Age awareness

June is Alzheimer’s and Brain Awareness Month:  About 95% of people with Alzheimer’s have the late-onset form, in which symptoms become apparent in their mid-60s.

At this month’s UCSF Dementia Research Education Symposium, UCSF Memory and Aging Center Director Bruce Miller said that California has 500,000 persons with Alzheimer’s Disease, the most in U.S.  While “normal aging” involves changes in brain structure, there is great variability in cognitive aging depending on modifiable factors: adiposity and obesity, chronic inflammation, physical exercise, vascular risk.  He also reminded us of the potential strengths of aging, including “increased generosity, creativity and wisdom.”

 

UCSF nurse Robin Ketelle emphasized dementia is a loss of brain function that affects memory, thinking, language, judgment and behavior (symptoms), and that occurs with certain diseases (causes), and “dementia does not mean a person is mentally ill.”  However, Alzheimer’s Disease, which accounts for more than half of all dementia cases, has been recognized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); the term “dementia” has been replaced with neurocognitive disorder in DSM-5 

  

June 15 marked the 10^th anniversary of World Elder Abuse Awareness Day (WEAAD).  In San Francisco, WEAAD was more like a month-long observation. 

This month’s Senior & Disability Action (SDA) meeting featured Avoiding Elder Abuse panel discussion:

• Jill Nielsen of Adult Protective Services (APS) has staff of 37 MSW workers, 3 nurses and case aides to respond to reports of suspected elder abuse; state law requires APS visit within 10 days, interview client alone; self-neglect represents 50% of APS cases; emotional abuse is hardest to investigate as law enforcement is not involved (reporting is encouraged, but not required).  APS can act only with consent of the victim, unless there is Penal Code violation.
• Hyun-Mi Kim and Ana Luz Vazquez of API Legal Outreach: Hyun-Mi said that legal remedy alone does not solve client’s life situation, so they take a holistic approach by partnering with Asian Women’s Shelter for more comprehensive services (case management) and Office of Citizen Complaints to train police (appropriately respond to immigrant victims).   In response to SDA Housing Organizer Tony Robles, who argued that Ellis Act evictions are a form of elder abuse that causes trauma, Ana mentioned she filed a restraining order against a landlord for harassing a monolingual Tagalog elder.   
• Prescott Cole of California Advocates for Nursing Home Reform (CANHR) discussed how predators use a familiar TV celebrity like Henry “Fonz” Winkler to repeat a reward message like “let your home pay you cash” to target vulnerable seniors, who do not investigate the risks of reverse mortgages.  Prescott noted that 10% of reverse mortgages go in default, which amounts to an expensive loan because predators skip telling seniors about the obligations of paying ongoing taxes, insurance, maintenance of home, etc.  He provided copies of CANHR’s Senior Scams Alert.
• Lisa Nerenberg of California Elder Justice Coalition (CEJC) provided an international perspective on elder abuse: World Health Organization (WHO) and International Network for the Prevention of Elder Abuse (INPEA) study, Missing Voices: Views of Older Persons on Elder Abuse (2002), identified disrespect as the most painful form of mistreatment by older adults in all countries.  Lisa provided examples of how Asian countries, influenced by Confucian filial piety, use policy to strengthen families:  Singapore has a special court for older persons to compel financial support from their adult children, and China has an elderly rights law that requires adult children to visit their elderly parents.

At our Main Library, San Francisco Department of Aging and Adult Services (DAAS) hosted WEAAD with speakers and film screening.  Administration for Community Living (ACL) Regional Administrator David Ishida said APS now has a federal home in ACL’s Office of Elder Justice for data collection. Other federal level highlights: The Elder Justice Act, which marked its 5^th anniversary in March, received $4 million in funding for the first time in fiscal year 2015.  This year’s White House Conference on Aging also included elder justice as one of its four priority issues. 

DAAS Director Anne Hinton welcomed San Francisco District Attorney George Gascon, who said his staff scheduled presentations at four local senior centers in recognition of WEAAD.

These welcoming remarks were followed by a screening of Alive Inside and discussion, which I skipped since I had another appointment elsewhere and I had already seen this documentary when it was released last year with filmmaker in-person. ...and then I just wanted to listen to my own playlist like glam rocker Todd Rundgren (who turned 67 this month): Hello, It’s Me (“It's important to me that you know you are free ‘cause I never want to make you change for me”). ((^_^))

The Forum at Grace Cathedral hosted Safeguarding the Golden Generation: Understanding Financial Exploitation, which featured a screening of Last Will and Embezzlement (2012) documentary.  Seniors lose an estimated $2.9 billion annually to financial abuse and exploitation.  Perpetrators exploit the vulnerabilities of seniors who may have dementia and/or depression.  In addition, older adults from the Depression era may be more trusting and socially isolated.  Abuse is underreported due to embarrassment or fear of losing independence (like being placed under conservatorship or nursing home if they’re found to have diminished capacity). 

A lively panel discussion followed the film:

·         Filmmaker Pamela Glasner made her documentary based on her father who had Alzheimer’s Disease.  While in a Florida nursing home, her father was deceived by a stranger who added his name to her father’s bank account and will, allegedly during a “lucid moment” that was witnessed by a beneficiary.  When she reported this financial elder abuse to the Florida police, nothing could be done (police told her “nice guy said he didn’t do it”) so Pamela made this film to create awareness of this issue.

·         Evans Law Firm attorney Ingrid Evans provided tips on elder abuse fraud protection. 

·         Communities Against Senior Exploitation (CASE) program manager and California Senior Legislature assembly member Shirley Krohn has proposed increasing fines from $1,000 to $25,000 for financial institutions that fail to report financial abuse.

What else can be done to prevent elder abuse? 

“Unfortunately, regulations are really not preventing the abuses.  Why On Lok has never had an abuse problem, either by an employee or the organization, is because it is based in the community, and it’s open to everybody.  We have no visiting hours. ... The advantage of that is that there is an outsider that goes in or visits. ... So there is constant in and out.  People, the community is very aware of what happens. … You’re not a nursing home on the outskirts where nobody sees you and knows what happens.  So the problems of abuse are much more difficult to detect and combat.” -- Marie-Louise Ansak, Founding and Directing on On Lok Senior Health Services, 1971-1996 (pp. 127-128)

To support this transparency and reduce social isolation so we can age safely, it helps to design our environments so we can live out and about in the community with good public transportation options for all ages and abilities.  

At last month’s Aging and Tech conference, I couldn’t get enough of IDEO designer Barbara Beskind so I was hoping to see her again (but didn’t) at IDEO’s San Francisco office, which hosted At Home With Growing Older (AHWGO) forum, Embolden Bodies – Human Centered Design For Independent Living.

Susi Stadler, AHWGO cofounder and architect who specializes in the design of age-friendly and intergenerational environments, welcomed an intergenerational audience to discuss “approaches, strategies and products that assist people to gracefully age at home.”  She called aging an extreme sport—both delightful and scary, that takes focus and work. 

Ideas from interdisciplinary panel:

• Will Carey, Industrial Designer at IDEO, showed slides of products based on user experiences that fit into everyday like a tendon machine, guide for blind to navigate using vibration and sound, walkers with tennis ball material guides
• Jennifer Carton Wade, Senior Occupational Therapist at Laguna Honda – advocates for occupational justice (ability to do what’s needed to live fully in the community) because aging is marginalized, especially in transportation and mobility; she is less gadget-oriented, preferring to empower people to do on their own so they do not feel deficient; she also provided Handy Tips for Remaining Home as You Age  
• Tasneem Babul Rayani, Contributing Industrial Designer at AHWGO, emphasized addressing the real (versus perceived) problem and designing to use our bodies naturally like squatty potty 

One older woman in the audience asked that they “not design for, but with us, old people because you don’t know until you get there.”

Director Sheila Malkind invited the intergenerational audience to this year’s Legacy Film Festival on Aging: September 18-20, 2015 at New People Cinema! (I suggested that Sheila screen Dancing with Maria documentary about 90-year-old ballerina Maria Fux who challenges students of all abilities so they are "made to dance.")

Dr. Margaret (Peg) Miller and Lonnie Hinckley of St. Francis Episcopal Church hosted a Transportation Fair for Seniors and Persons with Disabilities, which included all-male representatives from local public and private options:

• BART:  FREE BART field trips for 10 to 20 seniors (age 65+) in group to get familiar with BART (includes roundtrip fare, Senior Clipper Card, travel tote, lunch, station and car tour, outing of choice); 62.5% BART fare discount for seniors and persons with disabilities
• SFMTA:  Muni fares will increase July 1, 2015 (senior fare from 75 cents to $1), but there is still FREE Muni for low-to-moderate income (up to $71,350 Bay Area annual median income level) seniors and persons with disabilities, FREE Shop-a-Round for seniors, persons with disabilities, or eligible for ADA Paratransit; FREE Van Gogh Shuttle for groups of seniors and persons with disabilities; check out Muni Access Guide 
• Flywheel: mobile app or phone call dispatch to request taxis with ramp van, wheelchair accessible, can specify vehicle
• Taxis (Luxor, Yellow Cab):  will serve every neighborhood
• Ride “sharing” platforms: did not address access for blind iphone users, riders with service dogs and wheelchair users, which is ongoing concern especially with City’s proposal to privatize paratransit and subject of discrimination lawsuits under Americans with Disabilities Act
• Private door-to-door transport 

  

DeSoto Cab rebranded as Flywheel Taxi & inside paratransit van

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/).