Tag Archives: Aging

Let’s Talk About Sex — After 60

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By Christina Pierpaoli Parker, MA (Geropsychology Doctoral Student, University of Alabama)

 

 

Science has started to pay attention to what happens between the sheets after 60, especially as medical advances permit us to live longer and healthier lives. Emerging research shows that older adults get busier than we think, finding that many adults remain sexual well into their 90s. As with other periods of development, sex in later life improves quality of life, mood, and health.

 

The Problem

But sex after 60 still has its consequences. Spikes in sexually transmitted disease (STDs) among older adults illustrate that. Compared to younger folks, older adults know less about STDs, underestimate their risk of infection, and practice safe sex less often. Data from the Centers for Disease Control and Prevention (CDC) reflect this, reporting that adults over 50 represent 15% of new HIV infections. By 2020, upwards of 70% of persons living with HIV will be 50 or older. Other STDs including chlamydia, gonorrhea, primary and secondary syphilis, show similar increases in older groups.

 

What’s going on?

Experts offer two explanations: (1) Treatment advances, such as antiretroviral therapy, have enabled already infected adults to live longer, inflating prevalence; and (2) the number of new infections (incidence) among older adults is increasing.

 

Fine, but why are adults becoming infected at all?

Growth in new infections altogether means recognizing that sex doesn’t retire after 60. Complex interactions of biopsychosocial factors underlie the incidence of STDs among older adults.

 

Biological factors. With normal aging, older adults experience changes in immune function, increasing their vulnerability to sexually transmitted diseases. For example, the number and maturity of their T- cells—white blood cells that help fight infection—decrease, depressing immune responsiveness and aiding transmission.  Systemic reductions in testosterone and estrogen can thin the vaginal and anal mucosae and reduce vaginal lubrication, leaving many older men and women susceptible to tears during sex that can facilitate viral entry.

 

Psychological & behavioral factors. Older adults underestimate their risk for contacting sexually transmitted diseases. A recent study comparing actual and perceived sexual risk found that older adults with the greatest risk of contracting STDs were also the group least aware of their vulnerability. Cohort differences surrounding the 1960s rise of penicillin to treat STDs like syphilis may skew older adults’ identification with risky sexual behavior, explaining low rates of condom use among boomers especially. The widespread availability of erectile dysfunction medications in a climate of shifting divorce and dating patterns in later life— when menopause hits and pregnancy ends— have intersected to create more opportunities for sex and infection.

 

Sociocultural factors. Of course, older adults aren’t entirely to blame. Stereotypes, taboos, and biases about aging and sexuality perpetuate misconceptions surrounding late life sex, trickling down into clinical practice. For example, physician-initiated sexual history taking remains suboptimal among older adults, despite CDC recommendations requiring patients of all ages to receive comprehensive STI/STD education and evaluation. A powerful study revealed that few men (38%) and even fewer women (22%) had discussed sex with a physician since age 50, consistent with findings describing the inverse relationship of age and frequency of sexual health discussions. Other studies simply find that practitioners feel uncomfortable initiating sexual health discussions with older adults.  Prevailing interpretations of these findings conclude that practitioners’ attitudes and beliefs about sex in later life may stem from stereotypes of aging and sexuality, rather than experiences with, or explicit education about, late life sexuality.

 

Where do we begin? A call to action

Sex researchers and educators alike have long pointed to the positive contributions of sex education to healthy sexual attitudes and behavior, but adult-specific models remain breathtakingly scarce. Psychologists must therefore work to develop, implement, and evaluate adult sex education protocols for practitioners and older adults on:

  • Increasing knowledge about sexual health and functioning, as well as their changes, in later life;
  • Growing understanding of the biopsychosocial contributions to sexual risk in older adulthood; and
  • Promoting growth in physician and patient comfort to discuss sexual concerns

 

Recent precedent supports this as a good starting point: internal medicine residents who received three brief 30-minute tutorials on sexual history taking demonstrated improved documentation of older adults’ sexual histories than those who did not.

 

Steps you can take right now

We’ve got a long way to go before the paradigm shifts. Here’s what you can do to nudge it:

  1. Pause to assess, recognize, and reflect on your biases. What attitudes and beliefs do you have about late life sexuality? Where do they come from and how do they serve you? How and why should you challenge them?
  2. Practice the kind of sex you’d encourage your child or loved one to have. Sex that’s safe, consensual, and well lubricated.
  3. Have the knowledge and courage to ask questions. If you’re a health care provider working with older folks, ask about their sexual concerns; research says adults appreciate it. If you’re an older adult, share your sexual concerns with your health care provider—a competent professional will work with you or direct you to someone who can.
  4. Learn more. Explore the references included throughout this piece to get more (scientifically sound) information.
  5. Embrace sexuality as a lifelong, developmental process that improves with age. Isn’t that more fun, anyway?

 

 

 

Biography:

Christina Pierpaoli Parker, MA, is a fourth-year graduate student in the Clinical Geropsychology doctoral program at the University of Alabama under the co-mentorship of Drs. Forrest Scogin and Martha R. Crowther. Her research and clinical work explore the intersection of older adults’ physical and psychological health, focusing on the adjustment to and behavioral management of chronic health conditions (e.g., HIV, metabolic syndrome, osteoarthritis). Current interests include developing psychoeducational interventions for understanding, treating, and improving sexual dysfunction in later life. Christina’s work has been published in the Journals of Aging & Health, Sex & Marital Therapy, and The Clinical Gerontologist and presented at international conferences. She translates her academic research for Eng(aging), her widely acclaimed blog on Psychology Today, which has landed her interviews as aging expert on The Psychology Podcast with Dr. Scott Barry Kaufman and The Aging Literacy Podcast with Dr. Bill Thomas. Her forthcoming book, Trixxx Aren’t Just For Kids, written with Dr. Elizabeth DiNapoli, explores the science and stories of sex in later life.

 

What High School Psychology Students Told Us About the Future of Healthy Aging

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By Maggie Syme, PhD, MPH (Member, APA Committee on Aging & Assistant Professor of Gerontology, Kansas State University)

 

In the past year, high school psychology students embarked upon an essay to describe an “Aging World,” the theme of this year’s Teachers of Psychology in Secondary Schools (TOPSS) annual essay competition for high school psychology students. Ultimately, four students from high schools around the world were named winners, but the broader impact was that a bevy of young people learned about how to age well and how to support this goal for our current aging population. The potential contribution of younger to older generations is enormous, and it has been truly inspiring to see the passion and ingenuity with which these high school students approach an aging world.

It was so inspiring that the APA Committee on Aging, which provided input to this year’s TOPPS competition, interviewed the essay winners. The winners provided insight into their experience and the implications for the psychology of aging.

Three thousand words on aging—this is no easy task. Just ask our winners. Each winning student (see below for names and affiliations) commented on the magnitude of the project, and some reflected on how their peers shied away from the task. Yet, each one appreciated the challenge and found clear benefits to participating.

 

Poorvi Dua, now at University of California – Berkeley, indicated that the size did not intimidate her, but instead the challenge was intriguing.

“The second [my teacher] mentioned it I got really excited, and knew if I put work into this it would be the coolest thing.”

 

Wendi Ji, a senior at Shen Zhen College of International Education, also saw the importance of the topic:

“I usually don’t want to participate in essay contests…but the topic really grabbed my attention.”

 

Grace Rhine, now a freshman at Millersville University, stated that the challenge was part of her motivation for doing the essay:

“I really wanted to prepare myself for the writings in college that I would do…It was really helpful for me.”

 

Similarly, Sophia Song, a senior at Seoul International School, indicated that the contest was a “golden opportunity” and further stated,

“I learned a lot about how to format a research paper, which will help me a lot later on.”

 

The winners were especially thankful for their high school psychology teachers in providing the opportunity. Several mentioned their teachers as an integral source of support in the process, and were appreciative of the formatting guidance, as this was the first APA research paper most had written. When asked about other sources of inspiration and guidance, several mentioned their grandparents or other key figures in their lives who had illustrated the importance of healthy aging.

“I thought often about them [grandparents] in my essay, and I asked them a lot about the concepts I explored to see if it was applicable to them.” Grace also pointed to the influence of her grandparents stating, “I’m really close with all my grandparents, and I thought about how their life will be in the future as they age and want them to have a good life.”

 

Wendi spoke about her grandparents as “fighters,” stating,

“They had to fight off against all the negative images they had seen in the media and stereotyping comments about them. [A family member] used the ‘Because you are old…’ a lot. But the truth is, my grandparents never listen when the sentence starts with those words.”

 

In contrast, Poorvi mentioned that she was highly influenced by her English teacher (and mentor), whose wife developed Alzheimer’s disease during Poorvi’s high school career.

“I saw the process he was going through and the mental toll it took on him. And, just how big it became…That really inspired me to write this essay, to see how we can improve the aging process.”

 

In fact, Poorvi is now studying molecular biology and psychology in college with hopes to go to medical school and do research on neurobiology, the brain, and Alzheimer’s. She reported that she has joined a local club at UC-Berkeley, Action for Alzheimer’s, and will be volunteering in a care center as part of the club activities.

 

The other winners also mentioned an intention to “follow up” on aging in some way. Grace, who is studying to be an art therapist, wants to be able to help people across the lifespan through her work. Sophia aims to take a few aging-related courses in psychology when she goes to college. Wendi also indicated her intent for continuing to study aging.

“After researching the aging topic, I find it very hard to just forget about it and go on studying other subjects, just because aging is such an important issue. I want to dedicate myself to helping elderly citizens fight off the negative mass media images and stereotypes.”

 

When talking about the aging-specific aspects of the essay, each winner felt they grasped key points about healthy aging as a result.

For example, Poorvi was captivated by the life course perspective and the real-life impact of psychological and social concepts on biological aging.

“One thing that really surprised me was how much of your early life can play a role in the process of aging. I knew you should exercise and eat healthy, but these studies actually show a direct correlation between things like stress and the length of telomeres in your DNA.”

 

Grace commented,

“I never really thought about it [aging] before, more than just the biological standpoint. Here, I thought about the different experiences people have in retirement, moving into a nursing home, and the impact on that person.”

 

Sophia also commented on broadening her understanding of aging.

“One thing that stood out to me was subjective happiness. We can help older adults have this through gaining independence, autonomy, and from the simplest things like having transportation.”

 

Wendi focused on the psychological impact on healthy aging, stating,

“The overall take-away message was most of the time people had choices, they had choices to lead a healthy and positive life in their 60s and 70s. But the choices originate from their psychology, their attitude and ways of interpreting life events. If we can help them realize the choices and encourage them to make the ones beneficial to their physical and mental health, the word ‘aging’ may finally be free of associated negative emotions fear and worry.”

 

The winners were asked to consider why people their age (or younger) should be interested in aging. What’s the need, if it is decades away?

“It’s going to happen to all of us, sooner or later,” stated Grace.

 

Similarly, Poorvi asserted,

“Every single day, every single second that you are alive, you are aging. You have to be conscious of the choices you are making now because they will play a role down the line. Very small things you wouldn’t think play a role, the effects are amplified as you go along.”

 

Sophia agreed, stating,

“Aging research is an investment for us as we grow up. It’s crucial to understand where we will be in a few decades.”

 

Wendi emphasized that our actions as younger people make an impact on today’s older adults.

“Young people’s attitude and actions towards elderly citizens impose a significant influence upon the expectations and attitudes of elderly people towards aging.” She further stated that, “as responsible citizens, young people should care and help improve the welfare of this very important group who have contributed so much to our society.”

 

Each winner also specified what people in younger generations could (and should) be doing to get involved with aging issues. All of them suggested methods on a larger scale (e.g., volunteering, getting involved in research), but they also mentioned person-level interventions.

“The easiest way is to get a more personal connection with your grandparents, and ask them about aging in general and how each of these things apply to them,” suggested Sophia.

 

The “gap” between older and younger generations was mentioned by Poorvi, stating,

“There’s very young people, and there’s the very old and it feels marginalized. It is a good idea to get them more involved, and there are studies about this. It is better for people in older care homes if they’re surrounded by young/lively people; it boosts their psychological health.”

 

Grace also emphasized the role of personal, intergenerational connections by stating,

“Getting younger people involved in different community programs can integrate the different generations. I’m really involved in my church, and there is a large older population there. I like to get to know them and spend time with them.”

 

Wendi adds,

“They can start by not stereotyping the elderly as ‘lonely, grumpy, and socially withdrawn,’ and hopefully convince others to do the same.” She also suggested the importance of family support for our older relatives. “Consider spending more family time with elderly members in the family. They have the most wisdom and life experience, not to mention the importance of family support for elderly people.”

 

Overall, the essay impacted each of these students in unique ways. Some gained much-needed college preparation, and gained self-efficacy after tackling that ever-challenging APA formatting. Some solidified a previous interest into a potential career pathway. But each one came away with a more profound understanding of healthy aging and the immediate impacts on society. This is summed up in the following from Poorvi:

“Writing this essay made me realize how important this field of study is…All the research in this field is incredibly important because every study is going to be the scientific background for which more programs and laws are created that are geared toward helping older people. It’s underappreciated, but it’s incredibly important in our society because it is so fundamental.”

 

The four winning essays are available to download and read here: http://www.apa.org/ed/precollege/topss/student-competition.aspx. We encourage you to take a look at how these high schools students have captured the challenges and solutions to aging well in our current world.

 

Of note, TOPSS provides students with a writing contest opportunity annually. See this link for guidelines and previous award winners. They also have an award for high school psychology teachers that have innovative lesson plans in psychology. See http://www.apa.org/about/awards/teaching-excellence.aspx for more information and how to nominate your teacher and/or colleague for this award.

 

2017 Essay Winners

Poorvi Dua (Xavier College Preparatory; Phoenix, AZ)

Grace Rhine (Penn Manor High School; Millersville, PA)

Sophia Song (Seoul International School; Seoul, South Korea)

Wendi Ji (Shen Zhen College of International Education, Guandong, China)

 

Biography:

Maggie Syme, PhD, is an assistant professor in gerontology in the Center on Aging and serves as a faculty member in the School of Family Studies and Human Ecology at Kansas State University. Her background is in counseling psychology and public health, with a doctoral degree from the University of Kansas and MPH from San Diego State University. Her clinical postdoctoral training was concentrated in geropsychology and neuropsychology as well as a research postdoc in cancer health disparities and aging. Prior to coming to K-State, Dr. Syme was a Research Assistant Professor at San Diego State University working on grant-funded research from the Alzheimer’s Association on sexual decision-making among cognitively compromised older adults. Her research interests are centered on sexual health in later life and across the lifespan, sexual decision-making in long-term care residents, and person-centered long-term care.

 


Filed under: Aging Tagged: healthy aging, high school psychology, TOPSS essay contest

Give the Gift of Kindness to Your Elders this Holiday Season

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By Sheri R. Levy, PhD, MaryBeth Apriceno, Ashley Lytle, PhD , and Jamie L. Macdonald 

 

The holiday season has a way of encouraging acts of kindness toward family, friends, and even strangers. As the holiday spirit inspires us to treat others with kindness and respect, let us not overlook older adults who tend not to receive everyday acts of kindness, gratitude, and respect.

Ageism (negative attitudes, stereotypes, and behaviors toward older adults) is a significant social problem that impacts their health and well-being.

As the World Health Organization points out:

“Ageism is everywhere, yet it is the most socially ‘normalized’ of any prejudice, and is not widely challenged – like racism or sexism.”

Older adults face disrespectful, avoidant, and patronizing behavior as well as discrimination and even abuse in the workforce, health care, and housing. Challenging ageist stereotypes and treating older adults with respect and kindness can help confront the detrimental effects of ageism.

 

Some figures that should give us pause:

  • Nearly all depictions of older adults in publicly available Facebook groups (including more than 25,489 members) involved the use of negative ageist stereotypes5.
  • There were 20,857 age discrimination claims in employment in 2016 alone, accounting for 22.8% of all discrimination claims in employment2.
  • Ageism was the most frequently reported type of discrimination by a nationally representative sample of 6,000 American adults ages 50 and over when asked whether they experienced discrimination by doctors or hospitals11.
  • The World Health Organization estimates that 1 in 6 older adults have experienced some form of elder abuse in the past year. This abuse includes neglect as well as physical, emotional, financial, and sexual abuse.

 

What you can do to reduce ageism:

 

1. Get the facts on aging:

2. Explore tips from the World Health Organization and the United Nations 

3. Steer clear of birthday cards that poke fun of older adults, which can lead to the internalization of negative age stereotypes, and further perpetuate myths about aging.

 

Celebrate older adults throughout the year:

 

 

If you would like to learn more about this topic, the following resources might be of interest to you:

 

1Abrams, D., Swift, H.J., and Drury, L. (2016). Old and unemployable? How age-based stereotypes affect willingness to hire job candidates. Journal of Social Issues, 72(1), 105-121. doi 10.1111/josi.12158

2Equal Employment Opportunity Commission (January, 2017). EEOC Releases Fiscal Year 2016 Enforcement and Litigation Data. Retrieved from: https://www.eeoc.gov/eeoc/newsroom/release/1-18-17a.cfm

3Erber, J.T., & Szuchman, L.T. (2015). Great myths of aging. Wiley-Blackwell: Malden, MA

4Levy, B. R. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6): 332-336.

5Levy, B.R., Chung, P.H., Bedford, T., & Navrazhina, K. (2014). Facebook as a site for negative age stereotypes. The Gerontologist, 54(2), 172–176. doi:10.1093/geront/gns194

6Levy, S.R. (2016). Toward reducing ageism: PEACE (Positive Education about Aging and Contact Experiences) Model. The Gerontologist. 10 AUG 2016, doi: 10.1093/geront/gnw116

7Levy, S.R., & Macdonald, J.L. (2016). Progress on Understanding Ageism. Journal of Social Issues, 72(1), 5-25. doi: 10.1111/josi.12153

8Lytle, A., & Levy, S.R. (2017). Reducing Ageism: Education about Aging and Extended Contact with Older Adults. The Gerontologist. Article first published online: 19 NOV 2017, https://doi.org/10.1093/geront/gnx177

9Palmore, E. B., Branch, L., & Harris, D. K. (Eds. 2005). Encyclopedia of ageism. Binghamton, NY, US: Haworth Pastoral Press.

10Pillemer, K,, Burnes, D, Riffin, C., Lachs, M.S., (2016). Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies, The Gerontologist, 56, 194–205. https://doi.org/10.1093/geront/gnw004

11Rogers, S. E., Thrasher, A. D., Miao, Y., Boscardin, W. J., & Smith, A. K. (2015). Discrimination in healthcare settings is associated with disability in older adults: Health and retirement study, 2008–2012. Journal Of General Internal Medicine, 30(10), 1413-1420. doi:10.1007/s11606-015-3233-6

12United Nations (2014). Retrieved from http://www.un.org/en/globalissues/ageing/

13World Health Organization (September, 2015). Ageing and Health. Retrieved from http://www.who.int/mediacentre/factsheets/fs404/en/

14World Health Organization (June, 2017). Elder abuse: Fact sheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs357/en/

 

Biographies:

 

Sheri R. Levy is a Professor in the Department of Psychology at Stony Brook University, USA. She earned her PhD at Columbia University in New York City, USA. Levy studies factors that cause and maintain prejudice, stigmatization, and negative intergroup relations and that can be harnessed to reduce bias, marginalization, and discrimination. Her research focuses on bias based on age, ethnicity, gender, nationality, race, sexual orientation, and social class.  With Jamie L. Macdonald and Todd D. Nelson, Levy co-Edited a special issue of Journal of Social Issues on “Ageism: Health and Employment Contexts” (Levy, Macdonald, & Nelson, 2016). Levy was Editor-in-Chief of Journal of Social Issues from 2010-2013 and is a Fellow of the Society for the Psychological Study of Social Issues (Division 9 of American Psychological Association).

 

MaryBeth Apriceno is a graduate student at Stony Brook University. She received her BA in Forensic Psychology from John Jay College of Criminal Justice. Her research investigates factors that affect ageist attitudes, aging anxiety, and self-stereotyping.

 

Jamie L. Macdonald is a doctoral candidate at Stony Brook University working with Sheri R. Levy. Jamie received her BA and MA in Psychology from Stony Brook University, New York, USA. Her research investigates prejudice, stereotyping, and discrimination with a focus on ageism in different contexts, like the workplace. She was a Co-Editor, with Sheri R. Levy and Todd D. Nelson, on a special issue of Journal of Social Issues on “Ageism: Health and Employment Contexts” (Levy, Macdonald, & Nelson, 2016).

 

Ashley Lytle is an Assistant Professor of Psychology at Stevens Institute of Technology in Hoboken, New Jersey, USA. Lytle earned her PhD at Stony Brook University, New York, USA.  Her research explores how prejudice, discrimination, and stereotyping impact academic, social, and health outcomes among marginalized groups. Much of Lytle’s research has focused on better understanding prejudice toward older adults, sexual minorities, and women, with the ultimate goal of creating simple, yet effective, interventions to reduce prejudice.

 

Image source: iStockPhoto


Filed under: Aging, Health and Wellness Tagged: age discrimination, ageism, discrimination, holiday season, prejudice

Finding Meaning in Life and in Death: A Call to Culturally Competent Action

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This is the second of three blog posts on grappling with end-of-life issues. Posts will go up for the next two Fridays. Subscribe to our Psychology Benefits Society blog to stay updated.

By Keisha Carden, MA (Doctoral Clinical Geropsychology Student, University of Alabama)

“Technically, I am still alive, but I’ve been dead for a long time. What was the meaning of it all?”

Elaina, seemed to be elsewhere as she shared this, her face void of affect. She was my 68-year-old in-home hospice patient suffering from a myriad of chronic health conditions with little time left to live. While I had used meaning-centered interventions with other clients, none had lived a life quite like this—a life peppered with physical, sexual, and emotional abuse, substantial self-harm, onerous failed attempts at healthy relationships and adaptive coping strategies, and an intimate familiarity with discrimination and prejudice. How could I help her make meaning of the senseless trauma, violence, and hate to which she had been subjected for so long? As a well-intentioned psychology scientist-practitioner, I looked to the evidence.

Like Elaina, many of our dying patients express the need for meaning—in life and in death. In palliative care, our primary goal is to facilitate comfort and maximize quality of life. We often employ interventions that emphasize the importance of meaning-making.

Unfortunately, these interventions seem to be overly individualistic and westernized, overlooking important aspects of intersectionality and cultural variations (e.g., Carden, Murry, Matthews, & Allen, in press). For example, Allen and colleagues (2016) reviewed the existing community-based interventions aimed at reducing the burden of palliative caregiving. Ten of the 17 interventions they identified were investigated among primarily (78% – 100%) non-Hispanic White participants and five studies did not report race. It is therefore conceivable that many palliative interventions fail to effectively assess and address the needs of many cultural groups.

So how do we move forward?

 

Back to the Basics

Meaning-based interventions are rooted in the teaching and writings of Viktor Frankl, founder of logotherapy and holocaust survivor. At their core, they assume:

  1. human beings consist of body, mind, and spirit
  2. life has meaning under all circumstances, even the most miserable
  3. people have a will to meaning
  4. people have freedom under all circumstances to activate the will to find meaning
  5. life has a demanding quality to which people must respond if decisions are to be meaningful
  6. the individual is unique

 

The individual is unique…

Have we lost sight of the individual in our efforts to be prescriptive and standardized in treatment development and delivery? It may be time to go back the basics and infuse our practice with more person-centeredness.

 

Promising beginnings

The scientific community seems to agree and is beginning to investigate innovative and creative solutions. These endeavors include utilizing culturally competent hospice educational materials (Enguidanos, Kogan, Lorenz, & Taylor, 2011), videos aimed at improving disparities in knowledge (Volandes, Ariza, Abbo, & Paasche-Orlow, 2008), employment of patient navigators (Fischer, Sauaia, & Kutner, 2007), and other peer support programs (Hanson et al., 2013).

 

What can you do?

It is time for researchers and providers to tackle this issue together. Research is needed that:

  1. explores factors contributing to differences and disparities in end-of-life and palliative care
  2. evaluates the effectiveness of current end-of-life interventions among diverse groups
  3. considers appropriate and ethical modifications to said interventions to enhance quality end-of-life care for all.

In the meantime, providers must go back to the basics and rely on ethical standards to facilitate quality care to diverse patients and their families.

 

References:

Allen, R. S., Noh, H., Beck, L.N., Smith L. J. (2016). Caring for individuals near the end of life. In L.D. Burgio, J.E. Gaugler, & M.M. Hilgeman (Eds.), The spectrum of family caregiving for adults and elders with chronic illness (pp. 142-172). New York, NY: Oxford University Press.

Enguidanos, S., Kogan, A. C., Lorenz, K., & Taylor, G. (2011). Use of role model stories to overcome barriers to hospice among African Americans. Journal of Palliative Medicine, 14(2), 161-168. doi:10.1089/jpm.2010.0380.

Fischer, S. M., Sauaia, A., & Kutner, J. S. (2007). Patient navigation: A culturally competent strategy to address disparities in palliative care. Journal of Palliative Medicine, 10(5), 1023-1028. doi:10.1089/jpm.2007.0070.

Hanson, L. C., Armstrong, T. D., Green, M. A., Hayes, M., Peacock, S., Elliot-Bynum, S., Goldmon, M. V., Corbie-Smith, G., & Earp, J. A. (2013). Circles of care: Development and initial evaluation of a peer support model for African Americans with advanced cancer. Health Education & Behavior, 40(5), 536-543. doi:10.1177/1090198112461252.

Volandes, A. E., Ariza, M., Abbo, E. D., & Paasche-Orlow, M. (2008). Overcoming educational barriers for advance care planning in Latinos with video images. Journal of Palliative Medicine, 11(5), 700-706.

 

Biography:

Keisha Carden is a fourth year graduate student in Clinical Geropsychology at The University of Alabama working under the mentorship of Dr. Rebecca S. Allen. Her primary clinical and research interests include: family caregiving for older adults (with and without cognitive impairment/Alzheimer’s disease and dementia); resilience; existential/death anxiety; childhood trauma; intergenerational relationships; and outcomes and treatment mechanisms of non-pharmacological interventions that incorporate aspects of positive psychology and meaning-making.

Image source: Photo by Jake Thacker on Unsplash


Filed under: Aging Tagged: end of life, existential, gender, intersectionality, meaning, minority, palliative care, sexuality

A Good Death is an Important Part of a Good Life

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This is the first of three blog posts on grappling with end-of-life issues. Posts will go up for the next three Fridays. Subscribe to our Psychology Benefits Society blog to stay updated.

By Amy Albright (Clinical Geropsychology Doctoral Student, University of Alabama)

We spend a lot of time talking about quality of life, but, increasingly, people around the world are talking about quality of death. Facing the end of life is hard for everyone involved, and many worry about the pain and loss of dignity associated with dying.1 In some areas of the world, individuals may choose legalized medical aid in dying, allowing them to control the time and place of their own death. This assistance allows patients to peacefully and painlessly end their lives through prescribed medication, which is often referred to as “assisted dying” or “death with dignity.” The majority of patients who choose these options are receiving hospice care,2 and many choose to die peacefully at home.3

Within the United States, residents of California, Colorado, Montana, Oregon, Vermont, Washington, and Washington D.C. may seek assisted dying.4 Currently, all U.S. states that allow assisted dying require that the patient is at least 18 years old, has a terminal illness, and has the legal capacity to make medical decisions.5 Psychologists don’t take a stand on this issue one way or the other; instead, they work with individuals to identify their own values and make their own decisions during this difficult time.6 There is a great deal of controversy surrounding  assisted dying, as the idea of ending one’s own life may be uncomfortable within certain cultures and religions.7 This is a choice that must be made at an individual level, and many who explore this option do not choose to hasten their own death. As of 2015, approximately 64% of medications prescribed under Oregon’s Death with Dignity Act were used.3

There is a great deal of variation in assisted dying laws,5 which may be due to how these laws develop. Brittany Maynard, a resident of California, was 29 when she was diagnosed with terminal cancer.8 While she wanted to choose death with dignity, this was not an option in California at the time, and she and her husband moved to Oregon so she could choose a peaceful death on her own terms. Ms. Maynard and her family advocated for California to pass a death with dignity law, and the California End of Life Option Act took effect in June of 2016.9 Due in large part to Ms. Maynard’s efforts, the idea of choosing assisted dying at the end of life is something that many Americans are now aware of. While hastening death is not something that most people will choose, having these tough conversations helps patients and their families become more aware of the services and options available to them at the end of life, allowing them to make the best decision possible.10

Choosing to pursue assisted dying is an incredibly difficult decision for all involved, and judging quality of death is very personal.11 While losing a loved one is never easy, family members of those who seek assisted dying have noted that their relative appeared prepared for death, allowing goodbyes to be said.1 Death is an inevitable part of life, and death with assisted dying  laws allow patients and their families some measure of control over the time and manner of death. Simply having the option to influence quality of death may be enough for some patients, and not all who consider assisted dying laws will choose to hasten death. Ultimately, there are no universal standards about the decision to pursue assisted dying, and this should always remain a matter of personal choice.6

 

References

  1. Smith, K. A., Goy, E. R., Harvath, T. A., & Ganzini, L. (2011). Quality of death and dying in patients who request physician-assisted death. Journal of Palliative Medicine, 14(4), 445-450.
  2. Campbell, C. S., & Black, M. A. (2014). Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. Journal of Pain and Symptom Management, 47(1), 137-153.
  3. Oregon Public Health Division. (2016). Oregon Death with Dignity Act: 2015 Data Summary. Retrieved from http://www.worldrtd.net/sites/default/files/newsfiles/Oregon%20report%202015.pdf.
  4.  Death with Dignity National Center. (2017). Death with Dignity Legislation. Retrieved from https://www.deathwithdignity.org/faqs/#laws.
  5. Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA, 316(1), 79-90.
  6. American Psychological Association. (2017). Resolution on Assisted Dying and Justification. Retrieved from http://www.apa.org/about/policy/assisted-dying-resolution.aspx.
  7. Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers, and the public on assisted dying. Palliative Medicine, 27(1), 13-26.
  8. Maynard, B. (2014, November 2). My right to death with dignity at 29. CNN. Retrieved from http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/index.html.
  9. Coalition for Compassionate Care in California. (2017). End of Life Option Act. Retrieved from http://coalitionccc.org/tools-resources/end-of-life-option-act/.
  10. Balaban, R. B (2000). A physician’s guide to talking about end-of-life care. Journal of General Internal Medicine, 15(3), 195-200.
  11. Meier, E. A., Gallegos, J. V., Thomas, L. P., Depp, C. A., Irwin, S. A., & Jeste, D. V. (2016). Defining a good death (successful dying): Literature review and a call for research and public dialogue. The American Journal of Geriatric Psychiatry, 24(4), 261-271.

 

Biography:

Amy Albright is a doctoral student in the Clinical Geropsychology program at the University of Alabama. Her research focuses on health literacy and the end of life, and she has a particular interest in factors that influence seeking medical assistance in dying. This includes both patient and provider attitudes towards physician-assisted death, as well as health and palliative care literacy.


Filed under: Aging Tagged: aging, assisted dying, death with dignity, end of life, hospice care, palliative care

Is Poking Fun at Birthdays a Harmless Way to Celebrate Them?

blog-ageism-birthday

By Sheri R. Levy, PhD, & MaryBeth Apriceno (Stony Brook University)

 

Have you ever noticed that the tone of birthday cards for children is upbeat with messages like, “way to go, you’re another year older”? Whereas that is rarely the theme in cards for adults older than 21, at least in the United States.

 

Next time you find yourself in a card store, read through a few birthday cards for adults. You might find one or two cards with an upbeat and pro-age sentiment like “Fifty and fabulous.”  More likely you’ll encounter a lot that reiterate false and negative stereotypes of aging and older adults — cards that exaggerate the incidence of Alzheimer’s disease, depict dramatic age-related physical changes, portray older adults as very unattractive and cranky, as well as cards that suggest older adults lack sexual interest or have inappropriate sexual interest.  Nothing appears to be off limits.

 

Likewise, the aisles for adults at party supply stores are often devoted to party supplies and gifts poking fun of older adulthood. Here you’ll encounter a lot of “over the hill” themed party supplies such as balloons and serveware. You’ll also likely see favors and gifts that refer to ageist stereotypes, like signs that say “CAUTION, slow senior zone,” over the hill potty night lights, over the hill emergency diaper kits, and over the hill canes equipped with a horn, plastic chattering teeth, and a mini fine-extinguisher.

 

Funny or foul?

 

Birthday cards and gifts that poke fun of older adulthood are communicating negative ageist stereotypes found in society, including negative depictions of older adults in books, movies, and television. Together, these negative stereotypes and images take a toll on older adults.  Negative ageist messages may be internalized over the course of a lifetime and cause older adults to adopt an older self-image.  Older adults may then tailor their behaviors to these learned stereotypes, resulting in more sedentary lifestyles, decreases in cognitive functioning, decline in overall health, and a shorter lifespan (see Levy, 2009). Such effects may be amplified in women who face ageism as well as sexism (see Chrisler, Barney, & Palatino, 2016).

 

Widespread sale of birthday cards and supplies poking fun of older adulthood indicates the accepted nature of the stereotypes they communicate and the pressing problem of ageism. In fact, the World Health Organization (2015) has noted, “Ageism may now be more pervasive than sexism or racism.”

 

Ageism affects society. It can limit intergenerational contact and undermine intergenerational harmony. It contributes to age discrimination in the workplace, worse health care and poorer health for older adults, as well as financial and physical abuse of older adults.

 

“The world is in the midst of a unique and irreversible process of demographic transition that will result in older populations everywhere” (United Nations, 2014).

It is more important than ever to take steps to reduce ageism, and this includes no longer tolerating cards and gifts that poke fun of aging and older adults.

 

If you would like to learn more about this topic, the following might be of interest to you:

 

Chrisler, J., Barney, A., & Palatino, B. (2016). Ageism can be hazardous to women’s health: Ageism, sexism, and stereotypes of older women in the health care system. Journal of Social Issues, 72(1), 86-104. doi: 10.1111/josi.12157

Demos, V., & Jache, A. (1981). When you care enough: An analysis of attitudes toward ageing in humorous birthday cards. The Gerontologist, 21, 209-215.

Levy, B. R. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6): 332-336.

Levy, S.R. (2016). Toward reducing ageism: PEACE (Positive Education about Aging and Contact Experiences) Model. The Gerontologist. 10 AUG 2016, doi: 10.1093/geront/gnw116

Levy, S.R., & Macdonald, J.L. (2016). Progress on Understanding Ageism. Journal of Social Issues, 72(1), 5-25. doi: 10.1111/josi.12153

United Nations (2014). Retrieved from http://www.un.org/en/globalissues/ageing/

World Health Organization (WHO; September, 2015). Ageing and Health. Retrieved from http://www.who.int/mediacentre/factsheets/fs404/en/

 

Biographies:

 

Sheri R. Levy, PhD, is a Professor in the Department of Psychology at Stony Brook University, USA. She earned her PhD at Columbia University in New York City, USA. Levy studies factors that cause and maintain prejudice, stigmatization, and negative intergroup relations and that can be harnessed to reduce bias, marginalization, and discrimination. Her research focuses on bias based on age, ethnicity, gender, nationality, race, sexual orientation, and social class.  With Jamie L. Macdonald and Todd D. Nelson, Levy co-Edited a special issue of Journal of Social Issues on “Ageism: Health and Employment Contexts” (Levy, Macdonald, & Nelson, 2016). Levy’s research has been funded by the National Science Foundation, and Levy publishes her research in journals such as Basic and Applied Social Psychology, Child Development, Cultural Diversity and Ethnic Minority Psychology, Group Processes and Intergroup Relations, Journal of Personality and Social Psychology, Personality and Social Psychology Bulletin, and Social Issues and Policy Review. Levy was Editor-in-Chief of Journal of Social Issues from 2010-2013 and is a Fellow of the Society for the Psychological Study of Social Issues (Division 9 of American Psychological Association).

 

MaryBeth Apriceno is a graduate student and teaching assistant at Stony Brook University. She received her BA in Forensic Psychology from John Jay College of Criminal Justice. Her research investigates factors that affect ageist attitudes, aging anxiety, and self-stereotyping.

 

Image source: Flickr user tawest64 via Creative Commons

 

 


Filed under: Aging, Health Disparities Tagged: age discrimination, ageism, aging, stereotypes, stereotyping

A Fate Worse than Death? Being Transgender in Long-term Care

Serious transgender couple standing together

 

By Mark Brennan-Ing, PhD (Senior Research Scientist, Brookdale Center for Healthy Aging)

 

“I would kill myself.” This is what a 70 year-old transgender woman told me recently when I asked what she would do if she needed long-term care. While this sounds dramatic, it is a common sentiment among older transgender and gender nonconforming (TGNC) adults (Witten, 2014). Many TGNC older adults do not have family caregivers available to meet their needs for assistance in later life, having been rejected and ostracized by their families of origin according to a study by Grant and colleagues (2011), and long-term care services may be their only option.

 

Plans for concealing gender identities, suicide and euthanasia are one way for older TGNC adults to cope with the fears of entering long-term care (Bockting & Coleman, 2007; Ippolito & Witten, 2014). The National Senior Citizens Law Center (2011) reports that TGNC older adults, regardless of the degree of gender transitioning, are at risk for abuse, mistreatment, or violence in institutionalized settings, especially those needing assistance with activities of daily living such as showering, dressing, and toileting.

 

Accessing medically competent care may also be a problem for older TGNC adults in long-term care. Geriatric care for TGNC older adults requires special considerations. Due to potential drug interactions, contraindications, and polypharmacy, TGNC older adults using hormone therapy concurrent with other medications may require close monitoring (Grant et al., 2011; SAGE & NCTE, 2012; Witten & Eyler, 2015). Sometimes these problems may require stopping hormone therapy, which may be especially traumatic for those who have transitioned later in life and not yet achieved their goals for masculinizing or feminizing their appearance.

 

Since private rooms in long-term care facilities are not covered by insurance, older TGNC adults may be assigned shared rooms based on their birth sex instead of their gender identities, which is problematic for the TGNC person as well as their roommate. The Department of Veterans Affairs (2013) has issued a directive that rooms for TGNC veterans are assigned based upon self-identified gender without regard to physical presentation or surgical history. This policy should be a requirement in all long-term care facilities.

 

The Nursing Home Reform Act and the Fair Housing Act prohibit TGNC discrimination and mistreatment in long-term care. The Affordable Care Act (ACA) also prohibits discrimination on the basis of gender identity by health care organizations (NCTE, 2015), but this legal protection is at risk following the 2016 election with promises by those in power to repeal the ACA. If ACA repeal is successful, older TGNC people will lose safeguards around denial of services, access to facilities like restrooms that conform to their gender identities, isolation, deprivation, and harassment by staff.

 

For long-term care providers, there are a number of resources available for continuing education to better serve their TGNC clients. These include the National Resource Center on LGBT Aging, which offers a variety of in-person and on-line training options (http://www.lgbtagingcenter.org/training/index.cfm). Providers working with veterans can review training and education options in the VA system at http://www.patientcare.va.gov/LGBT/index.asp . And TRANSLINE provides on-line consultation for medical providers (http://project-health.org/transline/ ).

 

Sadly, we may soon witness a rollback of protections for TGNC individuals in long-term care. Therefore it is imperative that the TGNC community and their allies work harder than ever to insure that policies, legislation, and training programs are in place to guarantee that older TGNC people are treated with the dignity and respect they deserve in long-term care and other clinical settings.

 

Portions of this blog were drawn from “Providing competent and affirming services for transgender and gender nonconforming older adults” (Porter, Brennan-Ing et al., 2016), and “Guidelines for psychological practice with transgender and gender nonconforming people (American Psychological Association, 2015).

 

References:

American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864. http://dx.doi.org/10.1037/a0039906 .

Bockting, W. O., & Coleman, E. (2007). Developmental stages of the transgender coming‐out process. In R. Ettner, S. Monstrey, & A. Eyler (Eds.), Principles of transgender medicine and surgery (pp. 185‐208). New York, NY: Haworth.

Department of Veterans Affairs (VA; 2013). Providing health care for transgender and intersex veterans (VHA Directive 2013–003). Retrieved from http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Kiesling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality & National Gay and Lesbian Task Force. Retrieved from http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf

Ippolito, J., & Witten, T. M. (2014). Aging. In L. Erickson-Schroth (Ed.), Trans bodies, trans selves: A resource for the transgender community (pp. 476-497). New York, NY: Oxford University Press.

National Center for Transgender Equality (2015). Know your rights: Healthcare. Retrieved from http://www.transequality.org/know-your-rights/healthcare

National Senior Citizens Law Center (2011). LGBT Older Adults in Long-Term Care Facilities: Stories from the Field.  Washington, DC: National Senior Citizens Law Center.

Porter, K. E., Brennan-Ing, M., Chang, S. C., dickey, l. m., Singh, A. A., Bower, K. L., & Witten, T. M. (2016). Providing competent and affirming services for transgender and gender nonconforming older adults. Clinical Gerontologist. http://dx.doi.org/10.1080/07317115.2016.1203383

Services and Advocacy for GLBT Elders (SAGE) & National Center for Transgender Equality (NCTE; 2012). Improving the lives of transgender older adults. New York, NY: Authors. Retrieved from http://transequality.org/Resources/TransAgingPolicyReportFull.pdf

Witten, T.M. (2014). End of life, chronic illness and trans-identities. J. Social Work in End-of-Life and Palliative Care, 10(1), 1-26. doi:10.1080/15524256.2013.988864

Witten, T.M. & Eyler, A.E. (2015). Care of aging transgender and gender non-conforming patients. In. R. Ettner, S. Monstrey and A.E. Eyler (Eds.), Principles of transgender medicine and surgery. New York, NY: Routledge Press.

 

Biography:

Mark Brennan-Ing, PhD is the Senior Research Scientist, Brookdale Center for Healthy Aging at Hunter College, City University of New York. He was the 2016 Chair of the APA Committee on Sexual Orientation and Gender Diversity.

 


Filed under: Aging, Health Disparities, LGBT Issues Tagged: health disparities, health equity, LGBT, long-term care, older adults, transgender

The Hidden Population of Caregiving Youth in Our Schools

 

blog-young-caregivers

It’s that time of year again – back to school! Follow along with our newest blog series on prepping your young ones for the new school year. Most posts will focus on issues affecting children (K-12) and eventually college-age youth.

By Ann Farone, EdD; Connie Siskowski, RN, PhD; & Carol D. Goodheart, EdD

 

As students around the country are excitedly gathering their backpacks and school supplies in anticipation of the new school year, there is another group of students who are more worried than excited…worried about the family member(s) they are caring for…”What if something happens when I am at school?”  “What if people at school find out what I do…will they take me away from my family?”

 

These are not carefree days for caregiving youth.

 

The National Alliance for Caregiving research (2005) on this population estimated there are over 1.3 million youth, ages 8-18 years, who are sacrificing their education, health, well-being and childhood by providing care for an ill, injured, elderly or disabled family member. It might be a parent, sibling, grandparent or even great-grandparent or other relative in today’s extended families.  Frequently these students are assisting more than one person.  Their responsibilities include administration of medications, transferring, bathing, toileting, cooking, translating at doctor’s visits, and anything else that an adult caregiver might do.

 

Yet, they are still children – developing, maturing and trying to figure out life and their futures.

 

“Why me?” some ask. Most do not identify themselves as “caregivers.”

 

A child’s job is to learn. With the challenges of academic success compounded by adult-sized caregiving tasks, how do these youth manage and cope?

 

They often feel isolated and alone. “Who else does this?” they wonder.  Feelings of anger, sadness, anxiety and depression are typical and normal responses to tough circumstances.

 

What can be done?

 

A Model Program

 

In the U.S. the first comprehensive program to address the challenges faced by these children began in Palm Beach County, FL in 2006. At the time, many were skeptical. However, in partnership with schools, the Caregiving Youth Project (CYP) of the American Association of Caregiving Youth (AACY) began.  Youth caregivers and their families were no longer alone – others understood and would help to support their challenges.

 

School staff began to look at the back stories of children who had frequent absences or acted out in school. They learned that before school one student made sure her mom got off to dialysis safely.  A boy was having trouble staying awake in class. Why? He was up during the night settling down his mentally ill mother.  Furthermore, financially insecure families often do not have computers or internet access for homework help.  If the sole parent is ill, who helps with school projects, buys the supplies or advocates on their child’s behalf?  Lack of participation in school meetings may be misinterpreted as disinterest in the child’s well-being.

 

Interventions – The CYP has developed specific prioritized support services for student-caregivers:

  • They are identified through a screening process in grade six.
  • The CYP professional team provides Skills Building groups from 6th grade through high school.
  • Lunch and Learn sessions educate about illnesses common to care receivers such as heart disease, diabetes, Alzheimer’s and autism.
  • CYP staff participates in School Based Team meetings, working with school counselors to identify student issues and collectively strategize solutions.
  • The home visit results in linkages to resources to strengthen families and reduce stress on youth.
  • Sponsored activities, including an overnight camp, provide caregiving youth time to bond with each other and experience childhood fun.

 

Our Changing Society

Not everyone agrees that a child should be in the role of a family caregiver. However, changes in family composition and healthcare delivery impacts children:

  • There are more single parent as well as multi-generation households.
  • Complex care, formerly delivered in medical facilities, is now done at home.
  • Managed care programs have decreased home care support.
  • More grandparents are raising grandchildren with little consideration for illness or disability affecting that family unit.

 

Particular Risks for Caregiving Youth

We must face the realities of youth caregivers’ lives, recognize their valiant work, and strive to reduce their worries so they can focus on learning.

 

Risk of invisibility – Few people are aware that the numbers of youth caregivers far exceeds those in the foster care system. They face the risks for school drop-out, depression, anxiety, physical injury, trauma, abuse, grief, loss of normal developmental and social activities.

 

Risk of not meeting school expectations – signs of caregiving may include tardiness, absences, incomplete assignments, non-participation in school events, distraction or inability to focus, lethargy, unkempt appearance, and being isolated, anxious or bullied.

 

Risk of school dropout – the Civic Enterprises Silent Epidemic (2006) reported that among young adults who had dropped out of school, 22% said it was to care for a family member.  Others reported dropping out for financial reasons.  Did these young people have to go to work because mom or dad was no longer able to work?

 

Risk of exposure – Families may fear that if others knew their child was providing significant care, the child would be removed from the home. They do not know about possible resources to support their family.

 

Risk of role “blindness” – Parents may not be aware of the anxiety that family illness creates. The child, realizing how overwhelmed the family already is, may not share his/her own feelings or concerns.  Also, when an adult in the home is employed, the adult may not fully appreciate all the caregiving the child is doing when the parent is not home.  “But, I’m the caregiver” a parent said until asked if her son gave medications or assisted with feedings; then the mom realized that he too was providing care.

 

All caregivers within a family deserve recognition and support!

 

Educators, counselors, school nurses, psychologists and others can help by identifying and then supporting a caregiving student.

 

Resources

 

American Psychological Association, Connecting with Caregivers:  http://www.apa.org/pi/about/publications/caregivers/consumers/index.aspx

American Association of Caregiving Youth: www.aacy.org or call 800-508-9618 or 561-391-7401 for direct assistance. The AACY website has suggestions and links that can help families, professionals and school-based staff to assist these vulnerable students.

View short videos of real caregiving youth as broadcast on national TV via the home page of www.aacy.org

 

Help caregiving youth to gain recognition and support by sharing this blog post.

 

Biographies:

 

Ann Farone, EdD, is the Director of Education Services at the American Association of Caregiving Youth (AACY). With over four decades of experience in the field of education, Dr. Farone began her career as a teacher in NYC. She has also been the Program Director for the NYS Department of Education, Assistant Dean of the Graduate School of Education & Human Services at St. John’s University, and as a Principal in NY & FL.

Connie Siskowski, RN, PhD, is founder of the American Association of Caregiving Youth (AACY). She was named as a Purpose Prize winner in 2009 and a top 10 CNN Hero in 2012. She went to nursing school at Johns Hopkins University and holds a PhD in Public Administration from Lynn University. She founded AACY in 2006.

Carole Goodheart, EdD, earned her doctorate in Counseling Psychology at Rutgers University and is a licensed psychologist practicing in Princeton, New Jersey. She was the 2010 President of the American Psychological Association. She is also a Fellow of the American Psychological Association, a Distinguished Practitioner in the National Academy of Psychology, a Registrant in the National Register of Health Service Providers in Psychology, and the recipient of national and state Psychologist of the Year Awards from Psychologists in Independent Practice and from the New Jersey Psychological Association, as well as the recipient of the Gold Medal Award for Life Achievement in the Practice of Psychology.

 

Image source: iStockPhoto.com

 


Filed under: Aging, Children and Youth Tagged: academic problems, caregiving, caregiving youth, Education, school absences, stress

Accepting Help is Hard: Here’s Why There’s No Shame in Getting a Personal Care Assistant

Senior African American patient with female nurse

By Patricia Parmelee, PhD (Alabama Research Institute on Aging, The University of Alabama) & Alette Coble-Temple, PsyD (John F. Kennedy University)

 

Our society places the highest value on independence; doing things by ourselves for ourselves.  Because of this, we rarely think about what it would be like to need someone else’s assistance with even the most basic activities: getting dressed, brushing teeth, eating, driving, or filling out paperwork.  Thus, when individuals are faced with changes in their physical abilities, the adjustment to using personal care assistance can be challenging.

 

Adjusting to a disability or physical limitation is a complex process. Practitioners traditionally focus treatment on regaining physical functioning, rather than on how to successfully navigate receiving assistance and learning how to hire, train, supervise, and retain personal assistants. Additionally, most of the literature on professional caregiving focuses on the care providers. We want to spend some time addressing the other side. What is it like to be the recipient of personal care? And what can we do to make the process easier, less frustrating, and more efficient?

 

One of the most complicated aspects of being a personal care recipient is identifying what type of help you need and how you want that help to be delivered. People don’t think much about how personal care tasks are completed.  For example, everybody does not brush his or her teeth in the same way. Some people like heavy brushing, some people like light brushing; some like to start on the upper teeth, while others prefer the bottom.

 

Now you may be asking, “What is the big deal?” The big deal comes when a person who needs assistance simply states, “I need help brushing my teeth.” This can cause problems, because the person helping complete the task will naturally do it “their” way rather than asking how the care recipient would like the task to be completed. For the person receiving help, this may lead to frustration, resentment, and anger.

 

People receiving personal care assistance often feel they don’t have the right to request that a task be completed in a certain way. These individuals are often conditioned to be grateful for receiving help, period, rather than taught how to be a savvy consumer of assistance.  When individuals express their desire for care to be delivered in specific ways, they may be labeled by service providers as “difficult,”  “challenging,” or “resistant.”  Clinicians assisting people in navigating personal assistant services should emphasize identifying not just one’s needs, but also the way in which one wants the task to be completed. Utilizing personal care assessment screening tools is a useful strategy (See PCA screening assessment).

 

Once an individual has identified their specific needs and preferences, the next step is to develop a hiring process. Here, it is critical to determine what qualities and personality characteristics the care recipient values, to help in screening for the best fit. This is essential due to the personal nature of the position. Being a personal assistant requires intimate interactions within the care recipient’s personal space. Personality strongly affects the working relationship between recipient and care provider; being able to assess this dynamic early on can predict success in retention of personal assistance. Some individuals want a personal assistant who will dote on them, while other individuals find this style offensive and demeaning. Healthcare professionals can play an instrumental role in determining which characteristics are most valued for the recipients of personal care services.

 

For many reasons, personal care assistance has traditionally not been viewed as a professional role. First and foremost is the low pay. According to the National Bureau of Labor Statistics, the average hourly rate for personal care aides is $10.92: less than $23,000 annually. In many areas, this is not a living wage. Thus, it can be very difficult to attract competent, motivated employees. In-home support services are complicated systems to navigate for both recipient and employee. As a result, there is a real dearth in qualified applicants.

 

Even when one is successful at identifying and hiring personal assistants, the next challenge is retention of these qualified individuals. This is where healthcare professionals can play a beneficial role, by helping care recipients to develop structured evaluation methods, as well as processes to facilitate growth and development for the personal assistants. Structured evaluation rubrics can be useful tools in creating and maintaining a professional relationship based on transparent communication and clear expectations.

 

In sum, persons with disabilities face numerous challenges in finding, training, and retaining personal care assistants who can help them with daily needs. It’s important to understand that how care is provided is just as important as the care itself, and that the care provider–recipient relationship is a crucial one. Empowering persons with disabilities to treat the personal care relationship as a “real job” can help ensure satisfaction for both parties.

 

Biographies:

 

Patricia A. Parmelee, PhD, is Director of the Alabama Research Institute on Aging and Professor of Psychology at the University of Alabama. A social psychologist by training, she has been active in research and services for the elderly for more than 30 years, and is nationally known for her work on quality of life and quality of care for chronically ill older persons. Prior to joining the UA faculty in 2008, Dr. Parmelee held positions at the Emory University School of Medicine, the Atlanta Veterans Affairs Medical Center, and the Birmingham/Atlanta Geriatric Research, Education and Clinical Center. She previously served as Vice President for Outcomes Management at Genesis Health Ventures, a Pennsylvania-based provider of long-term care; as Associate Director of Research and Senior Research Psychologist at the Philadelphia Geriatric Center, and as Associate Professor of Clinical Epidemiology at the University of Pennsylvania School of Medicine. She is an elected Fellow of both the American Psychological Association and the Gerontological Society of America.

Alette Coble-Temple, PsyD, is a professor of clinical psychology at John F. Kennedy University. She is a noteworthy member of the disabled community as a fierce advocate for equal rights for individuals with disabilities. In addition, she is also a leader among women in the field of psychology. She currently sits as both a member of the American Psychological Association Committee on Women in Psychology, and as a member of the APA’s Leadership institute for Women in Psychology. She lives with cerebral palsy and much of her work has focused on disability rights. In 2015, she won the Ms. Wheelchair California pageant.

 

Image source: iStockPhoto.com


Filed under: Aging, Disability Issues, Health and Wellness Tagged: aging, caregiving, disability, healthy aging, personal aide, personal care, personal care assistance, support services

How Do We Blunt the Impact of Ageist Stereotypes?

Senior woman make-up face on white background

By Jeff McCarthy, MA (University of Windsor) & Anne Baird, PhD (University of Windsor)

In Western societies, negative stereotypes about being an older person predominate. However, these patterns vary across groups and across times. Typically, researchers study ways to diminish the negative impact of stereotypes on two groups:

  • younger adults, to whom these negative stereotypes are not applied by others or themselves4
  • older adults, to whom these negative stereotypes likely are applied both by others and themselves.

Reducing the impact of these stereotypes on older people themselves has been the subject of some interesting recent studies.

 

When we look at the way older people are shown in and participate in traditional and social media, we see both progress and continued shortcomings. On the one hand, a study of Super Bowl commercials from 2010 to 2014 suggested more appearances of older characters than in earlier traditional media1. Moreover, the portrayal of these characters overall was more positive than in the past.

 

On the other hand, the use of social media by older people and the description of them in these media are far from optimal. Social media are potential avenues for older people to address ageism directly and advocate for themselves, but inaccessibility of design, failure to appreciate the value of social media, and worries about privacy keep some older people from pursuing these avenues9.

 

A review of over 80 public Facebook groups related to aging uncovered overwhelmingly unfavorable comments about older people in all but one5. In addition to the lack of participation by older people, Levy and colleagues5 give several reasons for this harsh negative bias. These reasons include:

  • the fact that creators of these sites were younger rather than older people
  • the known tendency for stereotypes of all kinds to become more negative as an individual’s contact with social media increases5.

The lack of participation by older people and the prominence of negative aging stereotypes on social media work to accentuate unfavorable views about aging9.

 

So, how do we deal with this?

 

Most people would be tempted to shine a light on these negative stereotypes. By bringing them to attention, we can reduce them, right? Unfortunately, it doesn’t seem to be that easy. Ironically, while some interventions with explicit focus on the stereotypes may help (e.g., imagined intergroup contact10), there is growing evidence that this approach can backfire.

 

Many education-based interventions that provide information regarding stereotypes essentially suggest suppressing thoughts about negative stereotypes, which usually doesn’t work. For example, try not to think about a pink elephant — what are you thinking about now? Further, teaching groups about stereotype threat may serve to activate these same threats later7. Even explicit focus on positive age-related stereotypes can end up reinforcing antiquated beliefs — both negative and positive3.

 

Research has shown that as we get older, we increasingly perceive ourselves to feel younger than our chronological age11. These perceptions may shield us from negative stereotypes. In fact, some older people do not identify themselves as a member of their chronological age group; a term called “age-group dissociation.”

 

Age-group dissociation may:

  • protect older people from applying negative age stereotypes to themselves,
  • reinforce their feelings of being more youthful than their chronological age, and
  • expand their sense of future time left11.

 

However, there also may be unfavorable effects of age-group dissociation. Older people who do not view themselves as such may not complete important tasks, such as writing advanced directives11. In other words, age-group dissociation probably is not an entirely satisfactory response to negative stereotypes about getting older.

 

On a more positive note, recent research suggests that self-compassion may be key to developing more balanced beliefs about one’s status as an older person2,8. Using self-compassion to blunt the effect of negative aging stereotypes in older people is a relatively new strategy, although self-compassion and the related constructs of self-acceptance and self-love are not new6. Self-compassion can be defined as unconditional care towards oneself when one is going through difficult times8.

 

Phillips and Ferguson8 found that higher self-compassion was linked with more positive affect and a greater sense of personal wholeness and meaning in older people. Similarly, greater self-compassion in middle-aged women was associated with more positive attitudes towards aging2. Helping older people nurture self-compassion may be a better way to reduce the influence of negative aging beliefs on older people than a direct attack on those stereotypes.

 

References:

1Brooks, M., Bichard, S., & Craig, C. (2016). What’s the score?: A content analysis of mature adults in Super Bowl commercials. Howard Journal of Communications27(4), 347-366. http://dx.doi.org/10.1080/10646175.2016.1206046

2Brown, L., Bryant, C., Brown, V., Bei, B., & Judd, F. (2015). Self-compassion, attitudes to ageing and indicators of health and well-being among midlife women. Aging & Mental Health20(10), 1035-1043. http://dx.doi.org/10.1080/13607863.2015.1060946

3Kay, A., Day, M., Zanna, M., & Nussbaum, A. (2013). The insidious (and ironic) effects of positive stereotypes. Journal Of Experimental Social Psychology49(2), 287-291. http://dx.doi.org/10.1016/j.jesp.2012.11.003

4Kotter-Grühn, D. (2015). changing negative views of aging: implications for intervention and translational research. Annual Review Of Gerontology And Geriatrics35(1), 167-186. http://dx.doi.org/10.1891/0198-8794.35.167

5Levy, B., Chung, P., Bedford, T., & Navrazhina, K. (2014). Facebook as a site for negative age stereotypes. The Gerontologist54(2), 172-176. http://dx.doi.org/10.1093/geront/gns194

6Muris, P., & Petrocchi, N. (2016). Protection or vulnerability? A meta-analysis of the relations between the positive and negative components of self-compassion and psychopathology. Clinical Psychology & Psychotherapy. http://dx.doi.org/10.1002/cpp.2005

7Nelson, T. (2015). Handbook of prejudice, stereotyping, and discrimination (2nd ed.). New York: Psychology Press, Taylor & Francis Group.

8Phillips, W., & Ferguson, S. (2012). Self-compassion: a resource for positive aging. The Journals Of Gerontology Series B: Psychological Sciences And Social Sciences68(4), 529-539. http://dx.doi.org/10.1093/geronb/gbs091

9Trentham, B., Sokoloff, S., Tsang, A., & Neysmith, S. (2015). Social media and senior citizen advocacy: an inclusive tool to resist ageism? Politics, Groups, And Identities3(3), 558-571. http://dx.doi.org/10.1080/21565503.2015.1050411

10Turner, R., Crisp, R., & Lambert, E. (2007). Imagining intergroup contact can improve intergroup attitudes. Group Processes & Intergroup Relations10(4), 427-441. http://dx.doi.org/10.1177/1368430207081533

11Weiss, D., & Lang, F. (2012). “They” are old but “I” feel younger: Age-group dissociation as a self-protective strategy in old age. Psychology and Aging27(1), 153-163. http://dx.doi.org/10.1037/a0024887

 

Biographies:

 

Jeff McCarthy is a PhD candidate in the Clinical Neuropsychology program at the University of Windsor in Ontario. His clinical and research interests involve incorporating technology, therapeutic assessment, and a focus on everyday functioning into neuropsychological rehabilitation and management of neuropsychology disorders. He also has an explicit focus on prospective memory and its function in both healthy adults and in those with acquired brain injury and memory impairment.

 

Dr. Anne Baird is an Associate Professor on the Clinical Neuropsychology track in the Psychology Department at the University of Windsor in Ontario. She has a long-standing research and clinical interest in understanding and supporting everyday function and problem-solving in normal and cognitively-impaired older people.

 

Image source: iStockPhoto


Filed under: Aging Tagged: ageism, aging, healthy aging, self-acceptance, self-compassion, stereotype threat, stereotypes, stereotyping