Thursday, January 20, 2022
Pew Research Center periodically releases reports about older adults using tech, with the latest one released last week. Share of those 65 and older who are tech users has grown in the past decade explains although tech use is higher among younger folks, "on several fronts, adoption of key technologies by those in the oldest age group has grown markedly since about a decade ago, and the gap between the oldest and youngest adults has narrowed, according to new analysis of a Center survey conducted in 2021." Here's some data collected about specific technologies: about 65% of older adults (65+) have smart phones, about 1/3 less than younger people. There's a bigger gap between the age groups as far as social media uses. The gap on internet access is narrowing, although those 65+ are connected at about 75% of the rate of younger folks, but this gap narrows for the near old. However, the data on frequency of internet usage shows a significant gap based on age, with less than 10% of the 65+ group indicating they were on the internet constantly.
I was a bit surprised at the numbers, thinking with social isolation, the participation by older adults would have been higher. There is some good info in this report, so check it out.
Wednesday, January 19, 2022
DOJ's Elder Justice Initiative announced an upcoming webinar on Trauma Informed Counseling. Here's info about the webinar
Many older adults have been exposed to trauma in their lifetime. They may have been exposed to violence, discrimination, natural disasters or have survived a past crime.
The accumulation of past trauma experiences can exacerbate symptoms related to a current trauma.
In this webinar, attendees will learn:
- the importance of referring older survivors of crime to counseling services,
- the factors that increase an older adult's risk for future victimization,
- how counseling services can help a survivor and aid in your professional role,
- and what types of counseling resources are available to older adults.
Issues pertaining to cultural sensitivity and ethical dilemmas will be explored.
Sheri Gibson, PhD
To register, click here.
Wednesday, December 22, 2021
With this latest COVID surge right in time for the holidays, folks may be debating about traveling vs. staying home. As we learned during the first lockdown, isolation can have a particularly devastating impact on many, and especially on older adults.
A bit ago, the Washington Post published an article, How technology can help seniors beat loneliness and isolation, which examines social platforms that provide connections, entertainment, and more. The article reviews some of these platforms. One featured, Papa, is provided through Medicare, Medicaid and some employer health plans and provides in-person connections. Other platforms provide these connections as well, and there is an opportunity for younger generations-not just family-to connect with older folks. Then, of course, are the platforms that connect virtually for virtual communications, some that emphasize intergenerational connections and match folks based on a common interest. Then the more "high tech" platforms are those that provide virtual reality, with the article noting that "[t]he immersive, 3-D experience is more compelling than FaceTime or Zoom. “It’s like the difference between a phone call and a video call...."
Wednesday, December 15, 2021
My friend Professor Naomi Cahn, sent this essay published in the Washington Post that really resonated with me. Opinion: Please do not put a party hat on my head — and other indignities of old age. When I look at birthday cards that note a person is infirm because of age, or party decorations with an over the hill theme, I shake my head. I'm glad I'm not alone in this. The author offers that she is "83 and have no idea if I’ll ever reach that three-digit number. But I’m warning my children and friends that if they dare to top my noggin with [a child's birthday party hat] I will use every bit of strength to rise from my chair, grab a cane if there’s one handy and whack them all in the head." She writes about the helpful folks who assume she needs assistance instead of asking first. Here's her approach
Whenever I get the chance, I announce my age. I do this because it’s a disservice to us older folks if we hide it. To me, that’s saying we’re ashamed to have lived so long. We’re covering up an important fact, as if we’re descendants of a long line of serial killers.
One way I’m protesting against the popular image of an old person is to be a showoff. On my 80th birthday, to celebrate my achievement of finally learning how to swim (the crawl, with flippers), I got a tattoo on my right biceps. I’d gotten my first on my left — my kids’ names and images reflecting them — for my 60th. But the newest has not shut me up.
If you’re a woman of my vintage, I ask this of you: Do not dye your hair. Do not get cosmetic surgery. Do not lie about your age. Be proud of the years you’ve lived, the talents you’ve contributed to your world and the importance of your being a witness to decades of history.
And maybe, get a tattoo.
So don't buy decorations or cards that imply an age number correlates with infirmities and remember that ageism is a real and harmful thing.
Thursday, December 2, 2021
The Stanford Center on Longevity has released a new report, The New Map of Life. Looking at the 100 year life, "make a clear distinction between aging, the biological process, and longevity, the measure
of long life. The Center’s goal is not to advocate for longer life—a phenomenon that is well underway—rather, it is to identify ways to enhance the quality of those century-long lives, so that people experience a sense of belonging, purpose, and worth at all ages and stages." One focus is looking forward, "on the economic potential of a more age-diverse population in which older adults contribute in increasingly significant and measurable ways to the social good and to GDP, so that opportunities for healthy longevity are shared across races, geographical regions, and socioeconomic status." (citations omitted).
The report addresses the following: Age diversity is a net positive, investment in centenarians to gain big returns, realignment of health spans to life spans, be amazed by the future of aging, work to an older age courtesy of flexibility in working, lifelong learning, invest in longevity communities, and look at life transitions as a positive. In preparing to take this new road on the new map of life, the authors note that "[m]eeting the challenges of longevity is not the sole responsibility of government, employers, healthcare providers, or insurance companies; it is an all-hands, all-sector undertaking, requiring the best ideas from the private sector, government, medicine, academia, and philanthropy."
Be sure to read this report!
Friday, November 26, 2021
It's not "Big Brother ... Watching You." (If you are a Baby Boomer, you will likely remember the phrase.) So who is watching if you are using tech to age in place? The Washington Post addressed this question in For seniors using tech to age in place, surveillance can be the price of independence.
On the surface the benefits of home and health monitoring technology seem obvious. A flow of information about the older person can put a caretaker at ease and help keep track of physical or cognitive decline. It is a way to extend the amount of time they are able live in their own homes before moving to someplace like a retirement or nursing home.
But the devices, many of which grew out of security and surveillance systems, can take privacy and control away from a population that is less likely to know how to manage the technology themselves. The idea of using tech to help people as they age is not a problem, say experts, but how it’s designed, used and communicated can be. Done wrong or without consent, it is one-way surveillance that can lead to neglect. Done right, it can help aging people be more independent.
New tech is being developed according to the article, and the article points out that the tech requires maintenance. "Aside from privacy issues, Internet connected devices are also a security worry. Many are stuffed with insecure software and require regular updates and password changes so they are not vulnerable to breaches." Even though tech can offer some advantages, there are still some caregiving tasks that require a human to perform (at least for now).
Here's an important point about the use of monitoring technology. "There is an imbalance of power that often exists between the elderly and their caretakers when it comes to technological know how. In the worst case scenario, it can also play a role in elder abuse, whether it is financial, physical or emotional, experts say." The elder needs to give consent to the use of the monitoring devices and understand that "[b]eing old does not mean you lose your rights."
Thanks to Professors Bauer and Cahn for sending me the link to the article.
Thursday, November 4, 2021
Professor Kaplan sent me a link to a very interesting essay published in the Wall Street Journal. The Bunk of Generational Talk dismisses the stereotypes of the various generations and points out that society's discussions should be about the real issues the generations face.
[S]uch stereotypes, myths and contrived conflicts can be genuinely destructive when they stand in the way of a real understanding of generational differences, which shape our attitudes and behaviors on many key issues: religion, sexual activity, smoking, drinking alcohol, connection to political parties and trust in other people.
Our wrongheaded thinking about generations leads us to focus on the wrong problems. Headlines about spendthrift young people, for example, distract us from the huge shift in economic policy in recent decades toward the interests of older people. We avoid facing up to a challenge like climate change by laying the blame on older generations while placing our expectations for salvation on the coming generation. Across a range of issues, manufacturing fake generational battles denies us the benefits of intergenerational connection and solidarity.
The article destroys the generational myths and stereotypes on some of the major issues facing us today as well as the reasons for the popularity of such myths. This is an excellent article and I plan to assign it to my students.
Wednesday, November 3, 2021
A couple of weeks ago, CNN ran this article, Seniors decry age bias, say they feel devalued when interacting with health care providers.
In health care settings, ageism can be explicit. An example: plans for rationing medical care ("crisis standards of care") that specify treating younger adults before older adults. Embedded in these standards, now being implemented by hospitals in Idaho and parts of Alaska and Montana, is a value judgment: Young peoples' lives are worth more because they presumably have more years left to live.Justice in Aging, a legal advocacy group, filed a civil rights complaint with the U.S. Department of Health and Human Services in September, charging that Idaho's crisis standards of care are ageist and asking for an investigation.
In other instances, ageism is implicit. Dr. Julie Silverstein, president of the Atlantic division of Oak Street Health, gives an example of that: doctors assuming older patients who talk slowly are cognitively compromised and unable to relate their medical concerns. If that happens, a physician may fail to involve a patient in medical decision-making, potentially compromising care, Silverstein said. Oak Street Health operates more than 100 primary care centers for low-income seniors in 18 states.
Sunday, October 24, 2021
Friday I wrote a post on the FTC resources on COVID Scams, and now I wanted to be sure you saw their recent report to Congress, Protecting
Older Consumers 2020–2021. Here is an excerpt from the introduction:
This past year, the global pandemic has hit the health and finances of older communities particularly hard. As can be seen from numerous FTC cases, older adults continue to be targeted by a wide range of scams and the unfair and deceptive marketing of products and services. This past year, the FTC’s law enforcement efforts included a focus on schemes capitalizing on the fears and economic uncertainty associated with the pandemic to deceptively peddle products related to the prevention and treatment of COVID-19. In addition to its law enforcement efforts, the FTC has redoubled its efforts to reach communities of older adults throughout the country with its varied outreach campaigns. The FTC also has conducted research regarding fraud reports filed by consumers nationwide, which reveals patterns and trends related to fraud impacting older adults. These analyses help inform the agency’s efforts to respond to the needs of older consumers.
This is the 4th year that the FTC has done this report; the Elder Abuse Prevention & Prosecution Act of 2017 added the reporting requirement. This year's report lists and discusses 15 actions that the FTC determined had a significant effect on older consumers and a summary of enforcement actions. The report includes consumer outreach efforts as well as the strategies that the FTC is using to shield older consumers from these scams. Appendix A is a chart of the various cases from the year, a quick scan of which will give you a good idea of the types of scams being perpetrated against older consumers.
Tuesday, October 5, 2021
The Adult Protective Services Technical Assistance Resource Center (APS-TARC) released a new brief, COVID-19 Fraud and Scams: What APS Needs to Know. Noting the pandemic causes greater use of technology, increased isolation and changes to personal circumstances, the Brief discusses several COVID-related scams. These include healthcare scams, government impersonator scams, money transfer scams, charity scams, mortgage relief scams, helper scams, and scams around vaccinations, treatments for COVID, and tech. The Brief offers suggestions for prevention, agencies to contact for help, and dealing with misinformation.
Monday, October 4, 2021
My dear friend and colleague, Professor Feeley, sent me a link to this recent article, Likely cause of Alzheimer’s identified in new study.
Here's a brief bit of info about the study
[S]cientists in Australia have recently discovered an additional factor that may be responsible for the development of this neurodegenerative condition.
Lead study author Dr. John Mamo, Ph.D. — distinguished professor and director of the Curtin Health Innovation Research Institute at Curtin University in Perth, Australia — explained to Medical News Today the conclusion from the new research...
“This study,” he added, “shows that exaggerated abundance in blood of potentially toxic fat-protein complexes can damage microscopic brain blood vessels called capillaries and, thereafter, leak into the brain, causing inflammation and brain cell death.”
Several lines of study suggest that peripheral metabolism of amyloid beta (Aß) is associated with risk for Alzheimer disease (AD). In blood, greater than 90% of Aß is complexed as an apolipoprotein, raising the possibility of a lipoprotein-mediated axis for AD risk. In this study, we report that genetic modification of C57BL/6J mice engineered to synthesise human Aß only in liver (hepatocyte-specific human amyloid (HSHA) strain) has marked neurodegeneration concomitant with capillary dysfunction, parenchymal extravasation of lipoprotein-Aß, and neurovascular inflammation. Moreover, the HSHA mice showed impaired performance in the passive avoidance test, suggesting impairment in hippocampal-dependent learning. Transmission electron microscopy shows marked neurovascular disruption in HSHA mice. This study provides causal evidence of a lipoprotein-Aß /capillary axis for onset and progression of a neurodegenerative process.
Friday, October 1, 2021
A couple of weeks ago, the Commonwealth Fund released a report, The Impact of COVID-19 on Older Adults: Findings from the 2021 International Health Policy Survey of Older Adults. Here are the survey highlights:
Compared to their counterparts in the other survey countries, older adults in the U.S. have suffered the most economically from the COVID-19 pandemic, with more losing a job or using up all or most of their savings.
Latino/Hispanic and Black older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences.
COVID vaccination rates for older adults were highest in countries where vaccines were most widely available when the survey was fielded. In the United Kingdom, nearly all older adults (97%) had already been vaccinated. The U.S. had the largest percentage of older adults who were not planning to get vaccinated.
The conclusion includes several steps for going forward "to reduce this burden on older Americans and to ensure that their health care needs are met":
Reducing care barriers... affordable access to care is increasingly a priority for policymakers and care delivery systems. Timely access to primary care is particularly important for older adults with multiple chronic conditions, because effective treatment requires coordination and follow-up plans....
Role of telemedicine... countries clearly have an opportunity to improve care delivery to older adults through the expansion of virtual care services for those unable or resistant to receiving care in a clinician’s office....
Expanding vaccination ... "[f]or older adults who said they were not planning to get vaccinated, limited trust in government to ensure vaccine safety and concerns with side effects were the most cited reasons. To increase uptake in this population, messaging campaigns should address their apprehension by engaging a wide range of voices, from clinicians and scientists to community members and local, state, and federal government agencies, to get the word out....
Thursday, September 30, 2021
Jane Brody wrote an article a few weeks ago for the New York Times, How to Age Gracefully. The catalyst for the article is a new book, “Stupid Things I Won’t Do When I Get Old, the title of which really appealed to me! The book inspired her to take an "inventory of my life and started at the top, with my hair. I’d been coloring it for decades, lighter and lighter as I got older. But I noticed that during the pandemic, many people (men as well as women of all ages) had stopped covering their gray. And they looked just fine, sometimes better than they did with hair dyed dark above a wrinkled facade. Today, I too am gray and loving it, although I can no longer blame my dog for the white hairs on the couch!" She also changed her attitude about her clothing and use of makeup. She also discusses things she won't stop doing just because of her age, some of which observers might consider risky behavior. As she observes, "[s]ooner or later, we all must recognize what is no longer possible and find alternatives... [and has] vowed to stop talking to whoever will listen about my aches, pains and ailments, what [the book's author] called the “organ recital.” It doesn’t provide relief — in fact, it might even make the pain worse. Rather than instill empathy, the “organ recital” likely turns most people off, especially young ones." She discusses two more major hurdles she will tackle, clutter and driving. She offers this quite lovely advice for us "Live each day as if it’s your last, with an eye on the future in case it’s not...."
Monday, September 27, 2021
I was interested in this recent opinion from the Penn. Supreme Court. Not elder law specific, but interesting info none the less. In Penn. v. Purnell, the court was reviewing
the appropriate test to apply to a trial court’s determination concerning whether a witness in a criminal case may utilize a “comfort dog” for support during his or her trial testimony. We hold that a trial court should balance the degree to which the accommodation will assist the witness in testifying in a truthful manner against any possible prejudice to the defendant’s right to a fair trial. Here, the trial court allowed a witness to testify with the assistance of a comfort dog, and the Superior Court concluded that the trial court did not abuse its discretion in this regard. For the reasons stated below, we agree with the Superior Court and, therefore, affirm that court’s judgment."
The issue arose when one witness to a killing was concerned about her own safety, so the State sought
a “comfort dog” be present during [the witness'] testimony. ... The motion explained that a sheriff’s deputy would transport the comfort dog, Melody, to the court and that the dog would enter the courtroom before the jury’s entrance. According to the motion, the comfort dog would be placed in the witness stand outside the presence of the jury and would exit the courtroom after the jury left the room. (citations omitted).
After reviewing arguments and rulings from other states, the court determined "that trial courts have the discretion to permit a witness to testify with the assistance of a comfort dog. In exercising that discretion, courts should balance the degree to which the accommodation will assist the witness in
testifying in a truthful manner against any possible prejudice to the defendant’s right to a fair
trial and employ means to mitigate any such prejudice."
The full opinion is available here.
Friday, September 17, 2021
Morris Klein, elder law attorney, friend and frequent contributor to this blog sent me links to two articles. Washington's first-in-the-nation long-term care program starts in January, with opt-out deadline soon and Payroll Tax Will Fund New Washington Long-Term Care Program.
The WA Cares fund was created by [their] Legislature in 2019 as a safety net for the seven in 10 people who will ultimately need professional or personal care at some point in their lives.
The only opportunity to opt out of the program is fast approaching, raising questions for workers who may be deciding whether getting a private policy is better or worse. Here, we lay out answers to some of the common questions.
. . .
Part of the motivation for creating the worker-funded program is the fact that private long-term care insurance policies can be too expensive for retirees to keep paying premiums on until they need to use them.
"Beginning in 2025, the plan will pay benefits to enrollees who need help with non-hospital-based health care expenses." "As more families applied for Medicaid, [Washington's legislators] saw a greater share of the state’s future budgets going to health care expenses. So, in 2019, the legislature ... opted to put the state in the long-term care business."
The articles are worth reading to learn more about how the program will work. Considerations for employees in deciding whether to stay in or opt out can be found here.
Thursday, September 16, 2021
AARP Research has a new report, Working Caregivers' Worries Over Workplace Return. With some employers bringing employees back to the physical office, will the flexibility provided by working from home completely disappear?
AARP surveyed Americans who provide unpaid care to a family member or friend and work part- or full-time to learn about their concerns coming out of the pandemic. Of the national sample of adults polled by phone, 56% say their employer offered new benefits as a result of the pandemic, such as flexible schedules and the ability to work remotely.
As of July, about half of caregivers (52%) were continuing to work from home at least some of the time and 89% would like that option going forward. Most said it's been easier to juggle the demands of work and caregiving while not having to commute (49% to a great degree and 40% to some degree), according to the AARP survey.
The full report is available here. I have pasted the key findings here for your convenience:
- Working caregivers have felt the strain as the COVID-19 pandemic has ensued. With nearly eight in ten saying the pandemic increased their level of stress. Two in three caregivers (66%) express concern that they will have difficulty juggling responsibilities in the next 12 months.
- More than half of working caregivers say their employer instituted new benefits as a result of the pandemic. The most common benefits instituted were flexible schedules and the ability to work remotely.
- Flexibility is important for working caregivers to successfully balance caregiving with work. In fact, it is so highly valued that more than four in ten caregivers say they would consider looking for a new job if their employer rolled back any of the benefits they instituted during the pandemic.
- A slight majority of working caregivers currently have the ability to work at home at least some of the time and most want to continue with this arrangement.
- Nearly half say working at home has helped them manage their dual roles a great deal.
In addition to balancing responsibilities, working caregivers are most concerned about exposing the person they care for to the coronavirus or leaving them home unattended while they go to work.
Wednesday, September 1, 2021
This New York Times article from last week took me a bit by surprise. Many Older Americans Still Aren’t Vaccinated, Making the Delta Wave Deadlier explains
The United States has a far higher share of seniors without full vaccine protection than many other wealthy countries, a key risk factor driving serious Covid-19 illness and death, a Times analysis shows.
As the Delta variant has torn across the country, America’s pace of vaccinations has sped up after months of relative stagnation, and full federal approval of the Pfizer vaccine on Monday could extend that momentum. Just over half of Americans are now fully vaccinated.
But national averages mask the high rate of older Americans who remain deeply vulnerable. Older people still account for most Covid-19 deaths, and in many counties, especially in the South and Mountain West, seniors without full vaccination make up more than 10 percent of the total population.
We know from the experiences of last year how deadly COVID can be to elders. And recent data proves this still to be true. "The Delta variant has hit many areas with clusters of vulnerable seniors particularly hard. Low elderly vaccination rates in Arkansas, Florida, Idaho, Louisiana and Nevada have coincided with surging rates of hospitalization and death." There are still areas of high risk, without a current outbreak, according to the article. There are many reasons for vaccine hesitancy and whether the full FDA approval of Pfizer will move the needle (pun intended) remains to be seen. "Signing up older Americans for their first shot remains a struggle, public health experts say, as people who really wanted a vaccine have already gotten it. While getting to a vaccine provider may still be an issue for some, especially in more rural areas, many more people are resistant to immunization because of their politics and personal beliefs, and those of their friends and family."
Thursday, August 19, 2021
Older adults in the United States are functioning better on their own and a shrinking share are living in nursing homes and assisted living settings than a decade ago, new data show.
Disability is down, as a smaller percentage of older adults receive help with daily activities and a larger share manage independently with home modifications and devices, according to 10 years of data from the National Health and Aging Trends Study (NHATS). The physical, sensory, and cognitive capacities of older adults, particularly women, are improving. And older adults are online more than ever before: They are more than twice as likely to use text or email than in 2011.
Despite these encouraging trends, NHATS data also reveal persistent racial and ethnic disparities among older adults, particularly in their ability to carry out daily tasks without help and modify their homes to meet their needs. The data also show that older adults were far less likely to participate in activities they value during the COVID pandemic than in previous years.
Conducted annually, NHATS collects information on the functional ability of older Medicare recipients, aiming to guide efforts to improve quality of life. Many NHATs findings are now available in new interactive dashboards and a companion chartbook, allowing users to dig into the data by demographic subgroup and create a custom picture of how the lives of older Americans—a rapidly growing segment of the population—are changing. (citations omitted)
Click here to access the report and all the nifty charts.
Wednesday, August 18, 2021
There was a bit of a buzz last week with the publication of a new study about metabolism. What We Think We Know About Metabolism May Be Wrong explains the recent study: "[u]sing data from nearly 6,500 people, ranging in age from 8 days to 95 years, researchers discovered that there are four distinct periods of life, as far as metabolism goes. They also found that there are no real differences between the metabolic rates of men and women after controlling for other factors."
We probably only think about our metabolisms when we are trying to lose weight. But as the article explains, the implications are far beyond weight gain and loss.
Central to [the researchers'] findings was that metabolism differs for all people across four distinct stages of life.
There’s infancy, up until age 1, when calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.
Then, from age 1 to about age 20, metabolism gradually slows by about 3 percent a year.
From age 20 to 60, it holds steady.
And, after age 60, it declines by about 0.7 percent a year.
For us in elder law, here is the point: "And around age 60, no matter how young people look, they are changing in a fundamental way...'There is a myth of retaining youth, [one expert said] That’s not what the biology says. In and around age 60, things start to change. ... There is a time point when things are no longer as they used to be.'"
Thanks to Professor Naomi Cahn for sending the link to the article.
Monday, August 16, 2021
Elder Law attorney and friend Morris Klein sent me the link to this article, Some NHs Use POLST Inappropriately; Practice, Policy, Research Considerations Can Help. In discussing the importance of advance care planning, the authors note "[o]ne [step] involves the POLST (Physician Orders for Life Sustaining Treatment) paradigm. POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limited medical condition. However, according to the authors of an article in the August issue of JAMDA, some nursing homes (NHs) are using it in potentially inappropriate ways with patients who are ineligible because they are not at such risk. They also make recommendations for NHs to implement the appropriate use of POLST." The article, POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care, can be found here. The abstract explains
POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form used to document preferences about cardiopulmonary resuscitation (CPR), medical interventions such as hospitalization, care in the intensive care unit, and/or ventilation, as well as artificial nutrition. Programs based on the POLST paradigm are used in virtually every state under names that include POST (Physician Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and MOST (Medical Orders for Scope of Treatment), and these forms are used in the care of hundreds of thousands of geriatric patients every year. Although POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limiting medical condition, some nursing homes and residential care settings use POLST to document CPR preferences for all residents, resulting in potentially inappropriate use with patients who are ineligible because they are too healthy. This article focuses on reasons that POLST is used as a default code status order form, the risks associated with this practice, and recommendations for nursing homes to implement appropriate use of POLST.
The article in pdf is available here.