Tuesday, June 27, 2017
A recent story in the Toronto Star covers a ruling from a trial court judge about Canada's Medical Aid-in-Dying law. Advocates hail judge’s decision in woman’s assisted death appeal explains the judge's decision: "[a] 77-year-old woman seeking medical assistance in dying has a “reasonably foreseeable” natural death, a judge declared Monday in an attempt to clear up uncertainty that left her doctor unwilling to perform the end-of-life procedure for fear of a murder charge." The concern in the case was the meaning of "reasonably foreseeable" and the judge held "[t]o be reasonably foreseeable, the person’s natural death doesn’t have be imminent or within a specific time frame or be the result of a terminal condition...."
The judge went on to explain
“The legislation is intended to apply to a person who is “on a trajectory toward death because he or she a) has a serious and incurable illness, disease or disability; b) is in an advanced state of irreversible decline in capability; and c) is enduring physical or psychological suffering that is intolerable and that cannot be relieved under conditions that they consider acceptable,” ....
Wednesday, May 17, 2017
If you scoffed at this title, thinking "of course I am" then you are not alone. But, if you scoffed at this title, thinking "nope, I'm not" then you are not alone either. The Pew Research Center Fact Tank released another News in Numbers, this time on social media use. Not everyone in advanced economies is using social media found higher usage in certain countries than others. Sweden, US, the Netherlands and Australia are top in social media use (about 70%) by country. But what about use by age? "The age gap on social media use between 18- to 34-year-olds and those ages 50 and older is significant in every country surveyed. For example, 88% of Polish millennials report using social networking sites, compared with only 17% of Poles ages 50 and older, a 71-percentage-point gap." With a 71% age gap in Poland taking the #1 place in the Pew brief, the U.S. was ranked last with only a 34% age gap in social media use.
Friday, May 12, 2017
On May 10, 2017, my research colleagues Gavin Davidson (Queens University Belfast) and Subhajit Basu (University of Leeds) participated in a policy briefing at Stormont, the Northern Ireland Assembly in Belfast. They appeared in support of recommendations by the Commissioner of Older People (COPNI) Eddie Lynch on a major plan for modernization of social care programs for vulnerable adults (of any age).
Professors Davidson and Basu focused on three key recommendations:
- Northern Ireland should have a single legislative framework for adult social care with accompanying guidance for implementation. This could either be new or consolidated legislation, based on human rights principles, bringing existing social care law together into one coherent framework.
- All older people in Northern Ireland, once they reach the age of 75 years, should be offered a Support Visit by an appropriately trained professional. This will be based on principles of choice and self-determination and is aimed at helping older people to be aware of the support and preventative services that are available to them.
- Increasing demands for health and social care reinforce the importance of considering how these services should be funded. All future funding arrangements must be equitable and not discriminate against any group who may have higher levels of need.
The audience, which included researchers, social service program administrators and elected officials (not only from Northern Ireland, but elsewhere, including the Isle of Man), reportedly responded strongly to the recommendations, especially to the concept of specially-trained "support visitors," offered to persons age 75 or older. The intent is to provide individuals with planning support and, where needed, medical assessment. Guidance and information is often needed for pre-crisis planning, thus moving in the direction of prevention of crises and reduction of need for last-minute response. The support visitor concept has been used successfully in Denmark and other locations in Europe. The next step for Northern Ireland would likely be a pilot or test project.
As a co-author of the research reports that led to the COPNI recommendations, working with Professors Gavin Davidson and Subhajit Basu as part of a team headed by Dr. Joe Duffy of Queens University Belfast, I found it an interesting coincidence that at almost the same time as the Northern Ireland government session, I was addressing similar interests in "preventative" planning while speaking on elder abuse in a "Day on the Hill" program at the Capitol in Pennsylvania, hosted by the Alzheimer's Association. It is clear that on both sides of the Atlantic, we are interested in cost-effective, proactive measures to help people stay in their homes safely.
Monday, April 17, 2017
Register now for Justice in Aging's latest webinar, Older Adults & Immigration. The webinar is set for Friday April 21, 2017 from 2 p.m. to 3 p.m. edt. Oh, and did I mention, it is free! Here's a description of the webinar
Are your immigrant senior clients coming to you with immigration-related questions? Recent events may leave your immigrant senior clients understandably confused. Need clarification on an immigrant older adult’s eligibility for safety net programs like Medicaid or SSI? Join Justice in Aging as we host a special immigration law webinar with our partners from the National Immigration Law Center. Intended for an audience who work with low income seniors but who are not familiar with immigration law, this webinar will cover basic topics, like:
• Different types of immigrants in our communities;
• Rights and protections for immigrant seniors;
• Immigrant senior eligibility for SSI, Social Security, Medicare, and Medicaid; and
• Resources for individual assistance
This free webinar will also highlight some of the recent events affecting immigrant seniors and how they may be affected by changes in government policies.
To register, click here.
Wednesday, February 15, 2017
Our good friend, a true expert on international perspectives on elder law, Professor Kate Mewhinney, is offering her course on Comparative Law and Aging in London this summer. Here are the details for the 3 credit course, part of a summer program that begins May 29, 2017:
This course examines how countries address what has been called the “silver tsunami” – the rapidly aging demographic. Through a comparative and international analysis students will learn how different legal systems address similar challenges brought on by increased longevity and fewer births. The course allows us to compare legal approaches to such issues as retirement ages, pensions and Social Security, appointment of financial surrogates, employment discrimination, filial responsibility and health care policies on long-term care and end-of-life options. The focus will be on the U.S., U.K. and major European countries, as well as Japan, the European Union, and China. There are no prerequisites. Students will be graded on class participation, a quiz on fundamentals, and a short research paper to be turned in within a month of the course end.
Wednesday, January 25, 2017
The Denver Post ran an AP story a few weeks ago about Americans retiring abroad. Growing number of Americans are retiring outside the U.S. highlights the increase in the number of Americans who decide to retire and live abroad. "The number grew 17 percent between 2010 and 2015 and is expected to increase over the next 10 years as more baby boomers retire... Just under 400,000 American retirees are now living abroad, according to the Social Security Administration. The countries they have chosen most often: Canada, Japan, Mexico, Germany and the United Kingdom." The article references a lower cost of living or cheaper health care as a reason some Americans choose to retire to other countries. Climate may also be a factor. It would be an interesting exercise for students to list the issues and considerations when clients decide to retire to another country. Anyone want to assign this as a project?
Thursday, November 3, 2016
The Guardian ran a story last month about proposed legislation in the Netherlands for elders who aren't terminally ill, but instead believe they have lived long enough. Netherlands may extend assisted dying to those who feel 'life is complete' explains that "[t]he Dutch government intends to draft a law that would legalise assisted suicide for people who feel they have “completed life” but are not necessarily terminally ill." Cabinet ministers have provided the Dutch Parliament with a letter about the plan, explaining "people who 'have a well-considered opinion that their life is complete, must, under strict and careful criteria, be allowed to finish that life in a manner dignified for them'." The intent is to limit the law's application to elders "'because the wish for a self-chosen end of life primarily occurs in the elderly, the new system will be limited to' them." The article indicates that there would be safeguards in the law. The target for completing the draft legislation is the end of 2017.
Thanks to Ron Hammerle for alerting me to the proposed legislation.
Friday, October 21, 2016
LeadingAge, the trade association that represents nonprofit providers of senior services, begins its annual meeting at the end of October. This year's theme is "Be the Difference," a call for changing the conversation about aging. I won't be able to attend this year and I'm sorry that is true, as I am always impressed with the line-up of topics and the window the conference provides for academics into industry perspectives on common concerns. For example, this year's line up of workshops and topics includes:
- General sessions featuring Pulitzer Prize winning journalist Charles Duhigg on the "The Science of Productivity," 2013 MacArthur Fellow and psychologist Angela Duckworth on the the importance of grit and perservance for successful leadership, and famed neurosurgeon and speaker Sanjay Gupta on "Medicine and the Media."
- Hundreds of sessions, organized by "interest groups":
October 21, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Retirement, Science, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (2)
Wednesday, October 12, 2016
A new stage has been added to the human life cycle due to increasing numbers of the very old. In particular, adults over eighty constitute a new focus for developmental research. These older adults seem to have reached a stage beyond Erikson’s eight stages, first proposed sixty-four years ago. As Joan Erikson suggested, eight stages no longer capture the end of life concerns of this older group. In this paper, I review the research focusing on the self-reports of individuals who are still thriving in their eighties and nineties. I suggest that this research supports a ninth Eriksonian life stage. This ninth stage might be called “Appreciation versus Resignation with the associated strength, Enthusiasm.” A defining aspect of the elders described in the studies cited below is that they express a keen appreciation for their extended years and a determination not to squander them. I discuss implications for practice and for further research.
Who are these 9th stagers and why study them? According to the introduction,
“Ninth stagers” are individuals in their eighties and nineties. I suggest that the emerging picture of this stage is considerably brighter than the one Joan Erikson painted. In the spirit of Erik Erikson’s (1950) proposed eight stages, I suggest that the ninth stage is characterized by a dialectical tension between two qualities, appreciation and resignation, with the associated strength, enthusiasm. I consider research focused on ninth stagers’ self-reports as well as research on the essential conditions for sustaining vitality and enthusiasm. Following Gawande (2015), I suggest that our diminished picture of the capacity for vitality in ninth stagers is, in part, an artifact of the medicalized assisted living environment in which many of our seniors live and the deleterious effect of this environment on their autonomy, competence, and relatedness.
The 9 page article looks at vitality, longevity and psychological variables to name a few. The author concludes "this ninth life stage might be called “Appreciation versus Resignation with the associated strength, Enthusiasm.” A defining aspect of many of the elders in the studies cited was that they expressed keen appreciation for their extended years and a determination not to squander them. Enthusiasm does not seem too strong a word to characterize their strength. Toquote Henry David Thoreau: 'None are so old as those who have outlived enthusiasm.'"
A pdf of the article is available for download from here.
Wednesday, August 24, 2016
Dickinson Law Professor Laurel Terry sent me a timely link to an NPR story about Japanese convenience stores. I was already thinking about how retail shopping has changed over the years. For example, on the corner of 7th Avenue and Indian School Road in Phoenix, there used to be a high-end Scandinavian furniture store. I'd only been in it once, and that was to use a gift certificate for what seemed like a huge amount of money at the time as a wedding present. My husband and I realized the most we could afford in the store was a wooden bowl. A very nice wooden bowl, mind you, but still, it was a wooden bowl.
Yesterday, as I passed that corner, I realized there was still a big, fancy sign out front, but the store is now a Goodwill franchise store.
So, with that change in mind, I enjoyed the NPR story, captioned Beyond Slurpees: Many Japanese MiniMarts Now Cater to Elders. From the written account:
Case in point is a Lawson convenience store in the city of Kawaguchi, north of Tokyo. It sells products that an American consumer would never find tucked between the aspirin and the candy bars. For example, there's a whole rack of ready-to-heat meals in colorful pouches. They're rated at levels from 1 to 5, based on how hard it is to chew what's inside.
Or, as the store's manager, Masahiko Terada, puts it, "the higher the level, the less need for you to chew. In the end it's porridge."
This Lawson store in Kawaguchi is one of six in a special line called Care Lawson. The company plans to expand to 30 by early next year. And these Care Lawson stores have another special feature: staff like Mika Kojima.
She's a nursing care manager and she's stationed at this Lawson store. In fact the franchise owner of this store is actually a nursing services company. Anyone who comes in can ask for Kojima's help. For example, she'll go to an older client's home to make sure it's set up so they can live there safely. And she'll connect families with adult day care services.
Convenience stories should be just that, convenient, right? With adults over age-65 making up nearly 27 percent of Japan's population, it just makes sense for retailers to provide customer-specific merchandise that is easily accessible, especially for people who might prefer to avoid large supermarkets. The Lawson chain also offers home deliveries.
The story made me wonder more about Lawson. How was it that the Japanese chain came to have such a non-Japanese name? It turns out Lawson began back to 1939 in Ohio, in the United States, where J. J. Lawson ran a dairy milk store. "'Mr. Lawson's milk store' was locally renowned for its fresh and delicious milk and many customers came to buy milk there every morning." The first Lawson convenience store opened in Japan in 1975 and sold "party food," very different from the model of today.
Sunday, August 7, 2016
Investment News published a story about retirement security across the globe, and reports that the U.S. ranks #14. U.S. comes in 14th in global ranking of retirement security reports on Natixis Global Asset Management's annual ranking. The article explains that Norway, Switzerland and Iceland came in 1, 2 and 3 respectively, while the U.S. finished at 14 out of 43. According to the article, we did better in some categories, even breaking the top 10, for example, "No. 7, in the health care part of the index." But bummer, we were "No. 30 for life expectancy." But even more of a bummer, "[o]ne area in which the U.S. had an abysmal ranking was in its high level of income inequality, which helped drive it down to No. 37 of the 43 countries. The U.S. and Singapore share the dubious distinction of being the only countries in the top five for income per capita and in the bottom 10 for their large gaps in income equality." According to the article "Norway joins a number of top 10 countries in having a compulsory workplace savings program. It requires employers to fund private retirement accounts with 2% of a worker's earnings annually. That pales next to Australia, No. 6, where employers must kick in at least 9.5%. "
The full Natixis report is available here.
Wednesday, June 8, 2016
Hopefully none of the readers of this blog have ever been a victim of a consumer scam, had their identities stolen, or know someone who has been a victim. That said, it is unfortunately likely that we all know someone who has been a victim of a scam. But there is good news on an international front regarding a scam that required victims to send money in order to claim their "winnings".
An article about efforts from U.S. and Dutch law enforcement efforts explain that FIOD and US DoJ conduct simultaneous operations against worldwide multi-million euro fraud with false letters. The article explains Dutch law enforcement is seizing mail from 300 mailboxes and is investigating 6 companies. At the same time DOJ filed suit "against two of the suspected companies and one director in the Netherlands, on behalf of hundreds of thousands of victims." Here's how this scam worked
[T]he main suspects sent millions of letters to people in the United States, Great Britain, Switzerland, Italy, France, Japan and many more countries. In the letters, addressed to people personally, the recipients were made to believe that they had won an award in the amount of money or a check, which they had not claimed yet. Another example was that the sender of the letter intended to give money to the recipient as an act of charity. In addition, letters were sent which stated that the recipient was a guaranteed winner in a lottery. To be able to transfer the money to the recipient, the latter had to send a cash amount of between 20 and 45 euro or a cheque, each time to a mailbox in the Netherlands.
In various letters, approximately 300 different mailbox numbers in the Netherlands were mentioned. Allegedly, the six suspected Dutch companies, which are the subject of the FIOD-investigation manage a large part of the mailboxes, empty them and process the mail. Presumably, the companies were allowed to keep part of the money as payment for services rendered, but the larger part of the money was transferred to bank accounts, which allegedly belonged to the main suspects of the fraud.
Wednesday, April 20, 2016
Prime Minister Justin Trudeau was the focus of an article in the New York Times last week on physician-aided dying in Canada. Justin Trudeau Seeks to Legalize Assisted Suicide in Canada reports that a proposed law was introduced that would allow physician-aided dying "for Canadian residents and citizens who have "a “serious and incurable illness,” which has brought them 'enduring physical or psychological suffering.'"
Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.
One striking difference in the proposed legislation in Canada compared to those states in the U.S. where physician-aided dying is legal is that "a doctor or nurse practitioner [may] administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process."
Not all in Canada are in favor of the legislation. CBC Canada ran a story, Religious groups react to physician-assisted dying bill LIVE where a number of groups stated concerns about the legislation. The video is available here.
If any of our readers are from Canada, we would be very interested in hearing more about the discussion in Canada on this proposal.
Thursday, April 7, 2016
Sunday, April 3, 2016
The U.S. Census Bureau recently released it's updated international population report, An Aging World: 2015. Lots of interesting numbers in this 135 page report (plus tables), with analysis indicating trends. To highlight a few:
- Growth of world's older population will continue to outpace that of younger population over the next 35 years
- Asia leads world regions in speed of aging and size of older population
- Africa is exceptionally young in 2015 and will remain so in the foreseeable future
- World's oldest countries are mostly in Europe, but some Asian and Latin American countries are quickly catching up
- Some countries will experience a quadrupling of their older population from 2015 to 2050
The document compares India and China as two "population giants" that are on "drastically different paths of population aging."
In 2015, the total population of China stands at 1.4 billion, with India close behind at 1.3 billion. It is projected that 10 years from now, by 2025, India will surpass China and become the most populous country in the world. . . . Although both China and India introduced family planning programs decades ago [graphic available in report], the fertility level in India has remained well above the level in China since the 1970s. By 2030, after India is projected to have overtaken China in terms of total population, 8.8 percent of India’s population will be aged 65 and older, or 128.9 million people. In contrast, in the same year, China will have nearly twice the number and share of older population (238.8 million and 17.2 percent).
The report also introduced me to a new acronym - HALE - for "healthy life expectancy," as an important measurement of population health across the life span. For example, while among European countries France has the longest life expectancy, Norway has significantly better projections for healthy life expectancy, the number of years older adults can be expected to live without activity limitations.
Friday, March 11, 2016
The abuse of older people is likely to worsen as Australia's population ages and relatively wealthy baby boomers become vulnerable to mercenary family members and carers.
The federal government is "appalled" at the extent of elder abuse and has asked the Australian Law Reform Commission to find ways to safeguard older Australians....
The article discusses the number of victims, risk factors, and perpetrators. Similar to the U.S., Australia doesn't have good data on elder abuse as far as how big a problem it is, "has to extrapolate from international research. "We say that it frequently is a form of family violence - because it happens within families - but the significant difference is that it's most often between generations," said Jenny Blakey from Seniors Rights Victoria. " The 4th annual national conference on elder abuse was held in Melbourne, Australia in late February. More information about the conference can be found here.
Tuesday, March 8, 2016
The Justice Department in the Southern District of Illinois issued a press release on March 3, 2016 announcing a perpetrator in the midst of trial changed his plea to guilty. Nigerian Scammer Convicted Of On-Line Romance Fraud notes that the perpetrator, the ringleader, pleaded guilty to all charges. He was arrested in London in 2014 and at trial, "'the evidence established that [the perpetrator], a citizen of the Federal Republic of Nigeria, was the ringleader of a criminal organization operating within South Africa that targeted and stole from hundreds of women across the United States, including dozens in the St. Louis metropolitan area." noted Acting United states Attorney Porter. "Our office will continue to pursue justice for these victims in [the perpetrator's] prison sentence and in our never-ending efforts to get restitution."'
Sentencing is set for early in the summer, and "[b]y statute, [the perpetrator] faces a maximum prison sentence of 127 years, a fine of $250,000 on each of the eight counts of the indictment, and as much as five years of supervised release. He will also be required to pay restitution to the victims of his crimes."
Tuesday, February 23, 2016
Here are three recent articles of note on Physician-Aided Dying (PAD) that might be useful in your classes.
First, the Journal of the American Medical Association (JAMA) Psychiatry ran at article on February 10, 2016, Physician-Assisted Death for Patients With Mental Disorders—Reasons for Concern. As the article opens:
Physician assistance to help people end their lives—by prescribing or directly administering medication—is now legal in some form in 4 American states, Canada, and 4 European countries. In the United States, laws permitting physicians to write prescriptions for medications intended to end patients’ lives are limited to patients with terminal conditions and preclude physician administration of the medication. However, other countries, including the Netherlands, allow direct physician involvement and have expanded the criteria to include patients with irremediable suffering, whatever the cause. Therefore, the door has been opened for people whose suffering is primarily due to mental disorders to seek assistance in dying. (citations omitted)
Next in the same volume is the article about the study referenced in the first article: Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. The full article is free, and the tables and references are also available in the online version. The authors conclude
Despite some limitations, an important strength of our study is that we examined reports of actual psychiatric EAS cases across an entire jurisdiction, rather than asking physicians to recollect their experiences or opinions. The results show that the patients receiving EAS are mostly women and of diverse ages, with various chronic psychiatric conditions, accompanied by personality disorders, significant physical problems, and social isolation or loneliness. Refusals of treatment were common, requiring challenging physician judgments of futility. Perhaps reflecting the complexity of such situations, the physicians performing EAS generally sought multiple consultations (but not always), and disagreement among physicians—especially regarding competence and futility—was not unusual. Despite these complexities, a significant number of physicians performing EAS were new to the patients. We conclude that the practice of EAS for psychiatric disorders involves complicated, suffering patients whose requests for EAS often require considerable physician judgment. The retrospective oversight system in the Netherlands generally defers to the judgments of the physicians who perform and report EAS. Whether the system provides sufficient regulatory oversight remains an open question that will require further study.
The New York Times ran an article about the study on February 10, 2016. Assisted Suicide Study Questions Its Use for Mentally Ill notes that
A new study of doctor-assisted death for people with mental disorders raises questions about the practice, finding that in more than half of approved cases, people declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. The study, of cases in the Netherlands, should raise concerns for other countries debating where to draw the line when it comes to people’s right to die,
Discussing the findings from the study, the NY Times article notes that that it
finds that cases of doctor-assisted death for psychiatric reasons were not at all clear-cut, even in the Netherlands, the country with the longest tradition of carefully evaluating such end-of-life choices. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a “mobile end-of-life clinic” — a nurse and a doctor, funded by a local euthanasia advocacy organization.
Good sources for your classes and for students writing papers on the topic!
Friday, February 19, 2016
The 2016 Aging & Society: Sixth Interdisciplinary Conference has released a call for papers for the October 6-7, 2016 conference to be held in Sweden. The call for papers includes papers, poster presentations, workshops/interactive sessions, or colloquia on one of the four conference themes. The themes are economic and demographic perspectives, social and cultural perspectives, medical perspectives and public policy perspectives. More information is available here.
Monday, February 15, 2016
My friend, colleague and renaissance guy, Mark Bauer, keeps an eye out for interesting articles for me, including those that focus on a community's livability for elders. He sent me this great article that looks at how a vibrant, walkable community can increase one's longevity once one reaches 80. The article, Land use mix and five-year mortality in later life: Results from the Cognitive Function and Ageing Study, appears in volume 36 of Health and Place at pages 54-60 (Mar. 2016). Here's the abstract
This study explores the potential modifying effect of age and mediation effect of co-morbidity on the association between land use mix, a measure of neighbourhood walkability, and five-year mortality among the 2424 individuals participating in the year-10 follow-up of the Cognitive Function and Ageing Study in England. Postcodes of participants were mapped onto Lower-layer Super Output Areas, a small area level geographical unit in the UK, and linked to Generalised Land Use data. Cox regression models were fitted to investigate the association. For the younger older age group (75–79 years), the effect of high land use mix on an elevated risk of mortality was mediated by co-morbidity. For older old age groups (80–84, 85+ years), a higher land use mix was directly associated with a 10% lower risk of five-year mortality. The findings suggest differential impacts of land use mix on the health of the younger and older old.
I thought this quote from the implications/future research section persuasive: "[P]olicy planning should take note of such variation within older populations, and in particular the needs of the middle and oldest old cohorts. This observation is particularly relevant to the recent movement toward age-friendly environments, which have been advocated worldwide to create inclusive and supportive living environments for active ageing... improving the mix of land uses in local areas may be a potential approach to reduce limitations in activity of daily life and support active ageing for these older age groups."
A pdf of the article is available here.