New Horizons Summer 2009

village care of new york SUMMER 2009

summer 2009

F E AT U R E S

NewHorizons Editor-in-Chief

Engaged Aging

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V O L UME 4 , N UM B ER 1

8 More Than Just a Companion BY Samantha Thacker

how pets help us stay healthy and give us purpose

By Emma DeVito, President and CEO

Louis J. Ganim Managing Editor Brett C Vermilyea —————— Published by Village Care of New York 154 Christopher Street New York, New York 10014 Chairman

One thing that we’ve certainly learned is that isolation in old age is very often bad for your health.

BY Bonnie Rosenstock

More than just physical therapy, a hot meal and activities. It’s a community.

And while loneliness isn’t a “medical condition,” it can spawn complications – poor nutrition, depression, frailty, for example.

David H. Sidwell

This issue of New Horizons examines socialization among older adults as well as

President & CEO

aging and happiness. Village Care’s Renee Cottrell, who is in charge of our Senior

emma devito

Information Center in Chelsea, points out in one of the articles that “social isolation is a

www.vcny.org

key factor in depression and anxiety for seniors.” She spends a fair amount of her time

(212) 337-5600

12 Putting Patient Care First

helping older adults who drop by the Center with advice on addressing social services, medical and legal issues. She also supplies information on where to go to socialize.

20 Aging and Happiness BY Samantha Thacker

Studies show that happiness increases with age

26 Seniors and Socializing BY Bonnie Rosenstock

Also in this issue, you’ll get a look at Village Care’s adult day health program. Adult day has considerable benefit for seniors with care issues, addressing their medical

Getting together with other people can keep you mentally and physically fit

needs and giving them the opportunity to interact with others in a congregate setting. This helps combat the isolation they might otherwise endure. The full range of services that the day program provides includes personal care, meals, health screens and monitoring, coordination of medical appointments and care, educational programming and counseling. Many who attend adult day might otherwise be homebound and could also be at risk of having to go into a nursing home. Village Care’s SeniorChoices programs are all aimed at making growing old a better proposition. For some, that may only mean a little bit of help and guidance. For others, it may require considerable support and care. For whatever level of help, Village Care is there as your best choice for better health and well-being.

In the News D E P ARTMENTS

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Guides for Family Caregivers and Health Care Providers; Older Adults Face Mounting Anxiety; EMR is now “live’ at Village Nursing Home; You Must Remember This; Village Nursing Home To Receive Annual “Wish List” Grants; Emma DeVito Named CEO at Village Care

Senior Perspective

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How do you feel about the economy since President Obama took office?

Opinion

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Aging Group Sees Call-to-Action Needed for Chronic Care Reform; Caring About Long-Term Care 

The Last Word

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The (Not So) New Old Age

Older Adults Face Mounting Anxiety

In the News Guides for Family Caregivers and Health Care Providers To improve the working relationship between family caregivers and health care providers, the United Hospital Fund has launched the “Next Step in Care website” (www.nextstepincare.org). The website offers a range of guides and checklists – most intended for family caregivers of persons with serious illness, with some specifically for health care providers – designed to make patients’ transitions between care settings smoother and safer. The website is the first stage of a larger campaign, called Next Step in Care, which will engage hospitals, nursing home rehabilitation facilities and home health agencies, as well as patient advocacy groups and other family caregiver-focused organizations, in addressing a range of transition-related challenges. Many studies have shown that miscommunication and lack of coordination in transitions lead to errors, particularly around medication changes. The tools are expected to reduce confusion and anxiety for family caregivers – family members or friends who provide or manage care – as well as improve patient outcomes and reduce unnecessary rehospitalizations. “Family caregivers are the invisible work force in health care,” said Carol Levine, director of the Families and Health Care Project at United Hospital Fund. “They are usually responsible for coordination of care after a stay in a hospital, nursing home, or after home care services end. Yet they are rarely trained, supported or included in transition planning. These guides are intended to give them basic information to navigate an increasingly complex system.” An estimated 34 million Americans, or one in five adults, are family caregivers – defined as relatives, partners, friends or neighbors who provide or manage full- or part-time care to a chronically ill or disabled person. Family caregivers are an essential part of the health care work force, providing 80 percent of chronic and longterm care in the U.S., and pressures on them are growing. Shorter hospital stays and increased use of outpatient procedures – changes that have increased the effectiveness of medical care in many ways – have shifted responsibility from paid to unpaid providers of care, increasing burdens on family caregivers. Coordinating care during transitions is particularly challeng2 N E W HORI Z ONS | Summer 2009

ing in today’s health care system, in which chronically ill patients visit many physicians during any given year and may take a dozen prescription medications daily. When frail elderly or chronically ill patients move from one facility to another, each transition brings new challenges, new providers and new financial concerns, as well as changes in medication and treatment. The responsibility for many of these changes often falls primarily on the family caregiver. Next Step in Care aims to help family caregivers better manage transitions in care, in part by helping providers and family caregivers to work more effectively together. Created and tested by the United Hospital Fund, its tools can guide family caregivers in determining what issues to consider, how to seek assistance, how to manage medications, and how to better communicate with physicians and other health care professionals. For example, one guide – “What Do I Need as a Family Caregiver?” – asks a number of basic questions such as, “Can you lift the patient?” and “Can you give an injection?” These are designed to help providers and family caregivers assess how well prepared the family caregiver is, what training and support, if any, he or she may need, and what tasks the caregiver cannot manage alone. “Ultimately, we hope Next Step in Care can change provider practice so that family caregivers are routinely included in transition planning,” said David Gould, senior vice president of United Hospital Fund. “Smoother transitions mean fewer medication and other errors, better patient outcomes and greater satisfaction among family caregivers and health care providers.” The guides and checklists available on the Next Step in Care website were developed and tested by a team of current and former family caregivers, long-term care experts and health care providers from hospitals, rehabilitation units in nursing homes and home care agencies. In English and Spanish, these tools can be downloaded for free at www.nextstepincare.org.

Newswise — For older adults who have lived through the Great Depression, news stories comparing present circumstances to the harsh realities of food lines, few jobs and extreme poverty of the 1930s may be panic-producing. Add that to the fact that an economic crisis disproportionately affects older adults who need access to retirement funds, and it’s not surprising that seniors are feeling anxious. Saint Louis University psychiatrist George Grossberg, M.D., has seen an increase in economy-related anxiety. “The anxiety and worry are immense. It is affecting millions and millions of people, especially those who were looking forward to a comfortable retirement,” said Grossberg. Grossberg, who directs Saint Louis University’s geriatric psychiatry program, notes that in many cases, older adults respond well in a crisis, drawing on a lifetime of experience. For example, after September 11, seniors often had a less impulsive, more measured response

than did younger people. In today’s economic crisis, however, older adults have the most to lose financially and a sense of what a true economic depression can look like. Retirees who have planned to rely on investments are hit hardest by financial downturns, but they may also have less obvious reasons for their fears. For some, the worry extends beyond retirement funds to a general and sometimes intangible sense of unease. “I’ve had patients who are themselves financially secure talk about their anxiety for society as a whole or their worry that there may be unprecedented problems, like civil unrest,” said Grossberg. The constant drum beat of bad economic news and promises of worse to come can be stressful to everyone. For those who are suffering because of economy-related stress, Grossberg offers the following pieces of advice: — Do a reality check. Take a breath and look at the facts. Don’t let speculation about the future run wild. Most

over-the-top grim predictions won’t come to pass. — Don’t act impulsively. Be careful that you don’t make poor decisions in a moment of panic. Grossberg gives the example of one patient who sold off the bulk of his investments while the market was low, fearful that he was losing his retirement savings. Discuss what you plan to do with someone else before you make a rash decision. — Count your blessings. Take time to think about the things for which you’re grateful. Whether it’s your health, your family, or $1.49/gallon gas, being thankful is a healthy reminder of what’s good in your life. — Take care of your health. Exercise, eat right, get enough sleep and don’t put off preventive doctor visits. Staying healthy will help you to deal with financial issues and other stressful problems, and exercise has benefits for mood. — Get help. If you feel overwhelmed, anxious, or depressed, seek help from a doctor.

EMR is now “live’ at Village Nursing Home

Abdul Madeen, CNA at Village Nursing Home, one of the facility’s EMR “champions,” demonstrates use of the touch-screen.

Village Care continues to roll out electronic medical record (EMR) technology, with Village Nursing Home expected to be fully “live” during the first half of this year. Nurses and certified nursing assistants are now using touch-screens on the units to document patient findings and to record tasks and results directly into the patient record. A wireless EMR network will be an essential part of the new Village Center for Rehabilitation and Nursing, which is currently under construction and scheduled to open in 2010. Sally Forde, one of the first CNAs at Village Nursing Home to begin using the touch-screen EMR system, said that it allows her to spend more time with residents. “This is why I love the computer,” she said. “It allows us to provide quality care – that’s what matters.” In addition to Village Nursing Home’s EMR, two AIDS Network program sites are now using “electronic progress notes.” Available to the staff at the Rivington House and 20th Street AIDS day treatment centers, these electronic notes offer ready access to activities involving each client and are available to all disciplines to view. This helps assure continuity of care.

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Village Nursing Home To Receive Annual “Wish List” Grants

You Must Remember This If you can’t seem to remember things as well as you used to, “conquering the planet” may help. From the American Geriatrics Society

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n the first study of its kind, researchers recently found that older adults can improve their memories and other mental abilities by playing a video game in which players use planning and strategy to take over the world. As we grow older we all tend to find it somewhat harder to remember and carry out other mental tasks. Looking for a way to help older adults boost these abilities, researchers trained volunteers in their sixties and seventies to play “Rise of Nations,” a video game that rewards you for successfully managing, building and expanding empires. Compared with 20 older people who hadn’t played the game, those who had showed improvement in working memory (the ability to “hold on to” small bits of information for a short period of time), visual memory (the ability to recall information from pictures and lists, for example), and other thinking abilities, the researchers report in the journal Psychology and Aging. Dominating the world isn’t the only way to improve your memory and other thinking abilities, of course. Seeing your health care professional regularly is a crucial part of maintaining your “mental vitality.” That’s because health problems such as high blood pressure, diabetes and depression can cause thinking problems if left untreated. Exercising – at least 30 minutes, three times a week – can also help, by increasing blood flow to your brain and, some research suggests, helping new brain cells grow. In fact, exercising the body helps the brain grow nerve cells in that part of the brain where working memory resides. And the more exercise the better. Getting enough sleep – at least 7 or 8 hours a night – can help you concentrate and remember better. Eating a good diet – lots of fruits and vegetables, along with whole grains, and fish like 4 N E W HORI Z ONS | Summer 2009

salmon, tuna, and sardines, which are rich in heart- and brain-healthy omega3 fatty acids – is essential. And don’t forget activities – like yoga, meditation and prayer – that take the edge off stress, which can make it harder to learn and recall. Activities that involve solving problems and other mental “work” such as reading, learning an instrument or language, playing bridge or participating in a discussion group also keep your mind fine-tuned, as does socializing regularly. In addition, consider these tips, specifically for maximizing memory: See your health care provider if you snore at night and feel sleepy by day. Snoring while sleeping and feeling drowsy the next day can be signs of sleep apnea. People with untreated sleep apnea stop breathing briefly, but repeatedly, while sleeping. Eat your carbohydrates. Diets that are very low in carbohydrates – such as fruits, vegetables, bread, and pasta – can interfere with memory. That’s because your body breaks down carbohydrates or “carbs” into a form of sugar called glucose, and your brain runs on glucose. In another recent study, women on a low-carb diet scored significantly lower on memory tests than those eating a more balanced diet. When these women started eating carbs again, their memories improved. Minimize multitasking. Doing two or more things at once, like reading this tip sheet and listening to the news at the same time, will make it harder for you to recall either later. That’s because multitasking makes it harder for you to process detailed information. Multitasking overloads your working memory circuits. According to researchers at UCLA, you usually process new information in the part of your brain called the cerebral cortex. But multitasking forces your brain to process some information in an area called the striatum, which can handle fewer details than the cortex.

Double-check your meds with your health care provider. Certain antidepressants, antianxiety drugs, blood pressure and cholesterol medications, sleeping pills, ulcer drugs, painkillers and allergy meds can affect your memory, especially if you take more than one of these drugs. Talk to your health care provider if you start having trouble remembering things after starting a new drug. Adjusting the dose of your medications, or switching from one drug to another may well solve the problem. If you’re being treated for diabetes, making sure the treatment is just right is particularly important, since blood sugar levels that are too high or too low can cause the memory to fail. Trust your memory. Worrying about forgetting can make it harder to remember things. In a recent study published in the journal Psychology and Aging, a group of healthy older adults who were told that “aging causes forgetfulness” did worse on memory tests than a group that wasn’t told anything about aging and memory. Older adults in a third group who were told that memory declined only somewhat with age scored the highest of all. Here are some time-tested memory strategies: Write it down. Keeping some sort of diary in which you write down your appointments, and carrying it with you, can help you keep track of what you need to do, when and where. Give everything a place. Designate a specific place for your glasses, say, on your nightstand. Every time you take them off, put your glasses in that spot. Designate other places for your keys, your medications, your wallet, your checkbook and the remote control. Finally, your brain works like a computer, but think of it as a muscle. Keep it healthy, happy and well worked out. Find something that really stimulates your mind and an exercise, like walking, that you really enjoy. Then find a partner to share the fun. With a companion you will be much more likely to enjoy the effort and more likely to keep going.

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lushing Savings Bank selected Village Nursing Home to receive the financial institution’s first ever award in the Senior Crimestoppers program, a nationally sponsored undertaking that provides “wish list” grants and crime prevention assistance to skilled nursing facilities and other senior living programs. The award, which included a presentation of a plaque to Administrator Neil Pollack, was announced at a ceremony at Village Nursing Home that was attended by many residents and staff. The presentation was made by Marie A. Grasso, the bank’s executive vice president and chief operating officer. As part of the award, Village Nursing Home will receive $1,000 annual “quality of life” grants for five years that will go toward fulfilling the facility’s “wish list” for residents. This year, the grant is being used for the purchase of a flat-screen television. The national program is sponsored by the Senior Housing Crime Prevention Foundation. Peter Gwaltney, the Foundation’s CEO, was emcee of the recent presentation event. He said the Senior Crimestoppers program is designed to reduce and prevent the occurrence of crimes in long-term care facilities and in senior housing communities. The Foundation will also be providing each Village Nursing Home resident with a lockbox for rooms to store valuables. Founded in 1994, the Crimestoppers program also provides a toll-free tip line for family and residents. In addition, Village Nursing Home received a “Time of Your Life” video series for residents. “It’s a trip down memory lane,” Gwaltney said.

Village Nursing Home Resident Angelo Diaz holds a plaque given to Village Nursing Home as part of the Senior Crimestoppers award from Flushing Savings Bank. Standing, from left, are: Peter Gwaltney, CEO and vice chairman of Senior Housing Crime Prevention Foundation; Neil Pollack, VNH administrator; Marie A. Grasso, executive vice president and chief operating officer of the bank; Sandy D. Freeland, VNH director of operations and support services, and Daniel Babb, vice president of the New York Bankers Association. Seated in the front are Weyman Monakey and Julia Casartelli, both VNH residents.

Emma DeVito Named CEO at Village Care

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he board of directors of Village Care of New York has appointed Emma DeVito as the organization’s president and chief executive officer. Ms. DeVito, who has worked in Village Care since 1991, was named chief operating officer in 2003. “We are extraordinarily pleased that we have someone within Village Care who can readily step up to the challenges of bringing quality care to older adults and persons living with HIV/AIDS.” said David Sidwell, Village Care board chairman. “The board is truly excited about working with Emma and looks forward to her leadership as we tackle the challenges of a difficult economic environment.” Mr. Sidwell pointed both to Ms. DeVito’s lengthy financial experience along with her understanding of, and commitment to,

Village Care’s programs as key factors in taking over the reins of the not-for-profit organization. Ms. DeVito joined Village Care as its chief financial officer in 1991. In her most recent role as COO, she was responsible for managing the daily operations of the organization in serving some 10,000 individuals annually with a staff of more than 1,500 employees. Village Care operates SeniorChoices and a Network of AIDS Services, which provide both community-based and residential services. The organization is also building a state-of-the-art rehabilitation and skilled nursing care center on West Houston Street, which is scheduled to open in 2010. Ms. DeVito replaces Arthur Y. Webb, Village Care’s CEO since 1993, who has become the chief operating officer at neighboring St. Vincent’s Hospital. 5

s e n i o r perspective

How do you feel about the economy since President Obama took office?

Art Exhibit at Village Adult Day Health Center Artist Paul Catalanotto stands by one of his works displayed at Village Adult Day Health Center in the West Village.

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illage Adult Day Health Center hosted an art exhibit featuring the works of artist Paul Catalanotto. Paul invented a new medium known as Polished Fresco, which is made up of plaster and hollow wooden doors. “I rely heavily on the physical properties of color, how they react with each other and my plaster medium to embody our visual experience,” Catalanotto said. This exhibit is the first in a series of art

shows being brought to the center. “Our participants who enjoy art will benefit greatly from the exposure to different art styles being presented to them by the artists,” Nancy Ferrara, director of the Center, said. A photography exhibit is being planned for the near future. The exhibit was open to the public, which has brought members of the community into the Center, and Catalanotto’s works were available for purchase. He will donate a portion of proceeds to Village.

Older Volunteers’ Benefits Vary with Program Traits

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he advantages of volunteering reported by adults aged 55 and older are largely dependent upon the characteristics of the activities in which they participate, according to a recent article appearing in The Gerontologist. The lead author is Nancy MorrowHowell, PhD, of Washington University in St. Louis. She and her colleagues document the benefits of volunteering as identified by older adults – a departure from many previous studies, which have focused on the benefits observed by researchers. They

also compare reported benefits with information about the volunteer program, such as volunteer training, support and stipends. “These findings suggest that characteristics of volunteer programs can be strengthened to maximize the benefits of volunteering to older adults,” the authors said. Morrow-Howell’s team sampled 401 people aged 55 and older from 13 volunteer programs. The volunteer activities included teaching, tutoring, mentoring, policing and public safety work, conservation

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efforts and supportive counseling. More than 30 percent of participants said they were “a great deal better off” because of the service they contributed, and almost 60 percent identified a benefit to their families. Twenty percent reported improved overall health. The reported benefits depended upon the participant’s demographics as well as the type and characteristics of activity. For example, among those who received compensation for their work, the positive relationship between stipend

and perceived advantages was weaker for the oldest of the 55+ sample, for non-white older adults, and for those with lower education and lower income. Women and lower-income volunteers also reported more benefit than others from participating in public security programs. The researchers speculated that those older adults who traditionally had less authority thrived in roles involving law enforcement.   Support for this research was provided by the MetLife Foundation and the Longer Life Foundation.

Vern Fry, Greenwich Village The economy is the same as before. The current administration is making mistakes on how to attack this failing economy. They need to go back to the basics to fix this mess. They have to stop all of these complex ideas and trickery with our tax dollars and focus on job creation and revenue-generating techniques. While the bailouts have a good underlying purpose, it’s just costing us way too much money and we’ll never be able to recuperate from that.

Donald Long, Kips Bay The plan by President Obama to fix the economy had definitive purpose to help all Americans. I think that he has done a good job of that so far, but there is definitely still more work to do. I believe in President Obama and his views on how to fix this staggering economy. My only hope is that partisan politics don’t get in the way of his long-term plan to boost our economy. Locally, I must say that the city has not done enough for the senior population. We are losing our homes and assets rapidly.

Russell Fleming, Chelsea I believe the economy is better than it was six months ago. I do believe, however, that this is a false-positive and the economy is actually going to get worse. We’ve put ourselves in quite a hole and these Band-Aid techniques that we’re doing now to fix the economy will only come back to hurt us worse in the end. There is too much theft and fraud out there in the financial sector, and unless we can pass government regulations, only the greedy will survive. Seniors, children and the sick population are the most vulnerable right now, and who is going to help them?

Emily Rich, Chelsea Well, I sure hope the economy is getting better. There is too much false information and propaganda out there to truly know if the measures taken are working. As a local artist, I can say that it is getting harder each day to survive and my business has not increased at all, only decreased. Obama’s promises sound great, and if his hopes and goals come true, then yes, I do believe the economy will be better.

Merle Lister-Levine, Chelsea I think President Obama is the greatest thing to happen to this country in my lifetime. We are indeed in troubled times, but his high confidence level helps to increase morale across the country. This will ultimately lead to more production and a stronger economy. As our President warns us, it will not happen overnight, but I believe we have the right man in office making the right decisions. God bless President Obama and the United States of America. 7

46&Ten resident Lillian Horowitz with her thirteen-year-old Shitsu, Monkeyface.

More Than Just a Companion Pets help us stay healthy and give us purpose By Samantha Thacker

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ets are an important part of our lives. In fact, the term “pet ownership” seems to be a bit of a misnomer as those of us who have pets often consider them to be friends, companions and roommates – even seeing them as “children.” Pets bring us happiness. Take the cats Horatio and Jane, who have lived with Peggy Keating at The Village at 46th & Ten for the past four years. The nine-year-old, part-Maine Coon brother and sister felines were born in the West Village in a deli between the two streets for which they are named. They came to live with Keating, who then lived in the West Village and she has raised them from kittenhood. When they were five, she decided to relocate to a senior living apartment and being able to take Horatio and Jane with her was a big factor in the decision-making process. 8 N E W HORI Z ONS | Summer 2009

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“Had I not been permitted to take my cats, I would not have moved here,” says Keating at The Village at 46th & Ten. “But Village Care is very sensitive to our needs and would not have us forsake our pets.” Keating appreciates the distinct personalities of each cat, calling 35-40 pound Horatio “as sweet as he can be,” and a devoted companion. The more petite Jane, on the other hand, is “a seductress,” who flirts with all that come to visit. “I don’t know where I’d be without them,” says Peggy. Lillian Horowitz, Keating’s neighbor, would agree with that sentiment. Lillian lives with her thirteen-year-old Shitsu, Monkeyface (a nickname Lillian’s mother had called her as a girl), whom she adopted when Monkeyface was five, and for the past eight years, she has walked her at least three times a day. “People will ask me how can I go out in all sorts of weather to walk my dog, but it has to be done,” says Horowitz. “And I do it gladly.” Horowitz also notes one of the benefits of having a dog: it keeps her moving. “It’s so easy not to move,” Horowitz remarks. “Besides, Monkeyface just makes me happy.” Clearly, living with a pet provides the human counterpart with more than just pleasure. The routines of feeding, walking, changing a litter pan or birdcage or cleaning a fish tank are thought to be key factors in retarding some of the negative aspects of aging, such as loneliness, seclusion, memory loss and becoming sedentary. Experts say that caring for an animal companion offers a sense of purpose and the opportunity to give and receive love and affection, unconditionally. Our pets are also our confidants. They are friends to talk to, and even if we don’t speak the same language, they seem to understand us and vice versa. Any pet owner can tell you that the responsibility of caring for our pets gives us a feeling of significance. Our furry, feathered and finned friends depend on us and in turn we depend on them for all they have to offer. Many of us don’t like to admit to feeling lonely – unlike our animal friends who are not always shy about voicing their objections to being alone. Any dog owner who’s come home to signs of displeasure or separation anxiety – a tornapart pillow or half-eaten shoe – can attest to this. 10 N E W HORI Z ONS | Summer 2009

Loneliness is a more serious condition than many realize, particularly for older adults, and animals can help overcome the pain it causes and combat depression and feelings of isolation. Among the many benefits of pet companionship is the social interaction it offers. Discussing our pets acts as an ice breaker in social situations. Older adults who find themselves in new social environments can talk about their pets with enthusiasm, whether the pets are dogs, cats, birds, fish or guinea pigs. Also, as dog walkers know, walking our dogs can lead to striking up conversations with complete strangers, as well as providing the dog and its owner with exercise. Research has shown that having a pet can add years to our lives. In addition to being a friend and companion to live for, the simple act of petting a cat, watching them play or observing fish in their environment can lift up a bad mood or offset that sense of loneliness. “My little bird greets me when I walk in the door,” said an 82-year-old, former opera singer who didn’t want to be identified. “She’s excited and whistles. I let her out of her cage and she sits on my shoulder and we sing together.” Pets are also therapeutic, whether they live in our homes or are found in more institutional settings. A number of studies have found that just 10 minutes of physical interaction with a beloved pet can lower blood pressure and increase finger temperature — both clear signs of relaxation, reports an article by Mara M. Baun and Nancy J. Dapper. Baun is a professor at the University of Texas Health Science Center at Houston School of Nursing, and Dapper is vice president of program operations for Delta Society. They also report that there are welldocumented benefits of pet ownership to people with high blood pressure. They cited a study that involved two groups of stockbrokers who were already being treated with ACE-inhibitors, a common therapy for people with hypertension or who have suffered congestive heart failure. The study broke the stockbrokers on medication into two groups – one with pets, one without – and found significant differences in their physiological reactions to stress tests. Those with pets were about half as reactive to stressors. This is significant because ACE-inhibitors play an

important role in controlling resting blood pressure but they do not control blood pressure related to stress. The article also reports on studies regarding Alzheimer’s patients who live in special-care units. It was revealed that “residents were less agitated and expressed more socially interactive behaviors when therapy dogs were present.” It has become increasingly widespread for birds and fish to be placed in communal areas of senior environments for the enjoyment of all residents and visitors. Additionally, the use of service animals has become a more common practice over the years when or where people cannot themselves care for a pet. Animal visits and pet-assisted therapy have existed for many years within nursing homes and hospital settings based on the mounting evidence that people benefit from interacting with animals. Brico – a 13-year-old Belgian Malinois whose face and ears resemble that of a German Shepherd – is a docile and obedient dog who will wander up to those he encounters in such a laid-back manner one might think he’s saying, “Hey. How’s it going?” He was raised in Germany and originally trained as a service dog for law enforcement and the secret service. Ten years ago he was adopted by Dr. Stephen Klein and his wife and re-trained to aid in Dr. Klein’s practice. Now Brico is not only a service dog but a much-loved member of the Klein family. Dr. Klein, a New York physician who specializes in pain management and rehabilitation, often introduces Brico to his patients, both in his office and at the day treatment programs at which Dr. Klein provides his expertise. “Brico makes people feel special,” says Dr. Klein, who notes that his patients are very receptive to Brico’s calm and unobtrusive, yet friendly nature. He cites an occasion when he brought Brico to a nursing home to see a patient — a man in his mid-70s with mild mental retardation and in a wheelchair. “He was ornery, restless and uncomfortable,” says Dr. Klein of the man. “Until he met Brico.” The dog warmed to the man and showed him affection in a way only dogs can. “The stimulation from the dog licking his fingers made the man happy, and he was smiling and laughing by the time he was wheeled back to his room.” g 11

More than just physical therapy, a hot meal and activities. It’s a community.

Village Adult Day Health

Putting Patient Care First

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he workday starts with a flurry of activity at Village Care’s adult day health program. Even before the patients arrive, breakfast must be set up and last minute details fine-tuned for the day’s activities. At Village Day, located at 644 Greenwich St., Evelyn Quintana, program assistant, on this particular morning was eagerly looking forward to celebrating Mardi Gras with the patients; there will be beads, special music and a special lunch. (She hung the decorations the day before.) At 9 a.m., when the van, which provides door-to-door transportation to and from the center, drops the patients at the entrance, a staff member meets the vehicle, someone is at the front door and another greets them inside. This

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By Bonnie Rosenstock

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“three-point system” is crafted so the patients are kept safe from the moment they arrive to the moment they depart. The breakfast is good, pronounced director Nancy Ferrara, who makes it a point to check all the food. “The food comes from Village Nursing Home, and our chef, who is a graduate of the Culinary Institute of America, adds special things to the meals.” After a light breakfast, the program assistants, who are CNAs – certified nursing assistants – with broader responsibilities, help those who need toileting. During the week, Recreation Assistant Migdalia Roman, Physical Therapist Randi K. Schwartz or one of the program assistants take turns jump starting the patients’ day. They talk about current events, what day it is, look at the calendar and horoscope and give the patients an opportunity to share some thoughts or concerns – all activities geared to getting the memory going. Then there is some stretching, range of motion exercises, even some heart healthy marching in the airy dining room. They go over the day’s activity schedule, which is printed up in English and Spanish. The morning groups might include creative arts, cooking, dance, music therapy, jewelry making, physical therapy, a movie, a live performance or Spanish, which some English speakers might also be inclined to attend. The three main languages spoken here are English, Spanish and Chinese. If a patient speaks another language, per diem staff would be hired. After a hot lunch, the patients attend more groups, such as bingo, wheel of fortune, choir practice or a sing-a-long. Roman leads a variety of recreation therapy activities, including jewelry making. “I bring in new projects so they can be more creative,” she said. “It’s a way to allow them to bring out their skills that are hidden inside. They might have low self-esteem, but when they see the finished project, they feel satisfaction.” Volunteers and paid consultants supplement recreation therapy activities with yoga, tai chi, massage therapy and

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musical performances. Other services provided include occupational therapy, speech therapy and use of the computer room where patients can check their e-mail and search the Internet. There are snacks around 2:30, followed by getting ready to leave by 3 p.m. The reverse preparation ensues, with toileting, helping patients gather their possessions, putting on their coats, and the three-point system to say good-bye. If they don’t have anyone at home and don’t qualify for a food service, such as Meals on Wheels, the center will provide a take-away meal for them. “You never see us sitting still,” declared Quintana. “We are constantly busy attending to patients’ needs.” And that is a succinct summary of what adult day health care is about. According to the Adult Day Health Care Council, “Adult day health care is designed to meet the health care needs of chronically ill, frail elderly and disabled adults who require certain primary, preventative, diagnostic, therapeutic, rehabilitative or palliative services.” Ferrara added, “They could have a disability, dementia, Alzheimer’s, diabetes, depression, high blood pressure, behavioral health issues or mental illness, which have to impact on them cognitively or functionally.” This might be the result of an existing medical condition which worsens, a new diagnosis which requires acute or chronic medical care, an accident, the end-stage of a disease, or a need for hospice care or restorative therapy. Patients are admitted to the program based on a referral by a registered nurse, the person’s physician, a hospital discharge planner or other medical provider, a family member or the patient himself. A full assessment is made by all center disciplines – social worker, nurse, recreation therapist, physical therapist and nutritionist – to evaluate if the program can satisfy the patient’s needs entirely or in part. Once in the program, there are weekly interdisciplinary team meetings to assess patients’ progress and to revaluate those needs. Adult day health care is a community-based long-term care program

“You never see us sitting still,” declared Evelyn Quintana. “We are constantly busy attending to patients’ needs.”

15

“Here they get socialization, which is an issue that stops them from functioning in the community.”

16 N E W HORI Z ONS | Summer 2009

designed to help individuals continue to live in the community. Patients are not required to live with a traditional family as long as there is a caretaker or someone to help them. They may live in a group home, in specialized apartments or intermediate housing. Some live in the neighborhood, but many come from all over the city – one is from the Bronx. “Even though they are fragile, there is no reason to be in a nursing home if there is someone to take care of them,” Ferrara said. “Here they get socialization, which is an issue that stops them from functioning in the community, two nourishing meals, and all their needs are addressed. They really love it.” Ferrara said it’s not difficult to get into the program if the patients fit the referral and assessment criteria and have a doctor’s order. The only restriction is they need to be eligible for statefunded Medicaid; if not, they must pay privately or have a private insurance source, Ferrara, who splits her time as director of both adult day health centers, explained. Patients range in age from 55 to the nineties at Village Day. Ferrara said there are more “younger” patients in the Village Day program because the center has behavioral health care and Parkinson’s disease specialties. Another effort specializes in Alzheimer’s and other memory impairments, and the staff is also being trained for a specialty in multiple sclerosis. Depending on assessment, patients attend various groups designed to help their particular conditions. They are free, nonetheless, to choose what they wish to participate in. Since all groups are therapeutically geared, there is always something for everyone. “The younger participants like Wii, the interactive video game,” said Ferrara. “It’s also good for physical therapy.” Schwartz defines her job as a physical therapist as “being responsible for keeping everyone preventative more than treating the consequences of diseases. We try to keep them functionally intact.” If it’s part of their prescription, patients receive physical therapy two-tothree times a week to maintain muscle strength, joint range of motion and

cardiovascular health. They may also receive gait training and learn how to get up and down from a chair and to walk safely. Eyesight, joint pain and arthritis impact on their ability to walk safely, explained Schwartz, so sometimes they need an assisted device, like a walker, cane or wheelchair. The gym has sophisticated top-of-theline equipment, including two stationary bicycles, a treadmill and an upperbody machine. Schwartz might make a home visit to assess if the patient needs adaptive equipment and a better way to get up and down stairs. “Many live in a walk up,” she explained. “Home issues can be difficulty getting in and out of a bathtub, negotiating steps to the apartment and opening doors.” In the nice weather, she takes them out for an hour walk. They might go to the supermarket or walk down to the Hudson River pier. Those who can’t make it that far will sit along the way with an aide. They also go to a nearby park. “They sit, do balancing activities, using the cobblestones, cracks in the street and curbs. I try to use the outside environment as much as I can. We want to keep them mobile in the community as long as possible,” Schwartz said. She sees about ten patients a day, in either a group or individually. At Chelsea Day, where she also works, she sees fewer patients. “They are more dependent and medically complicated,” she explained. Referring to the Parkinson’s patients at Village Day, she acknowledged they don’t get cured. “We can try to help them maintain range of motion, muscle strength, flexibility, balance, coordination and walking to decrease the incidence of falls, and offer nutritional counseling services and individual and group education sessions, but we can’t slow down the ravages of the disease,” she said. Lisa Bohmart’s office walls are ablaze with brightly painted pictures on various themes – lots of flowers, still lifes, abstracts, country and city scenes. Her collection started when a few patients gave her paintings from their art class, and then others wanted their work to be displayed, too. Her responsibilities are “to help with any services they might need,” like home care, recertification for

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Medicaid, food stamps, Access-A-Ride, half-fare cards, outside providers and all issues dealing with mental health. She also does individual counseling. “People with disabilities have a feeling of loss of independence, aging issues. They have to deal with family members and friends dying,” she said. On Tuesday evening Bohmart runs a support group for family caregivers who are dealing with loved ones who mainly have Alzheimer’s, but it’s open to everyone. “They have a lot to cope with, and it’s exhausting,” she said. “It helps that they receive the emotional support from people who are going through the same thing.” Because adult day health care is different from a social day program, they couldn’t operate without a nursing component, Ferrara said. Rita Toback, nurse manager, runs the nursing department and supervises the program assistants. Even though 52 is the mandated daily maximum number that can come for services, there are over 80 patients enrolled at Village Day. The medical director at Village Nursing Home oversees the entire operation. Toback explained that patients come in with their own prescriptions from their private doctors, but they currently administer and manage the medications for about 20 patients. Village Care has its own pharmacy, which delivers once or twice a day, so that all patients can get refills. “It’s a great service because they can call it in or send it in and can get their medications delivered here,” Toback said. The van also takes patients to and from medical appointments, and the nurses follow up with their private doctors. “There’s a lot of collaboration,” said Ferrara. Toback also conducts health education groups and individual counseling. She focuses on diet, exercise and how they can manage chronic diseases. She reported that some patients with diabetes were able to get off their medications with proper diet and weight loss. “Not everyone can do that, but in a certain number of cases, diet can control diabetes. With a low sodium diet, controlling stress and increasing exercise, it’s also possible with hyper-

18 N E W HORI Z ONS | Summer 2009

tension,” she said. In addition, nursing students sometimes conduct a Trivial Pursuit group, with a game from the 1980s. “It’s a great way to trigger memories,” stated Toback. She related how one Alzheimer’s patient had incredible recall from fifty years ago even though his present day memory was compromised. “It was very stimulating and satisfying for him, as well as for others,” she said. The medical staff also handles routine monitoring – like vital signs, blood pressure and wound care – with physician’s orders (especially for those with diabetes and hypertension) and deals with medical emergencies with the back-up support of nearby St. Vincent’s Hospital. At the end of February, Village Day completed a large grant from the New York State Health Foundation for shortterm rehabilitation care of over forty Medicare patients who had cardiac and stroke events and were acutely ill. After finishing their acute care stay in a hospital, they came here instead of going to a nursing home or other facility for rehabilitation. They received physical therapy two to three times daily, and they could also participate in any of the activities available at the center. Ferrara declared the project a great success. “We found that not only did people get better physically, but it was the socialization piece that was important for them,” she said. “When three or four started at the same time, it became a cohesive group of friends. Getting better was so much more fun with people with similar thinking and issues. When they were discharged after six-to-nine weeks together, some kept in touch afterwards. It made a big difference in their lives.” “We have a nice little community here,” Ferrara said. “Socialization could be a challenge, but because the staff is so tenured and specialized, they provide an atmosphere where patients co-mingle beautifully, take care of each other and become very close.” “It’s a really nice place. I really like working here,” added Quintana. “The people who come here really like and appreciate it.” g

“We want to keep them mobile in the community as long as possible,”

19

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20 N E W HORI Z ONS | Summer 2009

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prehensive examinations of happiness in America. It is based on data from the National Science Foundation-supported General Social Survey (GSS) of the National Opinion Research Center at the University of Chicago. Since 1972, a scientifically selected cross-section of Americans ages 18-88, totaling about 28,000 over a 32-year period (1972-2004), were asked this question: “Taken all together, how would you say things are these days – would you say that you are very happy, pretty happy or not too happy?” The question is administered with other queries in face-to-face interviews. “Understanding happiness is important to understanding quality of life. The happiness measure is a guide to how well society is meeting people’s needs,” said Yang Yang, assistant professor of sociology at the University of Chicago and author of the article, “Social Inequalities in Happiness in the United States, 1972-2004: An AgePeriod-Cohort Analysis.” The study found that Baby Boomers are not as content as other generations, African-Americans are less happy than Caucasians, women are happier than men; happiness can rise and fall between eras, and, as people age, their happiness increases while the differences between genders and ethnic groups narrow. Of the 88-yearolds, 33 percent said they are “very happy,” versus 24 percent of those under 25. The increase in happiness with age is consistent with the “age as maturity hypothesis,” Yang said. With age comes positive psychosocial traits, such as self-integration and self-esteem. These signs of maturity could contribute to a better sense of overall well-being. In addition, group differences in happiness decrease with age due to the equalization of resources that contribute to happiness, such as access to health care, including Medicare and Medicaid, and the loss of social support due to the deaths of spouses and friends, Yang added. The time span of the survey also helped determine how different people in the same generational group fared. A definite rise was observed when the nation flourished economically. For example, 1995 was a very good year on the happiness scale when the nation’s economy was on an upswing, but the Baby Boom generation (born from 1946 to1964) was still the least happy among those surveyed. “This is probably due to the fact that the generation as a group is so large, and their 22 N E W HORI Z ONS | Summer 2009

expectations so great, that not everyone in the group could get what he or she wanted as they aged due to competition for opportunities. This could lead to disappointment that could undermine happiness,” Yang said. A separate University of Chicago study, also published in the American Sociological Review, noted the significant effect of socialization on just how happy older adults are. Those results found that about 75 percent of people aged 57 to 85 are active in one or more social activities at least every week, including socializing with neighbors, attending church, volunteering or going to group meetings. The nationally representative study was based on in-home interviews with 3,005 people in 2005-06, not including nursing home residents. Those in their eighties were twice as likely as those in their fifties to do at least one of these activities. “People’s social circles do tend to shrink a little as they age – that is mainly where that stereotype comes from, but that image of the isolated elderly really falls apart when we broaden our definition of what social connection is,” said the study’s coauthor and University of Chicago researcher Benjamin Cornwell. Ilse Siegler, a 84-year-old retired nurse manager in Chicago, said in the article, “Happiness is getting out and being with people, and that’s why I recommend it.” Her husband died 35 years ago and she says that she still misses him every day. Although she has vision problems and has slowed down with age, she still swims, runs a social group in her condo, volunteers in a retirement home and is active with her temple. “Contentment as far as I’m concerned comes with old age,” Siegler said, “because you accept things the way they are.” Nancy J. Ferrara also sees the advantages of getting out and being with people. She is a registered nurse, holds a masters degree in health care administration and is a member of the Holistic Nurses Association. Ferrara is the director of Village Care of New York’s two adult day health centers in the West Village and Chelsea. “People come to Village Care’s adult day health centers and establish new relationships with others they might not have met through past circumstances and have the opportunity to exchange stories and form new bonds,” she says. They can also experi-

ence activities in new ways – going on local outings, participating in a yoga class or discussion group – that they find stimulating.  At any age, socialization is very important for retaining a high level of happiness and health, and for those who would otherwise be socially isolated, this program is vital. The older adults who come here enjoy the experience and have reported feeling better both mentally and physically.” A study by Heather Pond Lacey, Ph.D., and colleagues published in the Journal of Happiness Studies claimed that greater happiness may well be a perk of aging. Lacey works at the University of Michigan’s Center for Behavioral and Decision Sciences in Medicine. Her team conducted an online survey of 273 people aged 21-40 and 269 people aged 60-86. In the survey, participants rated their current happiness on a 10-point scale and estimated how happy they would be, or had been at ages 30 and 70, and how happy they thought people generally are at those ages. Though the survey was conducted over the Internet, of which many older adults are not that knowledgable, and was also not tracked over a period of time, the older group showed higher happiness ratings in the survey than the younger group. Lacey’s team concluded that: – People may get better at handling challenges as they age. – Older adults may tend to play up the positive and minimize the negative. – Over the years, people may lower or change their goals, making success and happiness more likely.

Life moves out of a red flare of dreams Into a common light of common hours, Until old age bring the red flare again. – William Butler Yeats Land of Heart’s Desire

I Socializing being a key ingredient to happiness, The Village at 46th & Ten hosts a social hour for residents every Friday evening.

t has also been theorized that psychological well-being is U-shaped through the life cycle. The most stressful times are between childhood and old age, the happiest times at both points of the U. In any case, attitude plays an important role. Psychology Today reported on yet another study that found that many seniors find great joy in living. That study was performed at the University of California at San Diego, and surveyed 500 Americans

between the ages of 60 and 98. The subjects lived independently and had experienced various illnesses, mental health conditions or other health concerns. Despite their health problems, on a scale of 1 to 10, rating themselves on successful aging, the average rating was 8.4. “These findings suggest that physical health is not the best indicator of successful aging – attitude is,” stated Dilip Jeste, lead researcher of the University of California at San Diego. “What is most interesting about this study is that people who think they are aging well are not necessarily the healthiest individuals,” said Jeste. “In fact, optimism and effective coping styles were found to be more important to successfully aging than traditional measures of health and wellness.” A study released in 2007 found that people who described themselves as highly optimistic had lower rates of death from cardiovascular disease and lower overall death rates than strong pessimists. Later research noted that sick and disabled persons are often as happy as anyone else, and showed that people who spent time each day socializing, reading or participating in other hobbies rated their aging satisfaction higher. “For most people, worries about their future aging involve fear of physical infirmity, disease or disability,” said Jeste. “However, this study is encouraging because it shows that the best predictors of successful aging are well within an individual’s control.” Pychology Today noted four traits common to people of all ages who consider themselves happy: they like themselves; they are positive thinkers; they are outgoing and they have a sense of personal control. Again, attitude is key to happiness. Good self-esteem, optimism, being an extrovert and having the ability to be independent contribute to happiness in older years. Additionally, it is also important to develop close relationships. It was found that those with several supportive friends seem to experience greater health and happiness. Often in the retirement years, people have lost many friendships from their workplace, and feel isolated. Being able to confide in a close friend enables a person to feel relaxed and at peace. Some psychologists believe that when there are few social connections, greater depression 23

occurs. Friendships provide support in difficult times, and enhance your life experience. A spiritual connection is also found to be beneficial. Studies have shown that older adults report being happier when they are active in a church or religious setting. The spiritual community can offer an essential network of social support, as well as purpose in reaching out to others. Rest and exercise are also necessary for a positive outlook. Rumor has it that older adults don’t need as much sleep at night because sleep habits change, but the National Institute on Aging recommends that older adults get as much nightly sleep as younger adults – seven to nine hours. When you awaken refreshed, you have the energy needed to accomplish your daily goals. Lack of sleep can contribute to anxiety, depression, attention problems and other physical illnesses, as well as general crankiness. Exercise can also help in relieving many of these problems. Surveys show that people are in better spirits and experience less stress when they exercise. Laura Carstensen, director of the Stanford Center of Longevity, has also found that people generally get happier as they age. She attributes the greater happiness to a desire to make the most of the time left. The frequency of negative emotions declines in old age, as well as the duration, she noted. Research by Gene Cohen, a psychiatrist, gerontologist and director of George Washington University’s Center on Aging, Health and Humanities, supports this theory. He found that brain function changes as a person ages. Imaging studies have shown that older people’s brains react less intensely, and for less time, to negative emotions. This contributes to increased morale in old age. Older people become more experienced in handling problems and challenges, and they may have also lowered their expectations, thereby making it easier to experience happiness. In a radio interview, Catherine Ross, professor of sociology at the University of Texas in Austin, said older people have more positive emotions, not negative, and the life experience that comes with old age tends to have a calming effect. “They feel more calm, they feel more at ease, more content. Older people are not only less emotionally negative, their emotions also tend to be more passive,” said Ross who added that having more positive 24 N E W HORI Z ONS | Summer 2009

and passive emotions means that those older adults are less likely to have negative and active emotions like anxiety and anger. Joan O’Kray, 61, was an international tour director for more than twenty years, and has worked as a mediator in conflict resolution since 1994. She enjoys her work and has no plans to retire. She’s always been physically and socially active, and in recent years has participated in two bike-a-thons — the New York City Five Borough Bike Ride and the Boston to New York AIDS Ride, which took three days to complete. A frequent visitor to Village Care’s Senior Information Center at 220 W. 26th St., O’Kray takes part in programs such as focus groups, holiday events and computer training, and finds she can use her own vast knowledge to help others. With her impressive background and cheerful outlook, one may doubt O’Kray ever had insecure bone in her body. Still, she says, “When you’re younger, you’re still feeling your way. As you get older and have more experience under your belt, there’s less of the unknown. You have a better understanding of how to deal with things, giving you more control over how to handle them and the ability to do so more calmly.” O’Kray has noticed that this accumulated wisdom is heeded by many people she knows. “I find aging to be very empowering,” she adds.

Singularity is only pardonable in old age and retirement; I may now be as singular as I please, but you may not. Philip Dormer Stanhope, 4th Earl of Chesterfield, British statesman, man of letters, in a letter to his son on April 5, 1754. Chesterfield was 60 at the time, and his son 22.

T

he senior years provide an opportunity to pass on the knowledge that life has given us. Youthful thinking can be an inspiration to the old, and the wisdom of age can bring great enlightenment to the young. And as the Earl of Chesterfield imparts to his son, it gives us the right to be unconventional. Many older adults reinvent themselves in their senior years. They find a different focus or career, try new things and

go after dreams of more youthful years. Many actors, scientists, politicians, statesmen, teachers, writers, and Nobel Peace Prize winners have been most productive in their senior years. Mother Teresa was almost 70 when she received her Nobel Peace Prize. Benjamin Franklin was 70 when he helped edit the Declaration of Independence, and 81 when he worked on the Constitution of the United States of America. In possibly the most well-known case of making lemonade when handed lemons, Anna Mary Robertson Moses was in her seventies when arthritis kept her from doing the needlepoint she had been creating for most of her life. She turned to painting and became a prolific and admired artist. Grandma Moses lived from 1860 to 1961, passing at the age of 101. In a 2006 article titled “The Surprising Power of the Aging Brain,” Time magazine focused on the case of Crook and Strozier, and the confidence and stamina their new brain power afforded them. Barbara Hustedt Crook started writing her first musical just before turning 60. Robert Strozier, her friend and collaborator, was 65. Both had had careers in New York City, writing and editing, and Ms. Crook has a background performing. They are creative people, but neither thought they had the “chops” to tackle a musical. In the article, author Jeffrey Kluger states: “Far from slowly powering down, the brain as it ages begins bringing new cognitive systems on line and cross-indexing existing ones in ways it never did before. You may not pack so much raw data into memory as you could when you were cramming for college finals, and your short-term memory may not be what it was, but you manage information and parse meanings that were entirely beyond you when you were younger. What’s more, your temperament changes to suit those new skills, growing more comfortable with ambiguity and less susceptible to frustration or irritation.” “I find that my brain makes leaps it didn’t make so easily. I can hear my inner voice and trust instincts and hunches in ways I didn’t used to,” said Crook. “Somehow I have the confidence I didn’t have before.” Strozier acknowledges that they are both more willing to take chances than they once were. “At a certain age, you either get older or you get younger. If you

get younger, you venture out and take risks.” While the Earl of Chesterfield felt that age granted him the right to be unconventional, English poet Jenny Joseph’s 1960 poem – Warning – has empowered older women to be unique, to be bold, to be noticed, and not to be thought of as just the cookie-baking, apron-wearing grey-haired granny. Warning is probably more recognized from its opening lines: When I am an old woman I shall wear purple With a red hat which doesn’t go and doesn’t suit me. And I shall spend my pension on brandy and summer gloves And satin sandals, and say we’ve no money for butter. Though Ms. Joseph was not yet 30 when she wrote Warning, now 76, she is known to wear purple and red hats. The poem prompted the founding of The Red Hat Society, an international organization of ladies of a certain age (you must be 55 to join), who gather for events in regions throughout the world, wearing red hats and enjoying themselves. The Red Hat Society’s founder, Sue Ellen Cooper states: “The Red Hat Society began as a result of a few women deciding to greet middle age with verve, humor and élan. We believe silliness is the comedy relief of life, and since we are all in it together, we might as well join redgloved hands and go for the gusto together. Underneath the frivolity, we share a bond of affection, forged by common life experiences and a genuine enthusiasm for wherever life takes us next.” Sixty-six-year old Andrew Weil, wellknown author and physician who popularized integrative medicine notes the resilience in older people and their ability to enjoy the simple things as a key to happiness in later years. Happiness comes from within. To paraphrase Abe Lincoln, you are as happy as you make up your mind to be. As research on happiness, contentment and satisfaction continues in years to come, it will be interesting to observe if the Baby Boom generation, as they come into the senior years, will overcome the noted dissatisfaction their high expectations seems to have brought them, and be happy with the simplicity of old age. g 25

By Bonnie Rosenstock

Seniors and Socializing: A Way to Keep Fit

Ballet class at the Sirovich Senior Center

Mingling with others keeps the body healthy and the mind sharp. 26 N E W HORI Z ONS | Summer 2009

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eople over age 60 make up more than 16 percent of New York City’s population, with Manhattan having the highest rate of seniors living alone in the country. Fifty-one percent aged 75 and over live by themselves. Put these statistics together, and they add up to a major risk factor for psychological distress. According to the New York City Department of Mental Health and Hygiene, the greatest number of seniors with emotional problems caused by low levels of contact with family, friends, neighbors and community, live in downtown Manhattan – in the Lower East Side, Chinatown and Little Italy. “Social isolation is a key factor in depression and anxiety for seniors,” acknowledged Renee Cottrell, director of community social services, at Village Care of New York’s Senior Information Center at 220 West 26th St. Along with the advice Cottrell dispenses to seniors on social services and medical and legal issues, she also supplies information on where to go to socialize. The usual places, she suggested, are senior citizen centers. A common thread that centers share is that in addition to having a wide array of activities and events of both the physical and intellectual kind – meals, outings, movies and Internet services – they also create a sense of community

and caring. Hudson Guild, 119 Ninth Ave., closest to the information center, offers adults 55 and older classes in bridge, poetry, arts and crafts, yoga, aerobics, creative writing and the lively arts, to name a few. The Caring Community, the largest non-profit agency for seniors, has three locations in Greenwich Village and one in Tribeca. The Educational Alliance’s Sirovich Senior Center, 331 East 12th St., is well-known for its free ongoing ceramics and painting classes. The Jewish Association for Services for the Aged (JASA), West Side Senior Center, 120 W. 76th St., has conversation, meals, discussions on current affairs and history, exercise and wellness programs, classes in dance, art, music, writing, trips, parties and celebrations. Barbara Steele, 59, who makes use of free Internet access at the Senior Information Center, suggested the Judith C. White Senior Center at Greenwich House, 27 Barrow St. She goes there for breakfast and lunch and to participate in their stretch and tone, tai chi and belly dancing classes and “to meet new people and experience new challenges,” she said. “Interaction is important and keeps me younger.” Indeed, in a study, reported in the February 2008 Personality and Social Psychology Bulletin, across all ages (24 to 96), “cognitive functioning was better the higher the level of participants’ social interaction.” Many of the senior centers offer field trips to museums, tickets to theater events or walking tours, which are head and heart healthy. A British study published in the Journal of Epidemiology and Community Health, November 2003, showed that “independent of socio-economic position, the highest level of cognitive ability was associated with regular cultural visits to theaters, art galleries and stately homes.” A leisurely stroll or a brisk walk in the Great Outdoors is a healthy way to meet active seniors. Walking groups abound

in the Big Apple to raise funds for charities and for fun, fitness and friendship. Google “Manhattan Walking Clubs” for an extensive list. Cottrell observed that many of the seniors come to the Information Center to use the computers because they don’t have one at home. “There isn’t a lot of instruction here,” she said, “so they help each other and get to know each other.” Steele agreed there is a lot of mutual aid, and she met “a wonderful lady” here that way. The Village and Chelsea neighborhoods have not been identified as “most at risk” for socially isolated seniors; however, there are large pockets, especially among the lesbian, gay, bisexual and transgender community. The reason is that they often have no adult children or a permanent life partner and frequently face prejudice and discrimination. “Paul,” 58, who comes solely for the center’s computers, goes to SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders), 305 Seventh Ave. (at 13th Street), which he said is a great place for older gay men to socialize. “Some have pets, but human contact that comes from senior citizens centers is also important,” he said. Don’t underestimate pooch power, not only for home companionship but also as a people magnet. Neighbors and dog lovers can’t resist striking up a conversation with the owner of a cute canine. Also, there are dozens of dog runs in Manhattan, where both dogs and owners have a grand time exchanging pleasantries, which can always open the door to socialization outside of the enclosed circuit. You can find a list at www.nycgovparks.org/facilities/dogruns Paul also enjoys the senior programs at the Marble Collegiate Church at 1 W. 29th St. Many houses of worship have meal programs, activities for seniors, holiday and other events where seniors

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Few Friends Combined with Loneliness Hurts Health for Elderly Newswise – Although not having many close friends contributes to poorer health for many older adults, those who also feel lonely face even greater health risks, a study from the University of Chicago suggests. Older people who are able to adjust to being alone don’t have the same health problems. The study is the first to examine the relationships between health and two different types of isolation. Researchers measured the degree to which older adults are socially connected and socially active. They also assessed whether older adults feel lonely and whether they expect that friends and family would help them in times of need. “Social disconnectedness is associated with worse physical health, regardless of whether it prompts feelings of loneliness or a perceived lack of social support,” said study co-author Linda Waite, Lucy Flower Professor in Sociology at the University of Chicago. At the same time, researchers found a different relationship between social isolation and mental health. “The relationship between social disconnectedness and mental health appears to operate through feelings of loneliness and a perceived lack of social support,” Waite said. Older adults who feel most isolated report 65 percent more depressive symptoms than those who feel least isolated, regardless of their actual levels of connectedness. The consequences of poor mental health can be substantial, as deteriorating mental health also reduces people’s willingness to exercise and may increase healthrisk behaviors such as cigarette smoking and alcohol use, Waite explained. Among the study’s findings • The most socially connected older adults are three times as likely to report very good or excellent health compared to those who are least connected, regardless of whether they feel isolated. • Older adults who feel least isolated are five times as likely to report very good or excellent health as those who feel most isolated, regardless of their actual level of social connectedness. • Social disconnectedness is not related 28 N E W HORI Z ONS | Summer 2009

to mental health unless it brings feelings of loneliness and isolation. Older adults who are able to withstand socially isolating circumstances or adjust their expectations so they do not develop strong feelings of loneliness may fare better, the study suggests. “We need to better understand how older adults adapt to changes in their social relationships,” Waite said. The work is reported in the article, “Social Disconnectedness, Perceived Isolation and Health Among Older Adults,” published in the March issue of the Journal of Health and Social Behavior, a quarterly journal of the American Sociological Association. Waite conducted the study with lead author Erin York Cornwell, a postdoctoral associate in sociology at Cornell University. For their research, the scholars examined the results of the National Social Life, Health and Aging Project, a nationally representative study of older adults supported by the National Institute on Aging. The study, a comprehensive look at aging and health, included interviews with about 3,000 people aged 57 to 85 between 2005 and 2006. Because of the size of the survey, the researchers were able to consider in detail older adults’ social networks, their participation in social activities, their feelings of loneliness and their perceptions of the availability of help or advice from friends and family members. They also asked questions about physical health, mental health and feelings of sadness or depression. The work should help policymakers develop programs to compensate for the problems brought on by social disconnectedness and loneliness among older people. Aging often brings changes in social relationships as individuals retire, take up new activities, endure losses and experience health changes, the authors said. “For some older adults, a shrinking circle of friends and family can lead to feelings of loneliness or isolation. Our findings suggest that those who adapt to losses so that they don’t feel isolated fare better with respect to both physical and mental health,” Cornwell said.

“When they come to a community like this, where they have a lot in common, it helps them blossom again, where before they were shut in and didn’t see people very often.” – Roberta Mikhael The Village at 46 & Ten Hudson Guild’s Fulton Center provides many social opportunities for seniors, such as this movie discussion group.

feel welcome and part of a compassionate community. Cottrell also noted that many of the seniors who come in for information say they want to socialize but don’t want to go to a senior center. “They feel they don’t fit in there,” she said, “but would like a discussion group to talk about aging.” So she obliged and started one. A big issue is also support for decluttering, so she has ten different ongoing decluttering groups. “They meet with other seniors, talk about what to save, what to throw out, and work out how to do it together,” she said. The local Y’s are abuzz with social activity. Many have special classes or programs for seniors at discounted rates, like the Educational Center for Retired Adults at the 14th Street Y, which is at 344 14th St.; the McBurney Y, 125 West 14th St.; and the 92nd St. Y, 1395 Lexington Ave. In addition, the Chelsea Recreation Center, at 430 West 25th St,. between Ninth and Tenth avenues, is a stateof-the-art facility run by the New York City Department of Parks & Recreation, which offers a $10 annual membership for seniors 55+ for use of all its recreation centers and indoor pools. Chelsea is one of the largest recreation centers in the city and features a six-lane, 25-yard pool, a gymnasium with basketball and volleyball courts, fitness rooms, a dance studio, a game room and an arts and crafts room. It also has a computer resource center with instruction and senior painting workshops. The Asser Levy Recreation Center, 501 Asser Levy Pl., at E. 23rd St., also caters to seniors with senior swim time and special Fitness Room hours. Being a student is a great way for seniors to expand their social network. Many schools and universities have programs for seniors at reduced rates, such as New York University’s Osher Lifelong Institute (www.scps.nyu.edu/ learning), the Lifelong Learners Program at Columbia University (www.columbia. edu/cu/bulletin/uwb/), and some of CUNY’s schools of continuing education. However, if you don’t want to commit to courses, there are book clubs at local libraries, readings at local theaters, museum lectures and talks at historic institutions, which are listed in newspapers, on websites and on community bulletin boards. Claudia Teller, the activities director

at Village Care’s 82-apartment senior living residence, The Village at 46th & Ten, saw great changes in people who participate in the building’s acting group. “They have to work together,” she said. “They have movement, hearing and sight issues, which they have been able to conquer in the acting class. It’s a marvel to see them.” Roberta Mikhael, director of community relations at the residence, sees the value of community up close and personal every day. She says that as people get older and friends die off or move way, they feel isolated. “When they come to a community like this, where they have a lot in common, it helps them blossom again, where before they were shut in and didn’t see people very often,” Mikhael said. She cited the example of one current resident, who previously lived on his own. “He wouldn’t see people for a long time and wouldn’t talk on the phone. When he came here, he became one of our very active residents. I love to see this happen,” she said. A lot of the seniors who drop in at the information center are already engaged in political action and issue-oriented groups like the Grey Panthers and Chelsea housing groups, said Cottrell. Getting involved with like-minded individuals and causes is not only an invaluable socializing tool, but can also benefit your building, neighborhood or the world at the same time. With budget cuts and layoffs, volunteers are more necessary and appreciated than ever to keep social programs running. In New York City there are myriad opportunities, such as working in a community garden, feeding the hungry, visiting the homebound seniors, tutoring immigrants, taking care of pets or helping out at an understaffed non profit. New York Cares, a leading volunteer organization, has dozens of postings on its website. Lastly, a word about Internet chat rooms. While they provide some networking for seniors, Facebook will never replace face time. Scientists have concluded that there is a biological difference between virtual communication and real communication. People who get too involved in online activities are not exercising or engaging with others, which are by far the best ways to live long and prosper. g 29

standpoint

viewpoint

Aging Group Sees Call-to-Action Needed for Chronic Care Reform A new survey commissioned by the nonprofit National Council on Aging (NCOA) reveals a bleak and broken health care system for millions of Americans suffering from a variety of chronic conditions.

30 N E W HORI Z ONS | Summer 2009

WASHINGTON, DC – The results of the Reforming Health Care: Americans Speak Out About Chronic Conditions and the Pursuit of Healthier Lives survey shows many chronic disease sufferers are delaying health care due to cost. As a result, they are living in pain and feel abandoned by their health care providers. The survey was conducted of more than 1,000 Americans, 44 and older with a chronic illness such as heart disease, arthritis, hypertension and diabetes. Surveyors found that more than two-thirds (68 percent) have two or more chronic conditions – and 20 percent have four or more chronic conditions. Alarmingly, one in four (25 percent) survey respondents have delayed health care or not filled muchneeded prescriptions due to cost in the past year, despite the fact that they are frequently or sometimes living in pain (71 percent), stressed (65 percent) or depressed (50 percent). While most survey respondents say they rely on the health care system for ongoing help, many feel as if they are not getting the support they need. Over half (57 percent) of those surveyed say their health care providers have not asked whether they have help to manage their problems and 45 percent say that they rarely or never receive referrals to resources such as classes, counselors, dieticians and health educators. Over one-third (38 percent) say they don’t have the money it takes to do things that will improve their health, and this percent is much higher among Latinos (63 percent), African-Americans (58 percent), people with annual household incomes below $20,000 (65 percent) and people with four or more chronic conditions (59 percent). With chronic conditions as the central challenge to American health care today, the NCOA seeks to identify gaps in appropriate chronic care, including self-care, to inform the national conversation about health care reform. The survey examines the attitudes of Americans with chronic conditions and explores their quality of life, health needs and experiences with the health care system. The survey also identifies barriers to self-care and what is needed to bet-

ter manage overall health. “Chronic disease accounts for more than 75 percent of the nation’s $2 trillion medical care costs,” said Nancy Whitelaw, senior vice president of NCOA’s Center for Healthy Aging. “In order to truly help direct health reform efforts, NCOA listened to those most affected to get a better understanding of their challenges and what they need to better manage their health. Given what the survey participants told us, we identified three areas of focus necessary for reforming the health care system in order to support Americans with chronic conditions.” NCOA characterizes the following three areas of focus as: Policy: The federal government needs to make investments in community-based programs, and in primary care and hospital settings to ensure team-based, coordinated care across all settings. Practice: Health care professionals have a responsibility to connect their patients to effective community self-care programs, as well as improve the quality and coordination of care to people with chronic conditions. Personal Skills: Americans with chronic conditions need to develop the skills and confidence to manage their health and to advocate for the help and support they need. According to NCOA, a key element for success resides in community-based programs that focus on self-care, which includes teaching problem-solving, decision-making and communication skills that are needed by people with chronic conditions to manage their own health outside of the clinical setting. “It is important for Americans with chronic conditions, especially older adults, to seek support programs in their local areas to better manage their health,” said Dr. Chad Boult, professor of Johns Hopkins Bloomberg School of Public Health. Evidence-based health programs can result in significant improvements in energy, health status, social activities, less fatigue and lower use of the hospital and/or emergency room. For more information, please visit www.healthyagingprograms.org.

Caring About Long-Term Care By Lisa Eckenwiler As Americans live longer, the need for long-term care and long-term caregivers will continue to grow. Indeed, a defining issue for current and coming generations is how the United States and other nations will address the needs of their aging populations and  provide adequate care for the dependent elderly. The number of Americans over the age of 75 will more than double and the number of those over 85 will roughly quadruple in the first half of this century, overwhelming the nation’s long-term care services with 80 million elderly by 2050 – up from the 34 million today who are already mostly underserved or worse. The current health care system is poorly suited to serve the needs of the elderly and their families, and we lack a framework to address and improve it. Assisted living facilities, residential care facilities, and adult day care centers are plagued by insufficient funding; shortages of staff, particularly experienced staff, and unsafe conditions. And paid caregivers account for only 20 percent of long-term care. The majority of long-term care – a staggering 80 percent – is provided by unpaid caregivers, usually family and friends. At least six out of 10 of these caregivers are also employed in the paid work force, and 42 percent are over the age of 50 themselves. Yet few employers have written policies regarding elder care, and even fewer subsidize any elder care benefits. The United States is ill-equipped to handle the current demand for long-term care, and the growing elderly population will only exacerbate these strains. It is therefore vital to explore the range of concerns raised by the current system of caregiving now and create an ethical framework for addressing the issues. A strong ethical framework for discussing and understanding long-term care – as well as evaluating programs and practices – will provide a foundation for meeting the needs of the dependent elderly and their caregivers, and serve as a guide for policymaking. The report, An Ethical Framework for Caregiving from the Center for American

Progress, outlines seven ethical principles of caregiving that can help guide policy makers and other stakeholders in their efforts to ensure that the country meets its obligations to the dependent elderly and their caregivers. From this principled foundation, we can better envision and design specific policy strategies. The seven principles are: An Ecological Ethic: Recognizing the interconnectedness of people, systems and policies. Respect for Human Dignity: Respecting the unique worth of all people and their pursuit of a good life at all stages. Beneficence: Maximizing benefits, including health and security. Compassion: Demonstrating concern for the well-being of others, especially the vulnerable. Reciprocity: Appreciating and compensating those who give back to society. Temperance: Taking a long view rather than looking for short-term fixes. Social Justice: Treating all people fairly and equally and building just social institutions. The report reviews the circumstances facing the dependent elderly and their paid and unpaid caregivers. It highlights how the needs of dependent elders and those who care for them are intertwined. And it shows that policy sectors are interconnected, affecting decisions made across the policy spectrum and, in turn, affecting the lives of these givers and recipients of care. The report follows this ecological analysis and elaborates on the ethical framework that can guide policymakers and other stakeholders in their efforts to envision and implement specific, integrated policy strategies and ensure that the country  meets its moral obligations to the elderly and their caregivers while also growing stronger  socially and economically.

Thanks in part to a century of progress in public health and medicine, many people are enjoying healthier lives. Yet the success of modern medicine also presents us with challenges

(Ms. Eckenwiler, associate professor of philosophy in the Department of Philosophy and director of health care ethics at the Center for Health Policy Research and Ethics at George Mason University, is a visiting fellow at the Center for American Progress, www.americanprogress.org. She is the author of An Ethical Framework for Caregiving.) 31

the l a s t word

Order your copy of

By Louis J. Ganim

Legends of the Village

The (Not So) New Old Age

T

he other evening, an upstate woman was featured on TV news as having “reinvented” herself. She was in her early sixties. The woman had lost her job of many, many years as a comptroller (pronounced controller, by the way), and, not wanting to retire, what did she do? She started baking pies. And selling them. She started in her own kitchen and her pies were so good, or at least sold so well, that she soon outgrew the space and sought out a nearby ARC (Association for Retarded Citizens) for baking assistants and a larger kitchen. At last count, they were baking – and selling – more than 800 pies a month. But things are about to get more demanding. She just signed a deal with a local supermarket chain. Starting soon, she and her ARC workers will have to turn out some 5,000 pies a month! They say they are ready for the challenge, however daunting it may seem. At the end of the news piece, the reporter asked the financial-pro-turned-baker if she had any advice for people. She said: “Don’t worry about what you are going to do tomorrow – worry about what you are going to do today.” What surprises us as we get older, I think, is less about how frail we can get – we always expected that – than it is in realizing how much we can do and accomplish. We also learn that the well-worn adage was indeed wrong. You can teach an old dog new tricks. This isn’t anything new. It’s always been this way. I think we notice it more now because there simply are more people living longer and who, as singer Curtis Mayfield put it, “keep on keepin’ on.” There’s a lot of talk about how Baby Boomers are going to “redefine retirement.” Retirement as a concept is itself relatively new in the first place. You don’t have to look much farther than the early 20th Century when there was no such thing as “retirement.” After all, the life expectancy

of someone born in 1901 was just under 50 years. Not a lot of demand for retirement planning in those days, except that there was one unfortunate consequence in that women were expected to outlive men, by at least three years, it was estimated, of those born in 1901. As the U.S. population grew, so did the numbers of destitute widowed women As the decades of the 20th Century moved on, life expectancy kept advancing primarily due to modern developments in public health and the development of antibiotics, interrupted by the occasional world war. The generation born in the 1920s-1940s had a life expectancy of 55 to 60 years. But you know what? We kept getting better and better at keeping people alive, so that by the time these folks reached their “life expectancy at birth” of 55 or so, as many of them did, whoops, what do you know, we discovered they could live maybe another 20 years. Or more. Remember, we were a manual labor kind of country for most of the 20th Century and the opportunities in the workplace often declined with age, especially with every influx of new, young, strong workers. We had to do something with the survivors: Give them a little Social Security check, a gold watch maybe, a pat on the back and off you go into “retirement” for a while before you go to the “old folks home” and then into the pine box. An oversimplification? Perhaps. There have always been those who have resisted the idea of retirement. In olden days it was those with good genes and good fortune who lived extended lives, and those who did gave little thought to dropping out and becoming idle. Ben Franklin, for example, invented bifocals when he was 79. Nowadays, lots more of us live longer because science and medicine have given us that opportunity. Baby Boomers, a force to be reckoned with as they have aged as a group, are looking to create their own

opportunities to stay active. They will, assuming the economy cooperates. This is a good thing. We only have to look back to the last century to see examples of how age is no barrier to continuing to contribute and to excel. Here are some examples: • Frank Lloyd Wright completed his architectural design of the Guggenheim Museum at age 89. • Choreographer Martha Graham premiered Maple Leaf Gala at age 95. • Ichijirou Araya climbed Mount Fuji at the age of 100. • Harlan Sanders, make that Colonel Sanders, started the Kentucky Fried Chicken franchise at 65, using his first Social Security check. • Walt Stack completed the Ironman Triathlon at 73. Switching subjects (a bit): Some people just are late bloomers. Anna Mary Robertson Moses was an embroiderer most all her life, but arthritis ended that. So, she started painting. Some of her work, displayed in a drug store window in the little upstate New York village of Hoosick Falls, was spotted by a collector, and it wasn’t long before everyone knew who “Grandma Moses” was. She painted for much of the next three decades before her death at 101. One of her works hangs in the White House. Another sold for $1.2 million. Someone once said that as you grow older, you become more carefree. Maybe it’s just that a life of experiences somehow frees the spirit. A song that captured this was written in 1967 by Paul Anka, who adapted the work of three French songwriters – Jacques Revaux, Gilles Thibaut and Claude Francois. Anka’s version has lyrics that include: I’ve loved, I’ve laughed and cried. I’ve had my fill; my share of losing. And now, as tears subside, I find it all so amusing. That, of course, is My Way, made famous by Frank Sinatra.

A compilation of striking photographs and short stories of the legends of Greenwich Village.

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212.337.5750 price: $95

Geoffrey Holder Artist, Actor

Village Care of New York

32 N E W HORI Z ONS | Summer 2009

33 We’re here here for We’re foryou. you.

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Meet many interesting, intelligent people from your Be a part of ongoing preneighborhood with similar sentations on current issues interests. affecting seniors.

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k in and bring your queshether they are about governefits, living well, medical issues g, long-term care services or concerns you may have about r an older family member. staff will give you personal and provide you with direct . We will point you in the of the appropriate resources in of services and programs that ur community.

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