Optimal Aging Through Research at GSA

As the only SFSU gerontology student at last year’s Gerontological Society of America (GSA) annual meeting , I became (by default) GSA Campus Ambassador, which involved promoting GSA membership and activities, re-activating our gerontology honor society (Beta Xi chapter of Sigma Phi Omega), obtaining Careers in Aging Week (CIAW) award, etc.  Eager to retire from Ambassador duties, I was pleased when seven classmates joined me at last month’s GSA annual meeting in New Orleans (birthplace of Benjamin Button, who looked like an old man at birth, so he was abandoned on the porch of a nursing home and then he kept growing younger)!

President’s Welcome Reception & Exhibit Hall Opening – enjoyed Mardi Gras and muffuletta

What a difference a year makes (getting wiser with age and experience): last year, I was ambivalent about starting over again with a new career and now I feel more confident about this change. Instead of being all over the place like last year, I am now more focused on health promotion, home- and community-based services to support aging in place, and elder rights protection. 

Optimal v. Successful Aging

Adapting to change has a lot to do with Optimal Aging, the theme of this year’s GSA annual meeting.  According to The Optimal Aging Manual author Dr. Kevin O’Neil, the definition of optimal aging is necessarily subjective as it takes into account psychosocial factors like resiliency, adaptability, good self-esteem, positive attitude, self-efficacy, as well as spirituality. 

Unlike Rowe & Kahn’s 1997 definition of successful aging (based on avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement), optimal aging recognizes that people can age well in spite of disabilities or chronic conditions.  As Dr. Kenneth Brummel-Smith wrote in his 2007 Annals of Long Term Care articles on Optimal Aging, “almost all older people are interested in a life that is meaningful, fulfilling, and relatively independent,” and “much of optimal aging is under the individual’s control; however, ideally, society provides support and assistance in helping its members achieve optimal aging."     

Successful Aging: Successful for Whom? (HS) panel took exception to a universal application of Rowe & Kahn’s criteria for successful aging, which might be more appropriate to non-Latino white Americans.  Basing successful aging on physical function has the effect of alienating minorities who experience higher burden of chronic disease due to multiple stress (weathering/allostatic load) over their life course.  For example, today’s cohort of African-Americans age 50+ lived the dehumanizing experience of structured and systematic disadvantage from Jim Crow laws that separated races and restricted housing, education, employment and other opportunities.  Because their social networks are protective in persevering through adversities, Kia Jeffers proposed defining “successful” according to social context and self-evaluation (self-perceptions guide behavior). 

In The Gerontologist’s December 2013 article, “Perceptions of Successful Aging Among Diverse Elders With Late-Life Disability," a diverse group of On Lok seniors in San Francisco perceived Successful Aging as accepting limitations in ADLs/IADLs; adapting to optimize functions that are important to them (e.g., “if I cannot walk, I’ll use a walker.  If I can’t use the walker, . . . I will use the wheelchair”); trusting in God; and shifting priorities (focus on positive)—rather than rejecting their new reality by clinging to the notion of successful aging as being forever young or middle-age, which is arguably ageist. 

Ageism

“Standing in the way of optimal aging, however, is that familiar foe: ageism.”

-- U.S. Department of Health & Human Services blog post, Ageism: How Negative Stereotypes of Aging Impede an Inclusive Society

The term ageism (discrimination based on age) was coined in 1968 by Robert Butler, the subject of a new book (Robert N. Butler, MD: Visionary of Healthy Aging) by Andy Achenbaum (no-show at this year’s meeting).  Chronic stress from ageism can accelerate subjective aging (age identity), or make one feel older than chronological age, by lowering both positive affect and sense of control.

 

Chronological Age Doesn’t Tell the Whole Story: Current Directions in Perceptions of Aging Research (BSS) looked at older adults’ subjective perceptions of aging and consequences for their functioning.  In Subjective Aging and Cognitive Functioning: A 10-Year Prospective Study, Yannick Stephan (photo above) found that more stressors and poor health make people feel “older,” which is a risk factor for cognitive deficits.  “Younger” subjective aging is associated with lower mortality risk, better life satisfaction, better self-rated health, and better physical functioning.  In When Feeling Different Pays Off:  How Older Adults can Counteract Negative Age Stereotypes, David Weiss discussed older adults’ self-protective responses of distancing, differentiation, and shifting to alternative age identities (e.g., generation).  

Social Psychological Perspectives on the Implications of Ageism for Health and Health Care Professions (BSS) symposium by Age UK researchers included Hannah Swift’s Being Old and Ill Across Different Countries: Social Status, Age Identification and Older People's Subjective Health: in European countries where older people are perceived as having lower social status, strongly identifying with the old age group is related to higher levels of subjective ill health; in countries where the status of older people is perceived as higher, there was no relationship between age identification and self-rated health.  (UK law includes age as "protected characteristic" in its Equality Act of 2010, though this ban on age discrimination in the provision of goods and services does not extend to financial services.)

In An Applied Test of the Contact Hypothesis: Exploring the Effects of Contact with the Elderly on Care Workers’ Attitudes, Libby Cuthbert found that while positive contact between age groups reduces prejudice (i.e., less explicit ageism, less dehumanization, and more empathy), outcomes of negative contact (more dehumanization) were more enduring than positive.

Meeting Together

GSA Executive Director James Appleby welcomed 3,300 meeting registrants

GSA President Dr. Larry Rubenstein announced GSA will host 2017 IAGG (International Association of Gerontology and Geriatrics) meeting in San Francisco! 

Keynote speaker Bruce Clark, a marketing specialist focused on baby boomers and mature consumers, set the agenda for GSA attendees of the world’s need for our “expert voices” to counter “sound-bite” mentality.  In this blog post, I’ll attempt to provide bite-size expert voices. 

Dr. Rubenstein, a marathon runner in all 50 states, shows off fancy foot moves.

 

2012 Kleemeier Award recipient Eileen Crimmins of USC presented lecture, Lifespan and Healthspan: Past, Present and Promise.  She concluded that increasing lifespan and healthspan should not depend only on scientific discoveries, but opportunities to substantially increase life expectancy with behavioral changes, improvements in early life circumstances, and reductions in health disparities.

Chronic Disease Self-Management Program (CDSMP)

Dr. Brummel-Smith identified the evidence-based CDSMP as a societal approach to optimal aging.

Living Well with Chronic Illness: Comparing Research and Policy Developments in Australia, Canada, U.S. and China (BSS) – Living Well with Chronic Illness refers to the well-being paradox, or one's satisfaction (subjective) in face of poor health (objective).  CDSMP is offered in 25 countries.  In Australia, the policy focus is on younger participants rather than older adults.  Just the opposite in the U.S., where ARRA (American Reinvestment and Recovery Act of 2009) provided funding to implement CDSMP, as an initiative led by the U.S. Administration on Aging, in collaboration with the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS).

National Dissemination of Evidence-Based Health Promotion for Older Adults: Successes, Challenges and Impact (SRPP) symposium with Marcia Ory (Texas A&M), Janet Frank (UCLA), Kristie Kulinski (NCOA), and Michele Boutaugh (ACL).  Discussant Michele Boutaugh mentioned that grant funding is not a strategy for expansion, but we need to build delivery into healthcare (both referrals and funding) for sustainability.

Last year’s GSA President Nancy Whitelaw of the National Council on Aging (NCOA) collaborated with CDSMP developer Kate Lorig and Texas A&M researchers Marcia Ory and Matthew Lee Smith, in the national evaluation of CDSMP in the U.S. 

Unbeknownst to me while at GSA meeting, California Association of Area Agencies on Aging (C4A)—which held its annual meeting at the same time in Los Angeles—presented San Francisco Department of Aging and Adult Services an award to San Francisco Healthier Living Coalition for sustainability! Woo-hoo!

Self-Management of Disability and Optimal Aging: Current Trends in Research, Policy & Practice (SRPP) symposium included Outcomes of CDSMP for Persons with Disabilities presentation by Phillip McCallion, who found CDSMP participation improved outcomes for persons with disabilities that significantly impair daily functioning.  His next study will examine persons with intellectual/developmental disabilities participating in CDSMP adaptation, as there exist versions of CDSMP tailored to particular groups.

  

Aging in place

Aging in Multiple Environmental Settings:  What Factors Contribute to Optimal Aging? (BSS)  Check out presenter Anne Glass’ Elder Cohousing website! 

The Village Model: A Unique Organizational Approach to Fostering Aging in Place? (SRPP)  The Gerontologist’s December 2013 issue published “A Tale of Two Community Initiatives for Promoting Aging in Place: Similarities and Differences in the National Implementation of NORC Programs and Villages" article authored by panelists Emily Greenfield, Andrew Scharlach, Amanda Lehning, and Carrie Graham.  This research team also created a companion website, Aging and Community: A National Study of NORC Programs and Villages.

Theoretical and Empirical Developments in Understanding Aging in Place & Relocation (SRPP) covered continuum of care from homeless to housing to assisted living to skilled nursing facility.  People make choices based on a cost-benefit analysis of where they are to alternatives that consider value of stability/status quo; the most vulnerable are those “stuck in place.”

Inspiration

At last year’s GSA meeting, I really didn’t know anyone other than SFSU professors but found it easy to connect with other attendees.  This year’s meeting was like a reunion as I got re-acquainted with my favorite gerontologists! 

Bobbie Yee with Giyeon Kim, who chaired Mental Health Disparities in Racially and Ethnically Diverse Populations (BSS) symposium.  At this year’s American Psychological Association meeting, Bobbie received a Lifetime Achievement Award for her contributions to the field of racial and ethnic minority psychology.  Giyeon is mentee of Bobbie’s hubby David Chiriboga, who received last year’s GSA Minority Mentorship Award. Wow, Gerontology Power Couple Award should go to Bobbie & David J.

Task Force on Minority Issues in Gerontology (TFMIG)’s Outstanding Mentorship Award Presentation & Reception, sponsored by Senior Service America, Inc. (SSAI) - sliders

SSAI Executive Director Tony Sarmiento with Keith Whitfield, co-author of Handbook on Minority Aging.  Tony also hosted Concept Coffee, with continental breakfast (beignets), to discuss career path options.  

ESPO Awards Presentation & Reception – eat a rainbow of veggies!

 

Tara McMullen spoke about Self Advocacy: Finding Your Balance at ESPO Presidential Symposium Total Professionalism in the Emerging Stages.  At last year’s GSA meeting, Tara had inspired me to consider returning to public service after hearing her speak about her policy/advocacy work at CMS, so it was cool seeing her again in person to thank her as I had just secured my internship with U.S. Administration for Community Living!

Humanities & the Arts Committee Open Meeting & Reception – I adopt SEA FOOD diet:  I SEE FOOD & eat it!

SFSU representation 

Classmates Maggie and Diane with SFSU Gerontology Professor & Program Coordinator Brian de Vries, after he delivered his presentation on Resistance and Resilience Amongst Adversity: Finding Meaning Among LGBT Boomers.  As second-year graduate students, we think he’s the coolest because he’s the only faculty member who’s ok when we call him by his first name, Brian J. 

SFSU Social Work Professor Rashmi Gupta took a break at ESPO lounge.  Professor Gupta co-chaired two symposia, Caregiving and Culture: Richness in Variations and Values (which included Brian’s presentation on Expectations of Care-Receipt: A Focus on LGBT Persons, and Harry Moody scheduled as discussant but was no-show) and Home Care of the Aging and the Dying: Challenges and Issues of Family Caregiving in Asian Countries (which included her own presentation, Health Care Decision-making and Well-being among Older Adults and Caregivers in Allahabad).

SFSU Gerontology Professor Darlene Yee (missing from this year’s GSA meeting because she was attending CANHR’s 30^th anniversary celebration) will co-chair GSA annual meeting in 2015, which marks the 50^th anniversary of the Older Americans Act!

Exhibit hall & poster session

 

At poster session, National Association for Professional Gerontologists (NAPG) Executive Director Donna Schafer stood in for SFSU Gerontology Professor Anabel Pelham to discuss Assessing Gerontology Competencies: A Pilot Study – which involved graduate gerontology students (including yours truly) responding to essay questions in this research to measure competencies, as part of a larger plan to credential gerontologists.

Dear Aunt Polly and Uncle Pete are therapeutic older couple dolls created by a psychiatrist.

Judy Berry founded Lakeview Ranch, which provides specialized dementia care in rural Minnesota.  When trained staff provide holistic and humane care to persons with dementia—tending to not only their physical needs, but emotional and spiritual needs as well, they avoid unnecessary hospitalizations and overmedications.  Judy also founded Dementia Care Foundation, a non-profit to help low-income seniors gain access to specialized dementia care.

GSA & NIH (National Institutes of Health) booths offered useful research publications.

  

Geroscience: Societal Implications of Delaying Aging

This meeting was a follow-up to last month’s Trans-NIH Geroscience summit that explored the physiological effects of aging as a common risk factor for chronic diseases affecting the aging population.  Do aging biology (nature) or lifestyle (nurture) factors cause chronic disease?  Cancer, diabetes and obesity are found in younger populations, so it’s not like aging is a disease to attack.  The Fall 2013 issue of Public Policy & Aging Report (now included as GSA member benefit!) is devoted to The Longevity Dividend: Geroscience Meets Geropolitics. 

Jay Olshansky and other geroscientists believe the period of healthy life can be extended by slowing the biological processes of aging, and hope to compress the infirmities of old age into a shorter time frame at the end of life. 

 

Aubrey de Grey delivered his expert opinion:  “I think we have a 50% chance of adding 30 years to seniors’ healthy lifespans within 25 years by damage repair, subject to funding.”

 Laissez Les Bon Temps Roulez (Let the Good Times Roll)

The GSA meeting venue was split between Marriott (near French Quarter) and Sheraton (Central Business District) on opposite sides of Canal Street,  so we shuffled back and forth for sessions.  Food at both hotels quite good (better than last year's convention center food at San Diego).

 

Sampled Creole sauces in French Quarter store 

Took a break from information overload during poster session to visit nearby Lafayette Park. 

Lafayette Park’s statue of Ben Franklin (1706-1790) with his retirement planning advice:  “Save while you are young to spend while you are old; one penny saved is better than two pennies earned.” 

Between sessions, I stood in line to order hearty jambalaya for take-out at 75-year-old Mother’s Restaurant.

Rain on parade

As a thrifty graduate student, I took a red-eye flight out of SFO with stopover in ORD (Chicago) before arriving in MSY (New Orleans) to check into India House at $20 per night--just two miles from the crowds at GSA meeting’s official hotels at $200 per night.  

Smile-Traveling with Buddha mural in dorm room 

Love rolls thru. . . love your life 

The Scream in psychedelic colors

My daily two-mile walk from hostel to GSA meeting sites included passing by New Orleans Council on Aging (NOCOA), local Area Agency on Aging, located on 4^th floor of building with broken elevator.  “The best age is the age you are!”

Po-Boy ending

After last session ended on Sunday, I took the trolley over to Oak Street Po-Boy Festival! 

Po-boy recipes

Live music outdoors in sunny afternoon 

Panko and slaw on sweet potato waffle 

Lafayette Cemetery founded 1833, on National Register of Historic Places

Quality of life

According to Chinese Medicine’s Five Element (WuXing) system, the autumn/fall/harvest season is associated with metal (element) and old age (life stage).  As an introverted old soul, I identify with the metal element and embrace old age with its potential for gerotranscendence:

“These typically include a redefinition of the Self and of relationships to others and a new understanding of fundamental existential questions. The individual becomes, for example, less self occupied and at the same time more selective in the choice of social and other activities. There is an increased feeling of affinity with past generations and a decreased interest in superfluous social interaction. The individual might also experience a decreased interest in material things and a greater need for solitary "meditation". Positive solitude becomes more important. There is also often a feeling of cosmic communion with the spirit of the universe, and a redefinition of time, space, life and death.” --Lars Tornstam, author of Gerotranscendence: A Developmental Theory of Positive Aging

I crave private moments to experience nature in solitude.  It’s about knowing how to be with “aliveness and newness moment by moment,” according to ancient Taoists, if we can experience energetic balance (qi flow) as we become one in harmony with our natural environment, and privacy gives one the freedom to be.

In this era of online social networking, I can seem like a Luddite because I

I don’t participate in friending, tweeting, LinkedIn, etc.  I value privacy, freedom of being off-the-grid and maintaining my small circle of confidants.  These cherished values inform my support for aging in place since an institutional alternative would diminish privacy and freedom that I believe to be so essential to quality of life. 

Social butterflies don’t have deep friendship connections (Butterflies & Blooms exhibit at Conservatory of Flowers), but social introverts do J.

Maslow’s theory of motivation suggested that our most basic needs must be met before attaining self-actualization (gerotranscendence). 

Physiological: gimme shelter & food

Senior & Disability Action (SDA) Housing Organizer and POOR Magazine co-editor Tony Robles and Housing Rights Committee of SF Tenant Rights Advocate Jennifer Willis at last month’s SDA meeting focused on Public Housing.  Jennifer said that SF Housing Authority is in the process of purging its Section 8 waiting list of 30,000 persons (some have been on this list for 10 years!) through the end of November, so it’s important to respond with current address: if letter is returned to sender, then person is removed from wait list.  Housing Authority wait list has been closed for years, and expectation is to purge 10,000 from current list and then re-order based on preferences such as disability or no permanent address.

The median age of America’s rapidly aging homeless population is 53.  Homelessness and the stressful conditions of living on the streets can take a heavy toll on health, and life expectancy on the streets is about age 64. 

At times, it seems like legislation tackles the problem of homelessness as a quality of life issue that jeopardizes public safety and aesthetics for NIMBY residents.  Homeless advocates view the effect of San Francisco "quality of life" ordinances that make it illegal for persons to sleep in public parks (which are now closed from midnight to 5 am) and in oversized vehicles parked overnight in certain neighborhoods as criminalizing homelessness and poverty. 

Why pick on vulnerable people who are already suffering (sleeping in vehicles are the last refuge from ending up on the streets), and why can’t we be just like Mister Rogers’ Neighborhood where neighbors peacefully work out their differences with compassion?  If we view homelessness as a symptom of poverty and the larger problem of wealth concentration (99% of Americans subject to the wealthiest 1%, who control more than 40% of the nation's wealth), then perhaps we can look to rich countries, like Sweden and Japan, that distribute their income the most equally have the longest life expectancy and the highest quality of life.

California Alliance for Retired Americans supports AB 5, Homeless Person’s Bill of Rights and Fairness Act.  According to the Bill’s author Assemblymember Tom Ammiano, “This bill is really about basic justice.  People who are homeless not only have to struggle with life on the street, [but] the indignity of being treated like criminals because they have nowhere to eat, sit or sleep except in public.”

San Francisco has the highest median rent in the nation.  The economic recovery, fueled by the latest tech boom (thanks to tax breaks and other corporate welfare incentives), has raised concerns that new, young workers willing to pay more for housing are displacing long-time, older residents on fixed incomes who are losing their homes because they can’t afford rent increases and Ellis Act evictions.  More LGBT elders are homeless on the streets of San Francisco.

Inclusionary housing isn’t just about affordability but universal design access for all ages.  This month the Long-Term Care Coordinating Council endorsed the Mayor’s Disability Council Resolution #2013-01 Recommending Guiding Principles for the Construction, Maintenance and Financing of Permanently Affordable and Accessible Housing for People with Disabilities and Seniors.

On Election Day (November 5), Tenderloin Neighborhood Development Corporation hosted Home Matters for Health symposium as part of a campaign to raise national awareness about the connections between home and health:  the impact of stable affordable homes on health, the value of supportive housing with health services provided at home, and the cost effectiveness of health care that prevents homelessness.

Mayor Ed Lee talked about San Francisco Department of Public Health’s Direct Access to Housing that provides on-site supportive services to low-income residents who were homeless or at-risk; last year’s creation of the $1.5 billion Housing Trust Fund for affordable housing to low- and middle-income residents over the next 30 years; tripling the funding to Human Services Agency to provide homeless prevention and eviction defense services; “re-envisioning” public housing by working with HUD on repairs (including elevators) to expand on SF HOPE model of community development; the opening of Veterans Commons with on-site supportive services for senior veterans; and emergency services with strong housing connections by expanding Project Homeless Connect to Every Day Connect. 

According to Dr. Joshua Bamberger (only male on panel, pictured above), San Francisco Department of Public Health’s Medical Director for Housing and Urban Health, living in “more beautiful” housing is associated with better health outcomes and even lower mortality rates--“self-efficacy and beauty make the difference.”  After the symposium, I asked Dr. Bamberger for his definition of “beauty” – did he mean housing that includes therapeutic landscapes, perhaps feng shui design? In response, he sent photos, which are posted online, but the interior spaces are not visible so I couldn’t see the inner beauty.

One in four San Franciscans is food insecure, or lacks access to healthy food, according to the San Francisco Food Security Task Force, which presented its 2013 Assessment of Food Security in San Francisco report to the Board of Supervisors this month.  The report notes that low-income households with seniors, children or a single parent are especially vulnerable, yet the report covers for 2010 and 2013 feature photos of young children only.

This month SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps and now branded as CalFresh in California) benefits were cut by 5% due to expiration of stimulus funding.  I volunteer at Project Open Hand, which prepares nutritious “meals with love” to 18 senior congregate meal sites in San Francisco, so I wanted to participate in its SNAP Challenge from November 21 to 28, by spending no more than $4.56 per day on food, which is the average amount received by 4.1 million SNAP beneficiaries in California.  

This SNAP Challenge week coincided with my attendance at the Gerontological Society of America (GSA) annual meeting in New Orleans, where I couldn’t resist all the receptions and then the Oak Street Po-Boy Festival, where I enjoyed this amazing sweet potato, kale and pesto po-boy from Slow Food NOLA that cost me $5—exceeding the average daily SNAP food budget.

For my Aging & Social Policy class assignment to propose a budget-neutral policy, I presented my poster on Improving CalFresh for Seniors by addressing food security and nutrition.  While my classmates didn’t object to my plan for targeted outreach and marketing to enroll more seniors eligible for CalFresh, I nearly got chewed out for suggesting a waiver from USDA’s Food and Nutrition Service (which administers SNAP) to apply WIC-like standards to promote nutrient-dense foods v. empty calories for low-income seniors, who have special nutritional needs like the WIC population (low-income pregnant/nursing mothers, infants and young children).  Of course, it didn’t help that I criticized SNAP rules that allow purchase of “junk food” items (e.g., soda, candy, chips, etc.) that my own classmates were eating in the classroom during my two-minute presentation.  Yet, proper nutrition is especially critical for senior health promotion and disease prevention, as malnutrition in seniors leads to chronic conditions (heart disease, diabetes), slower healing rates, increased hospital stays, premature nursing home placement, etc. that impair both quality and quantity of life.

Safety (net):  Social Security & Medicare

National Committee to Preserve Social Security & Medicare Foundation (Board Chair Carroll Estes, pictured above, provided introductory remarks) and Openhouse (Executive Director Seth Kilbourn seated in middle) hosted Know Your Rights and Claim Your Money: Social Security and the LGBTCommunity at the San Francisco LGBT Center.  This forum focused on the aftermath of the U.S. Supreme Court’s rulings in June, which cleared the way for federal benefits for same-sex married couples (finding Defense Of Marriage Act’s Section 3 unconstitutional) and for same-sex marriages to resume in California (rejecting Yes on Proposition 8 appeal).  The panel urged same-sex married spouses to file an application for Social Security spousal benefits now since eligibility date is triggered by the filing date of application. Because Social Security law looks to the state of residence in determining whether a same-sex couple is married, it’s not clear what happens to same-sex spouses who move to a non-marriage equality state. 

At JCCSF’s The Art of Financial Well-Being, Carroll Estes discussed how the proposed “chained” CPI (Consumer Price Index) for making COLA (cost-of-living adjustments) to Social Security benefits will hurt seniors by reducing benefits based on lower estimates of inflation.  The current COLA already undercounts the higher inflation experienced by seniors who spend a higher percentage of their spending to health care costs.  Instead, Estes supports a more accurate inflation measurement for the elderly, the CPI-E that was developed in 1982 to reflect the different spending patterns of consumers age 62+, with a greater weight on health expenditures that continue to rise faster than other expenses. 

Kenneth Gardner of the Centers for Medicare and Medicaid Services presented Medicare 101.  Medicare focuses on acute care (doctor visits, drugs, brief hospital stays) and short-term services for conditions that are expected to improve – not chronic conditions, so Medicare does not cover long-term (custodial) care.  Instead, Medicaid is the dominant source of payment for long-term care, followed by out-of-pocket payments by individuals.  The odds are 1:2 whether one will need LTC; in 2012, the national average cost of one year in a private nursing home was $90,520.  

SFSU Health Education Chair Mary Beth Love moderated New Era of Healthcare Panel, noting that the Affordable Care Act (ACA) endorses a public health or ecological model: 

• California Pan-Ethnic Health Network Executive Director Ellen Wu hailed ACA’s policy to improve quality and access to health insurance coverage, with an expansion of the insurance marketplace (e.g., Covered California) and some states expanded Medicaid eligibility.  ACA improvements to Medicare coverage include expansion of preventive services such as free annual “wellness” visits.
• City College of SF Community Health Worker (CHW) Program Coordinator Alma Avila discussed integrating CHWs, housing and employment services in community.
• SFSU Holistic Health Institute Director Adam Burke (also a licensed acupuncturist) discussed the role of low-tech Complementary and Alternative Medicine in health promotion and wellness, recognizing that consistent killers are lifestyle factors (exercise, nutrition, smoking, alcohol, stress) that can be managed with self-care. 

Health care v. insurance: “Medicare for all ages” is the motto for a single-payer system, while Obama’s attempt at universal health care via ACA appears to be a form of corporate welfare because it subsidizes the private health insurance industry by mandating that individual Americans buy its product.  Under ACA, pediatric dental and vision care services are mandated as “essential health benefits”—is this ageism? Aren’t dental and vision care (also not covered by Medicare) essential for all ages?

Social:  community building

One-third of older Americans live alone, mostly out of personal preference; women over age 60 who live alone report more happiness than married women the same age.  Moreover, older adults who live alone are more likely than their married counterparts to spend time with friends and neighbors.  LGBT Aging Task Force found that 58% of gay seniors in San Francisco live alone, but they often are reluctant to use public services for the aging because they don’t feel welcome due to their sexual orientation so informal support (family, friends, neighbors) is important.

 

Community Living Campaign presented its 4-week Connections for Healthy Aging workshop series focused on challenging myths about aging and normalcy, fostering inclusiveness through People First Language, building social networks of care to survive a hospital stay/discharge; documenting health care decisions (vial of life kits, advance health care directive) to make your wishes known to others, etc.

Esteem

Education and advocacy can empower persons against ageism and ableism.

“My moral opposition to prenatal testing and selective abortion flows from the conviction that life with disability is worthwhile and the belief that a just society must appreciate and nurture the lives of all people, whatever the endowments they receive in the natural lottery.” –Adrienne Asch, 67-year-old bioethicist, died this month 

Future Past: Disability, Eugenics and Brave New Worlds symposium was an opportunity to examine the debate favoring the value and contributions of all persons versus discrediting those “not worth living” in a utopian effort to “improve” human breeding via eugenics (like Nazi genocide, euthanasia, sterilization, prenatal selection, etc.).

 

In her welcoming remarks, Cathy Kudlick, Director of SFSU’s Paul K. Longmore Institute on Disability, rejected the notion that disability can or even should be erased; rather, disability remains despite scientific breakthroughs, which allow persons with disabilities to live longer.  By accepting disability and valuing disabled persons as worth preserving, Kudlick said we approach disability as a “generative force for productive conversations” and consider the fundamental questions to advance social justice: “What does it mean to be human? How do we respond ethically to difference? Who gets to decide? What do the answers reveal?”  

WHAT? Eugenics and Disability: Past and Present panel featured

Alexandra Minna Stern, SFSU alumna and author of Eugenic Nation: Faults and Frontiers of Better Breeding in America; Marcy Darnovsky, Center for Genetics and Society; Glenn Sinclair, Living Archives on Eugenics in Western Canada and sterilization survivor; and Nicola Fairbrother, Neighborhood Bridges. 

Eugenics is based on the medical model that attempts to diagnose, manage, control and prevent differences from “normality” by reducing persons who don’t "fit in" to labels (like defective, imbecile, mentally retarded, etc.) and then segregating them, with disparate impact on minorities and poor.  Instead of this misguided science dependent on value judgments, a social model that offers improved access to disability-friendly resources promotes inclusion. 

After listening to each panel, participants at each table engaged in small-group discussions based on materials introduced by Milton Reynolds of Facing History and Ourselves, and then voluntarily reported back to everyone in the conference room. 

 

SO WHAT? The Consequences of Misremembering Eugenics

Rosemarie Garland-Thomson, Emory University, stated “the presence or absence of a disability does not predict quality of life.”

Troy Duster, UC Berkeley Chancellor’s Professor of Sociology, considered the conditions under which society determines “what kind of people you don’t want”—disruptive socio-economic transformations that categorize people as “makers” or “takers” in the struggle for resources—create fertile soil for eugenics.

Rob Wilson, University of Alberta , talked about his institution’s complicity in the sterilization program yet has never apologized.

Marsha Saxton (moderator), World Institute on Disability, mentioned the challenge in funding research for drug treatments that could improve quality of life (like one based on a drug for Alzheimer’s to help “normalize” learning and memory in persons with Down syndrome) that compete against prenatal testing (to prevent Down births). 

NOW WHAT? Looking Ahead to Brave New Worlds

Patricia Berne, co-founder and director of Sins Invalid, showed video clips of her performance art project that celebrates artists with disabilities and other marginalized groups within a social justice context.

Milton Reynolds, Facing History and Ourselves Senior Program Associate, highlighted the role of education, such as California’s Fair, Accurate, Inclusive, Respectful (FAIR) Education Act that requires teaching LGBT, disability and other traditionally underrepresented cultural groups, in transitional justice processes that include institutional reform, cultural response, judicial response, reconciliation, restitution and reparations, and truth commissions.

Gregor Wohlbring, University of Calgary Professor of Disability Studies, who joined the conference via skype, noted that both negative (sterilization of those deemed “unfit to breed,” selective abortion after genetic testing reveals “undesirable” traits) and positive (somatic and germline therapy, human enhancement beyond norm) eugenics are based on ableism (disability discrimination/oppression).

Kate Wiley, SFSU alumna and Lick-Wilmerding High School teacher, talked about her students creating an online petition asking the State of California to include California’s history of eugenics in its public high school curriculum. 

In closing remarks, Emily Smith Beitiks, Assistant Director of SFSU’s Paul K. Longmore Institute on Disability, expressed her hope that in the future we will not need to hold a conference to make the argument that certain people have the right to exist. 

Joanna Fraguli of the Mayor’s Office on Disability (MOD) was one of the presenters at SDA's 4-week Disability Survival School.  In addition to SDA staff presenting on the history of disability rights movement, community organizing, health care and housing, we were introduced to representatives from Independent Resource Living Center for assistive technology and fair housing, SF Municipal Transportation Authority, Department of Rehabilitation for employment, Health Insurance and Counseling Advocacy Program (HICAP) for Medicare counseling, and AIDS Legal Referral Panel for reasonable accommodations.

San Francisco is the place to be happy, healthy and fit!

Coming out: disability awareness

Nearly 1 in 5 Americans has a disability, the nation’s largest minority.  Fewer than 15% are born with their disabilities; if you live long enough, you’re likely to acquire a disability. 

The U.S. has a long history of discrimination against persons with disabilities, keeping them out of public view via institutionalization.  As a result, most Americans may have learned about disabilities through popular media’s distorted images.  For example, disability portrayals feature younger persons more often than older adults, who actually represent the largest group of persons with disabilities.  Instead of perpetuating ableism and ageism, it’s time to learn from the experts—actual persons with disabilities!

Superfest: The Dissies

“Whether films take us somewhere far away outside or deep down inside, they involve an intimate dance between projection and reflection, a giant flickering mirror, not just back to us, but to the society and culture we live in.  They shape how we see ourselves individually and collectively, how others see us, and how we see others.  This is why movies matter, why they occupy a key intersection where entertainment, psychology, and social justice meet.” – Why the Dissies, by Catherine Kudlick, SFSU Professor of History and Director of Paul K. Longmore Institute on Disability 

SFSU’s Paul K. Longmore Institute on Disability  and SF LightHouse for the Blind and Visually Impaired provided an empowering opportunity to critique disability portrayals in their joint presentation of Superfest International Disability Film Festival to a full house at the Women’s Building in the Mission District. This event was fully accessible beginning with the program brochure, which was prepared in both large print and Braille.  The program included ASL interpreter on stage with closed-captioning (for hearing challenged), audio description of video clips (for visually impaired), and ample space for wheelchairs/walkers/canes.

Culture! Disability!Talent! passed Superfest Torch to Bryan Bashin of SF Lighthouse for the Blind and Catherine Kudlick of the Paul K. Longmore Institute on Disability. 

Superfest Committee member Emily Smith Beitiks (Longmore Institute) and Judge Todd Higgins (SFSU’s Disability Programs and Resource Center) mingled with guests, enjoying drinks + popcorn before show began.

Being volunteer usher was an awesome experience for a behind-the-scenes look at putting together a fully accessible event for persons of all abilities! “Bossy” Corbett O’Toole showed me the best seats for the hearing impaired to be close to ASL interpreter, center aisle for those in wheelchairs, back seats for guests with service dogs, etc.

This year’s Superfest featured The Dissies, a one-night retrospective of the “worst of the worst” film clips portraying cringe-inducing disability stereotypes in mainstream movies.  The audience, or experts, then voted by sound ("howl, heckle and hoot") and movement (“have a seizure”).  After a panel of three judges declared the winners, Vannas presented Tiny Tim statuettes to leaders from the disability community who took the stage to deliver fake acceptance speeches.

Master of Ceremonies Lawrence Carter-Long, founder of disTHIS! Film Series (and in his second week as a furloughed federal government employee at the National Council on Disability), watched 230 films to whittle down to 22 contestants.  Based on expert opinion, the winners were (drum roll . . .):  

Worst Portrayal of a Disability by a Non-disabled Actor awarded to Gene Hackman as a blind hermit in Young Frankenstein (1974) for cluelessly ladling soup on his guest's lap and then shattering a wine mug while toasting.  Hey, what happened to a blind person compensating with an acute sense of hearing?! asked Carter-Long. UC Berkeley English Professor Georgina Kleege accepted the award on behalf of Hackman for his representation with such effect that no one would want to come to a blind person’s home for soup.

So Sweet (that They’re Not) honor went to Shirley Temple in Heidi (1937) for urging Clara to walk without crutches “if only you try hard enough.”  This category was a tough call as contenders—other nominees were Mary of The Secret Garden (1987) and Pollyanna (1960)—featured almost indistinguishable "cute, little white girls" helping “pathetic” disabled. 

The Most Amazing Miracle award went to paralyzed Allan Mann of Monkey Shines (1988).  This was another close call with Forrest Gump (1994) for Run, Forrest, Run! scene when Forrest’s leg braces fall off as he sprints like an Olympic track and field athlete away from the bullies. Scientist Joshua Miele put on eyeglasses to get in character for his hilarious acceptance speech, noting that he was “drinking beer earlier and the fact that he didn’t miss his mouth one time was amazing. . . you people are so inspirational” and then thanking the “differently crippled, or whatever.”

The Most Tragic win was Million Dollar Baby (2004 Academy Award Best Picture) for its "better dead than disabled" scene of the former boxer, depressed over her sudden quadriplegic state, asking her coach (played by Clint Eastwood) to put her down like her family’s old dog instead of fighting to change her situation and environment.  Big audience applause when award acceptor Victor Pineda noted that the film’s protagonist would have been better off without Eastwood character.

Audio Eyes (mostly spoken by blind actor Rick Boggs) deserved honorable mention for audio description of video clips.  For example, after The Most Tragic nominee Al Pacino, who played a blind and retired Army officer, in Scent of a Woman (1992), attempts suicide saying, “I got no life! I’m in the dark here!” the sarcastic audio description says he “closes his useless eyes.” 

The Worst Disabled Villain:  Peter Sellers as Dr. Strangelove (1964) who has alien hand syndrome and uses a wheelchair

Crips Gone Wild! (And Ruining Everything):  Danny in Blind Dating (2006)

Hey, only we can laugh at that!: The Ringer (2005)

I enjoyed this view of the stage from the balcony, which was mostly standing-room. After the last laugh, there seemed to be a collective cathartic release from confronting tiresome tragic/heroic stereotypes of disability.  I’m looking forward to next year’s Superfest showcasing more diverse and complex representations of disability culture—as Carter-Long told us, “No handkerchief necessary, no heroism required.”

  

Mental health disabilities

At The Dissies, Glenn Close in Fatal Attraction (1987) was nominated for Worst Portrayal of a Disability by Nondisabled Person.  At the White House Conference on Mental Health this past June, the actress came out to apologize for her portrayal of the obsessive spurned lover who boiled the bunny to death.  Portrayals of persons with mental health disabilities as having suicidal and homicidal tendencies contribute to the stigma that silences those who need support toward recovery to regain control over their lives.

This October 31 marks the 50^th anniversary of the Community Mental Health Act, which helped de-institutionalize persons with mental disabilities back into the community.  Yet, the three largest mental health providers in the nation today are jails. 

Depression is a leading cause of disability.  Women, who tend to ruminate on sources of problems rather than solutions, are twice as prone to depression as men. Depression can cause cognitive impairment: executive function deficit, slower processing speed, psychomotor slowness, attention problems, and lower working and verbal memory.  Depression is emotional suffering, as opposed to apathy, which is loss of motivation that is typical in Alzheimer’s disease or dementia.

Depression actually declines with age, but is the most common emotional problem among older adults.  Yet many older adults are reluctant to talk about depression, seek psychological help, and tend to be noncompliant with medications.  At the SF Main Library, I attended gerontologist Hope Levy’s Brain Fitness class featuring guest speaker Charles Vella, who recommended SPEAK UP for self-care:

Schedule: sleep, eat

Pleasant activities: fun, people

Exercise

Avoid alcohol/drugs

Kind thoughts: challenge negative thinking

Unwind: relax

Practice assertiveness

In addition to self-care, Dr. Vella said that depression can be treated through medications, patient education, cognitive behavioral therapy, and relapse prevention.    

Dr. Vella also discussed suicide = permanent solution to temporary crisis:

·         Elderly make up 13% of U.S. population, but 16% of suicides

·         Most at risk for suicide are older white males; contributing factors are depression, chronic health problems, difficulty adjusting to life change, isolation

·         79% of all firearm suicides are white males age 85+ 

·         61% of gun deaths in America are suicides (50% of all U.S. households admit to having firearms, which is risk factor for completed suicide)

·         Firearms remain most common method of suicide: 46 Americans commit suicide with guns everyday.  Firearms are used in only 5% of suicide attempts, but almost always fatal.

·         Suicide completion rate for men is 4x higher than women

·         50% of completed suicides are done under influence of alcohol, which is a depressant

Suicide Prevention

SFSU hosted Suicide Prevention Regional Conference’s We All Matter: Creating a Community of Caring.  Keynote speaker was Kevin Hines, author of Cracked, Not Broken: Surviving and Thriving After a Suicide Attempt.  As a 19-year-old college student with a recent bipolar disorder diagnosis, he attempted suicide by jumping from the Golden Gate Bridge.  As a survivor, he advocates for a suicide barrier and mental health wellness.

 

In the closing keynote, clinical psychologist Wei-Chien Lee shared her Reflections, or casual sayings that can make depressed persons feel worse – reminding us that “the symptoms of our people are the symptoms of our culture.”  For example, do people really care or mean what they say, “How are you? Let’s do lunch.”  How do predominant American cultural values like rugged individualism (pull yourself up by your own bootstraps) and the exaggerated pursuit of happiness (“don’t worry, be happy” at the expense of other emotions like “smile and the world smiles at you, cry and you cry alone”) affect our well-being?  She concluded her presentation with a sincere Small Actions Count (El Llanto), similar to random acts of kindness philosophy.

Active Mind’s Send Silence Packing is a traveling art exhibit of over 1,100 backpacks that represent the number of students who die by suicide each year. 

Much of the conference and accompanying exhibit focused on suicide prevention among younger adults, but I spotted this backpack about Grandmother.  In addition to stories on some backpacks, white poster boards carried messages like:

Stigma is shame, shame causes silence, silence hurts us all

We may often suffer in silence, but we do not suffer alone

Each suicide produces as many as 100 survivors or people left to grieve

By the way, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eliminated the two-month bereavement exclusion so now people who grieve the loss of a loved one can be diagnosed with depression, making anti-depressants more readily available. 

Nihil de nobis, sine nobis (Nothing about us, without us)

As I reflect on disability awareness month, I think about having the cultural humility to meet people where they are, instead of imposing the medical model of disability.  For example, it’s disturbing that the American Psychiatric Association (APA) attempted to pathologize introversion in its DSM-5.  Instead, let people who are the experts in their own lives define their needs; respect the individual and provide a supportive environment.  In this social model, disability is a social construction:  the problem resides in the environment that fails to accommodate people with disabilities, and in the negative attitudes of people without disabilities.