This is what 60 looks like: ASA's Aging in America conference

At 60 years, American Society on Aging (ASA) is finally an older American under the Older Americans Act (OAA)!  More than 2,500 registrants, including yours truly, convened in sunny San Diego to celebrate ASA’s 60^th anniversary and learn, network, eat and drink together.  It was a real challenge to select from more than 600 sessions, workshops, roundtables, peer groups, constituent groups, summits and other conference events.  

Throughout this year’s ASA conference, I wore these “HAVE A HJPPY DEATH” buttons, which I picked up from Dr. Aviva Boxer while I was volunteering as room monitor during her presentation Bonding Your Life Legacy.  Aviva said that aging baby boomers mean there will be more deaths, so we need to prepare for our legacy and think about getting our core life message in one line.  An online authority on end-of-life, she mentioned websites like deadsocial (schedule social media posts into the future) and liveson to manage digital legacies. 

Earlier this month, I attended a celebration of life to honor my 94-year-old landlord.  It was a lovely memorial service which included remembrances from family and friends that were heartfelt, funny and lengthy.  Now I wondered how to capture the essence of his 94 years of living in a single line message—though my clueless neighbors recalled “he didn’t allow pets.”  When I learned about his death, I called his landline telephone number only to reach his recorded message, “This is the Hallford residence,” and later suggested that his widow keep the recording because it’s like part of his legacy.  Sadly, Mr. Hallford did not have a HJPPY death but a pLinful one from an infection caused by botched surgery.  (Note: The 5^th annual Dying Matters Awareness Week: You Only Die Once takes place May 12-18, 2014.)

Aviva bonding with her daughter Chelsea. 

Chronic Disease Self-Management Program (CDSMP)

Over two years ago, I became interested in adapting CDSMP to make it more relevant to different groups ever since our San Francisco Commission on Aging President Edna James told me this could be done while maintaining fidelity to Stanford’s evidence-based model, citing work done by Philadelphia’s Harvest Health: Translation of CDSMP for Older African Americans in a Senior Setting.  I work part-time organizing CDSMP workshops under a San Francisco Department of Aging and Adult Services (DAAS) grant that provides for targeting groups that have been identified as demonstrating the greatest economic and social need:  low-income, non- or limited-English speaking, minority, frail and Lesbian-Gay-Bisexual-Transgender (LGBT).  For my graduate culminating experience, I am researching and writing about adapting CDSMP to target low-income groups, based on a behavioral justice model (or providing universal access to resources needed to engage in health-promoting behaviors) to potentially reduce health disparities.  With this focus, I decided to attend sessions relating to CDSMP, health promotion, and senior poverty. 

CDSMP sustainability

 

National Council on Aging (NCOA)’s Howard Bedlin and Emily Dessen joined Administration for Community Living (ACL)’s Michele Boutaugh for Evaluation of Two National Initiatives Implementing and Sustaining Self-Management followed by Moving Toward a Sustainable Infrastructure for Delivery of Evidence-Based Programs.  Michele discussed ACL’s initiatives focused on scaling (marketing and partnerships) and sustaining (diversify funding and referrals) self-management and other evidence-based health promotion programs.  San Francisco’s CDSMP workshops are funded by a grant that runs through June 30, 2016, so it was helpful to learn about Medicare reimbursement for both CDSMP (health and behavior assessment) and Diabetes SMP (diabetes education). 

Monte Cimino, Programs Director at Curry Senior Center, which is a partner with San Francisco Healthier Living Coalition, mentioned that his Center’s clinic is a Medicare provider which will help to obtain Medicare reimbursement for its CDSMP workshops.  

Also in the audience was Oklahoma Department of Human Services Research Manager Zohre Salehezedeh, who presented Diabetes Self-Management Program Effectiveness in Preventive Care Practices in the previous afternoon (which I missed due to my volunteer duty).  It was great to finally meet and thank her in person because I had e-mailed her last year to obtain a copy of her study, The Impact of CDSMP on Nursing Home Residents, which was instrumental in convincing Jewish Home of San Francisco to host our CDSMP-Healthier Living workshop series for their residents, which included a couple of centenarians!

Michele mentioned that we could learn more about Medicare reimbursement for Diabetes SMP from consultant Tim McNeill in Network On Multicultural Aging (NOMA) Program—Diversifying Funding, Partnerships and Organizational Approaches to Diabetes Self-Management for Older Adults. 

Tim explained that Medicare reimbursement requires additional infrastructure (including review and sign-off by RN, RD or pharmacist) to Stanford’s Diabetes SMP; and current reimbursement rates are up to $550 for 13 hours including medical nutrition therapy (MNT), and $340 without MNT.

CDSMP adaptations & translations

 

Diabetes Self-Management Programs: Best Practice Models of State Implementation for Diverse Populations was an interesting panel discussion on the challenges of reaching diverse groups with Stanford’s highly structured Diabetes SMP.  Tammi Pollum reported that Detroit Area Agency on Aging dropped Stanford’s Diabetes SMP due to cost, length and inflexibility, in favor of Merck's Conversation Map, another evidence-based program reimburseable under Medicare. Kristen Smith said San Diego's Aging and Independence Services offers CDSMP in English, Spanish, Somali, Tagalog, Vietnamese and Arabic.  Robin McConney of Chicago's Rush University Medical Center adapted Stanford Diabetes SMP to target African-American women in Health Legacy Program that features Diabetes SMP health education along with cardiovascular exercise, support group/counseling and hands-on meal planning/nutrition counseling; clinical measures are included to monitor progress.  Finally, Merlyn Puente's Health Foundation of South Florida partnered with organizations serving primary target populations to serve 35,000 older adults in 5 years: 50% Hispanic, 17% Black, 25% White, 4% Haitian and 4% Other; the completion rate was 76% for English language, and 88% for Spanish language.

I attended a couple of sessions presented by the award-winning Hawaii Healthy Aging Partnership (HHAP), which has successfully adapted its evidence-based programs for Asian and Pacific Islanders:  CDSMP and Diabetes SMP. 

Kokua Kalihi Valley Elder Services Program Director Merlita Compton and University of Hawaii at Manoa Public Health Researcher Michiyo Tomioka presented How Multicultural Elements Within Health Promotion Programs Facilitate Improved Health and QOL.  Merlita discussed the importance of hiring multi-lingual staff with ethnic backgrounds similar to clients; conducting focus groups; acknowledging all cultures; providing transportation to increase access; offering culturally appropriate food, music and dance.  She also works with Michiyo to collect data annually because testimonials are not enough for program evaluation. 

Kauai County Aging Executive Ludvina Takahashi, Maui County Aging and Disability Program Specialist Jo Reyes, and Michiyo presented Best Practices in Sustaining a Statewide Health Promotion Initiative to share strategies to sustain their evidence-based health promotion programs, despite shrinking grant opportunities.  HHAP charges for CDSMP lay leader training and requests participant donation of $10 per CDSMP session (though scholarships available for low-income), which seem to inspire greater commitment with an active leader pool and 82% completion rate! They involve participants in annual HAP Advocacy Day to visit legislators, asking them if they’ve had to care for an elderly relative, and then stating their support for evidence-based programs to improve health of older adults by sharing their own experience and providing data sheet showing cost savings.

Senior poverty: do something

 

National Senior Citizens Law Center’s Special Counsel Paul Nathanson and Executive Director Kevin Prindiville presented Let's Talk Senior Poverty: What Are We Doing About It?  The official poverty rate for seniors is 9%, but the supplemental poverty measure after factoring health costs is 15%; the supplemental poverty measure is higher in DC (26%) and California (20%).  Senior poverty is rising due to growing number of seniors, impact of long-term changes in the economy (stagnant wages, decline in defined benefit plans, growing income inequality) and recent economic downturn (unemployment among older adults, loss of housing equity, loss of savings). 

Yet public programs designed to blunt the impact of elder poverty rate haven’t been updated much.  Supplemental Security Income (SSI) supports two million of the poorest seniors (majority are women), lifting monthly income to maximum $721 (or 74% Federal Poverty Level), but a senior cannot have more than $2,000 in resources to be eligible, as the benefit rate and resource limit have been updated only modestly since 1972 when Nixon envisioned SSI as providing “a step out of poverty and toward a life of dignity and independence.”  (California provides $156 monthly supplement, but does not allow SSI recipients to receive CalFresh food stamps.)  NSLC is advocating for SSI Restoration Act of 2014 to increase eligibility by raising amounts (for resource limit, general income disregard, earned income disregard) and providing for annual adjustments to reflect inflation. 

DOMA Repeal Nine Months Later: Did It Work? U.S. Assistant Secretary for Aging Kathy Greenlee with Carroll Estes and Max Richtman, both from National Committee to Preserve Social Security and Medicare, discussed how implementation of Supreme Court’s decision repealing In Defense of Marriage Act (DOMA) affected LGBT families’ access to Social Security benefits compared to previous situation described in Living Outside the Safety Net: LGBT Families and Social Security.

San Francisco State University (SFSU) presence

SFSU gerontology classmates Lois, Mary, Diane and Tony seated at opening general session 

SFSU gerontology graduate student Tony Maglio and SFSU gerontology Professor Brian de Vries at their poster session on Motivational Interviewing to Improve Diabetes and Ambivalence Towards Treatment 

SFSU interior design graduate Merijane Lee presented her poster on Home Modifications: BabyBoomer Intentions for Aging in Place  

SFSU gerontology classmate Brittany: ASK ME! VOLUNTEER

 

SFSU Professor Brian and graduate Loren Meissner join ACRIA’s Mark Brennan-Ing and SAGE’s Aaron Tax in presentation on The Intersection of Research, Policy and Advocacy Issues Among Older LGBT and HIV+ Adults.  Professor Brian and Loren presented preliminary research findings in last year’s ASA poster session.

This SFSU presence reminds me that I have to get back to work on my culminating experience and brevity . . .so few more conference highlights:

Past & future 

MLK, Jr. Community Choir performed before opening general session 

ASA’s 60 Years in the Field of Aging: Looking Back, Leaning Forward  

19 years ago, ASA’s The Future of Aging session featured Ken Dychtwald, Betty Friedan, Bob Butler and Fernando Torres-Gil (then the first U.S. Assistant Secretary for Aging).

General Session—The Future of Aging:  Ken (pop gerontologist) and Fernando (UCLA Social Work Professor) return, but Joseph Coughlin of MIT’s Age Lab and Jo Ann Jenkins of AARP take the place of Friedan and Butler.  

General Session—Veterans and Their Families included recognition to World War II veterans, including an original “Rosie the Riveter” who continues working for Boeing at age 94 because she has to “get out of the house”

 

Port of San Diego's Greatest Generation Walk  

The man, who claimed he was the sailor kissing a nurse in Times Square after World War II ended in famous Life magazine photo, recently died at age 86.

  

ASA’s 60th Anniversary Celebration

James and Jo of Maui County Office on Aging with palm trees behind

San Francisco-based Community Living rocks! Marie Jobling of Community Living Campaign and Darrick Lam of Administration for Community Living

Surprise! Jenn Chan, founder of San Francisco-based Senior Shower Project: A Novel Approach to Celebrating and Educating New Family Caregivers 

Technology 

Outliers: Who's Doing the Cool Stuff and What Difference Will It Make? featured The Patterson Foundation-funded Institute for the Ages, a non-profit based in Sarasota (oldest county in America, with 32% of its residents age 65+) that offers the market research services of its seniors to companies developing products and services to the growing senior consumer market.

General Session—Technology and the Quality of Older Life in the 21st Century 

SCAN Health Plan’s Delena Penner (also member of San Francisco Healthier Living Coalition) and Karen Richards presented on Gerotechnology: Using Interactive Technologies to Boost Intergenerational Communication

Diversity

Joined roundtable discussion on Fear of the Other: Managing Diverse Clients in a Segregated Culture to brainstorm strategies for developing greater acceptance of differences in a safe environment that respects everyone: communicating what’s appropriate ahead of time, posting reminders (table tents, posters) about acceptable behavior, correcting without shaming to protect everyone, organizing activities to move from fearing differences to understanding commonalities, showing films to start conversations versus lecturing, etc. 

American Geriatrics Society CEO (and former On Lok CEO) Jennie Chin Hansen speaks at Asian-American and Pacific Islander Best Practices and Networking 

APIs want their own Summit next year because conference presentations tend to focus on Whites, Blacks and Latinos.  My Hawaii colleagues and I felt so fortunate to have grown up in API/multi-ethnic-dominant place, and with enough beach time that we actually attended conference instead of going to San Diego beach! 

Diversity Summit:  Investing in the Future of Professionals in Aging—A Call to Action  Fernando Torres-Gil talked about how aging boomers might respond to the changing demographics of increasing non-white population, asking who are having the babies? Who will take care of us when we can’t? noting that Latinas are having the babies.  (This reminds me of Do it for Denmark campaign:  “There are not enough children being born to support an aging population . . .Can sex save Denmark’s future?”)  Fernando emphasized acculturation to be more effective participants in mainstream society, to learn English to navigate the country, yet retain own culture, as opposed to assimilation when one gives up ethnic heritage to join the melting pot because more assimilation is associated with being less healthy.

ACL Deputy Assistant Secretary of Aging Edwin L. Walker’s take-away message was that OAA funding is not keeping up with projected demand for services so need to change mindset that OAA provides "free services"; instead, Aging Network needs to be more entrepreneurial by partnering with health care providers and sell services.  In addition, he mentioned that plans for 2015 White House Conference on Aging (WHCoA) will maximize social media and technology to reach a more broad-based community, instead of sending the usual delegates chosen by Congress and Governors. (This month ACL's 2015 budget request to Congress included $3 million for WHCoA.)

Diversity Summit presenters discussed Affordable Care Act (ACA) enrollment challenges especially among Latinos and Pacific Islanders, engaging communities in interventions to reduce health disparities, providing culturally sensitive care, being vigilant against –isms and microagressions, etc.

One self-described “white, gay man” expressed his frustration at Diversity Summit, which focused on racial-ethnic diversity until one of the last presenters mentioned gay marriage.  Services and Advocacy for GLBT Elders (SAGE) Executive Director Michael Davis discussed the need for LGBT training for different care settings because LGBT elders faced official discrimination when being LGBT was considered a mental illness and crime, and "don’t ask, don’t tell, live and let live," creates obstacles to person-centered long-term care.  For example, the mentality not to appropriately ask if a client is LGBT means missing out on learning about a piece of one’s identity.  (This month San Francisco’s LGBT Aging Policy Task Force issued a report, LGBT Aging at the Golden Gate, which addresses these concerns with proposed solutions relating to data collection on gender identity/sexual orientation, cultural competency, access to health/social services/housing/legal services, etc.; page 13 of report acknowledges contribution of SFSU Professor Brian de Vries!)

Tai Chi for Arthritis creator Dr. Paul Lam got our Chi flowing at 7 am 

2013 Rosalinde Gilbert Reception for Innovations in Alzheimer's Disease honored San Francisco's The Genius of Marian documentary film by WeOwnTV.

 

ASA's popular webinar voice. . . er, host Steve Moore organized poster session: now we can match his smile to his voice :-)

What aging naturally looks like:  Feminine Transitions: A Photographic Celebration of Natural Beauty, by Alyscia Cunningham, shows the portraits of females from 7 weeks to 103 years of age, without make-up.

March is National Nutrition Month 

Brain Food: Bringing an Evidence-Based Nutrition Program to Assisted Living and Adult Day Health was a joint presentation by Amazing Place Executive Director Tracy Brown who worked to implement a brain-healthy meals plan at her senior facility with Nancy Emerson Lombardo, founder of Brain Health and Wellness Center.  Nancy developed Memory Preservation Nutrition Program (MNP)’s 6 guiding principles to reduce the risk, delay the onset and slow the progression of Alzheimer’s disease:

1. increase amount & variety of anti-oxidants from plant foods (spices, leafy greens, nuts & seeds, whole grains, berries)
2. increase omega-3s (fish, fish oil, flax seed); decrease omega-6s (corn oil)
3. reduce inflammation (increase omega-3s, berries, greens, green tea)
4. reduce insulin resistance (reduce sugar, eat complex carbs like whole grains)
5. reduce LDL cholesterol & saturated fats; avoid trans fats
6. assure adequate B, D, & E vitamins

Nancy believes drugs are not the answer and because the pathology of Alzheimer’s starts decades before symptoms appear, she promotes a healthy lifestyle program with nutrition at the centerpiece.  This can be a challenge due to lifestyle changes as we are more sedentary, have more work so less time to cook and grow our own foods, more stress so less sleep.  Her 11 brain healthy lifestyles are: nutrition & hydration; physical exercise; mental & cognitive stimulation; management of stress & depression; social engagement & support; sleep; balanced chi (energy); music & other creative arts; spiritual practices—pray, meditate, forgive, let go, be kind & loving, practice gratitude, be positive; humor, fun, laughter & joy; and sense of meaning & purpose in life.  She encouraged us to put nutrition into practice by offering us brain food samples like almonds and Trader Joe’s Oh my! omega trek mix.  Much thanks to ASA Project Coordinator Nancy Decia, for accommodating my request to volunteer as room monitor for this session (foodie that I am)!

Sam Beattie discusses how nutrition is a clinically proven intervention in many common chronic conditions in Nutrition Reconciliation: Critical for Chronic Condition Improvement and Successful Transitional Care   

Beth Burrough says home-delivered meal is the most requested service for patients in their homes, according to Aging & Disability Resource Center (ADRC) Care Transitions 

Aging's Not for Sissies: Guiding Seniors to Live Life to the Fullest presentation by vegetarian Seventh-day Adventists Rhonda Whitney and Marilyn Renk who discussed whole-person health CREATION (acronym for Choice, Rest, Environment, Activity, Trust, Interpersonal relationships, Outlook, Nutrition)

Never too late

After ASA conference ended, I returned to San Francisco for Meat Out. 

What senior vegetarians look like:  San Francisco Vegetarian Society President Dixie Mahy (80 years), Ann Wheat (almost 80), Patti Breitman (60), Mad Cowboy Howard Lyman (75), and Larry Wheat (80+).  Ann and Larry are owners of San Francisco’s premier vegan restaurant Millennium, which is their encore career following Larry’s retirement from managing a public accounting firm in Hawaii. 

Patti Breitman introduces her new book, Never Too Late to Go Vegan: The Over 50 Guide to Adopting and Thriving On a Plant Based Diet.   

Former President Bill Clinton went vegan at age 64, and reportedly his heart is “younger than it was 10 years ago.”  

Meat Out lunch prepared by Chef Patricia Allen Koot: plum and hazelnut kale salad, herbed polenta squares with vegetable ragu, Field Roast, and (not pictured) carob coconut cake 

Genius Albert Einstein was vegetarian.