Tag Archives: Aging

A Good Death is an Important Part of a Good Life

assisted-dying2

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

Kickstart a Lifelong Healthy Habit this Summer! 4 Reasons Gardening Benefits Your Health as You Age

Group of people planting vegetable in greenhouse

By Layla Dang, Brianna Wenande, Bethany Westphal, and Jessica R. Petok (Department of Psychology, Saint Olaf College, Northfield, MN)

 

Gardening is a popular summer activity for a reason! Research shows that it can have positive effects on our physical, mental, and social well-being as we age. Gardening can range from caring for a single plant to mowing the lawn or planting an entire vegetable garden. Don’t be intimidated. Given the versatility of gardening options, anyone can do it. It’s not too late to dig into gardening this summer! Here are four reasons to kickstart this healthy habit:

 

1. Gardening is great for your physical health:

Gardening is an enjoyable way to keep active and physically healthy1,2. Gardeners report increased levels of physical activity through planting seeds, positioning plants, watering, or simply walking through the garden2. Such physical activity has the following benefits3:

 

  • Increased hand and body strength
  • Improved flexibility
  • Reduced bodily pain

 

Regular gardening can also reduce your risk of4:

  • Some cancers
  • Type 2 diabetes
  • Heart disease
  • Osteoporosis

 

Beyond exercise-driven benefits, gardening can also improve nutrition, as well as sleeping and eating patterns. Planting a kitchen garden has nutritional benefits because it can encourage you to eat fruits and vegetables1. Spending time in an outdoor garden can help regulate your sleeping and eating patterns because sunlight controls your circadian rhythms4.

 

2. Gardening also benefits your mental and emotional wellbeing:

Gardening can keep you mentally active and alert, providing opportunities to cultivate new knowledge4. In addition to learning about new plants and gardening techniques, many gardeners enjoy the creativity of planning their gardens, which can include choosing what to plant or designing their garden’s layout4. Additionally, research shows that gardening and spending time in nature can even improve one’s attention span through exposure to a variety of sensory stimuli 5.

 

Among its emotional benefits, gardening can reduce depression and stress, and gardeners report feelings of anticipation, hope, and achievement4,5. If you are older, gardening can provide you with an opportunity to nurture and care for plants, giving you a sense of purpose and improving your self-esteem through a meaningful activity4. Many gardeners report simply gardening “for the love of it,” being attached to their gardens and finding them aesthetically pleasing4.

 

 

3. Gardening is an excellent way to improve your social life:

Gardening is a good strategy for expanding your social circle6. For instance, Participants in an organized horticultural program enjoyed sharing their gardening experiences and personal knowledge with others; it helped them form supportive relationships and become more socially active6. Additionally, gardeners have the opportunity to connect with others who share their passion through community gardens, gardening clubs, or social media groups4.

 

In addition to promoting social interaction and meaningful conversation with others, gardening can also increase your sense of companionship and combat loneliness. Many gardeners even form special bonds with their plants. For example, one participant in a gardening study reflected, “I say hello and talk to my plants everyday . . . It seems that the little plants can understand what I say to them . . . They respond to my encouragement and make me feel that I am not alone”6.

 

4. You can adapt your gardening habits as you age:

It is important to create optimistic goals as you age, and in order to promote optimum physical and emotional health, you should choose a gardening activity appropriate for your physical capabilities. You can continue your passion for gardening as you age, because luckily, gardening is easily adapted to meet changing needs. You can vary the duration and intensity of your gardening activities; ergonomic tools and low-maintenance plants such as succulents help make gardening more comfortable and achievable. Even just being in nature is cognitively and emotionally beneficial for you7,8.

 

Overall, gardening is a fulfilling, holistic way to improve your well-being as you get older. Even if you’ve never tended to plants before, gardening is within reach at any age. So, pot a plant today, and maybe it will blossom into a lifelong passion for gardening you never thought you had!

 

If you’re a gardener:

  • What is your favorite thing about gardening?
  • What do you like to grow in your garden?
  • Do you have any tips and tricks for new gardeners?

 

Let us know in the comments below! If you would like to learn more about the benefits of gardening, this information may be of interest to you:

 

1Wang, D., & MacMillan, T. (2013). The benefits of gardening for older adults: A systematic review of the literature. Activities, Adaptation & Aging, 37, 153-181. doi: http://dx.doi.org/10.1080/01924788.2013.784942

2Tse, M. M. Y. (2010). Therapeutic effects of an indoor gardening programme for older people living in nursing homes. Journal of Clinical Nursing, 19, 949-958. doi: http://dx.doi.org/10.1111/j.1365-2702.2009.02803.x

3Park, S., & Shoemaker, C. A. (2009). Observing body position of older adults while gardening for health benefits and risks. Activities, Adaptation & Aging, 33, 31-38. doi: http://dx.doi.org/10.1080/01924780902718582

4Scott, T. L., Masser, B. M., & Pachana, N. A. (2015). Exploring the health and wellbeing benefits of gardening for older adults. Ageing and Society, 35, 2176-2200. doi: http://dx.doi.org/10.1017/S0144686X14000865

5Detweiler, M. B., Sharma, T., Detweiler, J. G., Murphy, P. F., Lane, S., Carman, J., . . . Kim, K. Y. (2012). What is the evidence to support the use of therapeutic gardens for the elderly? Psychiatry Investigation, 9, 100-110. doi: http://dx.doi.org/10.4306/pi.2012.9.2.100

6Chen, Y. & Ji, J. (2014). Effects of horticultural therapy on psychosocial health in older nursing home residents: A preliminary study. The Journal of Nursing Research : JNR., 23, 167-171. doi: http://dx.doi.org/10.1097/jnr.0000000000000063

7Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224, 420-421. doi: http://dx.doi.org/10.1126/science.6143402

8Berman, M. G., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with nature. Psychological Science, 19, 1207-1212. doi: http://dx.doi.org/10.1111/j.1467-9280.2008.02225.x

 

Biographies:

 

Layla Dang is a senior at St. Olaf College, pursuing a bachelor’s degree in Psychology with concentrations in Management Studies and Women’s and Gender Studies. She is currently doing research focused on healthy age-related changes in various types of learning and memory, in the Petok Aging Lab. In the future, she hopes to pursue graduate studies in industrial/organizational psychology.

Brianna Wenande is a senior undergraduate student at St. Olaf College, pursuing a bachelor’s degree in Psychology, Neuroscience, and Statistics. She is currently doing research in the Petok Aging Lab on how healthy aging and genetics influence learning and memory, and in the future, she hopes to pursue a career in child clinical psychology or pediatrics.

Beth Westphal is a junior at St. Olaf College, and she is studying Chemistry and Neuroscience. She is currently researching healthy aging, learning, and genetics alongside Brianna and Layla. Although undecided about her future career goals, she plans to spend time this summer working in her mother’s garden.

Jessica Petok, PhD, is an Assistant Professor at St. Olaf College. Her research is aimed at understanding the cognitive and neural mechanisms of learning, memory and decision-making in healthy adults of all ages. Her current work examines how genetic polymorphisms contribute to variability in learning and memory across the adult lifespan. She received her BA in Psychology from Skidmore College and her PhD in Lifespan Cognitive Neuroscience from Georgetown University.

 

Image source: iStockPhoto.com

 

 


Filed under: Aging, Health and Wellness Tagged: emotional health, gardening, healthy aging, mental health, physical activity, physical health

We Lose Too Many Vietnam Veterans to Suicide: Here’s How You Can Help

 

blog-vietnam-vets-day2

By Megan Lacy (Doctoral Student, Palo Alto University)

 

As our Vietnam veteran population ages, many may become increasingly vulnerable for death by suicide. Despite the fact that the Vietnam war occurred approximately 40 years ago, the moral injuries sustained are still felt by many who served our country. It is not unusual for Vietnam Veterans to have coped with difficult times by staying busy at home or at work. As retirement looms, it is not unusual for Vietnam era veterans to experience additional age-related risks such as social isolation, a feeling of burdensomeness, and changes in health status.

These changes can coalesce to hamper coping strategies that previously worked to manage mental distress, such as depression and posttraumatic stress disorder. Alcohol and substance use increases the risk of suicide as the abuse of substances, particularly alcohol, is strongly associated with both suicide attempts and deaths. So what should friends and family watch out for and what could be done in response to warning signs?

 

Warning signs:

In general, individuals most at risk of suicide are white older adult males who have health issues. As risk factors associated with veteran status converge on risk factors associated with later life , there are a few specific things friends and family should be aware of.

 

What’s going on in their life?

  • A major change in routine including retirement or loss of a job
  • The death of a spouse
  • A new medical diagnosis
  • A break up, separation or divorce
  • Not having a stable place to live
  • Inadequate family income

 

How are they behaving?

  • Increase in drinking or drug use
  • Sleeping considerably more or less
  • A loss of interest in things they typically enjoy
  • Social withdrawal
  • Impulsivity – engaging in risky behavior (running red lights, driving recklessly, looking like they have a “death wish”)
  • Becoming aggressive- examples of this are punching holes in walls, seeking revenge, getting into fights
  • Anxiety- worrying excessively about things they cannot control
  • Agitation and mood swings
  • Putting affairs in order such as giving away prized possessions or making out a will
  • Seeking out firearms access to pills
  • Neglecting personal welfare including deteriorating physical appearance or hygiene

 

What are they saying?

  • A sense of hopelessness:
    • “I have no purpose”
    • “I have no value”
    • “Nothing is ever going to get better”
  • Rage or anger: expressed toward people or things
  • Expressed feelings of excessive guilt, shame or failure:
    • My family would be better off without me”
  • Feelings of desperation:
    • “There is no solution”
    • “I just feel trapped”

 

What do they have access to?

Familiarity and access to a firearm makes suicide by firearm more likely. Any means by which a suicide can be attempted, including pills, is something that should be asked about. Veterans are more likely to own a gun and be comfortable using one making death by firearm a common means of suicide among this population.

 

How can you help?

Social support is one of the most effective protective factors against suicide (Cummings et al., 2015). However,  many veterans have isolated themselves and their friends and family struggle to talk to them. Inviting them to an event, writing them a letter or participating in a shared activity (building something, fishing, walking, etc.) are great ways to get things started.

Talk about it. Suicide is an uncomfortable topic but its best to be direct. Ask overtly if they are planning on killing themselves or have had thoughts about killing themselves. Just because they say no doesn’t mean that they don’t still have suicidal intentions so be sure to have additional information to provide such as a suicide hotline number for veterans, apps they could utilize (PTSD Coach), or a therapist’s contact information.

If your loved one has a plan or tell you they are going to kill themselves, call 911. Its better to put their safety first. Demonstrating your support by seeking additional help is always best. If you can, include them in the process of seeking immediate help. Calling 911 or visiting the ER does not have to be a one-sided decision.

These by no means are the only risk factors, signs or solutions for suicidality. However, engagement with friends and family has shown to be extremely effective against suicide. Demonstrating your support with regular calls or visits is an important step toward safety for many veterans.

 

Related Resources:

APA Psychology Topic: Suicide

Resources for Caregivers of Service Members and Veterans

When Will We Face the Facts about Suicide in Older Men?

 

References:

 

Chronic PTSD in Vietnam combat veterans: Course of illness and substance abuse (1996). American Journal of Psychiatry, 153(3), 369–375. doi:10.1176/ajp.153.3.369

Conner, K. R., Britton, P. C., Sworts, L. M., & Joiner, T. E. (2007). Suicide attempts among individuals with opiate dependence: The critical role of belonging. Addictive Behaviors, 32(7), 1395–1404. doi:10.1016/j.addbeh.2006.09.012

Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. The Psychiatric Clinics of North America , 34(2), . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107573/

Cummins, N., Scherer, S., Krajewski, J., Schnieder, S., Epps, J., & Quatieri, T. F. (2015). A review of depression and suicide risk assessment using speech analysis. Speech Communication, 71, 10–49. doi:10.1016/j.specom.2015.03.004

Identifying signs of crisis. Retrieved February 26, 2017, from https://www.veteranscrisisline.net/SignsOfCrisis/Identifying.aspx

Lambert, M. T., & Fowler, R. D. (1997). Suicide risk factors among veterans: Risk management in the changing culture of the department of veterans affairs. The Journal of Mental Health Administration, 24(3), 350–358. doi:10.1007/bf02832668

Lester, D. (2003). Unemployment and suicidal behaviour. Journal of Epidemiology & Community Health, 57(8), 558–559. doi:10.1136/jech.57.8.558

Military Suicide Research Consortium (MSRC) Newsroom. (2017, January 28). Retrieved February 26, 2017, from https://msrc.fsu.edu/news/study-reveals-top-reason-behind-soldiers-suicides

Nademin, E., Jobes, D. A., Pflanz, S. E., Jacoby, A. M., Ghahramanlou-Holloway, M., Campise, R., Johnson, L. (2008). An investigation of interpersonal-psychological variables in air force suicides: A controlled-comparison study. Archives of Suicide Research, 12(4), 309–326. doi:10.1080/13811110802324847

Price, J. L. (2016, February 23). Findings from the national Vietnam veterans’ readjustment study. Retrieved February 26, 2017, from http://www.ptsd.va.gov/professional/research-bio/research/vietnam-vets-study.asp

United States Department of Veterans Affairs. (July, 2016) VA Suicide Prevention Program: Facts about Veteran Suicide. Retrieved from https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf

Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83. doi:10.1037/0022-006x.76.1.72

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, E. (2010). The interpersonal theory of suicide. Psychological review117(2), 575.

Warning signs of crisis. Retrieved February 26, 2017, from https://www.veteranscrisisline.net/SignsOfCrisis/

 

Image source: Flickr user Elvert Barnes via Creative Commons


Filed under: Aging, Violence Tagged: depression, post-traumatic stress disorder, substance abuse, suicide, suicide prevention, trauma, veterans, vietnam veterans

Elder Financial Abuse is Here to Stay and It’s Time We Do Something About It

blog-elder-financial-abuse

By Osnat Lupesko-Persky (Doctoral Student, Palo Alto University) and Lisa M. Brown, PhD (Professor, Palo Alto University)

 

On February 13, 2015, the Elder Justice Reauthorization Act (H.R. 988) was introduced in the House of Representatives. The bill addresses the growing problem of elder financial abuse and emphasizes the role the federal government should take in coordinating and leading state support efforts. It provides a legal framework for necessary cooperation between federal and state agencies that handle health, legal and social services.

 

Sadly, since April 2015, the bill has been buried deep in the Subcommittee on Higher Education and Workforce Training with no signs of progress in its legislation. In this blog post, we describe the reasons why we believe the Reauthorization Act would benefit millions of older adults and their families.

 

Financial abuse of older adults has been described as “the crime of the 21st century.” While some readers may consider such statements as hyperbole, the facts speak for themselves.

 

  • According to a 2011 MetLife Study “elder financial abuse is estimated to be at least $2.9 billion dollars, a 12% increase from the $2.6 billion estimated in 2008.”
  • More recent research from 2015 by True Link, a California-based financial services firm specializing in retirees, argues that MetLife’s financial estimates are significantly underestimated. According to the True Link report, annual losses due to older adult financial fraud reach $36.48 billion and have been identified as a rapidly growing epidemic.

 

It is of little surprise, therefore, that older adult financial abuse is an area of societal concern for policy makers, law enforcement, clinicians, and researchers.

 

What sets elder financial abuse apart from other types of financial fraud?

 

One significant reason that it is in a league of its own is that older adults are highly vulnerable relative to their younger counterparts. For example, those with diminished physical or mental capacity coupled with declined independence are at greatest risk for financial exploitation by:

 

  1. relatives, friends or caregivers,
  2. business fraud, such as nursing homes, attorneys, insurance or banking,
  3. fraud by strangers, through communication mediums (internet, phone, mail), and
  4. Medicare and Medicaid fraud.

 

What makes elder financial abuse so prevalent, persistent and ‘contagious’? Why is elders’ financial fraud ‘here to stay’ and even likely to increase?

 

There are several reasons supporting our conclusion:

 

  1. Baby-boomers, recently crossing the ‘senior’ threshold, are considered both money-makers and money spenders: According to a Nielsen report from 2012 “Boomers make the most money and they spend what they make”. Indeed, according to the National Committee for the Prevention of Elder Abuse, persons over 50 control over 70% of the nation’s wealth, and it is expected to increase.
  2. Improved longevity means an increased percentage of older adults with significant financial power: The Nielsen report predicted that by 2017, 50% of U.S. adult population will be aged 50 and older and they will control 70% of the country’s disposable income. Also, by 2050, there will be 161 million adults aged 50 and older, a 63% increase from 2010.
  3. Baby-boomers are a significant consumer force: Boomers account for nearly $230 billion in spending on consumer packaged goods and possess a whopping buying force of almost 50% of total sales. Such strong spending by an aging group of the population is bound to attract fraud attempts.
  4. Baby-boomers are technology-savvy: they account for 40% of wireless customers, and 41% of apple computers clients. In addition, they spend on average 22-25 hours monthly using the internet on a computer, which is 2 hours more than the monthly average of 14-25 years old. As financial fraud through the Internet increases, so will fraud attempts against older adults making purchases online.

 

How does financial abuse impact older adults?

 

Studies suggest that financial abuse frequently results in reduced emotional and physical health, in addition to financial damage. The True Link report estimated that almost 950,000 elderly victims are skipping meals as a result of financial abuse. Naturally, when a subset of the population is already more vulnerable physically and emotionally, the impact of a crime would be even more severe.

 

What is the right approach to address elder financial abuse – prevention or support and assistance after-the-fact?

 

In the past two decades, researchers and government policy-makers focused mainly on creating methods that law enforcement and other organizations could use to identify fraud attempts in order to preempt them. Far less academic research has focused on the types of support – legal, social, mental health or other – required after the damage was done. As a result, there are no viable policies that address mechanisms of support for older adult victims of financial abuse, and there are no significant mechanisms of coordination and cooperation between the different agencies (e.g., legal, social, health, etc.).

 

Since we now know that elder financial abuse is a growing problem, it is of paramount importance to expedite this legislation in order to:

  • accelerate collaboration between relevant agencies and
  • develop programs that provide better and more comprehensive care for older adults who are victims of financial abuse.

 

References:

 

DaDalt, O. (2016). Older adults and fraud: Suggestions for policy and practice. Journal of Economic & Financial Studies4(03), 38-44.

 

H.R. 988 Elder Justice Reauthorization Act. Retrieved from: https://www.congress.gov/bill/114th-congress/house-bill/988

 

MetLife (2011).The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders. Retrieved from: https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf

 

Nielsen and Boomagers, LLC. (2012). Introducing Boomers – Marketing’s most valuable generation. Retrieved from: http://www.nielsen.com/content/dam/corporate/us/en/reports-downloads/2012-Reports/nielsen-boomers-report-082912.pdf

 

True Link. (2015). The True Link report on elder financial abuse. Retrieved from: https://truelink-wordpress-assets.s3.amazonaws.com/wp-content/uploads/True-Link-Report-On-Elder-Financial-Abuse-012815.pdf

 

U.S. Government Accountability Office. (2011). Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse. Retrieved from: http://www.gao.gov/assets/320/316224.pdf

 

Biographies:

 

Osnat Lupesko-Persky is a second year PhD student in Clinical Psychology at Palo Alto University and focuses on various areas of intersection between psychology and the law. Prior to her studies, Osnat worked as a criminal defense attorney at the law firm of Brafman & Associates in New York City. Osnat holds a Master’s degree in International Law and Diplomacy from the Fletcher School, Tufts University.

Lisa M. Brown, PhD, ABPP is a professor of psychology and director of the Trauma Program at Palo Alto University. She is licensed in Florida and California and is board certified through The American Board of Professional Psychology (ABPP) in Geropsychology. Dr. Brown’s clinical and research focus is on trauma and resilience, aging, health, vulnerable populations, disasters, and long-term care. Her research has been funded by the National Institute of Aging, the Centers for Disease Control and Prevention, Department of Veterans Affairs Health Services Research and Development Service, and the Agency for Healthcare Administration.

 

Image source: Shutterstock


Filed under: Aging, Human Rights and Social Justice Tagged: aging, elder abuse, elder financial abuse, financial abuse, older adults

5 Ways to Become Better Involved In Medical Decisions as You Age

senior asian woman talking to family doctor

By Rebecca Delaney, MS (Doctoral Student in Development Psychology, West Virginia University)

 

Throughout our lives we face a range of medical decisions that can affect ourselves and others. Should I undergo a medical or surgical procedure? Should I encourage a loved one to get a medical screening or diagnostic test? What medication would be best to take when managing a chronic illness?

How people approach such medical decisions differs. Often, the responsibility for the medical decision is placed on the physician given their medical expertise. However, some patients prefer to be more involved in the decision process (Brom et al., 2014).

Facilitating physician and patient engagement in a shared, or collaborative, decision-making process is gaining more attention within healthcare. Using shared decision-making strategies gives physicians more opportunity to provide patients with the necessary medical information to make informed choices.

Patients can also discuss their own opinions and preferences to ensure that their medical choices align with their values. Through this approach, patients can better understand the potential harms and benefits of medical options and feel informed about their decisions (O’Connor et al., 2003).

 

Here are 5 ways to become better involved in the medical decision-making process:

 

1. Ask questions!

  • If you have difficulty understanding the medical information provided to you, be sure to ask your medical provider additional questions to gain clarity.
  • Ask specific questions about the benefits and harms regarding your healthcare options (e.g., types of treatment, medication).

 

2. Seek advice from others

  • Seeking advice and help from others can be beneficial for your long-term health (Delaney, Strough, & Turiano, 2016).
  • Speaking to others who have the same chronic illness or have gone through a surgical procedure you are considering, for example, can help you evaluate the pros and cons to medical choices you need to make.

 

3. Be vocal about your preferences and experiences

  • Make sure your medical preferences and values are known to the physician.
  • Provide your physician with as much information as possible about your pain, feelings, and context of everyday life. This can lead to different medical choices based on your answers.

 

4. Ask for decision aids

  • An increasing number of decision aids are being developed to help patients learn more about their health condition. Decision aids are used to facilitate conversations with their physician to decide which health care choice best fits the patients’ values and preferences.
  • These have been shown to improve quality of health care, increase patient knowledge of benefits and harms of health care choices, and increase patient satisfaction (Shafir & Rosenthal, 2012).

 

5. Create a medical support network

  • You can make your medical preferences clear to those close to you and have them be there to support you in your health care choices.
  • This can be informal, such as bringing someone with you to be a second ear in case you missed what the physician said. Or more formal, such as having your caregiver or an assigned health care proxy involved with your medical decisions.

 

 

For more on this topic, check out this resource from the National Institute on Aging:

 

Biography:

Rebecca Delaney is in the life-span developmental psychology doctoral program at West Virginia University, with plans to graduate in May of 2017. Rebecca plans to continue with research and work with older adults in the community postgraduation. Her research seeks to identify factors that can serve to inform intervention development to aid aging men and women with making advantageous health decisions and enhancing physician-patient relationships when considering important healthcare decisions.

 

References:

Brom, L., Hopmans, W., Pasman, H. R. W., Timmermans, D. R., Widdershoven, G. A., & Onwuteaka-Philipsen, B. D. (2014). Congruence between patients’ preferred and perceived participation in medical decision-making: a review of the literature. BMC Medical Informatics and Decision Making, 14(25), 1-16. doi: 10.1186/1472-6947-14-25

Delaney, R., Turiano, N., & Strough, J. (2016). Living longer with help from others: Seeking advice lowers mortality risk. Journal of Health Psychology. doi: 10.1177/1359105316664133

O’Connor, A. M., Stacey, D., Entwistle, V., Llewellyn-Thomas, H., Rovner, D., Holmes-Rovner, M., Tait, V., … Jones J. (2003). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 1, 1-106. doi: 10.1002/14651858.CD001431

Shafir, A., & Rosenthal, J. (2012). Shared decision making: advancing patient-centered care         through state and federal implementation. Washington, DC: National Academy for State            Health Policy.

 

Image source: iStockPhoto


Filed under: Aging, Health and Wellness Tagged: aging, health care, healthcare, healthcare decision making, healthy aging, medical decision making, older adults