Elderly with iPads

A while ago I received an email from a developer at the Social Service Center in a municipality located in the south of Sweden. She had bought 30 iPads that she had distributed to disabled, elderly, drug addicts and mentally ill adults within the municipality. She wrote to me as she and her colleagues were amazed by the results! A young mentally disabled man who normally did not move much, all of a sudden became very active to everybody’s surprise. The personnel filmed him with an iPhone and sent to his parents who were thrilled. An elderly Czech woman with dementia got the opportunity to listen to her native language on the iPad. The happiness that brought to her was enormous. An elderly man known for always acting out and being aggressive became calm and happy simply from watching puppies on the iPad. An elderly lady photographed herself from different angles making sure she looked her best in every picture, strengthening her self-image and self-esteem.

In addition, the elderly could easily stay in touch with relatives, near and far, by using Skype. The drug addicts were able to go online and read magazines, play games, paint and play instrument through the iPad.

The woman who emailed me concluded by saying that these changes in behavior may look small and insignificant but for the people going through this it is of great importance. This is a great example on how we can update the way we provide care for the elderly and invite them to take part of the high-tech devices that have already become a natural part of our lives.

How grandma celebrates Christmas by herself

I came across this article from the UK about elderly people spending their merry Christmas on their own. I found it interesting, depressing, and even discovered a link to health in the whole dilemma.

While for many people Christmas is the only time in the year when they actually meet family and friends, others are not cared for by anybody or do not care for anybody (anymore). Thus, they spend the celebration of love alone, like a quarter of all people in the UK that are older than 75 and live by themselves – even though the majority of them have children.

Experts say that “family breakdown is fuelling an epidemic of loneliness in old age” and that the fact that two in five marriages fail has serious impacts for the elderly. Young people have to divide their time between parents and step-parents. Besides, ‘silver separations’ are also becoming more common, with latest figures showing that more than 11,500 over-60s were granted a divorce in 2009.

In one of the largest surveys of its kind, the think-tank polled 2,000 over-75s to test how isolated the elderly truly are. ‘I’m 88 and I have nobody at all. I’m on my own’, said one, and ‘some days the only person I speak to is the boy in the shop when I pick up my paper.’

Growing isolation and loneliness makes elderly people particularly vulnerable – also in terms of health. Related mental and physical health conditions include a weakened immune system, sleep deprivation, higher blood pressure, a higher risk of dementia and depression. What to do?

In the UK there is an initiative that involves the police, fire officers conducting home safety checks, as well as social workers who see “warning signs” to connect people to local voluntary groups that can provide companionship. But is that a solution of the problem really?

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Chapman J (2011): 250,000 elderly people who’ll be spending their Christmas alone. Available: http://www.dailymail.co.uk/news/article-2078261/250-000-elderly-people-ll-spending-Christmas-alone.html#ixzz2FXDlyfWT

Science fiction medicine from Sweden

Imagine you were able to simply replace one of your organs once you fall sick. You just go to the hospital and quickly come out with a new intestine, kidney, liver or even heart, if an incurable disease was present.  This sounds more like an idea from a science fiction movie than a like a feasible therapeutic option, but research on regenerative medicine and the engineering of “artificial” organs is happening to make these options a reality for many patients worldwide in the near future.

Nowadays, chronic diseases are a major health issue in almost every country – they cannot be cured and the patient’s best bet is to prevent those diseases and their complications. We are talking about e.g. diabetes, heart and kidney failure, hepatic disease and hypertension. After treatment has failed the last resort for many patients is organ transplantation. However, as simple as it may sound, there are countless complications involved, as the organ has to be compatible with the patient. The patient will have to remain on medication to lower his immune system response to the minimal for the rest of his life, which can make him more vulnerable to infections.

By the year 2010, over 90,000 people were signed in for the waiting list for a kidney transplant in the US and 3,000 at any given day for a heart transplant. Many patients who have no other choice of treatment wait, and most of the times death arrives faster than the suitable organ.

What if you could build a custom-made organ according to a patient’s need? A group of biomedical researchers at Karolinska Institutet in Sweden have pioneered what can be the first step in the beginning of a science fiction medicine: working with stem cells, which are cells capable of giving rise to any human tissue. They have managed to make a fully artificial trachea from scratch and implant it in a patient with cancer without any immunological reaction. The newly formed organ is built on a PET mold, yes the same used in bottles, which is as anatomically identical to the patient’s actual trachea – not only in shape but also in composition.  The mold is filled with stem cells from the patient himself. Giving rise to a new and fully functional organ ready to be replaced.

The patient who went under this treatment is currently under annual checkups while living a normal life without health related restrictions. This is only the first step, but it is a firm step.

Thanks to Antonio Beltrán Rodríguez for sharing this post with our silverevolution-readers. Antonio is a biomedical student at Karolinska Institutet. Contact: antonio.beltran@stud.ki.se

And tomorrow WALL-E is taking care of you

Nowadays, a lot of research is conducted in the area of healthcare robotics, which has the potential to increase the quality of life for our silver population. Imagine!

I would like to tell you about the examples of New Zealand and South Korea – two countries that are combining their knowledge in order to build and develop something groundbreaking. Here, South Korea contributes from the hardware-side, while New Zealand is busy developing the latest software (check out: HealthBots Project, launched in 2008).

Healthcare robots that can take grandma’s heart rate or blood pressure are the outcome of the research. But besides simple medical jobs, robots can also play a tremendous role in monitoring, as they are able to store and manage the patient’s relevant medical data. All this can make elderly care much more cost-effective.

Another idea is that robots can enhance old people’s quality of live by offering entertainment, e.g. through music, films, games and the use of social media as Skype.

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All this sounds futuristic, but the question is if it is a concept that will be feasible: Will decision-makers be willing to invest in healthcare robotics? And will our grandparents (our parents? we? our kids?) enjoy interaction with robots? A lot more studies have to be carried out in order to find out more about cost-effectiveness, but particularly about interaction between human beings and machines – and thus, about the increase (or not) of people’s quality of life.

Healthcare robots could change lives: http://www.msi.govt.nz/update-me/success-stories/research/healthcare-robots-could-change-lives/ (December 2011)

23 and 1/2 hours

There seems to be one single, simple best thing to keep our lives healthy and to prevent especially non-communicable diseases: a small, but regular dose of physical activity. This is especially relevant for elderly people as they often suffer from multi-morbidity, but could potentially stay more healthy by changing their lifestyles just a little bit.

Wouldn’t it be easy to put eating and sleeping in 23 and 1/2 hours and keep 30 minutes for physical activit? It doesn’t even have to be on a daily basis, but e.g. going for a 30 minutes walk three times a week has already proven to reduce the risk for arthritis by 47%, for dementia by 50% and for diabetes by 58%.

So how about prescribing physical activity? If doctors did that for their patients – do you think it would have an impact on people’s health?

Check out this video by Michael Evans and Mercury Films Inc. http://www.youtube.com/watch?v=aUaInS6HIGo. It has also been posted by the Swedish Professional Association for Physical Activity. http://www.yfa.se/

Also check out Michael Evans’ blog: http://www.myfavouritemedicine.com/23-and-a-half-hours/

U-health in Korea

Our teacher once accused us: “You’re incredible! What you guys don’t find on Wikipedia does not exist in your world – or what?”

Trying to find out more about “u-health”, I remembered that and it made me smile. U-health or u-health care cannot be found on Wikipedia (yet) and on the first sight it does not seem to be on many peoples’ minds in today’s world, but dig a little deeper!

U-health stands for ubiquitous health – omnipresent, universal, ever-present health. Sounds big! And there you go with your online-search… [Small note: I found so many interesting aspects that I don’t know where to start now – so let me just give you a basic idea with this blog post and let’s explore the topic further within the following ones.]

On the Congress on Nursing Informatics 2006 in Korea, u-health did cause lively discussions. The Korean Government had started a project on u-health services for the provision of health care services in the country’s rural areas using the advanced broadband infrastructure (NI 2006).

U-health care is a developing area of technology to monitor and improve a patient’s health status. It uses different environmental and patient sensors to gather data on almost any physiological characteristic to diagnose health problems (Brown et al. 2007). U-health should stand out through availability, transparency, seamlessness, awareness and trustworthiness – anytime and anywhere (Cha 2008).

Many industrialized countries are sitting on a demographic time bomb – facing problems in health care that are related to the growing number of elderly. Their limited resources in health need to be used more efficiently and effectively. So especially these societies could benefit from u-health care and its innovations to reach better diagnosis and treatment. It also has a lot of potential in improving hospital administration and patient management with reduction of medical errors, and in enhancing service quality, communication and collaboration. (Chang) However, at the same time, u-health care confronts ethical issues, e.g. when it comes to trust, privacy and liability, or in combining computer and information ethics with medical ethics (Brown 2007).

Hence, the bottom line is that yes, u-health is and will increasingly be on peoples’ minds (and it will probably soon appear on Wikipedia).

Societies as well as individuals will have to make difficult choices in the future.

1 Korea IT Times offers a variety of more interesting articles by Cha Joo-hak on the topic: http://www.koreaittimes.com/source/cha-joo-hak
2 Brown I and Adams A A 2007. The ethical challenges of ubiquitous healthcare. International Review of Information Ethics Vol. 8. www.i-r-i-e.net/inhalt/008/008_9.pdf
3 Cha J-H (2008). Defining the Perfect Ubiquitous Healthcare Information System. Korea IT Times. http://www.koreaittimes.com/story/56/defining-perfect-ubiquitous-healthcare-information-system
4 Cha J-H (2010)Who Shall Live Better? – Health Care and Socioeconomic Choice. Korea IT Times. http://www.koreaittimes.com/story/8559/who-shall-live-better-health-care-and-socioeconomic-choice
5 Chang B-C ().Ubiquitous-Healthcare Changed paradigm after introduction of EHR. Yonsei University. www.health-informatics.kk.usm.my/resources/2_Chang.pdf
6 NI 2006. The 9th International Congress on Nursing Informatics. Seoul, Korea June 2006. http://differance-engine.net/ni2006blog/?p=22

The Elderly on Building Disaster Resilient Communities in the Philippines

Extreme weather conditions will become the norm in the Philippines, with long droughts and massive floods punctuated by intense typhoons, experts report. The monsoon alone that the country experienced early August  displaced  more than 260,000 people and caused damages to property amounting to an estimated Php 340 million. Communities now face the challenge of adapting to manage and reduce the adverse effects associated with these weather disturbances.

Vulnerable groups are most affected by calamities. These groups include women, children, persons with disability, and the elderly. Given that the Philippines is visited by an average of 20 typhoons annually, and is largely archipelagic, making emergency response a daunting task in far flung areas, each sector must contribute to building resilient communities locally.

In the aftermath of the heavy rains caused by the August monsoon, ACCESS Health International-Philippines organized the webinar, “The Elderly in Disasters” to  begin a conversation on how to care for the well being of vulnerable groups who are displaced in calamities. The invited resource person to speak for the elderly was Mr. Francis Kupang, Executive Director of the Coalition of Services of the Elderly (COSE).

Mr. Kupang gave inputs on Older People’s (OPs) Needs in Emergencies, specifically (1) the situation of OPs during disasters, (2) their needs and the problems they encounter in crisis situations, and (3) how organized OP groups participate in emergency relief services-emphasizing the role of empowered OP groups in building resilient communities.

Older Person’s (OPs) Needs in Times of Emergencies

The salient points shared by Mr. Kupang is that OPs are vulnerable during disasters because of their fragile physical condition and because the setting in evacuation centers are usually not OP-friendly. It is also in the nature of OPs to sacrifice their well being to give way to addressing the needs of the young-usually, their grandchildren or neighbors. Health also becomes a great concern for the elderly during disasters because provisions for their medicines (e.g., for diabetes, or hypertension) are usually taken for granted because priority is given to food and other basic needs.

The awareness of these vulnerabilities have inspired organized local OP Organizations (OPOs) to provide a range of services for their fellow OPs. Some have initiated programs related to livelihood, post-calamity psycho-social interventions, alternative energies, shelter repair, and workshops on Disaster Risk Response (DRR) and building community-based mechanisms in responding to future disasters. Through these efforts, Mr. Kupang noted that OPOs are actively engaged by different emergency service providers including national and local government units (LGUs), and civil society organizations (CSOs)and religious groups who organize calamity relief efforts.

As they continue to participate in building resilient communities, OPOs have formulated recommendations on how to address the unique needs of OPs in emergency situations. Mr. Kupang enumerates the following inputs from OPOs:

• Conduct a Damage Need Assessment (DNA) in partnership with the OPOs in the community;
• Establish coordination or working relations with OPOs in emergency response;
• For national government agencies and LGUs to designate a point person to coordinate all emergency services with OPOs;
• Prioritize  basic needs for food and health  of OPs during emergencies;
• For Government agency and LGU emergency service volunteers to have proper orientation and knowledge of how to address OP needs during emergencies;
• LGUs should develop a comprehensive Disaster Risk Reduction and Management (DRRM) Plan that integrates OP-sensitive policies and measures in emergencies;
• Enchance OPO participation in DRRM planning and implementation;
• Establish baseline information of the capacities, vulnerabilities and needs of OPs at all levels of political units (towns, cities, municipalities, etc.);
• Enchance and / or strengthen the participation of OPs and OPOs in the identification of their problems and needs, and the planning and implementationof community development programmes, including DRRM programs;
• Integrate OP agenda in all levels of government planning and program development structures and processes;
• Building partnership with Non-Government Organizations (NGOs) and CSOs in facilitating the formation and / or strengthening of community-based OPO partners in participatory development practice.

Sources:

Abano. Imelda. “Experts: Extreme Weather Becoming the Norm.” Business Mirror Online 30 August 2012 <http://www.businessmirror.com.ph/home/top-news/32096-experts-extreme-weather-becoming-the-norm>.

Tapang, Giovanni. “Pagasa and Hope.” Manila Times.net 16 August 2012 <http://www.manilatimes.net/index.php/opinion/columnist1/29030-pagasa-and-hope>.

The Philippine Telegeriatric Pilot Project: How did it Start?

Access Health Philippines promotes innovations for the healthcare delivery system so that “all people wherever they are, have access to quality and affordable healthcare”. In partnership with Asian Institute of Management – Dr. Stephen Zuellig Center for Asian Business Transformation (AIM-ZCABT), a Telemedicine Project was formed with an ultimate goal of filling the gaps of widening problems in health access and shortage in the number of health specialists.

Elderly in the Philippines comprises 6.8% of the total population (NSCB, 2010), which means 1 out of 5 households have senior citizens. Older people have special needs and challenges in accessing healthcare services. The physical and cognitive disabilities limit their capacity to travel and access healthcare. They need specialist care providers for the aged. With the lack of access or difficulty to access health care, distance medication can be of great help to this sector of the society. This brought the telemedicine team to propose a start up project for the elderly population which is known as the “Telegeria”.

A Telemedicine team was formed which composed of members from different sectors which have stakes in providing better healthcare for the elderly. They are the Ayala Technology Business Incubation- ACCESS Health Philippines, AIM SRF/AIM ZCABT, ClickMedix, Total Transcription Solution Inc., Coalition of Services of the Elderly, Inc. (COSE) and Alliance of Young Nurse Leaders & Advocates International Inc. (AYNLA).

The Team initially chose to pilot the project in one of the major cities in Metro Manila. However, with a show of hesitation and delayed response from the involved staff, the Team prompted to look for another entity that was willing to adopt the concept and pilot the Telegeria. This is the Home Health Care (HHC) in Quezon City.

HHC specializes in delivering wellness programs and services to seniors and persons with disability in the comfort of their homes. It has a multidisciplinary expert team of physicians, registered nurses, physical therapists, nutritionists/dieticians, medical technologists and trained caregivers. They have been cited as a community resource providing quality home care for seniors across all settings.

HHC agreed to participate in the project seeing the opportunity for a potential innovation that could improve their management system in providing better and more cost-effective health services towards their clients.  A virtual clinic from ClickMedix system was given to HHC for a free trial of one full month. This was applied in their four senior residential facilities.

Check out for the continuation of this project in the coming blogs. This pilot project is being documented by the Program Coordinator and Program Associate of AIM-ZCABT, Davidson Teh and Jayson Soriano, respectively.

Design for dementia

My co-blogger Stéphanie Treschow earlier blogged about an inspiring London-based fashion brand for pensioners by a young female fashion school graduate, Fanny Karst, designing clothes for women three times her age. I don’t know if Hampus Rendmar, a recent graduate from Konstfack (University College of Arts, Crafts & Design) in Sweden, had heard about her and gotten inspired or if we might be seeing an emerging trend among art/fashion school graduates, but his recent graduation project had a related audience – people with dementia.

Hampus feels that interior design at today’s nursing homes lags behind in general and says that dementia patients have the same right to trends and design as does everyone else. He means that many dementia patients must have gotten tired of the old and worn traditional furniture that fills residential care homes today. Therefore he has created a series of furniture targeting this audience with a focus on design that gives a sense of calm and safety. ‘Calm’ is also the name of two chairs in the project, made out of beech and steel, that have been painted in mediterranean green, since it is said to have a calming effect. Furthermore the chairs have a rocking effect, something that research has shown can diminish worry and stress.

What is up next for Hampus is yet to be told, but both visitors at the final art graduation projects’ exhibition by Konstfack and he himself noted that his furniture was widely popular among the audience throughout the whole exhibition. Maybe ‘Calm’ is soon to be found in a nursing home near you.

Source (in Swedish): http://www.dn.se/bostad/han-vill-ge-dementa-god-design

Image source: http://blog.trendgruppen.se/?p=10760

Innovations in Personal Transportation Vehicles: Challenge or Opportunity?

Dean Kamen’s Segway® Personal Transporter (PT) unleashed waves of enthusiasm with its release in 2001 quite frankly as a vehicle for the new age. The self-balancing gyrometers — with their fascinating ability to sustain an upright position — posited a truly bizarre realization for our populace: that times are changing and we need to be ready for it.

This realization certainly does not exclude the elderly population, whom have gone perhaps through the most changes humanity have ever faced in history; with such a dramatic recombination of technology in this past century.

If you browse through search engines and correlate the Segway with the elderly, you won’t find many innovations concerning our aged population. You will find concerns on how the elderly view such devices as the Segway — particularly the operator not being able to control it safely enough in order to prevent collisions with said elders. Forums may reveal that Segways are user-friendly for the elderly if they wish to operate them for themselves, however, safety and bug issues are always notable. It is difficult to find information, if any, regarding devices such as these specifically tailored for those in our population who require more care in their designs for mobility.

Personal Transportation Vehicles such as the Segway have brought a hallmark of inventive changes for the general population. Now, however, with a global, dramatically aging population, focus needs to be directed on the safety and effectiveness of such devices for those with more frail or limited mobility.

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References

http://www.segway.com/about-segway/index.php
http://www.ehow.com/list_6884791_segway-safety-issues.html
http://www.caregivershome.com/news/article.cfm?UID=1097

Happy times a comin’ – majority of to-be pensioners optimistic about their future

Graph description further down.

When my little brother was a kid he used to answer the question of what he wanted to be when he grew up with a firm and certain: ‘a pensioner’. Quite insightful, I must say, for a 5 year-old, but I guess he’d simply realized what so many pensioners-to-be are starting to realize as the day of retirement draws nearer. According to a recent study of the state of the elderly and elderly-to-be in Sweden, the UK and the US, life satisfaction increases steadily from the age of 47 and four out of five in this age group have a positive view of their coming years in ‘life’s third act’. This all the while two thirds of the same respondents fear that the care system for senior citizens will not be able to look after them when their time comes.

The study, presented by Kairos Future in cooperation with a number of Swedish companies and institutions*, is Kairos Future’s fourth in line of studies of attitudes among the baby boom generation. Previous studies being carried out in 1999, 2004 and 2008, they have all followed the same baby boom generation born in 1945-1954. It was first in the third one that the scope was expanded to include also the UK and the US.

Below I share a couple of highlights from the study:

1. Contentedness of life in general increases steadily from the age of 47. Graph above depicting contentedness of life. On the y-axis the scale of contentedness and on the x-axis year of birth of respondent. The arrow points at respondents of 50 years of age. As graph shows contentedness of life increases steadily from just before this point in time (and has a bottom low between age 35-45 (youngest respondents of study were of 30 years of age)).

2. The primary focus of most to-be pensioners is to stay healthy, both physically and mentally. To keep the brain alert and maintain an active lifestyle are top priorities for most baby-boomers. Many also say that they want to keep contributing to society to a larger extent than in earlier studies and statistics also reflect this fact showing that the number of 66-year olds that are still working have increased from 19% (1997) to 36% (2009). This is also reflected in that few of the already retired wish that they would have retired earlier (only 7%), whereas a larger group wish they would have retired later (20%). Which leads me to the last of the interesting findings I have chosen to highlight.

3. Many suspect that society’s elderly care won’t be able to support them, when they reach the later stage of the Third Age. As many as 37% of the baby boomers, and 35% of the 30-55 year-olds doubt this. Kairos Future have created an interesting graph depicting how society’s changing demography in the past century puts a lot more pressure on the working generation in order to sustain those not working, since we both start working later in life, and live longer after retirement today, than 90 years ago. Question is – will society be economically sustainable with people only working one third of their lifetime (as suggested will be the case if the demographic development continues til 2040, without changes to the number of working years)? Or will things have to change, and in that case, how? Is the current debt crisis around the world maybe even an early reflection of society’s debts to its people that is simply running out of hand due to the demographic changes with people living longer and longer? Interesting questions asked by Kairos Future and visualized through the following graph:

Average duration of different periods in life at different points in time (1920-2040). X-axis shows between which ages each period of life approximately runs and the periods (as explained in the top right corner) are, from the top: Childhood, Emancipation, Freedom years, Responsibility years and Old age.

So, to sum it up, an interesting read.

On a final note, I just loved the introduction of the report where they presented a number of the new names that people have started to give to the people living in this new active Third Age: Such as Silver surfers, Passionists, Passioners, SALLIES (Senior Affluent Life Lovers Enjoying a Second Spring), OPALS (Old People Active Lifestyle) and MAPPIES, (Mature Attractive Pioneers). Now that’s some granny!

* For the curious: SEB, SPV, Micasa Fastigheter in Stockholm AB, Apotek Hjärtat, Pensionsmyndigheten and Friskis&Svettis.

Source (where you can also find the report for download (unfortunately only available in Swedish)): http://www.kairosfuture.com/publikationer/framtidens-%C3%A4ldre?pub=Framtidens-%C3%A4ldre

Migration of Korean Nurses like Mama

“Yes, I’m also half Korean. My Mama is also a nurse!” My name is Olivia Biermann. I’m a half Korean German living and studying in Sweden. My Korean-German classmate was not the first person that I met during the past years having the same roots as I do. There are people in my generation whose mothers are nurses from South Korea who found work and love in Germany.

I always considered Mama a brave and curious person – coming to Germany when she was just 20 years old. Her older sister had already been working there as a nurse and Mama started nursing school once she had picked up enough of the German language. Then she met Papa. Mama worked in a hospital until she founded her own elderly care service a few years later. A few more years later she and Papa, who is a civil engineer, initiated a small nursing home, which has become a popular shared flat for 12 lucky seniors in our hometown.

I have always looked at it from Mama’s perspective and understood why she decided to take the leap and come to Germany. I have, however, never thought it through from the system perspective including her decision’s consequence for the Korean and the German health care systems and their silver generations.

The transnational migration of female nurses has long been a reality in South Korea and started with the dispatch of nurses to Western Germany in the 1960’s. This movement expanded as globalization proliferated. However, the reasons for migration of Korean nurses changed over time, and the inside story is not that unpretentious: Within the transforming Korean society, the only accessible profession and specialization area for women was nursing. After the Korean War (1950-53), the country’s government borrowed a development loan from the German government, and as a consequence, Korean nurses and mine workers went to Germany to serve that purpose. Nowadays, Korean nurses are leaving their country due to different reasons, e.g. excessive expectations from the Korean society, dissatisfaction through unemployment, stress, gender discrimination, poor working conditions and low recognition within the hospital.

This worldwide movement is leading to “brain drain” in countries like e.g. South Korea, which can be understood as an emerging social problem. However, there is actually a scarcity of job opportunities for nurses in South Korea, and their migration can also be seen as a phenomenon of the opening medical market, a solution to reduce unemployment and to acquire foreign funds to overcome the foreign exchange crisis. Finally, it gives those migrating nurses the chance to live in better conditions, earn a fair wage and fully express their capacities.

Advantageous brain drain or not – the wave of migrating South Korean nurses is getting bigger. Therefore, the meaning of today’s labor migration for the respective health systems should be studied in more depth. It is about finding out more through quantitative and qualitative studies about the releasing and absorbing countries, the migration systems, and of course the migrating individuals with their own personal history and identity.

As medical sciences advance and people get older, and thinking about Mama: Clearly, Mama is doing good for the demographic changes in our hometown, but how about her South Korean home which is facing similar challenges? How can the migration of nurses be in favor (or not) of the demographic change and health care?

Literature: Ga young Chung (2006). Transnational Migration of Korean Nurses: Labor, Gender, Global Migration – Case study of Korean Female Nurses, Working in Australia. Asian
Culture Camp: “Doing cultural spaces in Asia”. Session 15: “Global Contestation over Ecuation and Labour Market”. Yonsei University, Korea.

Its hard to match the care for our seniors

Be it organizing activities with the aim of promoting active lifestyle, improving assistance provided for the aged, or getting senior citizens to volunteer, the Community Development Councils (CDCs) in Singapore might just have it all. In Singapore, the CDCs aim to work towards a single goal: to champion social support for the silver population. In recent events, the CDCs organized “Caring for the Silver Community” project, where its main focus is on senior citizens aged mainly 65 and above. Studies have shown that by 2030, the amount of such senior citizens in Singapore will triple to about 900,000.

The trends of seniors that are living alone are on the rise, and many of whom face the risk of social isolation. In order to tackle such risks, the government sets aside more funds for the long-term care sector and also encourages families to continue to care for the seniors living with them. Such initiatives by the government through CDCs aim to raise awareness and engage the community in helping to enhance social support programmes for the seniors.

In the recent years, the CDCs have launched quite a number of programmes- one of which is known as a fall prevention programme, with a main aim to help seniors live independently in the community. The CDCs also work hand in hand with the local colleges and have helped to install safety features for close to 3,000 elderly beneficiaries. In the years to come, we can also expect a higher range of services to be provided by the CDCs.

This can be seen as a great initiative by the community to provide social care for the seniors, as well as bond and socialize them with other members of the community.

Source: TODAY newspaper, http://www.cdc.org.sg/

Image source: http://news.xin.msn.com/en/singapore/article.aspx?cp-documentid=5902349

Japan – a country of contrasts

”There are no children on the streets. No pregnant women. Of course you notice it!” Nhat Vuong, social entrepreneur and Founder of i-kifu shakes his head. Japan is not an aging society, in many aspects it has already aged. But as Nhat points out, the elderly still have money. They get care. A report from the Japanese Research Institute, 2008, on Household Expenditures supports his statement. The household spending power is redistributed from the young to the elderly. But the question is how long the economy can cope with a hastily declining number of workers in the national work force.

As Nhat points out, people are not that engaged in giving for the cause of the well-being of the elderly. If they give to society, they prefer to look at investments for the future, supporting children, education, the environment. The elderly will need support but they are not seen as investments.

The reason to why we meet with Nhat, a social entrepreneur based out of Tokyo since 5 years back, is to learn about the mentality of the young in Japan. The mentality of the entrepreneurs, the shakers and movers. Nhat himself is the founder of the i-kifu, meaning ”I donate” in Japanese. He has been working on the crowd funding venture since 2007, to give people the opportunity to achieve a social impact through their social engagements. His venture hands out karma points that can be exchanged for rewards to people that do good; either by donations or volunteering.

Nhat’s personal story is fascinating. Following the end of the Vietnam war, Nhat’s parents fled Vietnam in a boat and he was born in a refugee camp in Malaysia. From there his family was given asylum in Switzerland, with the help of the Red Cross, and Nhat enjoyed a safe upbringing just like any other child in the stable economy of the Swiss. His parents would mention to him how lucky he was that he could just go to school, not having to work, but the concept of poverty was hard to grasp. The only comparison he had was with his Swiss peers and just like them he desired the latest toys and the nicest gadgets. It was when Nhat for the first time visited Vietnam, 15 years old, that he was confronted with social injustice and extreme poverty. It was then that he realized that he wanted to make a positive social contribution to the world.

After finalizing his studies in Switzerland Nhat moved to Japan (mostly for love), started looking for job opportunities in the digital sphere and soon saw the opportunity to connect his skills in IT, marketing and gamification (peoples’ addiction to games and the reward systems these offer) with his social impact aspirations. The idea of i-kifu was born and now, some time and a lot of hard work later, Nhat has 25 Non-for-profits that share their projects through his site. Several socially minded businesses support the platform. The traffic to the site is growing even though the concept of crowd funding and donations is much less common than in other markets. In the US, for example, there are over 1 Million Not-for-profits whereas Japan only has 60 000. After the earth quake and the Fukushima disaster this is slowly starting to change, both in the social scene and in Japan’s orientation towards entrepreneurial ventures.

”Japan is waiting for an awakening. Some people were hoping that the earth quake would have the effect but that still remains to be seen. People live in invisible prisons, entrepreneurs and innovators are held back by social expectations- you are not solely responsible for your own success or failure, your family and friends share the shame if you don’t succeed. The circle of responsibility is strong and rigid. That is why it is difficult for Japanese people to try something new. The risk is too big”.

“When you approach someone with a really great idea the first question is: Has this been done before? Not? Well, please come back when a large corporation has tried it and it became really succesful. The entrepreneur scene is not easy. There is a lack of role models and the school system still focuses on training workers for long-term positions at large corporations”. But Nhat is optimistic. And determined to work the system. He says: “If I can make it work here, then I can succeed anywhere. Plus, as we learned from Steve Jobs, if you only ask people what they want and give it to them you will never reach the really groundbreaking innovation.”

Nhat also mentions the island effect; “Everything is so easy and accessible to the Japanese, they don’t really need to travel overseas or to learn English. Even if Japan was heavily dependent on technology export for a long time, cars and electronics, they themselves did not embrace technology at the same rate. Despite high-tech innovation in some Japanese corporations, there are still offices in japan that use their fax machine actively.” A country of contrasts, as Nhat describes it.

And the vision for the future? “The era when Japan thrived is gone. There is no longer time for time-consuming, hierarchical decision-making and deeply anchored decisions. Now the speed of technical development requires that companies try, fail, succeed, iterate faster. In previous times it could take a Japanese company six months to reach a decision, now, in six months, innovators from China and India would have rolled out the product already, succeeded or failed and moved on. That’s how innovation is achieved nowadays. Trial and error. Fast. Not processes with full internal consensus. Japan needs to embrace this. Iterate faster.”

Nhat pauses and formulates his conviction: “Japan has a huge potential. The people here are extra-ordinary. I have seen people achieve here what I didn’t think was humanly possible. They can do it. They truly can. With the right support they can achieve anything.”

Music Therapy: A Chronic Care Paradigm

Could music therapy be used for treatment of chronic conditions? Could it even prevent them from arising? Let us explore.

The biological effects of music therapy through clinical research have been explored before the turn of the century by GR Watkins of University of Illinois at Chicago, USA. In 1997, he both reviewed and confirmed the usefulness of the effects of music therapy on anxiety, blood pressure and heart rate.

Taking into consideration the death tolls from cardiovascular disease — the largest worldly contributor to chronic disease deaths — we need to find ways to maintain a healthy heart. We definitely can – for example – reduce our trans-fatty acids intake, but there are several pieces to the puzzle. Let us see if anything more recent has discovered similar phenomena as was discovered by Watkins.

A meta-analysis in year 2012, conducted by RS Loomba et al., apparently discovered the same phenomena as Watson’s findings, but here they report major effects. They mention the purported effects of music therapy on relieving anxiety and statistically reveal significant decreases both in systolic and diastolic blood pressure as well as heart rate. With these findings, further studies should triangulate these effects of music therapy after being incorporated into chronic disease prevention and chronic care management  programs. Finally, allopathic facilities should aim for integrative care initiatives and involve music therapy as part of holistic treatment — particularly for those who seek complementary or alternative modes of treatment.

References

1: Watkins GR. Music therapy: proposed physiological mechanisms and clinical implications. Clin Nurse Spec. 1997 Mar;11(2):43-50. Review. PubMed PMID: 9233140.
2: Loomba RS, Arora R, Shah PH, Chandrasekar S, Molnar J. Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis. Indian Heart J. 2012 May-Jun;64(3):309-13. PubMed PMID: 22664817.

Babushkimania – Russian grannies to take over Europe’s music scene?

In times when all of Europe (and some of its neighbouring countries) are preparing for the musical get-together of the year, The Eurovision Song Contest (ESC), Russia is generally a country to look out for. With a track record of ending among the top three in five of the past 11 years and a general strong voting base in the former Soviet Union they often bring an important contribution that’s considered an odds-on from the start. (Eurotechno or grand ballads with figure ice-skaters or ballet dancers usually being the winning concepts.) Nothing saying that that would have changed for this year, and many still saying they’re just as much of a favourite this year as other years, but you could definitely say they surprised many when bringing forth this year’s contribution.

Timely enough for the European Year for Active Ageing and Solidarity between Generations (that I blogged about here), they’ve namely selected a group of 8 grand-mothers called the Buranovskiye Babushki (literally ‘Grandmothers from Buranovo’) that with their ethno-pop style out-performed former ESC winners Dima Bilan and T.A.T.u with almost 10 points by the public vote in the Russian national song selection. With most of the group being 70-80 years of age, only 6 out of the 8 grannies will be performing in Baku, Azerbadjzan next week when the competition starts with the semifinals.

However it ends up going for Russia’s new grannie stars, I still think their initiative is admirable and the fact that Russia ended up voting them winners a true mark of Solidarity between Generations, in its very own special way.

See them perform their winning song here:

The effects of ginkgo extract on dementia

More than half of the elderly with dementia are over age 80 in high-income countries. Alzheimer’s — a purportedly incurable disease starting with mild memory loss and ending with severe brain damage and death – is the most common form of dementia. Indeed, progress for treating such conditions has not had much haste. Perhaps something is hiding within the alternatives — some formula or combination that may change a dreary caterpillar into a fluttering  butterfly. Antioxidants, Asian ginseng, cat’s claw, ginkgo, and grape seed extract have all been proposed as alternatives for treating Alzheimers and dementia. Let us, for example, focus on the extract from the ginkgo biloba leaf from the ginkgo tree — a unique plant species widely known and particularly respected both for its use in traditional medicine and for its symbolism in China, Korea, and Japan.

In addition to its explored potential effects such as improved blood flow, prevention of oxidative cell damage from free radicals (i.e. “aging”), and prevention of platelet aggregation and blood clotting, ginkgo has been purported to act with nootropic, or memory enhancing, properties. A double-blind, randomized, placebo-controlled study conducted by the National Institute on Aging and the National Center for Complementary and Alternative Medicine (NCCAM), of the National Institutes of Health, USA, found some promising results for ginkgo extract as treatment for dementia. Ginkgo biloba extract in this study was able to show an indication of reduced risk of progression of dementia and a smaller decline in memory when compared to the placebo group. It followed 118 volunteers age 85 or older who used 80 mg of ginkgo extract three times per day over a time period of 42 months.

To conclude, ginkgo extract has large potential for treating dementia, but an evidence base just as large is required. Broad clinical trials must commence to address the effectiveness of this treatment.

References

NCCAM (2012) Alzheimer’s disease and CAM. Retrieved May 9th, 2012, from: http://nccam.nih.gov/health/providers/digest/alzheimers.htm

NCCAM (2012) Pilot study provides new insight on effect of ginkgo extract on dementia in the elderly. Retrieved May 9th, 2012, from: http://nccam.nih.gov/research/results/spotlight/022608.htm

Involving eHealth: How health care leaders may envelop chronic care management strategies with health information exchange directives

As chronic diseases are becoming a rapidly growing problem in the world, methods to manage and present medical information both to care providers and patients require several avenues of thought. Janet Marchibroda, MBA is the chief executive officer of the eHealth Initiative and its Foundation — both independent, national non-profit organizations based in Washington, D.C., whose missions are to improve the quality, safety, and efficiency of health care through information and information technology.

Janet Marchibroda has devised three plans to bring together chronic care management strategies with health information exchange directives: 1) Leveraging Health Information Exchange Efforts for New Chronic Care Management Programs, 2) Augmenting Existing Chronic Care Management Strategies with New Data Sets and Services from the Health Information Exchange, and 3) Extending the Ability to Communicate with Care Providers and Patients. To summarize these three strategies, the first implies by asking those involved in chronic care management what tools are already existent or lacking, e.g. ongoing health information exchange initiatives, if any; types of data being exchanged and to whom, and so forth. In other words, a system must be put in place to set a helping “leverage” in managing chronic diseases. Secondly, the next paradigm focuses on improving an already existing chronic disease management initiative. Missing data elements may be included here, as well as methods to improve the measurement of quality of care and cost effectiveness. Thirdly, the final theme emphasizes an active patient-practitioner relationship, and methods should be identified for the patients themselves to be actively involved with the regimen of treating their diagnoses and preventing the onset of worsening or secondary conditions.

With this in mind, there are also some recommendations that may improve chronic disease management. Databases of eHealth ought to have a storage of health indicators, determinants, and conditions. Certain conditions could each have a specific variable (with a proper categorization, i.e. what type of condition is it, e.g. autoimmune, etc.) assigned to them and a constantly updated list of  symptoms (entered and updated by the care providers). The database could draw data of symptoms from each patient with a specific condition, and this should be accessible to health care providers to give them more clues for an accurate diagnosis and for the prevention of misdiagnosis. Finally, each of these specific conditions assigned with a variable should have a list of viable treatments and its strengths and weaknesses. These treatments could be taken from studies done in medical databases, i.e. PubMed, The Lancet, and contain and explore as many treatments as possible — both conventional and unconventional. The care provider informs the patient and/or family of the patient not only with the type of treatment they deem the most effective, but also viable alternatives. These methods of managing of eHealth may lead to effective treatment and prevention of chronic diseases.

References

Marchibroda JM (2008) The Impact of Health Information Technology on Collaborative Chronic Care Management. Journal of Managed Care Pharmacy 14:2, s3-10. Retrieved Apr 27 from: http://www.amcp.org/data/jmcp/JMCPSupp_March%2008.pdf

Discoveries of the effects of Tibetan monk practices: Can meditation be useful in addressing psychological stress and physiological well-being?

(Image retrieved from the Harvard Gazette Archives, April 18 2002 Issue)

Life adaptation – particularly to a brave new world of ever-new gadgets and gizmos – is particularly relevant for the aging population, requiring fundamental mechanisms apparently implicit in the human mind in order to prevent and treat the potential dangers to mental and physical well-being as caused by psychological stress and the fight-or-flight response.

Author William Cromie of the Harvard Gazette in the April 18, 2002 issue revealed one such implicit mechanism to counteract stress, accessible within the human mind. This article, titled, Meditation changes temperatures: Mind controls body in extreme experiments, revealed the works of Dr. Herbert Benson, Associate Professor of Harvard Medical School. Beginning in the 1980’s, with support from His Holiness Dalai Lama, Dr. Benson has been conducting metabolism experiments on Tibetan monks practicing g Tum-mo meditation from Buddhist monasteries in remote areas of northern India. Obstacles due to low funding proved difficult for continued research – including the lack of electricity in the Himalayan areas – until the turn of the century, where g Tum-mo monks were brought to a Guinness estate in Normandy, France, to be involved with another temperature experiment.

Studies which commenced in the 1980’s and on have shown that these monks could lower their metabolism by 64 percent and reduce oxygen consumption by 17 percent just by simple meditation. This may lead to less free radicals in the body, thus less oxidation, and thus less “aging.” The g Tum-mo technique is known for its by-product of producing large amounts of body heat still unexplainable today. Through g Tum-mo meditation, Dr. Benson recorded that monks could raise the temperatures of their bodies to breathtaking amounts of heat – with increases as much as 8.3°C in their hands and toes. Large, chilled, wet towels placed on these monks’ bodies which would normally produce a shivering response did not produce noticeable shivers, and proved to be dry within an hour. Techniques such as g Tum-mo could prove priceless to preventing the onset of illnesses for the elderly – whom are more susceptible to the cold, thus leading to a weaker immune system, which may lead to considerable conditions, i.e. pneumonia.

Dr. Benson – inspired by meditation – has developed the renowned “relaxation response,” published as a book over 40 years ago but used widely today. This technique counters the stressful state of mind and targets physiological equilibrium. The components involve choosing a word, sound, prayer, or phrase, relaxing the body, and letting any thoughts that come to mind simply pass by while continuing to repeat the chosen saying. It is regularly recommended in treating patients suffering from heart conditions, high blood pressure, chronic pain, insomnia, and many other physical conditions. Requiring only minutes to learn and just between ten to twenty minutes of practice twice a day, it can bring cost-effectiveness in all forms of public health ranging from general health clinics to those focusing on elderly care. Although g Tum-mo meditation – a well-guarded secret by the Tibetan monks who meditate hourly per day – may require years to learn and cannot be easily performed by the layman who would meditate 10-20 minutes twice a day, it is shown that simple meditation such as the relaxation response is all that is required to produce physiological, DNA-affecting changes in the body to alleviate the stressful fight-or-flight response and balance the body by putting it into homeostasis. To summarize, there is an indication from the trends of experiments that study some forms of meditation as practiced in Tibet that there may quite be something to the expression, “mind over matter.”

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Dr. Benson’s experiments with Tibetan monks

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ABCNEWS.COM – Simple relaxation techniques to help after a hectic day

via Easy Ways to Take the Edge Off.

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References

Cromie, William J. 2002. Meditation changes temperatures: Mind controls body in extreme experiments. Harvard Gazette. April 18 2002 Issue. Retrieved April 12^th, 2012 from http://news.harvard.edu/gazette/2002/04.18/09-tummo.html

Time to spin the wheel: A call for integrative medicine initiatives

With the push of Dr. Andrew Weil of the US – establisher of the field of integrative medicine (IM) — we need to move from a system of mere disease management to one that keeps people healthy, and, importantly, to have them stay that way. Deterioration of health only implies more work for those whom are part of care. If the elderly, for example, are able to take better care of themselves in this coming age, exhaustive effort will not be required for the dwindling amount of elderly care providers in contrast to the rising elderly population. There may quite be something to be found from a holistic perspective. One can, for example, take an antibiotic that rids away a pathogen, but it can very well come back again with a biological system somehow suppressed. What problem caused the initial unbalance from homeostasis? Was it the pathogen that was the primary problem, or rather, did it take advantage of a weakened system hindered by a certain state of psychology, mental/physical stress, and/or inadequate nutrition?

The path to finding the answer is a complex one. However, as IM uses so many perspectives and does not centralize treatment, this scientific, holistic process aims for both treating a condition and preventing it from arising again. This includes not only treating individuals by getting as deep as the bones of their body — in other words, physically — but to affect the whole core of their consciousness and unconsciousness — mentally and, arguably, spiritually. As several unconventional modes of treatment are spiritual, the very thought of integrating them into science brings up a vast dilemma. To even utter the word “spiritual” in the common scientific community is to be met as a black sheep, and thus, blunt skepticism has always been the barrier to the emergence of IM. The importance behind this is to understand the science behind the spirituality and to translate that language into what may be more “proper” to say. What an energy medicine practitioner might call the person’s “aura” may very well be the same thing as that person’s electro-photonic vibration response or “energy field,” present in all life forms. Methods to see this bio-electric field have been present now for over three-quarters of a century, starting with the Russian inventor, Kirlian; with more reliable adaptations present through Dr. Korotkov. It has been purportedly discovered in the late 90′s (see here, page 7) — not of course revealed through conventional science — that this bio-field appears to express our condition of health and went even so far as to diagnose patients based on their bio-field expression as based on the color and shape of the phenomena. This has also been purported by Dr. Ignatov of Bulgaria, whom has revealed highly controversial results regarding the bio-field phenomena of energy medicine practitioners.

With such a deep delving down into the rabbit hole and due to the way health care can be radically changed as a result, it can be understandable why IM has not been explored conventionally. However, this borders on ignorance, and the hindrance in exploring the mysteries of “those other treatments” is truly, at heart, unscientific. It is the heart of science to constantly explore the unknown; to challenge, test, or alter existing theories, and to aim for the discovery of those more universal. There is surely a lack of this regarding IM. For example, the National Institute of Complementary Medicine in Australia states,

Notwithstanding these factors, there is no current profile on integrated care initiatives; compendiums of examples and their benefits or information collected on a regularised and agreed basis to enable trends to be monitored and comparisions of health and cost benefits to be made.   Yet this information is required to inform future research choices and priorities as well as clinical practice.

Henceforth, with already-present tools available to quantify holistic treatment, a call should be sent forth to researchers and policy- and decision-makers in healthcare to create initiatives for researching and promulgating an evidence base to evaluate the effectiveness of integrative care.

References

Integrative medicine
http://www.relaxedpolitics.com/2009/08/integrative-or-holistic-medicine-the-future-of-health-care-a-debate/

Kirlian photography (Korotkov)
http://kirlianresearch.com/

More advanced stages of Kirlian photography and discoveries (Korotkov)
http://thiaoouba.com/choice.pdf

More discoveries from Kirlian photography (Ignatov)
http://www.reikiprofessionals.com/uploads/First_results.pdf

National Institute of Complementary Medicine
http://www.nicm.edu.au/content/view/59/57/