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    Ageism: The Dance of Marginality and Irrelevance

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    “I know I’m going to get older. I can handle that, and I even know that I am going to die. What bothers me the most, though, is the thought of becoming irrelevant.” This statement was made by a 69 year old man who is a member of my consciousness raising group.

    Old people are becoming less and less a minority in our country. Quite to the contrary; today, approximately 18 per cent of people living in the United States are 60 years old and older. By 2050, people over 60 will make up over 25 per cent of the population…hardly a small minority.  When we marginalize a group of people, we are pushing them to the edge of humanity and according them lesser importance.  Their needs and desires are then ignored.  When ageism is in action, this is exactly what happens. Ageist language and media portrayals of old people encourage this marginalization.

    Ageism can be very subtle, or as one of my colleagues describes it, “slow-drip” oppression.  It creeps up on us, sometimes without our ever knowing we are being oppressed until we find ourselves in the outer margins of society.

    Nobody wants to be pushed to the edge of society.  Yet, older adults teeter on this edge…always dancing on the line between inclusion and exclusion.  In today’s society pride in age is hard to find.  It’s no wonder that older people often hide their true age.  Stop for a moment, and ask yourself, “why?”

    Many of us tend to think of this practice as vanity, but consider that the true answer may be fear…fear of becoming irrelevant.  So, what do we do?  We drink the “Kool-Aid” dispersed by the media and the anti-aging industry; the message is, If you don’t look young enough, you too will be marginalized.  Not only is the advertising deceptive, it is detrimental to our overall health.

    Not wanting to be relegated to the outer margins, we support the anti-ageing industrial complex, spending hard-earned money on anti-aging products, medical and non-medical procedures, and cosmetic or plastic surgery.  When we do this, are we just satisfying our own vanity or are we hoping to buy a few more years of relevancy?

    The dance of marginality seems to start younger and younger these days, with people in their forties and some even in their thirties seeking out a magic bullet that will make them seem to appear younger than their true age.  For those of us who are older, however, one day you are a vital contributing member of society and only a few wrinkles later, you are dancing on the margins again, trying to figure out how to get back to the other side before you are turned into a trivial appendage, maybe even a burden, to the current social order.

    Ageism in itself can cause a more rapid decline of our physical and mental health as we edge  closer to the end of our lives.  Researchers have proven that older people who are constantly subjected to negative stereotypes of their age cohort often internalize these messages.  As a result of this internalized ageism, their own self esteem is affected; and this leads to both physical and mental health issues.  In addition, recent research has shown that those who accept their age and feel the wonderful combination of beauty and wisdom in their own selves are mentally and physically healthier than those who feel the pressure of having to conceal their true age.  Many of us just keep on dancing.

    Who is doing all this dancing?  First and foremost are the “invisibles.”  The “invisibles” are healthy people between the ages of 60 and 80 who are not ready to “retire” in the way that traditional retirement has been socially constructed.  This cohort is the most skillful at the dance of marginality; they get in a lot of rehearsal time.  They know that if they don’t enter the dance contest, they will automatically lose. And, they can lose a lot.  Mostly, they can lose their financial security and, with that, their dignity.

    You may have noticed that the age of the traditional concept of old has been pushed back quite a bit, with people living 10, 15, and some even 20 years longer than previous generations. In many ways the invisibles are in the prime of their lives.  Yet, they are constantly maneuvering to remain inclusive members of society. Most catastrophic is the cold shoulder they bear from American workforce.  If they are not still in their career jobs, they find themselves traveling a road that leads them closer and closer to the margins of society.

    A lovely 85 year old woman came to visit me in my office one day.  She was carrying a rather large umbrella.  “Is it raining?,” I asked.  “No,” she replied; I just refuse to be seen using a cane.”  Even at 85, she is still dancing.  To appear completely autonomous is her goal.  Afraid to admit that she may need some help, she struggles to keep up the appearance for fear that she will not be perceived as the smart woman she is.

    The way our society is constructed, it takes more courage to ask for help than it does to manage on our own regardless of the consequences. It is the American way, to “pull yourself up by your bootstraps” and rely only on yourself to get where you’re going.  Another octogenarian told me “if I show the slightest sign of  not being able to live independently, my children will whisk me into the nearest assisted living facility.”  She knows this, and so she dare not let her age show.  She, too, keeps on dancing.

    Fear seems to be the main reason why so many of us are caught up in this dance of marginality. There are other times and other places where older adults have been embraced by society.  For so many, this is no longer true.  Old people are often segregated, put aside, or discarded completely. They are often treated as if they are diseased. We need to start changing the way we view and interact with the older adults around us. Old age is not contagious.

    The ageing process, including the end of life, is part of the course of the lifespan.  Ageing is not a disease to be treated; it is a gift to be accepted.  It is an accomplishment to be proud of.  Older adults should not feel as though they have to “sing for their dinner,” nor should any of us have to “dance for our dignity”.

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    As a political social worker, Alice is deeply interested in best practices in community building and an advocate for improving services and quality of life for older adults. She developed and runs Senator Liz Krueger’s Roundtable for Boomers & Seniors.She is particularly interested in the challenges of longevity in today’s ageing society, and Alice holds an M.S.W. from Hunter College School of Social Work.

    Elder Care

    How New Tech Can Support Caregivers as They Support Seniors

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    Up to 42% of Americans over the age of 65 take five or more medications, and in 2018, at least one in every five seniors experienced an adverse drug reaction. Such reactions are more common when seniors can’t properly adhere to the instructions that accompany their prescriptions.

    In fact, according to U.S. Pharmacist, nonadherence accounts for about half of treatment failures and a quarter of hospitalizations every year. This, combined with the fact that healthcare providers are largely overwhelmed and overburdened, means caregivers have a unique opportunity to improve senior health outcomes. Caregivers can act as an extension of the medical industry to help seniors overcome the hurdles they face when it comes to medicating themselves properly.

    Why Medication Adherence Is Challenging for Seniors

    Experts agreed that the therapeutic efficacy of any medication requires an adherence rate of 80% or higher. To medicate properly, seniors must closely follow the instructions on each drug’s label and keep a consistent routine around consuming the right doses to avoid complications.

    Unfortunately, the current average for medication adherence for chronic health conditions is only about 50%. For most patients, this isn’t enough to improve or stabilize their conditions — much less boost their life expectancy. But nonadherence is often a combination of hurdles that can be difficult for seniors to overcome on their own.

    For example, the instructions on drug packaging may be confusing, and age-related memory loss can lessen the chances of proper adherence. The side effects of certain medications may also be uncomfortable, making patients hesitant to stick with them. Overall, keeping track of when and how to take various medications can be overwhelming for anyone.

    The Important Role of Caregivers

    Daily routines and medical schedules can be much easier for senior patients to adhere to with the assistance of a caregiver. As caregivers, a patient’s family members, friends, loved ones and volunteers can help ensure seniors take their prescriptions as directed and eat regular meals. What’s more, they can better monitor changing behaviors or symptoms that could indicate a poor reaction to medications.

    Because the healthcare system is becoming increasingly overburdened, healthcare providers don’t always have the time or means necessary to devote to helping patients adhere to medications. Instead, the healthcare system should focus on providing caregivers with tools they can use to make senior care more manageable, especially when it comes to drug adherence. This will become even more necessary as the senior population grows.

    The following tools can help caregivers address the medication adherence problem plaguing American seniors:

    • Automated medication dispensers: Medication dispensers have come a long way — from manually organized pillboxes to modern, automated dispensers that ensure people get the prescriptions they need. One of the most valuable aspects of automated medication dispensers is that they can sync with a mobile application to alert caregivers of missed doses and low prescriptions.
    • Personalized medication reminders: Medical alert systems and healthcare apps — or even simple reminders on a smartphone calendar — are vital to helping seniors prevent missed doses. Some apps are more detailed than others, so consider whether simple reminders will suffice or whether caregivers should receive confirmations as well.
    • Home delivery of presorted medications: In terms of convenience, having presorted medications delivered directly offers a critical advantage for both seniors and caregivers. Automated delivery systems can be synced with medication reminders to create a convenient, holistic routine that makes adherence more accessible than ever.

    When Medication Adherence Is Easier

    There are very clear, immediate benefits to practicing better medication adherence — the most obvious being the success of the medication. Data suggests that for every 10% improvement in medication adherence, healthcare costs can be reduced by 29%.

    Adherence also has a halo effect on other aspects of a patient’s life, improving chances of eating healthy, exercising regularly and taking one’s own personal wellness journey more seriously. Better adherence is key to improving seniors’ quality of life and reducing the burden on the healthcare system, and caregivers are in a great position to help make it happen when armed with the right tools.

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    Aging

    Loneliness May Be Due to Increasing Aging Population

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    Lonely workaholic with alcohol problem

    Despite some claims that Americans are in the midst of a “loneliness epidemic,” older people today may not be any lonelier than their counterparts from previous generations – there just might be more of them, according to a pair of studies published by the American Psychological Association.

    “We found no evidence that older adults have become any lonelier than those of a similar age were a decade before,” said Louise C. Hawkley, PhD, of NORC at the University of Chicago, lead author of one of the studies. “However, average reported loneliness begins to increase beyond age 75, and therefore, the total number of older adults who are lonely may increase once the baby boomers reach their late 70s and 80s.”

    The studies were published in the journal Psychology and Aging.

    Hawkley and her colleagues used data from the National Social Life, Health and Aging Project and the Health and Retirement Study, two national surveys of older adults that compared three groups of U.S. adults born in different periods throughout the 20th century. They first analyzed data in 2005 to 2006 from 3,005 adults born between 1920 and 1947 and a second time in 2010 to 2011 from 3,377 people, which included those from the previous survey who were still alive, and their spouses or partners. The third survey, in 2015 to 2016, comprised 4,777 adults, which included an additional sample of adults born between 1948 and 1965 to the surviving respondents from the previous two surveys.

    The authors examined participants’ level of loneliness, educational attainment, overall health on a scale from poor to excellent, marital status and number of family members, relatives and friends they felt close to. They found that loneliness decreased between the ages of 50 and 74, but increased after age 75, yet there was no difference in loneliness between baby boomers and similar-aged adults of earlier generations.

    “Loneliness levels may have decreased for adults between 50 and 74 because they had better educational opportunities, health care and social relationships than previous generations,” said Hawkley.

    Adults over 75 were more susceptible to becoming lonely, possibly due to life factors such as declining health or the loss of a spouse or significant other, according to Hawkley.

    “Our research suggests that older adults who remain in good health and maintain social relationships with a spouse, family or friends tend to be less lonely,” said Hawkley.

    In a similar study, researchers in the Netherlands found that older adults were less lonely than their counterparts from previous generations.

    These researchers used data from the Longitudinal Aging Study Amsterdam, a long-term study of the social, physical, cognitive and emotional functioning of older adults. A total of 4,880 people, born between 1908 and 1957, participated.

    The study measured peoples’ loneliness, control over situations and life in general and goal achievement. For example, participants rated loneliness on a scale from 0 (no loneliness) to 11 (severe loneliness) based on feelings such as, “I miss having people around.”

    Older adults born in later generations were actually less lonely, because they felt more in control and thus most likely managed their lives better, according to Bianca Suanet, PhD, of Vrije Universiteit Amsterdam and lead author of the study.

    “In contrast to assuming a loneliness epidemic exists, we found that older adults who felt more in control and therefore managed certain aspects of their lives well, such as maintaining a positive attitude, and set goals, such as going to the gym, were less lonely,” said Suanet. “Additionally, as is well-known in loneliness research, participants who had a significant other and/or larger and more diverse networks were also less lonely.”

    Suanet recommended that older adults take personal initiative to better nurture their social ties, such as making friends to help them overcome increasing loneliness as they age. Also, interventions to reduce loneliness should focus more on bolstering older adults’ feelings of control, instead of only offering social activities.

    “People must manage their social lives better today than ever before because traditional communities, which provided social outlets, such as neighborhoods, churches and extended families, have lost strength in recent decades,” said Suanet. “Therefore, older adults today need to develop problem-solving and goal-setting skills to sustain satisfying relationships and to reduce loneliness.”

    Seniors may also want to make use of modern technology to maintain meaningful social connections, according to Hawkley.

    “Video chatting platforms and the Internet may help preserve their social relationships,” said Hawkley. “These tools can help older adults stay mobile and engaged in their communities.”

    Articles: “Are U.S. Older Adults Getting Lonelier? Age, Period and Cohort Differences,” by Louise C. Hawkley, PhD, NORC at the University of Chicago; Kristen Wroblewski, MS, L. Philip Schumm, MA, University of Chicago; Till Kaiser, PhD; and Maike Luhmann, PhD, Ruhr University Bochum. Psychology and Aging. Published Dec. 10, 2019.

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    Aging

    How Universities Can Better Support Student Caregivers

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    More than half of family caregivers are between the ages of 18 and 49 years old – and as the U.S. population ages, increasing numbers of these caregivers will be enrolled in colleges. Often categorized as “nontraditional students,” college-enrolled caregivers are responsible for children, spouses, and dependent parents with disabilities and chronic illnesses. Nontraditional students of all kinds are more likely to drop out of higher education because of obstacles in their non-academic lives, and this certainly holds true for those who have to balance caregiving with their studies.

    Historically, Student Affairs professionals have developed programs and services to meet the challenges faced by underrepresented and underserved students. Given the growing prevalence of student caregivers, academic institutions should keep their needs in mind when distributing funds and creating student support services. While each student caregiving experience is unique, the fundamentals are constant. Very often, student caregivers must choose between attending to a human being for whom they are responsible or attending to academic tasks.

    Students managing such choices, balancing caregiving and academic demands, face significant barriers. For example, the amount of time they are able to spend with faculty and advisors is often limited by their caregiving responsibilities. Furthermore, efforts to disseminate information about support services on college campuses typically focuses on traditional students and thus may miss or leave out nontraditional students who are not part of established campus communication channels.

    Student-Centered Teaching Can Help Caregivers

    Student-centered teaching focuses on individual learning needs to promote persistence and success. Effective student-centered instruction is based on the understanding that one size does not fit all. When an instructor makes accommodations for student caregivers as emergencies arise, such flexibility demonstrates empathy and can promote success rather than indicate compromised standards.

    Consider the following examples from the lives of student caregivers I interviewed in my research:

    • Waldo told me about his experience during his first year of college. He began caring for his mom, who had Huntington’s Disease, while he was in high school. He grew up in poverty and was the first person in his family to go to college. He chose to stay at home and commute to college so he could continue to care for his mom and save money. During finals week of his freshman year, his mom required brain surgery because of a fall. He asked his statistics professor if he could take the final at an alternative time due to his mom’s surgery. The professor replied that it was his choice whether he came to the final or not, but he would not alter the time.
    • Alex, an assistant professor, cared for his mom who had a stroke while he was completing his PhD. He told me he was lucky the stroke occurred around Thanksgiving, when he had a break from the regular requirements of the semester. As he navigated his mom’s recovery, Alex only had to negotiate with his dissertation chair – who allowed him to alter deadlines to ensure he had the time he needed to care for his mom.

    Alex’s dissertation chair practiced student-centered teaching, while Waldo’s professor did not. The advantages to students of such teaching are evident, especially for student caregivers, who need a flexible learning environment to succeed academically and develop healthy coping skills while contending with the overriding needs of those for whom they care.

    Student Caregivers, Technology, Insurance, and Health

    Student caregivers are at a higher risk for stress-related illnesses than their peers, due to their time constraints and intersecting roles; and such difficulties can be compounded when students lack the time and resources to develop healthy coping strategies. Nevertheless, higher education policies have the potential to improve long-term health outcomes for student caregivers by providing access to appropriate supports and resources. Health is at the core of student learning and success. It is in the interest of university administration to ensure access to institutional support and resources, as the following examples suggest:

    • Natalia, a PhD candidate and caregiver, struggled with anxiety and depression. Her dissertation advisor empathized with her situation and allowed her to work remotely instead of commuting to campus when her mom needed care. She was fortunate to have access to all of the university’s technological resources while at home caring for her mom. Natalia’s advisor also encouraged her to apply for emergency funds. The flexibility and knowledge about university resources that Natalia’s advisor provided, helped her develop and employ healthy coping strategies.
    • Anne, a master’s degree student, told me about the university resources she received as a student caregiver. Assistive technology provided by her university was installed on her personal computer, allowing Anne, her husband, and their children to navigate various tools for coping with learning disabilities. Student health insurance provided by the university allowed her to get allergy shots, orthotics, and counseling to cope with anxiety and depression. Financial aid both increased and decreased stress. She worried about paying back the loans, but before she enrolled in graduate school her family did not have the financial reserves to weather a crisis.

    Toward Equity for Student Caregivers

    Like other students, caregivers seek higher education to improve their economic and social resources, but they face many obstacles and graduate less often than traditional students. To level the playing field for all students, administrators should ensure all students have access to health insurance, appropriate personally tailored learning technologies, and the flexible schedules and supportive resources they need to study even when caring for others. Colleges, students, and society alike only stand to benefit if student caregivers face easier routes to degrees.

    Read more in Lisa Schumacher, “The Lived Experience of Student Caregivers: A Phenomenological Study,” University of Iowa, 2018.

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