Transcript Document

Look Out! - The Boomers Have Arrived:
Psycho-Social Perspectives on Productive
Aging
April 18, 2014
8th Annual Maine Association of Psychiatric Physicians (MAPP)
Clinical Conference
Freeport, ME
Lenard W. Kaye, DSW, PhD
Professor, University of Maine School of Social Work
Director, University of Maine Center on Aging
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The Demographics of Aging
• Growing 3 times faster than the
young
• 38 million (13% of the population)
are 65 and older
• By 2030 there will be 70 million
persons 65+
• Fastest growing group are the 85
and over
• People 65 today will live another
18 years
• By 2030, 25% of elders will be
minorities compared to 16% today;
By 2050 it will be 36%
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Look Out! The Boomers
Have Arrived!
• Beginning January 1, 2011,
started celebrating their 65th
birthdays
8,000-10,000 people turn 65 every day
Will continue for 20 years
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The Elders of Maine
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The oldest state in the nation (median age = 43.5 yrs)
Maine is the most rural state in the nation (63% live there)
More than 16% are 65+ compared to 13% nationally
By 2020, 1 in 5 Mainers (20%) will be 65+
Older adults make up a larger proportion of the population in
rural areas (20%) than those in urban areas (15%)
• Maine state residents aged 50 and older make up 38.7% of the
total population (nationally – 31.5%)
• We have the largest proportion of baby
boomers anywhere in the nation
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There is Good News and Bad News
to Report About Elders in Maine
• The Bad News
 Higher rates of obesity
 Higher rates of chronic
disease and ADL
limitations
 Poorer self-rated health
 Lower amounts of physical
activity
 Poorer nutrition intake
 Less access to health care
 Poorer physical and mental
health
 Higher mortality rates
 Less educated
 Lower incomes
 Substantial physical
barriers
 Lack public transportation
 Difficult terrain
 Long distances and waits for
scarce services
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Maine’s Boomers are Expected to
Keep Health Care Providers Busy
• Abuse alcohol at
unprecedented rates –
14%-20%
• Reflect significantly
increased rates of illicit
drug use (opiates, cocaine
and marijuana)
• Continue to be impacted at
high rates by the threat of
Alzheimer’s disease
• Compressed mortality will
continue to rule the day
• Co-morbidities will be even
more commonplace into the
future
• Challenges associated with
polypharmacy will remain
rampant
• Will have fewer family
caregivers available to help
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The Dirty Truth About Baby
Boomers
• They are living longer but not always healthier
• Their health care costs will be a major drain on
their assets
• They are the least happy of all age groups
• They are often overweight if not obese
• They are more likely to be addicts
• They are committing suicide at an alarming rate
• They tend to be obsessed with (not) aging
AND YET THEY ARE THE HEALTHIEST
GENERATION OF OLDER AMERICANS IN
HISTORY!
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Conditions That Put Elders at
Risk Haven’t Changed
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Isolation
Dependency
Vulnerability
Declining Physical and/or
Mental Health
• Acquiescence
• Loss
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The Good News for Older
Mainers
• Higher rates of marriage
• More involvement in community activities
• More support from local organizations
• Less fear of crime
• Less abrupt retirement
• Greater feeling of open space and freedom
of self
• Greater life satisfaction
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Important Perspectives to Consider
in Clinical Practice with Older Adults
• Gender has an impact on help seeking behavior
• Don’t forget the caregiver
• Alcohol and substance use, misuse, and abuse
are on the rise
• Elder neglect, abuse, and exploitation is severely
underreported
• Be observant of nonverbal cues
in interpreting patient communication
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Keep an Eye on Older Men They Resist Seeking Help
• Men are 25% less likely than women
to have visited a doctor within the past
year
• Men are 38% more likely than women
to have neglected having regular
cholesterol tests
• Men are less likely than women to be screened
regularly for high blood pressure, cholesterol, and
cancers BUT 1.5 times more likely than women to
die from heart disease, cancer, and chronic lower
respiratory disease
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Don’t Dismiss the Rural Factor
in Serving Older Men
• Help seeking behavior of men is impacted by
rural-urban status
o Rural men adhere more to agrarian values that
emphasize stoicism
o Rural men use family and friends as first line of
defense
o Rural men prefer local, community-based services
to formal, institutional care
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The Communication of
Symptoms by Older Men
• Men disclose symptoms at later stages of disease when
more intense treatments are needed
• Gender differences in the portrayal of medical symptoms
may impact diagnosis and treatment regimens
o Men use fact-based/straightforward language and
acknowledge fewer risk behaviors
o Women use emotional/and dramatic language and
present more risk behaviors
• More aggressive treatments may be attached to factbased symptom description
• Practitioners need to be aware of the relationship
between symptom presentation and clinical response
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The Fact Is …
• Men endorse more negative attitudes toward help seeking
than do women
• Men are less inclined than are women to seek help when they
need it
• Men especially forego the benefits of preventative care
• Men lack awareness of health and social services that are
available
Combine that with the Fact that ….
Practitioners are often not cognizant of their own potential biases and
expectations concerning men
A Recipe for Providing Less Than Optimal Care !
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Barriers to Help Seeking By
Rural Men (and Women)
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Need for control and self-reliance
Minimizing problem and resignation
Concrete barriers
Distrust of professional caregivers
Privacy
Emotional control
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Challenges to Serving
Older Men
• Distinguishing between physical or somatic
presentation of symptoms and
emotional/psychological underpinnings
• Physical complaints presented by male patients
often have mental health correlates that require
attention. Case in point: is the close relationship
that exists between depression, alcoholism, stress
and physical decline
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Challenges to Serving
Older Men (cont.)
• Stiff upper lip mentality
o May be a changing dynamic given the
characteristics of the baby boomer generation
• Fear of losing independence, power, and control
o Threats to masculinity
o Danger of loss of autonomy
• Educating/reaching men who are isolated or not
familiar to the human services sector
o They won’t come to us, we must go to them!
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What Do We Call it?
• Normative male alexithymia (“without
words for emotions”)
• Male gender role conflict
• Patterned masculine behavior
• Traditional hegemonic masculinity
• The “disquiet” in men
• The masculine mystique
 My wife calls it “plain old stupidity”!
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Men-Friendly Styles of
Therapy
• Gather information initially – avoid stereotyping
• Listen and show respect
• Make your office masculine congruent or genderneutral
• Make office exteriors anonymous
• Confirm your credibility
• Use language carefully – focus on instrumental terms
• Play to men’s communication style as storytellers
• Engage in action-oriented exchanges and therapies
• Educate men to the therapeutic process
• Teach men how to identify and discuss their emotions
• Be patient and gain permission
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A Productive Aging Perspective for
Working with Maine’s Elders
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Hope
Growth and development
Health and wellness
Autonomy, independence,
and interdependence
Adjusting to change
Learning
Enjoying life
Giving, volunteering, and
exchange
Multi-dimensional quality of
life
Social engagement
• Community integration
• Confronting challenges
• Strengths, abilities, desires,
opportunities
• The future and what can still
be
• Activity and activism
The focus is on Assets, Empowerment, and Productivity!
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A Productive Aging Paradigm
for Geriatrics Practice
The Traditional
Perspective
A Productive Aging
Perspective
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Nihilistic
Deterioration
Disability
Institutionalization and dependence
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Rigid resistance to change
Unable to learn
Preparing for demise
Vulnerability/Passivity
Quality of life (One-dimensional)
Societal disengagement
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Hopeful
Growth and development
Health and wellness
Aging–in-place, independence,
and interdependence
Adjusting to change
Intellectual stimulation
Enjoying daily life
Empowerment
Quality of life (multidimensional)
Societal engagement
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A Productive Aging Paradigm
for Geriatrics Practice (cont.)
The Traditional
Perspective
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Community isolation
Denial and avoiding challenges
Needs, deficits, opportunities lost
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The past and what might have been
The micro-environment
Age appropriate behaviors
Therapeutic stock-taking
Sedentary lifestyles
Receiving
A Productive Aging
Perspective
• Community integration
• Confronting challenges
• Strengths, abilities, desires,
opportunities
• The future and what can still be
• The macro-environment
• Age neutral behaviors
• Therapeutic enhancement
• Activity and activism
• Giving, volunteering, exchange
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A Productive Aging
Perspective …
• Defends against the pitfalls of an
ageist perspective
• Guards against encouraging “learned
helplessness”, “excess dependence”,
and “compassionate ageism”
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Health and Human Service Programs
with a Productive Aging Orientation
• Volunteer and community
service
• Life-long learning
• Retirement planning
• Elder mentoring-tutoring
• Social action
• Job training and encore
careers
• Recreation and exercise
• Gero-therapy
• Self-help and mutual aid
• Intergenerational
programming
• Health and wellness
promotion
• Travel and elder
hostelling
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Amidst All the Challenges,
Remember….
Boomers generally and Maine’s boomers
in particular:
• Seek autonomy and participation in decision
making
• Report that the reality of aging isn’t so bad
• Do not perceive themselves as clients or
patients
• Are not willing to abandon their judgment for the
judgment of others
• Want to maintain control of their own destiny
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Your Greatest Allies –
Family and Friends
• Reaching older Mainers through their informal
natural helping networks
o Are more likely to obtain health care information from
trusted friends/relatives
o Have trusting and enduring relationships with friends
and relatives
o Informal supports can serve as health care mediators
o Important to accommodate family members who
accompany elders to appointments
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I’m a Boomer and I
Want to…
• Age and thrive in place
• Remain independent, autonomous,
mobile, active, and connected
• Remain in the work force for longer
periods of time
• Take advantage of life long learning
opportunities
• Return to school to further my education
and prepare for an encore career
• Travel
• Remain civically engaged
• Have choices in terms of how and where I
live my life
• Utilize health and wellness and fitness
facilities
• Use technology
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I’m a Boomer and I
Want to…
• Live in settings with homelike
architecture and living arrangements
that enable me to stay integrated in the
community
• Take advantage of smart home features
that maximize my safety and comfort
• Be in assisted living facilities that
accommodate ties with family and
friends
– Guest facilities and amenities
– A retirement locale that appeals to
visiting family and friends
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Boomers Will …
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Be troublemakers and risk takers
Test your skills to the limit
Know a little but think they know a lot
Tell you what they are thinking
Demand high quality care
Keep you on your toes
Not go quietly into the night
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Boomers will differ from the
Silent and Greatest Generations
• Less likely to display a stiff upper lip
mentality
• Less hesitancy to accept “charity” or
“public assistance”
• Less suspicious of “outsiders”
• Less fierce loyalty to tradition and custom
• Less importance placed on a people
orientation and face-to-face interaction
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The Generational Differences
Are Noteworthy!
Me
My Dad
• Individualistic
• Conformist
• Critical
• Accepting
• More educated
• Less educated
• “Rewirement” and encore
• Retirement/Disengagement
careers are the norm
is the norm
• Lifelong learning
• “I know what I know”/Familiarity
• Improve society by changing
• Improve society by working
the system
within the system
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I’m a Boomer and …
• “I knew I was getting old when I realized
all the names in my black book had
‘M.D’ after them”
– Harrison Ford
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I’m a Boomer and …
• the only downside of turning 50 is that
“everyone assumed I would take up
skydiving”
– Sandra Tsing Loh
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I’m a Boomer and …
• I realize “immortality is a long shot, I
admit; but somebody has to be first”
– Bill Cosby
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Resources to Turn to
Davidhizar, R., Eshleman, J., and Moddy, M. (2003). “Health promotion for aging adults.” Geriatric Nursing. 23 (1), pp.
28-34.
Glass, T.A. (2003). “Assessing the success of successful aging.” Annals of Internal Medicine. 139 (5), pp. 382-383.
Kaye, L.W. & Harvey, S. (2014). “Planning Services for Well Elders in Rural Areas,” In Aging in Rural Places:
Programs, Policies and Professional Practice. (Hash, K., Jurkowski, E.T., & Krout, J. Eds.), Springer Publishing
Company: New York, NY.
Kaye, L.W. (May, 2013). “What Research Tells Us About Living a Productive and Satisfying Old Age?” Policy brief for
Scholars Strategy Network (SSN). Available at www.scholarsstrategynetwork.org.
Kaye, L.W. (Ed.). (2005). Perspectives on Productive Aging. Washington, DC: NASW Press.
Mezey, M. and Fulmer, T. (2002). “Successful aging: Preserving function and choice.” American Journal of Nursing. 02
(8), p. 11.
Pierce, C & Seibold-Simpson, S. “Promoting healthy aging with attention to social capital,” In Wykle, M.L. & Gueldner,
S.H. (Eds.), (2011). Aging Well: Gerontological Education for Nurses and Other Health Care Professionals. Sudbury,
MA: Jones & Bartlett Learning, pp. 181-190.
Resnick, B. (2008). “Resilience in aging: The real experts.” Geriatric Nursing. 29 (2), pp. 85-86.
Thompson, Jr., E.H & Kaye, L.W. (Eds.). (2013). A Man’s Guide to Healthy Aging: Stay Smart, Strong, and Active.
Johns Hopkins University Press: Baltimore, MD.
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Contact Information
Lenard W. Kaye, DSW, PhD
Professor, University of Maine School of Social Work
Director, University of Maine Center on Aging
25 Texas Avenue
Camden Hall
Bangor, ME 04401
[email protected]
http://mainecenteronaging.umaine.edu/
207.262.7922
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