yeats, Shaw & O’Neill had Parkinson’s; de Kooning had Alzheimer’s; and Ravel had dementia.  Modifiable (non-genetic) risk factors that affect cognitive aging are adiposity/obesity, chronic inflammation, physical exercise that regrows brain-derived neurotrophic factor (BDNF), and vascular risk factors (hypertension reduces brain volume).  What we can do:

• Aerobic exercise is the only proven means to increase brain cells
• Protect against vascular disease (what is good for the heart is good for your brain)
• Participate in social networks & engage in mental activity
• See your doctor (e.g., treat low vitamin B12, thyroid)

UCSF oncologist Dr. Donald I. Abrams (who appears separated at birth from Mister Rogers?) returned to school ten years ago to study at Dr. Andrew Weill’s Arizona Center for Integrative Medicine.  He delivered the following 12-point program for Healthy Aging:

1.     Eat an anti-inflammatory diet: plant-based foods (whole grains, fruits, cruciferous vegetables); decrease animal fats except increase marine omega-3s; decrease refined carbs; season with garlic, ginger, onions, turmeric; drink green tea

2.     use dietary supplements wisely to support body’s defenses & natural healing power (e.g., medicinal mushrooms)

3.     use preventive medicine intelligently: know risks of age-related disease; get appropriate diagnostic & screening tests; treat problems in early stages

4.     get regular physical activity throughout life:  for posture, strength, balance, flexibility, endurance; brisk walk helps weight control, mental health, heart health

5.     get adequate rest & sleep: regular bedtime; avoid alcohol; no eating immediately prior to bed; evaluate meds for sleep interference

6.     learn & practice methods of stress protection

7.     exercise your mind as well as your body

8.     maintain social & intellectual connections as you go through life

9.     be flexible in mind & body:  learn to adapt to losses & let go of behaviors no longer appropriate for your age

10.think about & try to discover for yourself the benefits of aging: gift of time, freedom, senior discounts

11.do not deny reality of aging or put energy into trying to stop it:  use experience of aging as stimulus for spiritual awakening & growth

12.keep an ongoing record of the lessons you learn, the wisdom you gain & the values you hold.  At critical points in your life, read it over, add to it, revise it, & share it with people you care about.

More on Dr. Abrams’ thoughts on getting better with age (http://www.ucsfhealth.org/doctors_and_clinics/features/abrams_donald/index.html): 

“. . . aging is totally natural and, in fact, quite beautiful. I think of aging as something that adds value. As a culture, we appreciate things that get better with age, such as wine, cheese, and redwoods . . .”

“. . . age confers a certain understanding that life itself is the most valuable thing you have and what's valuable is still being here. . . “

“You can be smart when you're young, but you need to be old to be wise.”

non-profit approaches to aging in place

As adults with young children leave San Francisco (which has the lowest proportion of children of any major city in the U.S. according to the 2010 Census), this means aging parents are left behind without the informal support of family members, which could lead to isolation among these seniors.  AARP reports that many older adults join Villages because of a desire to age in place, yet “not be dependent on family members and friends” (http://www.aarp.org/home-garden/housing/info-03-2010/fs177-new.html). 

This month’s OWL (http://www.owlsf.org/) meeting featured a panel discussion on Aging in Place with Executive Director Marie Jobling of Community Living Campaign (CLC at http://sfcommunityliving.org/), Executive Director Kate Hoepke of SF Village (http://www.sfvillage.org/), Executive Director Jacqueline Zimmer Jones of NEXT Village (http://nextvillage.org/) and moderator Glenda Hope.  A common theme was building community to reduce isolation. 

Marie explained that formal services by agencies can deliver 20% of this support, while the rest comes from family, friends, neighbors and community.  A community organizer herself, Marie founded CLC in late 2006 as an organizing project with paid and trained Community Connectors who build small support networks of friends and neighbors (not “volunteers”) to care for one another and define the issues, and this evolves into a community.  For example, OMI Community Connector Deloris McGee began a food pantry delivery program for five mobility-challenged neighbors that has grown tenfold, attracting funding from DAAS.  This OMI Food Network has expanded to home modification assistance (install grab bars, repairs), breast cancer support, Fog Walkers group, computer training, etc. 

Founded about four years ago, SF Village and NEXT (Northeast EXchange Team) Village each charge $50 monthly fee for members to access network of volunteer services,  referrals and programs.  SF Village serves all of SF with a current membership of about 250.  NEXT Village concentrates on SF’s northeast corner with a current membership of over 60.  In February, SF Board of Supervisors gave $50,000 each to expand and diversify their membership, such as subsidizing cost to low-income members.

aging film fest coming soon to SFSU!

Executive Director Sheila Malkind is presenting the Legacy Film Festival on Aging (http://legacyfilmfestivalonaging.org/) at SFSU on June 7-9.  Malkind says the festival’s mission is to present films that inspire, educate and entertain intergenerational audiences about the issues surrounding aging.

saving CCSF older adults education 

Thanks to SDA advocacy training, I’ve prepared this two-minute elevator speech in response to SB 173 (http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB173, as amended on April 24, 2013), which threatens to “delete the authorization for noncredit community college parenting, older adults, home economics, and health and safety education courses and classes to receive program-based funding from the state.”

I am speaking out to support continued state funding for noncredit community college older adults, home economics, and health and safety education courses. 

While exploring a career change, I spoke with May Fong, Consumer Education Department Chair at City College of San Francisco (CCSF), who referred me to a noncredit Nutrition & Health course at Golden Gate Park Senior Center (GGPSC).  Lisa Yamashiro, a registered dietitian (RD) who taught the course, really made the connection between senior health issues and eating habits.  I immediately saw the value that this course brought to my mostly senior classmates in this safe learning community (no exam/grade pressures), so students were free to reveal their personal health issues and then Lisa would kindly suggest helpful dietary changes and positive reinforcement during each week’s class. 

Inspired by Lisa’s example, I eventually enrolled in her 17-credit Nutrition Assistant Program at CCSF and returned to teach my former GGPSC classmates in one class to fulfill a Community Nutrition class assignment.  Like Lisa, I also taught container gardening to involve seniors in their own food production!

I gained a greater appreciation for CCSF’s noncredit Nutrition classes during my field experience at Department of Aging and Adult Services (DAAS), the local Area Agency on Aging for the City and County of San Francisco.  Under the supervision of my preceptor, DAAS nutritionist Linda Lau, RD, I had the opportunity to work with different congregate meal sites, where many low-income seniors obtain their only nutritious meal of the day.

CCSF’s RDs teach free, noncredit health classes in nutrition/cooking/physical activity/safety at over 30 sites in the City, delivering the bulk of required nutrition education classes at senior congregate meal sites, and provide excellent training for students in the Nutrition Assistant Program.  Particularly with low-income seniors who cannot afford prescription meds, food is their medicine, so learning from CCSF RDs about proper nutrition and how to eat healthy from food pantries empowers them to take charge of their health so they can continue to age in community instead of premature institutionalization (more costly for Medi-Cal).

As you may be aware, we are experiencing an unprecedented growth in our older population—the so-called Silver Tsunami since the oldest Baby Boomers began turning age 65 in 2011.  The average 75-year-old has three chronic conditions, and the majority of these associated health costs can be managed by dietary/lifestyle changes.   I urge you to consider the impact of SB 173, as the current version of the bill to remove funding of critical nutrition and health promotion courses would be disastrous to our most vulnerable seniors.  Please keep funding intact to support our community college Nutrition & Health courses.

Thank you in advance for your support of lifelong learning so our seniors can age in community!

preparing for a good death

We all know there are two certainties in life: taxes and death.  Most Americans remember April 15 as filing due date for their federal income tax returns, but not as many are aware that the following day (April 16) is National Health Care Decisions Day.  If you haven’t yet done your advance care planning and you’re still competent, it’s not too late to execute your health care power of attorney or living will (free forms available at http://www.nhdd.org/public-resources/).