Tuesday, June 14, 2011

Wiser Older Adults

Everyone has a different definition of wisdom, but we all agree that is it something that is desirable. Aristotle was one of the first to argue for the importance of practical over theoretical knowledge in determining what wisdom is. Historically—when survival to older age was less certain—it was assumed that survivors were wise. They had the practical know how to survive. However, practical knowledge is no easier concept to define.

In a 2007 study, Fredda Blanchard-Fields and Susanne Scheibe showed a disturbing video for two groups of adults, ages 20-30 and 60-75. They then they asked them to ignore what they have just watched and to play a memory game. People in the older age group performed better on the memory test. It seems that older adults are better at separating their feelings and looking at the practical task at hand. This ability allows older adults to remain positive in the light of accumulating negative experiences.

Despite multiple chronic illnesses that cause functional disability or cognitive decline, most older adults are able to tune out negative information into their late 70s and 80s. The recent 2010 AARP study that looked at wellbeing also showed that despite reporting a decrease in high overall quality of life since five years ago (48% from 50%), everyone expects their quality of life to increase in five years time. It could be that the ability to be positive—despite the reality—allows for practical and therefore wise decisions. But happiness is not solely the privilege of older adults.

A study published this year in the Proceedings of the National Academy of Science found a U-shaped relationship between happiness and age: Adults were happiest in youth and again in their 70s and early 80s, and least happy in middle age. A 2007 University of Chicago study similarly concluded that rates of happiness—the degree to which a person evaluates the overall quality of his present life positively—crept upward from age 65 to 85 and beyond, in both sexes.

This paradox that exist for older adults and not for younger adults—that older adults are happier despite the likelihood of multiple chronic illnesses, functional disability, cognitive decline, and accumulating negative experiences—can be the definition of wisdom.

The ability for most older adults to be able to tune out negative information and evaluate the situation on a practical foundation is unique. Raising a family, navigating a career and experiencing love, loss, success and failure educate adults. It is the ability to see all of this and still manage to search for compromise, admitting uncertainty, overcoming fear and finding flexibility that is the seat of wisdom.

This explains that it is not simply life that is a precondition for wisdom. Aristotle insisted that only individuals with good character could acquire excellence in practical wisdom. And it seems that we have known this all along as the English philosopher Bertrand Russell (1872-1970) said “To conquer fear is the beginning of wisdom.”


Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Poverty is (really) on the Increase among Older Adults

Having $100 in San Diego is not the same as having $100 in Wichita, Kansas. Anyone can tell you that. But the federal government has ignored this for the past four decades.

The Federal Poverty Level, originally developed in 1963-1964 by Mollie Orshansky of the Social Security Administration, took the dollar costs of the U.S. Department of Agriculture’s economy food plan for families of three or more persons and multiplied the costs by a factor of three. As such the federal poverty level does not take into account housing costs, differences in living expenses across the country, child care, health care costs, medications and transportation. For older adults, the cost of food is the smallest cost when compared to housing costs, medications and health care—therefore the Federal Poverty Level becomes meaningless.

The 2010 Current Population Survey reported 43.6 million people living in poverty—the largest number in the 51 years for which poverty estimates have been published.

Surprisingly, the same report shows that between 2008 and 2009, poverty increased for children under age 18 (from 19.0 to 20.7 percent) and people aged 18 to 64 (from 11.7 to 12.9 percent), but decreased for older adults (from 9.7 to 8.9 percent).

Such statistics contrast wildly with today’s reality. Hardship among older adults can be gauged by increases in homelessness, having to return to work, demand for subsidized housing and requests for economic assistance. In response to the imprecision of the Federal Poverty Level, the National Academy of Science developed a new formula it hopes will replace the current one. This January, the federal government officially acknowledged the need to improve the outdated federal poverty level by releasing a ‘Supplemental Poverty Measure.’
California could not wait, having already embraced an alternate formula called the Elder Index. This index, calculated by the UCLA Center for Health Policy Research on behalf of the Insight Center for Community Economic Development, and Wider Opportunities for Women shows that the cost of living for California seniors far outpaces the Federal Poverty Level. The inadequacy of the Federal Poverty Level is important to California’s older adults as it determines eligibility for many public programs, determines funding allocations for other programs, and is used as an evaluation measure in determining program effectiveness.

The Elder Index estimates that 18.6 percent of Americans over 65 live below the poverty line, which translates to 6.8 million older adults. This index is more accurate than either the antiquated Federal Poverty Level or the Supplemental Poverty Measure because it takes into account the costs of child care, health care and transportation.

The Elder Index could take on added significance at a time when the government is flaunting an overhaul of Medicare and Social Security as its best hope for reducing the ballooning federal debt. With the potential to add more older Americans to the ranks of the poor, the numbers may underscore a need for continued—if not expanded—old-age benefits.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Ethnic Diversity Among Older Adults: Older adults becoming more diverse

By 2050 out of 439 million Americans, minorities—those Americans who identify themselves as Hispanic, Black, Asian, American Indian/Alaskan Native, Native Hawaiian, Pacific Islander or mixed race—will account for 54 percent of the U.S. population (currently 34%). Among the nation’s children, the trend is even more pronounced—jumping to 62 percent by 2050 (compared to 44 percent today). It will no longer be accurate to refer to these ethnically diverse groups as minorities.

Immigration plays a leading role in both the growth and changing composition of the U.S. population. Immigration is the single reason why the United States has not aged as fast as most European countries.

The Pew Research Center finds that immigrants and their descendants will account for 82 percent of the projected population increase from 2005 to 2050. Nearly 20 percent of Americans will be foreign-born in 2050, compared with 12 percent in 2005, the Center projects. On the other side of the age continuum, by 2050 one in five people will be 65 and older and 59 percent will be White. That same year, when 19 million people will be age 85 and older, 67 percent will be White.

These changes signal that America is changing color while aging. Although older adults are becoming more diverse, for the next four decades, we will have a predominantly White older group, and a predominantly ethnically diverse younger group following. This seems to create social tension, especially when older adults express less tolerant views of an ethnically diverse population.

A popular view holds that older adults hold more narrow views than younger adults because they grew up in a less tolerant era. However, recent research shows that—even though they might have ethnic biases—older adults are less able to regulate associations. For older adults, implicit racial biases—which we all have—are likely to be acted upon.

Although older adults might be perceived as biased against ethnically diverse younger populations, they must, at the same time, rely on these same populations to generate the funds for their federal benefits. Especially, in light of the fact that both Social Security and Medicare rely exclusively on younger workers’ contributions.

In what we euphemistically term “pay-as-you-go,” today’s younger workers—including undocumented workers—contribute to the benefits of current retirees. In a now outdated but pertinent 1994 study, Donald Huddle estimated that total revenues from undocumented workers was $10 billion, including $7 billion in Social Security taxes.

Because of proposed changes under discussion for Social Security and Medicare, any changes to these federal benefit systems will have grave impact on younger workers who are currently supporting today’s older adults. And these workers will predominantly be ethnically diverse. The “pay-as-you-go” system might become a “pay-and-go” system. Older adults have an obligations to maintain current privileges to younger Americans.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Monday, June 13, 2011

Gambling and the Older Adult: Losing More than Just Your Money

Older adults are gambling in record numbers. For the first time, a large number of older adults have disposable income. With fewer economic obligations, some retired older adults have increasing opportunities to engage in recreation and leisure activities. Americans view retirement as a time to have fun after a lifetime of responsibility, work, bosses, children, family and mortgages—and gambling seems an exciting form of recreation.

A new report from Richard K. Miller and Associates revealed that gross gaming revenue in the U.S. totaled $80.5 billion in 2009. And, according to Debbie Rull of the Union of Pan Asian Communities, San Diego County has ten casinos with a combined annual gross revenue of $1.5 billion, employing 13,000 workers with an annual payroll of $270 million. Gambling in San Diego attracts 40,000 people daily. Gambling by older adults is big business. Many retirees begin gambling without appreciating the risks.

Data suggest that recreational gambling provides both beneficial and detrimental effects. Among older adults, recreational gambling—like many enjoyable leisure activities—may create opportunities for socialization, mental stimulation, and other benefits. The majority of adults in the United States who gamble recreationally, do so at levels not considered problematic or pathological.

On the positive side, Rani Desai in 2004 found that in comparison to younger adults, older adults expressed fewer negative measures of health and wellbeing. Specifically, increased rates of alcohol abuse, substance abuse, and incarceration—found among younger recreational gamblers—did not occur among older recreational gaming participants. In addition, older gamblers reported feeling happier and had positive subjective ratings of general health then their non-gambling peers.

However, research also suggests that older adults may be particularly vulnerable to some gambling-related problems. Approximately one in twenty adults who participate in gaming have a problem or tendencies toward pathological gambling. Many older adult gamblers with fixed incomes are more vulnerable to financial devastation than younger gamblers. Whereas younger gamblers are more resilient to losses because they can recover income losses, for many older adults gambling can result in permanent poverty.

Older adult problem gamblers are less willing to seek timely help for their addiction. Approximately two-thirds of the older adult population has gambled in the past year. Over the past several decades, gambling participation has grown the most among older adults.

Although gambling can represent a safe way to socialize and spend a few hours being entertained, a small proportion of older adults find that the attraction consumes their focus. If you suspect that you have a problem, resources exist to help you. Between 1999 & 2003, California gambling addiction hotlines reported that calls from older adults increased by 25%. If you or your loved one need help, call the California Council on Problem Gambling (888) 250-2282 or you can reach them on their website www.calproblemgambling.org.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Older Drivers

In many Americans’ minds, independence is firmly connected to being able to drive. Our cities—especially San Diego—rely heavily on personal transportation options. But for an aging population, our transportation system needs to be—in the near future—very different from todays.
Changes in our bodies partly ensure that driving will become more precarious. Apart from clinical issues that affect some older adults, other, normal changes—things like diminished physical capacities—affect our driving competence.
Visual acuity begins to diminish in normal older adults. Night vision and peripheral vision both decline with age. At the same time, older Americans take more prescription medicines than any other age group. Several types of medication can make driving harder because they affect perception and our senses. Drugs that might interfere with driving include sleep aids, medicine to treat depression, antihistamines for allergies and colds, strong painkillers, and diabetes medications. Changes in sleep patterns start to affect how well we can concentrate. These events combine in an overture driving difficulties that are likely to result in death.
Despite these changes, the percentage of older people who continue driving is growing. The concern is that there is very little debate on the implications of this transformation. We are not preparing for the inevitable.
Apart from the promotion of the trolley (train) service, and small pilot programs looking at volunteer drivers, there is no state or city-level discussion on how the aging of our drivers will radical effect our transportation system and what options we have.
Even if baby boomers drive at the same (modest) rates as the current older population, their sheer numbers means that total miles driven by those 65 and older will increase by 50 percent by 2020 and more than double by 2040.
Although older drivers drive far fewer miles than younger drivers they are more likely to be injured or die in a crash of the same severity—older adults are frailer and they tend to drive older and less safe cars. Older cars are less safe, but 26 percent of drivers over the age of 80 are driving pre-1988 vehicles, compared to 16 percent of drivers under 60.
For most older adults personal transportation is very much a necessity. We will be seeing more older drives, more older cars, frailer less responsive drivers, resulting in a higher susceptible to injury and therefore increase road fatalities.
An innovative program currently running in Lincoln City, CA shows some promise. They have developed Neighborhood Electric Vehicle friendly city, that allow older adults access to city services and to connect to train and bus services for long distance travel.
For now there are a number of things you can do to improve your driving and your chances of survival. Think about taking a driving refresher class. AARP sponsors “55 ALIVE/Mature Driving.” Call 1-888-227-7669 . While AAA has a number of classes including some by Posit Science called DriveSharp. Driving safely ensures that you continue to retain your license as well as your life.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Saturday, June 4, 2011

Older Adults are programmed to remember happy thoughts: Happiness Helps You Live Longer

A 2008 Gallup telephone survey of more than 340,000 adults in the United States found that people become happier and experience less worry after they reach the age of 50. In fact, by the age of 85, people are happier with their life than they were when they were 18 years old. Is happiness part of growing older, or do happy people live longer?

In 2011 Donna Rose Addis from the University of Auckland (NZ), and her colleagues, tried to answer this question. They published a study that reveals that older adults' ability to remember positive events is linked to the way in which the brain processes emotions. In the older adult brain, there are strong connections between those regions that process emotions and those known to be important for retaining memories. They asked young adults (ages 19-31) and older adults (ages 61-80) to view a series of photographs with positive and negative themes, such as a victorious skier or a wounded soldier. While participants viewed these images, a functional magnetic resonance imaging (fMRI) scan recorded their brain activity. In older adult brains, two regions that are linked to the processing of emotional content were strongly connected to regions that are linked to memory formation. These findings suggest that older adults remember the good times well because the brain regions that process positive emotions also process memory. Living longer makes you remember positive emotions better. Older adults experience an increase in positive thoughts and feelings, along with a decrease in negative emotions like anger and frustration.

But it is not a one way street. Positive emotions not only make you feel good they also reduce blood pressure, promote better heart health, reduce frailty and promote exercise and a healthy lifestyle. Numerous studies continue to show that living longer relates to this ability to see things in a positive light. Research found that older individuals with more positive self-perceptions of aging—measured up to 23 years earlier—lived 7.5 years longer than those with less positive self-perceptions. This advantage remained after accounting for differences in age, gender, socioeconomic status, loneliness, and functional health.

Being happy also relates to being philanthropic, giving back to people. Anthropologists point out that early developed societies practiced helping others as a social norm. There appears to be a fundamental human drive toward helping others. Evolution suggests that human nature evolved emotionally and behaviorally by increasing longevity for those that helps others. We seem to prosper under the protective influence of positive emotions.

Being happy was always seen as important. Enshrined in the Declaration of Independent is the phrase “…endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness…” Jefferson himself equated happiness with living a virtuous and useful life. "It is neither wealth nor splendor, but tranquility and occupation (meaningful work)," he said, "which give happiness." How very true, and most older adults know that so well.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Fear of Alzheimer’s Disease

Far from abating Americans’ concerns about Alzheimer’s disease, public awareness of the disease has increased fears for many. According to a 2010 survey by the MetLife Foundation, people over 55 dread getting Alzheimer’s more than any other disease (after cancer). Although 93 percent were aware of the disease, almost three-quarters say they know very little or nothing about Alzheimer’s.

We do know that the disease is unprecedented, the repercussions pervasive, the impact profound and the effects enduring. We can only hope that increased knowledge about Alzheimer’s will alleviate some of the anxiety.

Of the more than 100 types of dementias, the four main types are irreversible. These include Alzheimer’s disease (60% of cases); Vascular dementia (30–40%); Lewy bodies (15%); and Fronto-temporal dementia (5%).

Other less common dementias result from head injury and trauma; tumors; pressure of fluid in the brain; bacterial and viral infections; toxic, endocrine and metabolic causes; chronic alcoholism; and lack of oxygen. Whatever the cause of the disease, the effect on the brain is the same. It begins with a gradual and progressive reduction in the number of living cells in the brain. The brain slowly begins to die.

Some potentially reversible causes of dementia—although a small proportion—include medication side effects, thyroid or excess vitamin B12 deficiency, abnormal calcium levels and abscesses in the brain.

The greatest risk factor in dementia is age, and as Americans live longer, the threat of Alzheimer's will continue to increase. The Alzheimer’s Association estimates that 4.5 million Americans now have dementia. It further affects more than a third of U.S. adults through a family member or friend who has Alzheimer’s. Three out of five people surveyed were concerned that they may someday have to be a caretaker for someone with Alzheimer’s. Although eight out of 10 people said they think it is important to plan ahead for the possibility of getting Alzheimer’s, they have taken no steps to prepare for the possibility of Alzheimer’s.

Apart from staying healthy, eating a balanced diet and generally staying mentally active, few options exist for stopping dementia. It is a degenerative disease that progressively weakens the capacity to function.

As a community, we still have not learned how to deal with this disease. The fear that cancer engendered is being replaced by “dementiaphobia.” The very word dementia inspires a degree of fear that “heart attack,” “stroke” or even “kidney failure” often do not. Any of these conditions can kill. Yet somehow, to many of us, the idea of dementia seems more horrifying. Perhaps we fear the idea of losing who we are—becoming a stranger in an unfamiliar body.

The unknown fuels fear. If you are one of the majority who has signs of dementiaphobia, start by finding family members or friends who have early stage dementia and talk with them. Converse. Keep the discussion simple, be patient and show compassion. You will be amazed how successful you will get at learning how to communicate differently. The fear will subside, maybe not completely diminish, but you will be able to see the disease without any emotional baggage.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Dying Older Adults

How would you like to die?  Gilbert Meilaender from Valparaiso University in Indiana suggested a one-word answer: Suddenly!  The idea is to live as long as we can at the peak of our powers, then fall off a cliff.  Doubtless he is right about contemporary attitudes toward death. If we have to go, let it be quickly and painlessly.

Last month a local woman, Sharlotte Hydorn, gained a measure of negative notoriety by offering to mail you, for only $60, a package containing a plastic bag, medical tubing, a canister of helium and instructions on how to commit suicide—by placing the bag on your head and filling it with helium which deprives the body of oxygen. The State of Oregon, one of the few states where physician assisted suicide is legal, was exploring the possibility of suing her.

These two perspectives point to the schizophrenic relationship many of us have with death. What we say we want is frequently quite different from how we deal with death. Since more than a quarter of us will likely die in an emergency room, our final departure might look more like a medical failure rather than a dignified release of life.

Despite the availability of hospice care—both at home and at hospitals, which often involves palliative care targeted to relieve pain—most older adults still experience widespread distress in the final stages of life. We have few guidelines how to deal with death or bereavement in older adults—even when death is not only inevitable but desired. The now classic Kubler-Ross’s process of bereavement—involving phases of denial, anger, rationalization and acceptance—was developed by her observation of children’s reactions to death.

Sherwin Nuland, an American surgeon, has made the point that death in older age is often a protracted affair, rather than a clear-cut process that allows patients and those bereaved to go through the classic end of life stages. He quotes an elderly patient as saying, “Death keeps taking little bits of me.”

Ever since it was eliminated as an official “cause of death” in 1951, we cannot die of old age. We have to die of a disease or trauma. In truth, there is only one real cause of death—oxygen starvation to the brain. The cause of death listed on death certificates is really the cause of the cause. As simple as this might seem, formalizing a definition of death was not easy, but we have been pioneers in California.

In 1973 hospitals threatened to cease organ transplants since criminal defense attorneys argued that harvesting a victim's organs while his heart was still beating caused the death. Dixon Arnett (R-Redwood City) introduced emergency legislation to recognize death when brain activity ceases.  This definition of death is now accepted across the world.  Despite such advancement, we still have difficulty preparing for death. Dying suddenly and painlessly might be our ideal, but we do very little as a society to give older adults that option.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Brain Fitness and Dementia and How We Can Re-Program Our Mind. The Story of Hormesis


Hormesis is the term used to explain the benefits of low exposures to toxins and other stressors as a kind of vaccination. Some of us take vaccinations every ear against the flu, so the concept of hormesis “what does not kill you makes you stronger” is not new. But can we apply the same concept to learning and developing our brain?
Psychologists think about learning in stages of development. Jean Piaget, a Swiss development psychologist, asserted that you can only teach infants what their development allows them to learn. Sigmund Freud also discussed stages of psychosexual development where each stage has its own set of learning requirements that determine our future emotional development. These stages have primed researchers to assume that changes to the brain stopped at adulthood. It is of little surprise, therefore, that anyone studying aging before 1960 looked at aging only as a period of loss and attrition.
David Snowdon’s research with Catholic sisters of Notre Dame living in Mankato, Minn., highlighted one of the paradoxes of aging—why some people who have the disease in the brain (neuropathology) continue to function normally; while others who do not have the disease seem to express demented behavior.  This study has made us re-evaluate how we think about dementia and learning in general because it shows us that we seem to have a reserve of brain cells. The question is how do we grow that reserve?
A developing body of knowledge shows that undertaking certain activities enhances and grows the brain in adults.  For example, studies show that London taxi drivers develop a larger part of their brain while learning different routes in London, than bus drivers who have a set route. Other studies that show that brain increases in size when medical students study for their exams, compared to brains of students who were not studying for exams.
Another popular and consistent finding relates to music and dancing. In a longitudinal study, growth in the hippocampus part of the brain was recorded among music students after two semesters of intensive musical training. A further study showed that participants over 75 years who frequently played a musical instrument and/or danced were less likely to have developed dementia over a five- year period.
These studies repeatedly show that the brain of older adults can develop a reserve of cells. The question is what works best in growing these extra cells?
In understanding what is happening scientists have come up with the Japanese term 苦労 (kurou), which stands for “hardship” and “labor.”  Learning happens when we are uneasy about what we know and make ourselves learn. Geoff Colvin In his book Talent is Overrated similarly argues that there is a learning zone which is above the comfort zone and below the panic zone—where all learning needs to take place. This mirrors Jean Piaget’s definition of intelligence —". . . what you use when you don't know what to do." We need to put ourselves in learning situations that make us uncertain. The uniqueness of the situation will trick our brain to develop ways to learn. What does not kill you makes you stronger.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com