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Racism, xenophobia, and profiling . . . oh my

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The powers that be have shut the U.S. government down over a nonexistent immigration crisis. Department of Homeland Security statistics indicate that illegal border crossings are down. There is also data that undocumented immigrants have lower crime rates than native born citizens.

This is all smoke and mirrors fueled by racism and xenophobia.

Profiling

Racial profiling is the practice of accusing someone of criminal activity because of their race or ethnicity alone without evidence to support that accusation.  It is where racism meets institutional power structures and it is all too common.  The circumstances in which it occurs range from the absurd to the deadly.

Citizenship profiling is an extension of racial profiling and is an example of what academic types call intersectionality. This is, when different marginalized identities intersect. For example, Black men experience racial discrimination differently than Black women because of the intersection of race and gender.  In the case of citizenship profiling, people in power question a person’s citizenship status based on things like the color of their skin, their accent, how well they speak English, or their clothing. In the process, they detain a significant number of innocent people, including U.S. citizens.

Citizenship profiling and neighborhoods

I recently came across an article by researchers at the University of Texas at El Paso that adds another layer to this issue by looking at citizenship profiling based on neighborhood as well as individual characteristics.  The authors surveyed 563 people living in 46 neighborhoods in El Paso, TX.  El Paso is 82% Latina/o, 25% foreign-born, and under heavy surveillance because of its location on the U.S.-Mexico border.  Here is some of what they found:

  • First- and second-generation immigrants are more likely to be questioned about their citizenship compared to third-generation, regardless of sex or age.
    • Please note that second-generation immigrants were born here. They are U.S. citizens. Let that sink in for a moment and ponder how you would like to have your citizenship questioned because someone in power just doesn’t like the way you look.
  • Those living in neighborhoods with a mid-range level of immigrants are more likely to be profiled than those with a higher density of immigrants.
    • This may seem counter intuitive at first, but it is likely because those in mid-level neighborhoods are more integrated into the city and more mobile.  That gives them more opportunity for law enforcement to give them the hairy eyeball.

We can’t generalize the results of this study beyond El Paso, but it does support the notion that citizenship profiling is occurring as a “back door” approach to enforcing immigration law.  There is little data available on the effectiveness of profiling in actually decreasing crime.  (If someone knows of some good studies on this, please share!)

Beyond whether or not it works, profiling raises a number of concerns. A few of those:

  • Its constitutionality
  • The ways in which it alienates vulnerable populations (the majority of whom are innocent)
  • The assumption that individuals in power can act on their own biases and prejudices with discretion.

As always, I welcome your thoughts. Even if they contradict mine. As long as they are expressed respectfully and in the interest of thoughtful dialogue.

 

Vulnerability of older adults to climate change

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We have witnessed the impact of numerous natural disasters and weather-related incidents such as heat waves on vulnerable older adults. Dramatic examples include the 2011 Tsunami in Japan , Hurricane Katrina, and the 1995 heat wave in Chicago.  There is broad scientific consensus that climate change is occurring, that it is caused by human activity, and that one of the effects of climate change is increasing volatility in weather-related incidents such as these.

Graphic on rise of CO2 over time

Vulnerability to climate change

According to the United Nations International Panel on Climate Change vulnerability to climate change is determined by how much you are exposed to the effects of climate change, how sensitive you are to those effects, and your ability to adapt to those effects. These, in turn, are influenced by where you live and your access to resources.

Although there is existing research on the impact of climate related stressors on older adults, it has largely been retrospective.  Less work has considered how to prepare within the context of climate change predictions.  Research to date has largely focused on the limitations of older adults’  and has not incorporated the perspectives of older adults.

A recent article from researchers at Antioch University in New Hampshire describes a community-based participatory action research approach with older adults in Bridgeport, CT to assess their vulnerability and ability to respond to predicted climate changes.

A slight detour: Community-Based Participatory Action Research (CBPAR)

Research happens in a lot of contexts and through a lot of mechanisms. We collect data through online surveys that are completely anonymous or through phone or face-to-face interviews.  We administer interventions to address a problem and collect data from people before and after to see what changes. We do longer, in-depth interviews with people to learn about how their experiences and perceptions. We observe community meetings, protests, or other events and document the ways that people react and interact.  In all of these cases, there is a wall between researcher and research subject. The solidity of the wall may vary depending on the focus of the research and the method used, but it is there.

CBPAR breaks down that barrier by involving stakeholders in the research process from beginning to end.  It is community-based because it is grounded in the needs of the community rather than the interests of the researcher, participatory because the community is directly engaged throughout the process, and action focused because the goal is to move toward some positive community or social change in addition to contributing to a body of knowledge.

This study used CBPAR to involve older adults in one community in a process to identify their vulnerabilities and strengths related to stressors from climate change. They did this through two open community meetings where they gathered data from 55 residents aged 65 and older.  From this data they developed a survey that was  administered to a different group of people and completed by 164 older adults.

Some key findings:

  • Participants identified a range of current impacts from stressors related to climate change such as physical ailments and personal injury, stress and mental health issues, social isolation, and financial strain related to damaged property or other issues.
  • Personal characteristics contributing to vulnerability included:
    • chronic health conditions that limit the ability to get to a shelter or are exacerbated by heat or air pollution,
    • living alone which may make someone less likely to receive warnings and limit social support for help,
    • living on a fixed income which can limit the ability to gather emergency supplies, run an air conditioner, or pay for alternative shelter.
  • Contextual factors included the adequacy of transportation resources, warning mechanisms, resources for coping and recovery, and resources for safe shelter such as shelters’ ability to accommodate those with special needs, good communication about where they are located, and transportation to get there.
  • Current adaptive strategies and resources included a range from remaining indoors, going to a hotel or staying with friends or families, and doing things like dressing light, drinking extra fluids, taking cool showers, and closing the blinds to keep the house cool.
  • The survey indicated older adults had a high level of concern that cut across a broad range of issues. More than 30% of respondents ranked 23 of the 31 questions as high concerns and over 15% of respondents ranked all 31 questions as high concerns.

This study focused on older adults living independently in the community, but we know from past experience that those living in skilled nursing facilities or other congregate living are also vulnerable.

Responses to climate change can happen in a variety of ways that include both prevention and preparation.  This study highlights the need to work with communities to identify areas of particular vulnerability and create a plan in anticipation of increases in volatile weather conditions that lead to increased air pollution, extreme heat, and storms and floods.

How is your community preparing?

For the complete article see Rhoades, J. L., Gruber, J. S., & Horton, B. (2018). Developing an In-depth Understanding of Elderly Adult’s Vulnerability to Climate Change. The Gerontologist, 58(3), 567–577. https://doi.org/10.1093/geront/gnw167

Gaming and older adults

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Bumper sticker that says: I don't need to "get a life". I'm a gamer. I have lots of lives.

https://www.flickr.com/photos/heatherweaver/7981252259

For every person I talk to who says their parent or grandparent or aunt or uncle wants nothing to do with computers or the Internet, there seems to be a grandma taking the Internet by storm.  It is true that computer use, Internet use, and mobile device use are lower among older adults than other age groups (especially among the “oldest old” defined as those 80 and older).  That’s not surprising. Technology wasn’t part of the fabric of world when they were in school or the work force as it is now. While it seems younger folks need to make a conscious decision to disconnect, older adults may need to make a conscious choice to embrace technology.

Despite ageist stereotypes many older adults are choosing to do just that.  Tech use among older adults is rising at an impressive clip.  Four in ten older adults own a smartphone which is two times more than in 2013.  Sixty-seven percent use the Internet.

What older adults apparently haven’t caught onto as quickly is gaming – 25% of adults 65 and older play video games compared to 50% of Americans age 18 and older and 67% of 18-29 year olds. Only 2% of older adults describe themselves as “gamers” compared to 22% of 18-29 year olds. (If you search online for “older gamer” you will find that means people in their 30s and 40s.)

The barriers to gaming among older adults are similar to the barriers for the use of other technology.  They include access, attitudes, and ability.  The data on Internet and smartphone use above suggest that access barriers are declining.  However, some research suggests that adults are more likely to believe video games are a waste of time and older adults in particular may not want to be seen as childish (a perhaps natural reaction to society’s ageist tendency to infantilize older adults). And there are some potential issues with changes in eyesight, cognition, and motor abilities that may make fast-paced action games less popular for many older adults.

Much of what we know about gaming habits to date are based on surveys or focus group studies that ask about gaming habits and reactions to descriptions of games. These studies suggest that when older adults do play games they are less likely to play immersive action games.  Computerized versions of card games, board games, and puzzles are more popular.

What’s missing is research that tracks actual gaming behaviors of older adults.

A recent study by an interdisciplinary team including researchers from psychology, engineering and kinesiology  tracked gaming behaviors among a sample of 150 adults aged 65 and older over the course of a year. The study was a secondary analysis of data from a randomized controlled trial testing the effects on social isolation of a system called PRISM, or Personal Reminder Information and Social Management. The PRISM system was installed in participants’ homes and they were given three training sessions and follow up calls one week, three months, and nine months later. This study reports on usage data over the course of a year, specifically use of 11 single player video games that were part of the system. All of these games were computerized versions of card games, puzzles, etc. based on what previous research found older adults prefer.

Here is some of what they learned:

  • Older adults played a game on 42% of the days they accessed the system. Games were one of the most used features after email and the Internet. Almost half of the sample (49%) had the equivalent of one month or more of days of game play.
  • Solitaire was the most played game.
  • There was a slight drop in activity over time, but gaming continued over the course of the entire year.
  • There were distinct groups of participants:
    • A group who played the most frequently and almost exclusively played Solitaire.
    • A group who played Solitaire almost exclusively, but less frequently.
    • A group who played a range of games.
    • A group who used the system for fewer days on average than other participants and did not play many games.
  • There were no clear predictors of game play except total number of days using the system. Not surprisingly, those who were in the system more played more.
  • Game use the previous week predicted more non-game system use the following week.

That last point is something I find particularly interesting.  It may simply be that those who used the system were going to use the system and those who used the system were also more likely to play games and keep using the system.  It might also be, however, that having access to the games kept people coming back and while there they were more likely to use other parts of the system as well.

Why is this important?

Telehealth is a growing part of health care and can range from devices in the home to track and report health indicators like blood pressure or blood sugar to virtual doctor visits in rural areas. Telehealth has potential to improve access to care, not by replacing human interactions, but by facilitating the real time sharing of important information and timely communication with health care providers.  While playing games to telehealth may seem like a stretch, for telehealth to work people need to be willing and able to interact with the technology tools (that includes the providers as well as the patients – perhaps a conversation for another day).  This study suggests that including games or other reasons to log in might encourage some older adults to use other parts of telehealth technology as well.

What do you think about older gamers and/or telehealth?  I’d love to know. Drop me a line or post in the comments below.

Introducing Area Agencies on Aging

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Earlier this week I was at a meeting of campus and community people working in the area of aging.  Among other things, we noted that we have all at some point had a conversation like this:

Two people talkingMe:  How is your [mother/father/husband/wife]?

Other person:  Not well.  I’m so exhausted all the time.  The rest of the family helps when they can, but they don’t live here and they have lives too.  I wish there were some resources to help.

Me:  Have you tried your Area Agency on Aging?

Other person: My what?

[close scene]

It’s frustrating that more people in this situation don’t know about the Area Agencies on Aging, but really why should we expect them to? I don’t think I’ve ever seen an ad for my local Area Agency on Aging. Physicians and other health professionals may or may not know about them and recommend them to their patients. And unless you know someone who has used their services there’s no reason for you to know that they exist.

So here’s some information about Area Agencies on Aging. I hope you’ll share it far and wide to those who might benefit now or in the future.

What are Area Agencies on Aging (AAAs or “triple As”)?

AAAs were established in 1973 under the Older Americans Act. That means they are in part federally funded, but they are intentionally given lots of flexibility to meet local needs and preferences. They plan, develop, coordinate, and deliver a wide range of services at the local level.  In addition to OAA funding they get money from Medicaid as well as a variety of state and local funding sources.  In fact, for every $1 of federal OAA money, AAAs leverage on average an additional $3 from other sources.

In 2016, there were 622 AAAs.  Their service area is based on population density so some AAAs may cover a focused urban area while others may cover one or more counties.  Their structure varies depending on local needs.  About 39% are independent nonprofits, 25% are part of county government, 28% are part of a Council of Governments or Regional Planning and Development Area, 2% are part of city government, and 5% have some other structure.

What do AAAs do?

AAAs offer five core services.

  • Vulnerable Elder Rights Protection Activities: provider training for recognizing elder abuse, outreach and education campaigns, efforts of coalitions or multidisciplinary teams
  • National Family Caregiver Support Program: information and assistance for caregivers; individual counseling, support groups and caregiver training; respite care; and other supplemental services for caregivers
  • Congregate and Home-Delivered Meals: can also include nutrition screening, education, and outreach
  • Disease prevention and health promotion: evidence-based programs related to things such as chronic disease self-management or reducing the fear and incidence of falling
  • Supportive services: transportation, outreach, information and referral, case management, adult day care, legal assistance, and in-home services such as personal care, chore, and homemaker services

They may also offer other services depending on the unique needs and preferences of the communities they serve.

Services are available for adults aged 60 and older as well as individuals of all ages who are caregivers, veterans, or have a disability or chronic illness.

What does this mean for me?

There is an AAA that serves your area. You can enter your zip code here and find the appropriate AAA as well as other relevant services in your area.  You can also call 1-800-677-1116.

Each AAA has a website that will describe the services available, online contact forms so you can get more information, and toll free phone numbers if you want to talk to a live person.

If they don’t provide the help you need directly, there is a good chance they can direct you to someone who can.  Based on the information you give them, they may also be able to suggest services that you didn’t even know were a possibility.

In case it’s not clear, I would recommend your local Area Agency on Aging as a first stop for any aging-related care needs you may have whether it’s for yourself or a loved one.

Have you used services through your local AAA? Let me know about your experience.

Social relationships and risk of dementia

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Fractured picture of older manDementia is a group of symptoms that can have a number of causes. Alzheimer’s Disease is the most common.  The symptoms include difficulties with memory, language, problem solving, and other cognitive skills that make it progressively more difficult for the person to take care of everyday tasks.

In 2017, 5.5 million Americans were living with Alzheimer’s Disease and there were approximately 480,000 new cases in adults aged 65 and older. This is expected to double by 2050 as more people reach age 65. (For everything you want to know about Alzheimer’s, the Alzhiemer’s Association is the place to go).

There’s no cure for dementia at this point and the medications available to treat the symptoms are not always that effective. So our best bet right now is to try and prevent and delay its onset. While there can be a genetic component, especially for particular forms of early onset dementia, there are some risk factors that we can modify – most notably cardiovascular disease.  (Yup – eating healthy and getting plenty of exercise. We know we need to do it.)

Social engagement is also thought to help, although the research on this is more limited.

What does social engagement mean?

But what does that mean exactly – social engagement?  I am an introvert and I’m pretty happy spending whole days not talking to anyone but Husband and The Quadrupeds. Does that mean I’m at risk? Should I be forcing myself to go out and interact with people just like I lever myself off the couch and go to the gym?

I recently came across an article by Jisca Kuiper and colleagues at the University of Groningen in The Netherlands that helps pull this apart a little bit.

First, the concepts of social engagement or social relationships encompass a variety of things.  There’s the structure of your social network – at its most basic the number of people you have connections to.  There’s also the more qualitative component which is how you interact with those people.  In this study, Kuiper and colleagues categorized social relationships as:

  • The size of your social network
  • Participation in community activities
  • How often you interact with friends or family
  • Whether or not you feel lonely
  • How satisfied you are with your interactions with others
  • And others things like how reciprocal you feel your interactions are (i.e., how much support you give to others and how much support they give back to you)

They used a meta-analysis to look at the relationship between these different aspects of social relationships and incident dementia in the general population.

A Slight Detour:  Meta-analysisDetour sign

Science is a cumulative process.  We take what we learn from one scientific study and we add it to what we learned from a previous study and the next study adds on to what we learned and so on so that over time we build up a base of evidence around a set of research questions.  Of course, in reality it’s messier than that because (among other things) studies can contradict each other. Half the fun is digging in and figuring out why.  Systematic reviews (of which meta-analyses are a subset) are a way to gather data from a group of similar individual studies and identify the patterns of results.  Meta-analysis is a type of systematic review that lets us statistically pool the results of a group of similar studies.

As with all scientific studies there are procedures that guide meta-analysis including how studies are identified, the criteria used to include or exclude particular studies, which measures are used from those studies, and how data from those studies will be combined. (If you really want to geek out on the details you can take a look at the Cochrane Handbook for Systematic Reviews of Intervention).

Back to our originally scheduled program

Kuiper and colleagues reviewed the titles and abstracts of 8,528 articles (crikey!) and from that identified 133 full articles to look at more closely.  Out of those 133 they identified 15 articles that met their inclusion criteria and identified another 4 from reference lists for a total of 19.  These articles reported on the association between social relationships measured at some baseline time point and incident dementia at a second follow-up time point using nationally representative data.  That means they weren’t looking at the effects of an intervention just at the way social relationships at time 1 were associated with onset of dementia at time 2 based on data that allows them to generalize the findings to a national population.

Here, in a nutshell, is what they found:

  • Social network size –not able to make any conclusions because there was too much variability across studies that included this measure
  • Social participation – those with less social participation had a higher risk of developing dementia
  • Frequency of social contact – those with less frequent social contact had a higher risk of developing dementia
  • Loneliness – those who were lonely had a higher risk of developing dementia
  • Satisfaction with social network – no significant relationship between low satisfaction and developing dementia

In addition, the strength of the associations were comparable to other well-established risk factors such as depression, physical inactivity, midlife hypertension, low education attainment, type 2 diabetes, and smoking.

Why might social participation, frequency of social contact, and loneliness show these relationships?

Kuiper and colleagues suggest a few theories.

  • Just like our muscles, you need to use it or lose it. Social interaction stimulates the brain and keeps it working.
  • The cognitive reserve theory suggests that social interaction actually affects the structure of the brain in a way that helps it use its networks more efficiently.
  • We know that stress increases the risk of Alzheimer’s Disease through structural changes in the hippocampus. Social support and can work as a buffer against the effects of stress.
  • The social environment (of which our social network is a part) can influence our health behaviors (positively and negatively) and facilitate (or inhibit) our use of health care which in turn can influence our risk of developing dementia.

So really the bottom line – eat healthy, get plenty of exercise, and don’t isolate ourselves.  (And this introvert would like to remind you that your isolation might be my happy quiet time).

As always, I’m happy to hear your thoughts about what you read here.  Let me know if there are topics you’d like me to cover or questions you’d like me to consider.

Survival fatigue – just thinking about it makes me tired

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Sometimes people make bad decisions. They overload high interest credit cards, skip rent payments, skip doses of medications to make the prescription last longer, quit a job, and refuse the help that is available to them.  From the outside it can seem like they are dysfunctional or lazy or irresponsible.

But we don’t typically know the whole story. Maybe they quit their low-paying job because they have a child with special needs who requires full time care they can’t afford.  Maybe they made too much for government help, but not enough to pay for care out of pocket.  Maybe cable television is the only thing that keeps their child quiet for a little bit so they can get other things done. Maybe the only way to get help is to stand in long lines during working hours.

People don’t get help for a lot of reasons.  A recent article by Lens et al examines this issue in relation to material hardship and presents the idea of survival fatigue.

Material hardship

Material hardship is the inability to meet basic needs. It’s hard to find a measure of how much material hardship there is in the United States (readers, if you know of such a thing, let me know).  Lens et al found in previous work that 23% of New Yorkers were poor and 37% had at least one acute instance of material hardship.  This includes low-wage workers as well as those relying on government support.  Jobs alone are not the answer if they don’t pay enough to live on.

For many of these people, help is available from nonprofits, but they don’t ask for it. Stigma and knowledge of what is available are two common reasons.  But these authors focus on another issue – how our ability to make good decisions is affected when we are living in scarcity.

Survival fatigue

Cartoon of tired tired personThere is some evidence that living in poverty creates cognitive overload which in turn can limit our ability to make decisions.  Survival fatigue is the result of this. It is when we are so psychologically exhausted that we become paralyzed and unable to make good decisions which digs us into an even deeper hole. I imagine most of us have experienced some version of this at some point in our life.  In this context, it’s a daily way of life because of the ongoing struggle to just make ends meet.

Lens et al talked to 70 low-income people about whether or not they sought help from nonprofits.  They found that some people use nonprofits a lot, others occasionally, and some never seek help.  But the distinctions were more nuanced than users vs non-users.  Among the users there were:

  • The active help seekers – those who gathered information on all kinds of services and shared it with others;
  • Sporadic users – those who forged a connection with a specific nonprofit and used their services regularly, but didn’t seek help from others;
  • Selective users – those who sought help for a specific need, such as disability benefits for a child, but not for things like rent assistance or help with groceries even though they knew the help was available.

For those who did not seek help or did so only occasionally, the reasons were similar to those found in other research including stigma, knowledge of services, burdensome application processes, and other psychological (e.g., depression) and practical (e.g., transportation) barriers.

What they also found is that survival fatigue interacts with these barriers in a variety of ways.

  • Stigma can exacerbate survival fatigue. Food pantries, for example, were seen as a symbol of the lowest you can fall, particularly among low wage workers. Buying food is one of the most basic things these workers feel they should be able to provide and the fact that food pantries often require standing in lines outside, sometimes for hours before they open, adds a sense of public shaming. For many, this is seen as rock bottom and reaching that financial low contributes to paralysis and an inability to act.
  • Nonprofits are often less visible and less well known than government supports. Survival fatigue makes it hard for people to expend the extra energy needed to find these services.
  • Once they find them, burdensome application processes make it hard for people to access them. This is particularly true for low wage workers who have to juggle work schedules and kids’ schedules with nonprofits’ working hours and long lines. Survival fatigue magnifies these difficulties.

Lens et al paint a picture of people who are anything but lazy or irresponsible.  These are folks who work hard and just don’t have an ounce left to give.  While the authors give suggestions for how nonprofits can make it easier for people to access the services they provide there are larger systemic issues to work on here – jobs that pay a living wage, universal health care, and a safety net with fewer gaping holes being high up on the list.

In the meantime, if you need help with food, housing, utilities or other issues try http://www.211.org/ or call 211 at . . . well, 2-1-1.

 

On dog birthdays and pet therapy

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Loki turns four today!

Loki the Dog's head on my lap

Since last year’s birthday tribute we’ve embarked on a new doggy adventure and become a registered therapy dog team (not to be confused with a service dog which is a whole different litter of puppies).  Therapy dog teams volunteer to visit hospitals, nursing homes, and other places to bring some puppy love to people in need.  As a therapy dog team we have been tested by the Alliance of Therapy Dogs to make sure we are a good fit for this work and we are members of Therapaws of Michigan a volunteer organization that coordinates visits for therapy dog teams like us.

Meet Loki

For those who haven’t met Loki before, she is an Australian Cattle Dog, sometimes called a Blue Heeler.  A herding dog is not what typically comes to mind for a therapy dog. They are very energetic, extremely stubborn, and are often not particularly interested in people outside of their own family. They are sometimes called “Velcro dogs” because they do not like to be too far from their people. And, indeed, Loki is draped across my feet as I write this. Up until a minute ago all 55 pounds of her was in my lap. When I get up to refill my coffee she will follow me into the kitchen.  It is said that with a Cattle Dog you will never have to go to the bathroom alone again.  On the other hand, Cattle Dogs are smart and they need a job that works their mind as much as their bodies – otherwise you end up with something like this:

Loki the Dog "carving" a pumpking

For whatever reason, Loki has been a people person from the moment we got her.  But, when she was about nine months old we met a dog whisperer in the shape of a three-year old girl.  This girl knelt down and Loki immediately dropped to the ground, belly crawled over, and laid her little puppy head in her lap.  My husband and I were astonished.  Loki was friendly and loved meeting people, but usually in a burst of irrational doggy exuberance.  We were (and honestly still are) working on the no jumping thing.  Not long after that we encountered a gentleman at the park who was a bit wobbly on his feet.  Again Loki surprised. She carefully sat down at his feet and let him pat her head and then immediately turned to the non-wobbly person next to him and jumped around like an idiot.  A seed was planted in my head that Loki might be a good therapy dog someday.

Now we are one of four therapy dog teams that do weekly visits with patients at a forensic psychiatric clinic.  About 8 patients do pet therapy for a month seeing a different dog each week and then a new set of patients rotates in.  That means Loki and I do one visit a month for about an hour.  It’s such a small thing, but patients (and staff) are so happy to see Loki walk in the door. They get some hugs, toss a ball around, and we chat about dogs they’ve known and loved.  Anecdotally from the staff and from my own observation, this small thing seems to make a significant impact for the patients who are having a hard time and the staff who do a tough job.  They all look forward to Pet Therapy Day.

And the research says . . .

There is some research to support my personal observation (you knew that was coming, right?).  There is some scientific evidence that puppy time activates happy parts of our brains . Other research has found that animal assisted interventions ranging from the more informal work that Loki and I do to more structured treatment approaches have positive effects for people with dementia and patients who are critically ill.  Benefits for psychiatric patients in particular include reducing anger, anxiety, depression, and general distress, and improving socialization (Rosetti & King 2010; Souter and Miller 2007). A recent review of randomized controlled trials (comparing a group that gets some sort of treatment to a group that doesn’t) found that even a relatively short time spent with dogs had positive effects on symptoms and overall well-being for individuals with schizophrenia and all but one of eight studies reviewed found positive effects for animal assisted interventions (not limited to dogs).

Of course, dog alone is not enough.  People suffering from mental illness need access to medications and other therapies to manage their health just like those with diabetes and other physical chronic illnesses.  That means access to health insurance to pay for those treatments.

The battle over the Affordable Care Act is not in the headlines right now, but that doesn’t mean things aren’t happening. The Trump administration is quietly chipping away at ObamaCare in numerous ways.  If access to health care and universal coverage (including mental health care) are things you care about, let your Federal and State representatives know and remember 2018 elections are right around the corner.

 

Breaking out of the nursing home

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Recently my friend and author Teri Case wrote about her family’s nursing home experience. Her mom, Bonnie, was discharged to a nursing home for rehabilitation after being hospitalized for pneumonia.  This isn’t unusual.  Nursing homes are often used for short-term rehab.  On the one hand, this is a good thing. Hospitals are not healing places and a rehab facility can be a good place to recover until it’s safe to go home.

On the other hand, according to 2015 data from the Centers for Medicare and Medicaid Services (CMS), 70% of nursing homes are private, for-profits. They make money when their beds are full and once someone’s in a bed it’s to the facility’s advantage to keep them there. Teri’s family saw their mother declining with very little rehabilitation happening.  At the same time, they received lots of pressure to move her in permanently rather than returning her to the assisted living facility she called home.  Teri writes with humor and eloquence about how they busted their mom out and got her home where she has recovered nicely. It’s a story with a happy ending because Bonnie reached out to her family and they listened, asked the facility questions, and acted when they didn’t get the answers they wanted.

A faulty system

This is not to say that private, for-profit rehab facilities are inherently bad or even that in Bonnie’s case the staff at the facility didn’t truly believe they were acting in her best interest.  In general, health care professionals enter the field because they care about people and want to help them.  But they’re working in a faulty system.  When health care and profits become so tightly entwined, profit more often than not wins out over quality patient care.

This makes it all the more disturbing that the Trump administration is working to relax regulations on nursing homes and make it harder for residents to sue for substandard care, abuse or neglect. The administration argues that dealing with health inspections and meeting regulatory requirements is taking staff away from spending time with patients. They ignore the fact that facilities are routinely understaffed and staff are grossly underpaid and inadequately trained because that would cost money and reduce the overall profit.  They also ignore the fact that mistakes and neglect in patient care can lead to injury and death. Oversight and regulation help minimize these problems.

Once again the Trump administration is working for corporations at the cost of the people who pay for their services.  Next time you write or call your representatives, consider raising concerns about this issue. And next time you or a loved one need nursing home, or any health care, make sure you ask lots of questions and don’t assume they always know what’s best.

Also (sidenote), if you’re looking for a moving and engaging read, check out Teri’s new book, Tiger Drive.

Teri Case

Where Did Dr. Google Get Her Medical Degree?

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The flippant title aside, according to a 2012 Pew Research survey 35% of adults in the U.S. have gone online to diagnose a medical condition.  Another study found that of the 60% of adults aged 55 and older who reported using the internet in 2012, 80% looked for health information online.

It’s no surprise that using the Internet for health information has increased over time. This is true across the board even though there continue to be differences in Internet use by age, education, and income. This use of online sources is likely to continue so it’s worthwhile learning more about it.

What does health-related information use look like?

One of the nice things about Pew is that you can download their data and play with it yourself. (Those of you have followed this blog in the past know that I love to play with data).  So I did.

The Pew Research  September 2012 Health Tracking survey

The sample for this survey included 3,014 adults in the US. Their age ranged from 18 to 99 with an average of 53.  Over half were married or living with a partner. About a quarter had never been married and the remainder were divorced, separated, or widowed.  A small proportion had less than a high school education, half had a high school degree or some college, and 37% a college degree or higher. Almost three-quarters were White, 19% Black/African American, 3% Asian/Pacific Islander, 1% Native American/American Indian, and 3% identified as mixed race. Over half had less than $50,000 in family income.

The survey includes a range of questions about health, caregiving, and Internet use.  I focused on the Internet use questions that seem most relevant to my interests of older adults and caregivers, although here I look at the full sample, not just older adults.

Communicating with others

  • Among those with a serious health issue, about three-quarters reported getting information from a health professional, 62% got information and support from family and friends, and 24% got information from others with the same condition.
  • Most people made these contacts offline. However almost one-third used both on and offline methods with family and friends or with others with the same condition.
  • More of those without a chronic illness used both on and offline methods to get info from family, friends, and others with the same condition. It seems like people with more health issues are more likely to stick to traditional offline communication and information gathering.

Caregivers

  • Over half of the sample reported providing unpaid care to an adult relative or friend in the past 12 months. Sixty percent of those said the Internet was helpful in providing care overall and half said that the Internet helped them cope with the stress of caregiving.

Types of information

% who said they looked for different kinds of health-related information on line

67% of the sample said they looked online for some type of information. Looking online for information about a specific disease or medical problem or certain treatments or medical procedures were most common. Not surprisingly, a higher proportion of people who had a chronic illness or were caring for someone reported looking online for information across all categories.

It seems like Dr. Google has a pretty good practice going.  That is not necessarily a bad thing as long as people pay attention to the sources they are pulling information from and evaluate the quality of that information.  Of course, we all know how easy it is to find unreliable and inaccurate information online and sorting out what’s credible and what’s not can be hard.  Going to sources like the Mayo Clinic and the National Institutes of Health or organizations that focus on a particular illness, such as the National Stroke Association, can be one way to insure you’re getting solid information.

Talk with your doctor about medical information you gather online.

Of the people who said they went online specifically to figure out what medical condition they might have, half said the information convinced them they needed to see a doctor.  Of those 67% said they actually talked with a medical professional about what they found. That was actually more than I would have guessed, but still raises questions for me about how people are evaluating and using medical information they find online.

What do you think? Do you use Dr. Google? If so, how?

Graduation Day!

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Graduation cap that says "test the limits and break through.It’s graduation weekend at my university and this morning we had our School of Social Work recognition ceremony. It’s a happy day. Faculty parade around in funny robes and hats. Family and friends come to applaud and honor the hard work their graduate has done. There’s no parking anywhere, but the usual campus hot spots (like my office which is typically a dance party all day long) are ghostly quiet.

I’m proud of our social work students and what they’ve done to get here and look forward to see the great things they will do moving forward.  And let’s face it, the work that social workers do is more important now than ever.

To me, that’s obvious, but I recently read some research that made it very clear that most people don’t actually know what social work is or what social workers do.  Unless you know someone who is a social worker or have been on the receiving end of social work services, why would you?  So, for this Graduation Day edition of #justthefactsfriday I thought I’d share a few thoughts about the social work profession and the types of things our graduates will be doing in the world.

  • Social work promotes social justice and social change, works to enhance human well-being, and helps meet the basic needs of all people, particularly those who are vulnerable, oppressed, and living in poverty.
  • Social workers work with individuals, organizations, and communities. They provide individual and group counseling, case management (which basically means helping connect clients with resources they might not otherwise know about or have access to), and a whole host of other services.
  • They do this in a variety of settings from hospitals and primary care offices to substance abuse treatment facilities and social service agencies to schools and private practice.  They work with children, families, and older adults, people who are homeless, people struggling with mental health and substance use issues, Veterans, and people with disabilities of all kinds.  If you’re thinking to yourself “Wow, social workers are everywhere”, you’re right, we are.
  • Social work is one of the fastest growing careers in the U.S., with almost 650,000 jobs in 2014. This is expected to increase by 12% between now and 2024, a rate of growth that is faster than the average for all occupations.  At the same time, the funding for many of these jobs is shrinking. As I type.
  • Social workers are one of the largest groups of mental health service providers and about 54% of social work jobs are in health care.  A third of social workers are employed by states or the federal government.
  • In addition to working directly with people, social workers advocate for change. Think Jane Addams who was the first American woman to receive a Nobel Peace Prize in 1931 and a badass community organizer.  Think Frances Perkins who was the first woman to be appointed to the cabinet of a U.S. president.  She was Secretary of Labor for Franklin D. Roosevelt and drafted much of the New Deal legislation.  And many many more we’ve never heard of who work for change in policies and practices across the spectrum.  Sometimes social workers are loud, on the streets and in your face. Sometimes we’re quiet and behind the scenes. Sometimes change moves fast.  Sometimes it moves painfully slow.  But it moves.

Today we sent more social workers off into the world.   Keep an eye out for them. They’ll be doing good stuff and shaking things up.

Have a social work story?  Share it here.