Archive | July 2012

Nutrition during Old Age


Source: jessnutrition.blogspot.sg

Old age is irreversible but we can ensure that even in our grey days we remain healthy and active. Nutritionists say, eating right can go a long way in helping maintain a more active and productive lifestyle.

As a person ages, the basal metabolic rate (the rate at which the body consumes energy) declines. This would reduce the need for energy in our diets. If we continue usual consumption of energy rich foods such as cereals, sugar, oil, butter etc. chances of developing obesity and subsequently diabetes, heart ailments etc. would increase rapidly. In fact these high energy foods are known to make one more sedentary therefore perpetuating the problem. So, these should be consumed in moderation. The requirements of proteins for the elderly are the same as that of a young person. In fact as some of the tissues degenerate with advancing age, it is good to consume proteins in the appropriate quantity. This will help provide the building blocks to regenerate some of these broken tissues and therefore maintain ones’ body. The sources of proteins are milk and milk products, meat, fish etc.

Carbohydrates are one of the major sources of energy. As energy requirements decline so should the consumption of sources of carbohydrates. Cereals in the form of rice, bread etc. should be reduced. One should move from consuming refined carbohydrates to more complex forms such as whole grains and fruit and vegetables. Another source of energy is fat. Though, there is no need to reduce the amount of fat in the diet (30% of all energy should come from fat), but if one is obese, it is good to cut down the intake. Also modification of the type of fat consumed is important. Saturated fats such as butter should be avoided while fats from fish sources would be more useful.

Calcium and vitamin D are critical for the aging body. Bone demineralization, which leads to weak bones, needs to be prevented and calcium and vitamin D are important for bone health. Milk and milk products should be consumed in moderate amounts to ensure a good supply of calcium in the diet. Sun shine is the best source of vitamin D but in case some elderly are confined indoors, supplements should be provided. Vitamin A, E and C are important to maintain immunity as well as prevent heart ailments and cancer by providing anti-oxidants. These vitamins are available from fruits and vegetables and therefore these should be consumed aplenty. Vitamins also provide the necessary fiber to prevent constipation. The last and one of the most important things is to ensure a good intake of fluids throughout the day. They keep the body clean and hydrated.

Some quick tips:

  1. Eat a variety of foods with lower amounts of carbohydrates and fats and higher amounts of fruit and vegetables.
  2. Break meals down into smaller sizes to aid digestion.
  3. The consistency of the food should be modified based on dental health.
  4. One should be physically active and should make at least some light physical activity a part of their daily routine.
  5. Start healthy eating earlier in life to ensure good health during old age.

Further reading

  1. Dr. Seema Puri, Nutrition in Old Age, Helpage India.
  2. http://www.who.int/nutrition/topics/ageing/en/index1.html
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Willpower: A tool for elders to reinvent themselves

Today gives rise to a new state of mind for the baby boomers. As our elderly are expected to retire during ages 60-65; start playing golf, cleaning the garage and priming up the garden, it brings forth question: Do they want to do this for the rest of their years?

According to Global Action on Aging (GAA) of New York, the elderly appear to have a strong incentive to contribute to society by having a will to stay in the workforce. Trends have shown that working men between ages 62 and 74 in the past decade have risen by about 40%, whereas working women in these ages and in this same time period have risen by 60%. A large proportion of elderly in the States report low amounts of savings, and though while financial reasons are a large contributor to the elderly staying in the workforce, apparently it is not the only one. “All the research we’ve done shows that, even when the money issue is put aside, people don’t want to do nothing.” – Tammy Erickson, author of “Retire Retirement: Career Strategies for the Boomer Generation” (Harvard Business School Press, 2008)

“Call it a second phase, an encore, a reinvention. Just don’t call it retirement. More people are entering their mid-60s — stuck, perhaps, with dismayingly skimpy savings accounts, but blessed with sound health and many years ahead of them — and deciding that retirement doesn’t top their agenda.” – Katy Read, The Courier-Journal

“My speculation is that the more mature the individual, the more self-reflective or self-aware they are, the more likely to recognize that they need to retool, to kind of reinvent themselves.” – Jeff Hudson, program director for continuing education and customized training at Normandale Community College in Bloomington, Minnesota

Perhaps the wave of baby boomers caused a silver evolution and revolution in and of itself; consciously, or unconsciously, as a self-protective mechanism by our elders themselves, to help contribute to the aging world. If it be conscious, however — striven with willpower — it will probably make the outcome much more successful. Willpower is the tool needed to reinvent yourself for a reinventing future, whether is it re-educating yourself, taking on a new initiative, or quite simply charting out a new path to meet your dreams.


References

GAA
http://www.globalaging.org/about_gaa/mission.htm

People Don’t Want to Retire: Many Seniors Prefer Reinventing Themselves
http://www.globalaging.org/elderrights/us/2012/Reinvention.html

Former Seattlites are Reinventing Themselves in the Hills of San Miguel
http://www.globalaging.org/elderrights/us/2008/SanMiguel.htm

The US Affordable Care Act of 2010: It’s Implications for Elderly Care

In no other country does public responsibility for health costs provoke such emotional chanting of ideological warfare. While many European countries have resolved and accepted the notion of public intervention in healthcare, after many failed attempts at reform and countless public debates, the issue of US Government involvement in the healthcare sector has clearly still not been fully resolved. Not only that, but this very issue affects the very nature of the American psyche!

‘Warfare’ is the correct word to use as EVERYONE in the US seems to have an opinion on the role of the Government in health! Whether it is seen as endangering the American free-enterprise system and the doctor-patient relationship or as a social and ethical obligation to make healthcare accessible and affordable (we are not even talking about what people think about the US Affordable Care Act of 2010 yet)!
Why has the Government’s role in health care become such a contentious issue? Why is there such a lack of trust of the Government and politics/politicians in general? Due to space and content restraints, I will leave you to ponder this as I address how I think these underlying issues factor into the implications for elderly care as outlined in the 2010 Affordable Care Act (ACA) and beyond.

First, it is worth mentioning that ACA does not make an attempt to overhaul the existing US health care system. In its essence, ACA essentially maintains the private, market-based health insurance system. It keeps the existing Medicare programme intact (albeit some incremental changes), it expands Medicaid eligibility for to cover a greater number of legal residents (up to 133 percent of the federal poverty level (US$14,404 for a single adult or US$29,327 for a family of four)) and also includes provisions such as: (1) an individual mandate, (2) regulations, (3) subsidies, and (4) adjusted community premium ratings.

So what does all this mean for the elderly?

Benefits pertaining specifically to the elderly are introduced in a number of sections. Some benefits address gaps in Medicare, and others are introduced as standalone programmes. For example, the ACA includes financial incentives to reduce healthcare acquired conditions in the hospital setting and to reduce readmissions of Medicare patients to hospitals after discharge (hospital readmission programme). The ACA also introduces voluntary, self-funded, long-term care insurance through the workplace for the elderly and for people with disabilities. It allows Medicare recipients, who fall under the “donut hole,” to get a 50% discount on brand name prescription drugs and to get access to free prevention and wellness services each year. These are just some of many examples, but from these there are key takeaway points worth pondering.

Firstly, many of these programmes will not come into effect immediately. Rather implementation is set to take place over a period of years, through 2019 (the phasing out of the “donut hole” for Medicare Part D coverage, is an example).The challenge with having implementation set further into the future is that it subjects the policy to a problem known as the saliency bias (where the urgency to take action diminishes over time). Given the fact that this issue also is unresolved and evokes so many mixed emotions from such a wide variety of stakeholders, suggests that the decision to delay ACA implementation introduces higher political risk: it creates the opportunity for progress to be circumvented, changed, potentially even reversed!

Secondly, in addition to delaying implementation, congress left many specific decisions and rulemaking on ACA for the regulators to establish. In many respects, this makes sense. Compared with congress, regulators are better equipped with the technical expertise to address this issue and are in a better position to ‘theoretically’ make technical decisions devoid of politics. However, one only needs to see what is happening with Dodd Frank implementation to know that in actuality, similar to the finance sector, leaving specific decisions on ACA for regulators to establish at a later date, may not work as intentioned in practice. This can hold true for a myriad of reasons: health regulators are not completely immune to lobbyist influence, there tends to be a revolving door of regulators from the industry itself and the decision to do so can lead to the unintended effect of diminishing the sense of greater accountability to the public to ensure effective health system reform.

Thirdly, while ACA represents a potential tool for the elderly to receive more comprehensive benefits and access to care, the Act takes minimal steps to reduce the many moving parts of the system, put more bluntly, its complexity. The lack of standardized rules regulating payment, coverage and provision, translates to an operational challenge to beneficiaries, especially the elderly. It will require them to single-handedly navigate and coordinate their services as they move from one benefit programme to another. Understanding ACA remains daunting to me, and I am a mid-career policy analyst, so you can imagine, how much more challenging and confusing it must be for the elderly to fully comprehend and experience! The sheer complexity, fragmentation, distrust and differing opinions on ACA, open the benefits provided to misunderstanding, misrepresentation and unintended consequences. On the latter, ACA may lead to the disruption of care services as eligibility requirements for different programmes may differ. Reimbursement differences may affect incentives for the provision and utilisation of services. To elaborate on this point, George Washington University’s School of Nursing Assistant Research Professor Ellen Kurtzman, lists some examples of unintended negative consequences in provision of care for the elderly under the ACA in an article (I have chosen to just list two of them):

• The National Pilot Programme on Payment Bundling reimburses a fixed amount to a hospital system for an episode of care and is aimed at delivering high quality outcomes at lowest possible cost, while avoiding post-acute stays and preventable rehospitalisations. However, the programme does not include bundle payments for long-term services and support so there are no incentives to coordinate care before or beyond the bundle.

• The Community-Based Care Transitions Programme, allow hospitals to serve as the “hubs” of care. However, it may prevent frail older adults who are not hospitalised or who live outside the geographic regions served by these organisations to have adequate access to transitional care services.

Thus, despite its benefits, ACA does seem to further complicate healthcare financing and delivery in the US health system. The sheer complexity of different programmes and initiatives fragments the system, causes greater room for misconceptions and misinterpretations and introduces some unintended consequences, all to the detriment of serving the population at-large.

The US has gotten itself in a bit of a muddle: while many Americans believe healthcare reform towards universal health coverage is needed to allow healthcare to be available at a price that is affordable, due to the unresolved issues surrounding the appropriate role of Government in health, everyone has a differing opinion on how to get there.

By the current nature of ACA’s design, it is clear that policy-makers made some sacrifices. In the need to design a policy that will pass congress (i.e. to maintain status quo, not offend too many stakeholders), ACA ended up not really doing much to fundamentally address the much needed health system overhaul that underlying dynamics in US population structures, costs and epidemiological conditions, require.
What will it take to bring about the needed change in health reform in America? Will the land of opportunities continue to allow itself to be mired in this ideological policy trap, amidst a clear need for reform?

References:
Email from Joe Albers Summarizing a Policy Analysis Brief of Affordable Care Act of 2010 dated July 17, 2012.

Medicalxpress. 2012. “The Affordable Care Act Could Have Negative Consequences for Elderly Recipients” By Ellen Kurtzman, June 22, 2012 http://medicalxpress.com/news/2012-06-negative-consequences-elderly-recipients.html#jCp  Accessed July 25 2012

Starr, Paul. 2011. Remedy and Reaction: The Peculiar American Struggle over Health Care Reform (Yale University Press, October).

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.

An example of social isolation prevention

The issue of social isolation among elderly people is a great worry and needs to be addressed. Statistics show that a quarter of 70 to 85 year-olds stay at home all day throughout the whole week except for short outings to the shop or for a walk. The corresponding figure in the younger group of 55 to 69 year-olds, is fourteen percent. The high degree of social isolation is often due to their own and their friends’ reduced mobility. Internet has become a natural way of staying in touch with old friends and connecting with new ones for most younger people but the uptake of interactive web offers among elderly is very small. This is largely due to the fact that most of what is offered is designed for experienced web users and pay little attention to the needs of the elderly who therefore feel confused and unable to cope.

 

One of the European Community’s great initiatives is the project Silvergame – a multimedia platform stimulating elderly to play and interact with each other and get in contact both virtually and in reality. The project is under development and technological advances in ICT are utilised to create an interactive platform. It is developed during a 26 months period in close collaboration with end users, psychologists and sociologists to enable the creation of a platform that takes into consideration the learning process and needs of older users. The project will be designed in a way that allows people that share the same hobbies and passions; such as singing, driving or dancing to connect with each other. Some examples of different applications on the platform are “The multimedia driving simulator for cognitive training”, ” a virtual silver song club”, “dance and fitness training”. Additionally, there are information services and contacts, such as travelling or dating services integrated on the platform. There are also offerings of real events such as concerts, song clubs or dance groups in a near location. All interaction includes videoconferencing and the thought is that friends and family shall exchange their experience before and after gaming.

By bringing web-based information services to the elderly people’s homes, social isolation is prevented and an active and social daily life is fostered.

Source:
http://www.silvergame.eu/

B. Seewald, M. John, J. Senger, A. N. Belbachir: Silvergame – A project aimed at social integration and multimedia interaction for the elderly

What do you want to be when you grow old?

Do you remember back in the day with vague glimpses of memory when your teachers would ask you, “What do you want to be when you grow up?” Naturally, it would be normal to think about all kinds of professions swimming in your mind.

How different would it be, however, if we ask the question, “What do you want to be when you grow old?”


It may be quite hard to imagine an answer like, “I want to be a monster truck rally daredevil,” as most might imagine themselves lounging in bed, nearly a century old, ponderously trying to recall in the noon what they had for breakfast a mere few hours ago. This is probably why our teachers never bothered to ask the question.

Unfortunately, if you wish to have it revealed how many minds pondered over this question by briefly swimming in the external consciousness of mankind, i.e. surfing the internet, you may not find much more than Adam Sandler’s “I Wanna Grow Old With You.”

How would our world view that question if our elders are given voices? What is life like for them, and is it really all that bad? Did they want to end up where they are now, or had they wished they thought of it? These types of questions with their answers could, for example, help prevent waves of mid-life crises. Perhaps when we think about questions such as these, more waves of innovative technology, paradigms and solutions may arrive to address fields concerning the elderly.

“What do you want to be when you grow old?” I want to be a wise man; healthy, and full of spirit; reading several books a week and even playing chess and tennis regularly. Lastly, I would wish to pass on whatever knowledge I have to my children so that they, one day, could do the same.

It is right to ask the question, is it not? We will all get to that destination in one way or another. I daresay that – for me – it will be fascinating to experience how it all will turn out.

So then, now it’s your turn. What do you want to be when you grow old?