Although we assume that faith leaders are experts in dealing with death, we might be surprised to find that they are not at all that comfortable with the topic. In master of science unpublished research conducted by three separate gerontology students at SDSU, we find that across all religions, faith leaders are poorly trained in end-of-life issues. Most faith leaders reported little to no formal training, and even those that have been exposed to some training admitted that they are ill-equipped to deal with end-of-life issues of their followers. And this finding was consistent for all religions studied.
We find the same story in other research. In a 2008 report by the Duke Institute on Care at the End of Life they also reported that faith healers were least comfortable and least prepared working with children, health care providers and providing grief support when death is unexpected. As you would expect, faith leaders reported being more comfortable with the rituals of their religion than with initiating discussions on end-of-life issues or training others to provide such support.
Kaye Norris and her colleagues, reported similar results from two separate 1997 studies. One is a Gallup survey which describes how people may not always receive the level of support and spiritual care they desire, which is not surprising since respondents in the survey also reported low expectations of clergy. This finding was supported by a survey from Missoula community--68 percent describing themselves as religious or spiritual--that reported that people as they near life's end, are more likely to rely for support on in order of importance; a spouse, children, immediate family members or relatives, friends and than on a faith-leader or faith community.
Faith leaders' lack of education and training about end-of-life issues and grief counseling is an obstacle that prevents them from being more effective support to the dying and the bereaved. The surprise in the research is that all faiths seem to lack end-of-life training.
But at least the issue surrounding end-of-life has entered into a discussion. Especially around the highly divisive issue of assisted end-of-life. Some religions embrace the option. Such as the Unitarian Universalist, United Church of Christ, Evangelical Lutheran Church of America, Methodists, Mainline and Liberal Christian denominations, Episcopalian (Anglican) Unitarian, Methodist, Presbyterian and Quaker movements. Even the American Baptists Churches--in contrast to the Southern Baptist Convention--support the right to decide.
It is not that we should completely eliminate religion from any discussion relating to discourse about social issues as Sam Harris crudely argues in the 2004 book The End of Faith: Religion, Terror, and the Future of Reason. We need religion because people expect their religion to console them in moments of need. The issue is that with the medicalization of death there is a passive acceptance by faith-leaders that death is a medical event rather than a spiritual journey. They need to reclaim their right. They must however first re-learn about the complex issues surrounding end-of-life.
© USA Copyrighted 2013 Mario D. Garrett
Sunday, September 29, 2013
Saturday, September 28, 2013
Diversity and Elder Abuse
Abuse is legally defined. The law has exact definitions and boundaries about what is considered abuse. However in social settings, abuse is necessarily a relative term. But ignorance of the law is no excuse.
Older adult law in California is unique in that if the government decides that a crime has been committed against someone who is 65 years and older--whether that older adult wants to or not--the government will prosecute. Elder abuse is not different from any other type of abuse. In some instances the victim might not understand the act of abuse, in most cases the abuser—the perpetrator—is a relative of the victim, and in some circumstances the victim does not want the abuse to be exposed. What is different in elder abuse is that the victim is an older adult.
Although all elder abuse victims are vulnerable, most are just ashamed that it happened to them and that a family member whom they trusted has so wronged them. Even with the belief across most cultures that older adults, especially mothers, should be honored--which Asian cultures calls filial piety--the practice is rapidly being abandoned and becoming...old fashioned.
The problem is that we have very little information about elder abuse in general and ethnic minorities specifically. The lack of information is primarily because lawyers are weary of sharing information about their clients, or allowing their clients to be researched since any evidence that is obtained can be subpoenaed by the defense. Also some of these incidents have a long history within the family.
In the late 1970s Suzanne Steinmetz reported that half of abused children grow up to abuse their elderly parents. There seems to be a social learning component to elder abuse. If the situation at home promotes certain behaviors as acceptable then those behaviors will be reflected back at the aging parents. For lawyers, identifying that abused children are repeating learned behavior makes it that much harder to prosecute the case.
In addition, anecdotal evidence suggests that a majority of older adults have some early stage dementia, which makes them vulnerable and in some cases unable to cope with aggressive and insistent demands. How a court deals with the victims’ evidence in such cases is predictable which is why researchers and lawyers rarely collaborate.
Cultural differences bring an extra layer of consideration. Some ethnic groups, view families as a unit rather than as individuals and therefore deal with "common property" as such. There are also cultural norms in dealing with erratic behavior in families. The legal system does not acknowledge that there are different cultural impressions of what is defined as abuse. Different agencies keep different data, and reporting of abuse is not uniform across ethnicities.
Elder abuse is a growing torment in our society. It is so widespread that we fail to notice it because we ascribe such behavior to culture or, at least, to family idiosyncrasies. We also ascribe behavior as cultural, but it is likely to be a learned behavior rather than culture. There is no culture that allows for the derogation of our elders. And there is an urgency to elder abuse cases. The victims have a high--natural in most cases--mortality.
© USA Copyrighted 2013 Mario D. Garrett
Older adult law in California is unique in that if the government decides that a crime has been committed against someone who is 65 years and older--whether that older adult wants to or not--the government will prosecute. Elder abuse is not different from any other type of abuse. In some instances the victim might not understand the act of abuse, in most cases the abuser—the perpetrator—is a relative of the victim, and in some circumstances the victim does not want the abuse to be exposed. What is different in elder abuse is that the victim is an older adult.
Although all elder abuse victims are vulnerable, most are just ashamed that it happened to them and that a family member whom they trusted has so wronged them. Even with the belief across most cultures that older adults, especially mothers, should be honored--which Asian cultures calls filial piety--the practice is rapidly being abandoned and becoming...old fashioned.
The problem is that we have very little information about elder abuse in general and ethnic minorities specifically. The lack of information is primarily because lawyers are weary of sharing information about their clients, or allowing their clients to be researched since any evidence that is obtained can be subpoenaed by the defense. Also some of these incidents have a long history within the family.
In the late 1970s Suzanne Steinmetz reported that half of abused children grow up to abuse their elderly parents. There seems to be a social learning component to elder abuse. If the situation at home promotes certain behaviors as acceptable then those behaviors will be reflected back at the aging parents. For lawyers, identifying that abused children are repeating learned behavior makes it that much harder to prosecute the case.
In addition, anecdotal evidence suggests that a majority of older adults have some early stage dementia, which makes them vulnerable and in some cases unable to cope with aggressive and insistent demands. How a court deals with the victims’ evidence in such cases is predictable which is why researchers and lawyers rarely collaborate.
Cultural differences bring an extra layer of consideration. Some ethnic groups, view families as a unit rather than as individuals and therefore deal with "common property" as such. There are also cultural norms in dealing with erratic behavior in families. The legal system does not acknowledge that there are different cultural impressions of what is defined as abuse. Different agencies keep different data, and reporting of abuse is not uniform across ethnicities.
Elder abuse is a growing torment in our society. It is so widespread that we fail to notice it because we ascribe such behavior to culture or, at least, to family idiosyncrasies. We also ascribe behavior as cultural, but it is likely to be a learned behavior rather than culture. There is no culture that allows for the derogation of our elders. And there is an urgency to elder abuse cases. The victims have a high--natural in most cases--mortality.
© USA Copyrighted 2013 Mario D. Garrett
Friday, September 27, 2013
Dementia and Sex in Nursing Homes
This affair was between an older couple. He was single, a
bit of a ladies’ man in his younger time. She was still married but now
separated. They met by chance. But they gravitated towards each other whenever
they came across each other. They were often seen holding hands, and were
relaxed and mellow when they were together. This older couple enjoyed moments
of intimacy and friendship. If this was anywhere else it would elicit a
smile. But this affair occurred in a nursing home and the couple suffered
from dementia.
In this case, the nursing home was the 120-bed Windmill
Manor in Itoralville, Iowa. The man was 78, while the woman was much older at 87.
Three and a half years of private litigation ended with the elderly couple
becoming separated to different nursing homes and each died within a few years.
While the administrator and the director of nursing home were both fired.
The issue is whether they had consensual sex and how you
determine that. The woman referred to her lover as her (living) husband.
Was she confused and therefore agreed to have sex under a delusion.
The sad story here is that the law attempts to define edges.
To enumerate a black and white picture in an otherwise blurred context.
Sometimes we have to look at how unique individuals deal with such cases to
find a moral or ethical compass. The law is too clumsy a tool for us.
Supreme Court Justice Sandra Day O'Connor’s husband was
suffering from dementia and was placed in a nursing home. While there he become
romantically attached to another resident. Justice O'Connor decided that this
made him happy and sanctioned their behavior. It takes courage to understand
the disease for what it is., a disease. And sometimes how we react to people
suffering dementia is more a reflection of our fears, prejudices and moral
expectations, as much as it is about the degenerative disease itself.
It is not that these moral and ethnical dilemmas exist. It
is that they are still dilemmas. In an age when the tsunami of dementia will
push us more frequently against the reality of older adults with dementia we
should have better tools than the law to deal with such radical changes in human
intimacy. For some couples coping with dementia, physical intimacy continues to
be a source of happiness. In others the dementia brings about behavioral
changes that might increase or decrease the need for physical expression and
relief. There might also be changes in sexual etiquette and expressions of
sexual urges (or not). It is difficult to separate the person from the disease.
But the disease can change the behavior of the person to such an extent that
you cannot rely on past experience in responding to them.
By the time the person is in a nursing home, there are
already noticeable changes in behavior. What this teaches us is not to rely on the law but to examine what the home will allow and what we are comfortable accepting.
© USA Copyrighted 2013 Mario D. Garrett
© USA Copyrighted 2013 Mario D. Garrett
Wednesday, September 25, 2013
Accepting Our Losses and Living Longer
Happy people live longer. Even happy countries have higher life expectancy. Scientists have even documented orangutans living longer if they are happy. It would seem that happiness is an important commodity. With older adults there is a conspiracy to be happy. Not only do happy people live longer but older adults are more likely to become happier with age.
What makes us so happy? In The Paradox of Choice: Why More Is Less, Barry Schwartz documents that the secret for happiness is not having a great choice or achieving your goals and dreams. No. Happiness comes from accepting what you have, being happy with the choices that you made. Having more choices makes us less happy. And it does not matter what those choices are. Which is why Daniel Gilbert's cheerfully engaging "Stumbling On Happiness" is so good. The argument that it is not choices that make us happy, but our acceptance of the choices we make has generated a lot of interest. In psychology Paul Baltes's model of selection, optimization, and compensation (SOC) argues that it is essential for successful development that older adults maximize their remaining capacities and minimize their losses. We do not choose to experience losses. But we choose to accept them.
In 2010 Alex Bishop and his colleagues working with the Georgia Centenarian Study found that happiness among these exceptionally older people was determined by “congruence” which was defined by three statements one of which was ‘I would not change my past life even if I could’.
"Even if I could". This is an important admission. If you are getting frailer, becoming more diminished, experiencing the loss of lovers, friends and colleagues, and facing increasing challenges you have limited options, and none of them include reversing this trend. The best utilization of your energies is to accept the changes and assume that you are destined to be here. Wherever “here” is. What psychologists call a positive character-disposition and strong adaptability to the adversities of their life. You are meant to be where you are.
And this attitude starts earlier in life, not learned when you become an older adult. Accepting “bad” choices, painful loss, forgiving people, being content with what you have in terms of money and health is how you tell your body that you are happy where you are and that you not ready to go just yet. You belong here still. Even if you could change circumstances, you would choose the same path because that is what made you.
Happiness tells your body that you are still present. That you are needed.
W.P. Kinsella in his book "Shoeless Joe" admits that "Success is getting what you want; happiness is wanting what you get." We are too concerned with success and our expression of that. What we should be looking at are vestiges of happiness. Smile wrinkles and laugh lines. Perhaps then we might stop trying to hide how we look.
What makes us so happy? In The Paradox of Choice: Why More Is Less, Barry Schwartz documents that the secret for happiness is not having a great choice or achieving your goals and dreams. No. Happiness comes from accepting what you have, being happy with the choices that you made. Having more choices makes us less happy. And it does not matter what those choices are. Which is why Daniel Gilbert's cheerfully engaging "Stumbling On Happiness" is so good. The argument that it is not choices that make us happy, but our acceptance of the choices we make has generated a lot of interest. In psychology Paul Baltes's model of selection, optimization, and compensation (SOC) argues that it is essential for successful development that older adults maximize their remaining capacities and minimize their losses. We do not choose to experience losses. But we choose to accept them.
In 2010 Alex Bishop and his colleagues working with the Georgia Centenarian Study found that happiness among these exceptionally older people was determined by “congruence” which was defined by three statements one of which was ‘I would not change my past life even if I could’.
"Even if I could". This is an important admission. If you are getting frailer, becoming more diminished, experiencing the loss of lovers, friends and colleagues, and facing increasing challenges you have limited options, and none of them include reversing this trend. The best utilization of your energies is to accept the changes and assume that you are destined to be here. Wherever “here” is. What psychologists call a positive character-disposition and strong adaptability to the adversities of their life. You are meant to be where you are.
And this attitude starts earlier in life, not learned when you become an older adult. Accepting “bad” choices, painful loss, forgiving people, being content with what you have in terms of money and health is how you tell your body that you are happy where you are and that you not ready to go just yet. You belong here still. Even if you could change circumstances, you would choose the same path because that is what made you.
Happiness tells your body that you are still present. That you are needed.
W.P. Kinsella in his book "Shoeless Joe" admits that "Success is getting what you want; happiness is wanting what you get." We are too concerned with success and our expression of that. What we should be looking at are vestiges of happiness. Smile wrinkles and laugh lines. Perhaps then we might stop trying to hide how we look.
© USA Copyrighted 2013 Mario D. Garrett
Tuesday, September 17, 2013
Fibs, Puffery, Lies and Immortality: Telomeres and Telomerase the Snake Oil of the White (Coat) Man
The University of California San Francisco's (UCSF) website is selling immortality. On September 16, 2013 Elizabeth Fernandez reports "Lifestyle Changes May Lengthen Telomeres, A Measure of Cell Aging." Reporting on a small study by Dean Ornish, Elizabeth Blackburn and eight other colleagues published in the Lancet Oncology journal. *
What the UCSF website reports is that "A small pilot study shows for the first time that changes in diet, exercise, stress management and social support may result in longer telomeres, the parts of chromosomes that affect aging." If this was true (ie valid) then it is indeed a revolutionary finding in science. Baiting all those venture capitalists to rush to the laboratory to invest their money.
Within a day the rest of the world news media started falling over themselves to report this story. Invariably ignorance and expediency did not help them from repeating the same mistake as UCSF had the day before.
"Lifestyle Changes Could Lengthen Telomeres, Life" reports the Voice of America. "Better diet and less stress can reverse cell ageing" shouted the Irish Times. "Healthy Lifestyle Changes Might Reverse Cell Aging, Study Suggests" the serious Huffington Post asserts."Lifestyle Changes Could Lengthen Telomeres, Life" Voice of America parroted. And on and on, ad nauseam.
Only Larry Husten in Forbes had the right title "No, Dean Ornish And Elizabeth Blackburn Have Not Discovered The Fountain Of Youth" but even he mistakes the result by reporting that “We noted a correlation between the degree of positive lifestyle change and increase in telomere length when all participants were assessed together, which supports the internal validity of this study." First of all a non random assigned study can never ever be an adequate study for causality. There is no part of this study that remotely contributes to internal validity. Not only that, but because the two groups where different to start, before the intervention took place (the control group versus those following diet exercise and yoga), completely erodes its internal validity. Two different groups will be found to be different even after nothing is done to them.
If we look at the original published paper the conclusion simply acknowledges "...showing that comprehensive lifestyle changes—or any intervention—are significantly associated with increases in cellular telomerase activity and telomere maintenance capacity in human immune system cells" (pg 1053)
Telomerase activity is very very different from telomere length. And telomere maintenance capacity is not equated with increase in telomere, it simply means that the decrease was slower. There is confusion about telomeres and telomerase in the newspaper reports. A short introduction to these two terms.
Most cell in our body have a nucleus. that contain 23 pairs of chromosome structures that hold "genes" which are a series of codes written with nitrogen-containing biological compounds. Each chromosome has two chromatid structures (left and right) connected at the center making an X. Each of the two chromatids have a special protective cap at each end called a telomere. Telomeres function by preventing chromosomes from losing base pair sequences at their ends. They also stop chromosomes from fusing to each other. However, each time a cell divides, some of the telomere is lost (usually 25-200 base pairs per division). The telomere can start off with length of 15,000 base pairs. The longer the telomeres the more times a cell can divide before it dies. Telomere maintenance is controlled by an enzyme called telomerase. Telomerase allow the telomere to maintain structure and in some cases to grow.Which is a good thing in most cases.
However, telomerase is also found in fetal tissues, adult germ cells, and also cancer cells. The connection between cancer research and immortality has not been closer. Since cancer cells are immortal (the HeLa cell lines are a prime example). Telomerase has been detected in cancer cells and is found to be 10-20 times more active than in normal body cells.
So when the authors of the article report that "...increases in cellular telomerase activity..." (pg1053) I do not think about immortality but about expedited mortality through cancer.
This is not to say that there are no benefits to exercise and low fat diet in maintaining organ health. But it is not a panacea for longevity.
There have been other promoters of the “clean living” argument. The following is a list of gurus of the clean living argument. What is unique is not only that these people are all dead (what an argument for internal validity), but that they died earlier than their life-expectancy (at the age that they started their intervention), and they died of the disease that they aimed to ameliorate through their intervention:
• Adelle Davis who often said she never saw anyone get cancer who drank a quart of milk a day, as she did.
• Nathan Pritikin after being diagnosed with heart disease, advocated regular exercise and a low-fat, high-fiber diet.
• Robert Atkins proponent of a high protein, low carbohydrates diet.
• Roy Walford a proponent of caloric restriction as a means to extending life.
• Jim Fixx who championed the health benefits of running and claimed that regular running offered virtual immunity to heart disease.
• Alan Mintz a controversial proponent of using human growth hormone—an anabolic steroid.
Francois Henri "Jack" LaLanne died in 2011 at the age of 96, due to pneumonia. He is a real hero. According to his family, he had been performing his daily workout routine the day before his death. When he was asked about the difference in public attitude between today and when he first opened his gym decades ago, Jack saw where we were going with our health kick, he said: "Then I was a crackpot and a charlatan, today I am an authority… and believe me I can’t die, it would ruin my image." His image is not ruined because through his death we have realized that mortality is not the fact that we are doing something wrong, but that there is a system of order in the world. Death is the price we pay for living. We do not need to fight death, we need to enhance our life. Exercise, diet and self awareness through meditation is an excellent way to improve the quality of our life. It might enhance our longevity because we are happier. But it will not reverse or stop aging.
The funding for the UCSF pilot project was supported by the U.S. Department of Defense among other entities.
* Dean Ornish, Jue Lin, Jennifer Daubenmier, Gerdi Weidner, Elissa Epel, Colleen Kemp, Mark Jesus M Magbanua, Ruth Marlin, Loren Yglecias, Peter R Carroll, Elizabeth H Blackburn Increased telomerase activity and comprehensive lifestyle changes: a pilot study.2011. Lancet Oncol, 9, 1048-57.
© USA Copyrighted 2013 Mario D. Garrett
What the UCSF website reports is that "A small pilot study shows for the first time that changes in diet, exercise, stress management and social support may result in longer telomeres, the parts of chromosomes that affect aging." If this was true (ie valid) then it is indeed a revolutionary finding in science. Baiting all those venture capitalists to rush to the laboratory to invest their money.
Within a day the rest of the world news media started falling over themselves to report this story. Invariably ignorance and expediency did not help them from repeating the same mistake as UCSF had the day before.
"Lifestyle Changes Could Lengthen Telomeres, Life" reports the Voice of America. "Better diet and less stress can reverse cell ageing" shouted the Irish Times. "Healthy Lifestyle Changes Might Reverse Cell Aging, Study Suggests" the serious Huffington Post asserts."Lifestyle Changes Could Lengthen Telomeres, Life" Voice of America parroted. And on and on, ad nauseam.
Only Larry Husten in Forbes had the right title "No, Dean Ornish And Elizabeth Blackburn Have Not Discovered The Fountain Of Youth" but even he mistakes the result by reporting that “We noted a correlation between the degree of positive lifestyle change and increase in telomere length when all participants were assessed together, which supports the internal validity of this study." First of all a non random assigned study can never ever be an adequate study for causality. There is no part of this study that remotely contributes to internal validity. Not only that, but because the two groups where different to start, before the intervention took place (the control group versus those following diet exercise and yoga), completely erodes its internal validity. Two different groups will be found to be different even after nothing is done to them.
If we look at the original published paper the conclusion simply acknowledges "...showing that comprehensive lifestyle changes—or any intervention—are significantly associated with increases in cellular telomerase activity and telomere maintenance capacity in human immune system cells" (pg 1053)
Telomerase activity is very very different from telomere length. And telomere maintenance capacity is not equated with increase in telomere, it simply means that the decrease was slower. There is confusion about telomeres and telomerase in the newspaper reports. A short introduction to these two terms.
Most cell in our body have a nucleus. that contain 23 pairs of chromosome structures that hold "genes" which are a series of codes written with nitrogen-containing biological compounds. Each chromosome has two chromatid structures (left and right) connected at the center making an X. Each of the two chromatids have a special protective cap at each end called a telomere. Telomeres function by preventing chromosomes from losing base pair sequences at their ends. They also stop chromosomes from fusing to each other. However, each time a cell divides, some of the telomere is lost (usually 25-200 base pairs per division). The telomere can start off with length of 15,000 base pairs. The longer the telomeres the more times a cell can divide before it dies. Telomere maintenance is controlled by an enzyme called telomerase. Telomerase allow the telomere to maintain structure and in some cases to grow.Which is a good thing in most cases.
However, telomerase is also found in fetal tissues, adult germ cells, and also cancer cells. The connection between cancer research and immortality has not been closer. Since cancer cells are immortal (the HeLa cell lines are a prime example). Telomerase has been detected in cancer cells and is found to be 10-20 times more active than in normal body cells.
So when the authors of the article report that "...increases in cellular telomerase activity..." (pg1053) I do not think about immortality but about expedited mortality through cancer.
This is not to say that there are no benefits to exercise and low fat diet in maintaining organ health. But it is not a panacea for longevity.
There have been other promoters of the “clean living” argument. The following is a list of gurus of the clean living argument. What is unique is not only that these people are all dead (what an argument for internal validity), but that they died earlier than their life-expectancy (at the age that they started their intervention), and they died of the disease that they aimed to ameliorate through their intervention:
• Adelle Davis who often said she never saw anyone get cancer who drank a quart of milk a day, as she did.
• Nathan Pritikin after being diagnosed with heart disease, advocated regular exercise and a low-fat, high-fiber diet.
• Robert Atkins proponent of a high protein, low carbohydrates diet.
• Roy Walford a proponent of caloric restriction as a means to extending life.
• Jim Fixx who championed the health benefits of running and claimed that regular running offered virtual immunity to heart disease.
• Alan Mintz a controversial proponent of using human growth hormone—an anabolic steroid.
Francois Henri "Jack" LaLanne died in 2011 at the age of 96, due to pneumonia. He is a real hero. According to his family, he had been performing his daily workout routine the day before his death. When he was asked about the difference in public attitude between today and when he first opened his gym decades ago, Jack saw where we were going with our health kick, he said: "Then I was a crackpot and a charlatan, today I am an authority… and believe me I can’t die, it would ruin my image." His image is not ruined because through his death we have realized that mortality is not the fact that we are doing something wrong, but that there is a system of order in the world. Death is the price we pay for living. We do not need to fight death, we need to enhance our life. Exercise, diet and self awareness through meditation is an excellent way to improve the quality of our life. It might enhance our longevity because we are happier. But it will not reverse or stop aging.
The funding for the UCSF pilot project was supported by the U.S. Department of Defense among other entities.
* Dean Ornish, Jue Lin, Jennifer Daubenmier, Gerdi Weidner, Elissa Epel, Colleen Kemp, Mark Jesus M Magbanua, Ruth Marlin, Loren Yglecias, Peter R Carroll, Elizabeth H Blackburn Increased telomerase activity and comprehensive lifestyle changes: a pilot study.2011. Lancet Oncol, 9, 1048-57.
© USA Copyrighted 2013 Mario D. Garrett
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