Category Archives: Uncategorized

National Healthcare Decisions Day – April 16, 2015

Refusal of TreatmentApril 16th this year is National Healthcare Decisions Day (NHDD), which is a day to think about and prepare or update your advanced directives for healthcare.  It’s a great gift to your family and friends to let them know your wishes in case of health crises in which you may not be able to speak for yourself.  It’s comforting to you to know that you’ve discussed the circumstances and interventions that would fit with your values and desires for your future.  It reduces family discord to have a designated patient advocate who has a written document with your decisions about treatment.  It’s also hard to think about and talk about such frightening eventualities.

There is a website about NHDD that helps make it easier to undertake those conversations and to execute the relevant documents.   It lists a number of websites in which to find state-specific advanced directives forms.  It also has links to many sites that help facilitate family conversations about health crises and each person’s wishes, including some card games and a phone app to store advanced directives for yourself and loved ones.

commlaw-aging-v-blackThe American Bar Association’s Commission on Law and Aging also has a number of helpful resources on preparing advanced directives and serving as a patient advocate.  There’s a guide to completing a universal health care power of attorney form, a guide to making medical decisions for another, and a toolkit that invites you to think about the various factors involved in coming to a decision about your possible care if you were faced with a serious medical condition.

Try not to put it off again this year.  My colleagues in the senior ER are begging us all to help them to help us and our families go through such harrowing experiences in a way that honors the person at risk and helps us all have greater peace of mind.

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

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March is National Nutrition Month

yellowpeppersAs we get older, we have to be mindful of what we eat.  With slowing metabolism, it’s easier to gain weight, and with less efficient digestion, we have to be sure we’re getting all the right nutrients packed into our diets.  To help prevent illness we want to include a lot of fiber, phytonutrients, and antioxidants.  Keeping up the normal flora in the gut is increasingly demonstrated to be a benefit to optimal functioning.  Preventing or minimizing bone loss required mineral supplementation.  Aging well requires more education and care than when we were younger.  You can’t retire from managing your own well-being!

ncoa-logoThe National Council on Aging has developed an infographic with helpful links, to help remind older adults of important nutrition habits to cultivate.  They also have produced several YouTube videos on eating well in later life.  I know I can use all the help I can get to stay healthy and able to function optimally.  Pass it on!

6 Ways to Eat WellSue Sweeney, Chair, Department of Aging Studies, Madonna University

2015 White House Conference on Aging

logo-WHCOA2015This is the year for the decennial White House Conference on Aging.  However, the Older Americans Act, which traditionally has outlined the Conference process, has not been reauthorized and the President’s budget has not been approved.  As a result, there are very little structure and no additional funds for the 2015 Conference.

nora-super-140Ms. Nora Super is the Executive Director of the Conference.  Her background includes more than twenty years experience in aging policy and community outreach.  The four themes that have emerged from community input, so far, are Retirement Security, Healthy Aging, Long-Term Services and Supports, and Elder Justice.  There is a blog for the Conference at  http://www.whitehouseconferenceonaging.gov/blog/   A number of regional forums are also scheduled.  The closest one to SE Michigan is the conference in Cleveland, OH on April 27th.

The Administration is using social and electronic media as much as possible to receive grass roots input and conduct informational meetings.  Everyone can participate by going to the web site and signing up to receive notices of events, such as webinars, and opportunities to participate.  You can also provide your thoughts and/or a story about your experience with aging or aging services, such as Medicare, Social Security, or in-home services, by submitting them through the following link:  http://www.whitehouseconferenceonaging.gov/submissions/register.aspx

Here’s the contact information if you have specific questions:

White House Conference on Aging
200 Independence Avenue SW, Suite 637D
Hubert H. Humphrey Building
Washington, DC  20201
(202) 619-3636
info@whaging.gov
www.whitehouseconferenceonaging.gov

Aging touches everyone.  I encourage you to participate in this opportunity for civic engagement at a time when our society includes the greatest proportion of older adults in history.

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

What “Ego Integrity” Looks Like

Erik Erikson

You have probably encountered Erik Erikson’s theory of psychosocial development, in which he posits eight epigenetic stages.  In each stage a developmental crisis must be positively resolved for optimal further growth to occur.  The final crisis occurs in late life, in which a person faces mortality and examines his or her life.  This life review can result in either ego integrity, a sense of appreciation for one’s life as lived, or in despair, a sense of regret and disappointment over the outcomes of one’s life.

In teaching adult development, I’ve found it much easier to convey the experience of despair.  Students seem to understand that a person could look back over her lifetime and conclude that she had not accomplished enough, had made bad choices, or harmed others unnecessarily.  Getting across the experience of ego integrity has been less successful.  Feeling a sense of satisfaction seems a pale accomplishment in contrast to the wrenching feeling of despair.  Then I read a brief essay in the New York Times online edition by neurologist and author Oliver Sacks.

Oliver Sacks

Among other writings, Dr. Sacks has written numerous very readable books about how people experience and adapt to unusual neurological phenomena and pathologies.  He is 81 and describes himself as robust.  However, he recently learned that he has metastatic and terminal cancer from a rare tumor he’d thought had been cured nine years ago.  The article, entitled, “My Own Life”, contains what I consider an eloquent representation of ego integrity.  It contains  a deeply genuine expression of expansiveness, individuality, and aliveness in the face of impending death.  He ends his essay with this observation, “Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

I urge you to read his moving essay.  To me it contains inspiration that each of us may reach the end of our lives  with a measure of authenticity, clarity, and gratitude.  It also conveys a sense of celebration of a life well-lived.  That’s the kind of ego integrity I hope to accomplish and wish for all of us!

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

National Council on Aging Funding for Outreach for SNAP

ncoa-logoIn the January 13th issue of the National Council on Aging‘s NCOA Week e-publication, they announced grant proposals for $25,000 or $50,000 to increase enrollment of older adults who are eligible for the federal  Supplemental Nutrition Assistance Program (SNAP).  The details of the RFP will be available next week.  As stated in the e-publication, “NCOA soon will be seeking proposals from community-based organizations for Senior SNAP Enrollment Initiative grants in two competitive categories ($25,000 and $50,000). The Request for Proposals will be released on or around Jan. 20. Optional Letters of Intent are due Feb. 13, and applications are due March 6.”

FoodNutrSvcesLogoA 2012 presentation by Lura Barber of the National Center for Benefits Outreach and Enrollment of NCOA is available online.  Called SNAP and Older Adults, the presentation points out that only one out of three eligible older adults are enrolled in SNAP, and provides basic information about SNAP organizational structure, eligibility, application process, and techniques to reach out to older adults who qualify.

World Elder Abuse Awareness Day – June 15th

Elder abuse is a violation of human rights and a significant cause of illness, injury, loss of productivity, isolation, and despair. – World Health Organization, United Nations

Because of the increasing older adult world population and because the oldest old group is growing the fastest, the prevalence of elder abuse is increasing.  In 2006, the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations designated June 15th as World Elder Abuse Awareness Day.  Since then, the U.S. Administration on Aging (now the Administration for Community Living or ACL), has recognized the day and has used the event to encourage organizations throughouACL_HeaderLogot the country to promote prevention of elder abuse.  This year the ACL has issued a useful publication in .pdf entitled, “How to Answer Those Tough Questions About Elder Abuse”.  It provides information about the nature of the problem and how to address it at individual and organizational levels.

Elder abuse takes many forms.  It can involve neglect (failure to provide for the basic necessities of life or to respond to potentially harmful situations); emotional abuse (in which a person is harassed or demeaned); physical abuse (in which a person’ health or welfare is harmed or they are given inappropriate medications or substances); sexual abuse (unwanted, intimate touching or looking); exploitation (involving improper use of an individual’s finances, property or personal dignity); or self-neglect (in which a person does not care for him- or herself so as to avoid harm).

In all cases, if the person at risk is able to understand the consequences of continuing abuse, then they have a right to refuse intervention if they choose.  However, I believe that means thoroughly discussing all the possible outcomes of staying in the abusing situation, so that the person wishing to intervene is absolutely clear that the person at risk is making an informed choice. It also means discussing alternatives, so that the person at risk knows what shelter, protection, benefits and services they may reasonably be able to employ in order to improve their life situation.  Abused adults often refuse help out of shame, the belief that they are to blame for the abuse, fear of retaliation, psychological denial of the abuse, and/or the fear of going from one bad situation to another.  Without information about housing, services, financial support, transportation, and protection, the abused individual can’t make a rational judgement about whether there is any expectation that their basic needs can otherwise be met.

ncea_logoMost states have laws addressing elder abuse. The National Center on Elder Abuse (NCEA) has a helpful resource for finding out about reporting and laws in a given state or territory.  In Michigan, elder abuse is covered under the Public Act 175 of 2012 [Social Welfare Act, MCL 400.11(b)].  Many groups of professionals are required by law to report suspected abuse in Michigan:  individuals involved in health care services, educational services, social welfare providers, mental health services, any other human services, law enforcement officers, and county medical examiners and their employees.  The Department of Human Services will maintain the reporter’s anonymity, unless legally required to divulge it. How do you know when elder abuse may be occurring?  The NCEA has another useful document called, “Red Flags of Abuse”, which describes behaviors and signs that suggest the likelihood of neglect, abuse, or exploitation.

Elder abuse is grossly under reported.  Those who are abused are intimidated or unable to report.  They may already feel unworthy of better treatment because of internalized ageism and may be emotionally attached to the abusive situation due to the Stockholm syndrome.  Most of the rest of us don’t want to believe it can be happening around us.  However, the most common perpetrator of elder abuse is a friend or relative.  We need to be more aware of this problem and its signs, and report suspected abuse.

In Michigan, notify the Department of Human Services (DHS), Adult Protective Services: http://www.michigan.gov/dhs  Statewide 24-Hour Hotline:   1-855-444-3911

If you suspect abuse, neglect or exploitation of a resident of a nursing home by another resident or by a nursing home employee, notify:   Bureau of Health Services Abuse Hotline: 1-800-882-6006

Michigan Protection and Advocacy Service, Inc.:  Developmental Disabilities:  1-800-288-5923
Mental Illness:  1-800-288-5923

Attorney General 24-hour Health Care Fraud Hotline: 1-800-24-ABUSE / 1-800-242-2873

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

Older Drivers

WPRBetaTaglineI was interviewed recently by Wisconsin Public Radio on the topic of older drivers.  There is a bill in the Wisconsin state legislature to require drivers over age 75 to renew their license more often than younger drivers.  Families so often struggle with discussing driving with older relatives because it’s such an important ability to quality of life and because public transportation is so limited, especially in rural areas.  Here’s the description of the piecehttp://www.wpr.org/challenges-elderly-driving  You can download the audio or listen online from that same link.

Driving is  an important issue for older adults and their families for many reasons.  Older adults more often suffer severe injury and death when involved in vehicle accidents, because of age-related physical changes and chronic illness.  Accident prevention is therefore an urgent goal.  There are a number of helpful Web pages on driving in later life.  AARP has a driver safety page on their site, which highlights their driver safety course for senior drivers, offered both online and face to face.  The course costs between $16 and $20 depending on whether the person is an AARP member.   I have my students take the We Need to Talk online seminar on the same AARP page, which discusses when to stop driving and how to discuss driving cessation with older drivers.  It helps them to have a more empathic view of driving and understand what driving means to people, beyond just getting from point A to point B.

CarFit is an organization that provides events in which older drivers bring their vehicle, and trained volunteers assess how to better fit the car to the needs and limitations of the driver.  While not every area of the U.S. is covered by these events, the Web site has a number of videos that illustrate proper alignment or fit of the driver to the car, such as the optimal distance between the steering wheel and the driver’s chest to prevent or minimize injury from an airbag, mirror adjustment for effective view of the side and rear, or the minimum distance needed of the line-of-sight above the steering wheel for a safe view of the road.

The Hartford Insurance Company has a very useful Web site on Family Conversations With Older Drivers.    The site offers conversation starters, conversation planners, a Warning Signs Worksheet, information on driving evaluation, a worksheet to evaluate transportation alternatives, and other helpful information.  The company also provides quite a few free guidebooks with information on a number of aspects of driving, in both electronic and paper form.

The American Medical Association has resources for physicians on older drivers, including a Web-based educational course called “Medical Fitness to Drive:  Is Your Patient at Risk?” and a “Physician’s Guide to Assessing and Counseling Older Drivers –  2010 Edition”, developed with the National Highway Traffic Safety Administration.  The Guide can be downloaded and has information useful to professionals and consumers.

Finally, the National Highway Traffic Safety Administration has an Older Drivers Education Web page with electronic brochures on adapting vehicles, conversations with older drivers, safe driving, and driving transition.

With the Baby Boom generation aging, there will be more and more older drivers on the road.  We need to be both sensitive and sensible so that the safety of everyone on the highway is optimized while the rights and quality of life of the older drivers are preserved as long as possible.  It’s gratifying that there are so many resources available to help us address the issue in informed and compassionate ways.  Sue Sweeney, Chair, Gerontology Department, Madonna University