When we think of innovation, we often think of new technology. This is true of just about every field, including aging services. There are plenty of technological advances in aging services: Remote monitoring systems that can tell a family caregiver a thousand miles away when Mom has gotten out of bed, gone into the bathroom, or opened the refrigerator door. Medicine dispensers that remind people when to take their pills. Internet-connected medical devices that can send blood pressure readings to a doctor in another place. Cars that drive themselves. Even smart flooring that can detect a slip and instantly soften to absorb the impact of a fall. All of these things are wonderful. They have a high “Wow!” factor, and its fun and easy to imagine technology solving all of our problems in a sort of science fiction utopia. But in the real world, that’s probably not going to happen. Some of these things may be quite helpful, and some may be a more cost effective way of doing things that service providers already do, but they are not a panacea. As long as there are older people who don’t get the dental care they need, who live in substandard housing, who are victims of fraud and abuse, or who have to choose between buying groceries and filling a prescription, our biggest problems cannot be solved by electronic gadgets.
Innovation involves a lot more than just technology. Most of the best innovations in the field of aging services involve people and organizations and how they relate to one another, how they help one another, how they share data and refer clients between one another, and how they cooperate to stretch precious service dollars further. Service providers have to constantly assess changing needs and respond to those changes. They have to evaluate what they are doing and how they are doing it, and try to do it better and less expensively and more effectively. They have to break down the silos that divide them, bridge divides, build partnerships, collaborate, and avoid the turf wars that have wasted resources and diverted their attention from the task at hand, which is to serve the needs of older adults and those who care for them.
How can that be done? The first thing we need to remember is that any individual agency cannot do it alone. They need to reach out and work with other organizations that serve the older adult population, or serve other populations with similar needs. The movement in Michigan toward ADRCs, Aging and Disability Resource Centers, is a good example of this trend. Those other organizations don’t have to be non-profits, and they don’t even have to be social service agencies at all. Particularly in rural areas, leveraging existing organizations can help seniors in a much more cost effective way, and can help the other organizations as well. Think about the places that seniors often congregate: Churches. VFW and Elks and Knights of Columbus halls. Diners and coffee shops. Pharmacies and post offices and public libraries. If aging service providers are trying to reach out, if they’re trying to develop community based programming, if they’re trying to stretch service dollars, they should think about ways they can work with businesses, clubs, and other public and private institutions to distribute information, provide services, and maybe even help them expand their senior membership or customer base. They need to look for opportunities to create partnerships that benefit all involved. These kinds of synergies can increase the impact of every dollar we spend providing services to older adults who need them.
And even among aging service providers, they need to work more closely together to minimize service overlap, fill gaps, play to each other’s strengths, and find as many ways to cooperate as they can. One organization that I work with is called the Southeast Michigan Senior Regional Collaborative. It covers Wayne, Oakland, and Macomb counties, and it has more than 25 member organizations that serve seniors in some capacity. They have found it in their interests to band together to do everything from assess needs in the community, train staff members, advocate for older adults with policymakers, gather and report data to funders, and join forces to exploit economies of scale in back office operations and purchase of services. I’m not being a Pollyanna; community partnerships and collaborations take great time and effort to build, can be difficult to hold together, and sometimes require an immediate investment that does not fully pay off until some time later. Collaboration can be hard work, it can be risky, but the potential rewards are great. The pie is shrinking and the number of people clamoring for pieces of it is growing. Organizations that serve older adults can no longer afford the luxury of fighting each other or trying to do their work in isolation.
Another thing to remember is that seniors are not a different species. They’re human beings too, key members of our communities, with families and friends of all ages, with children and grandchildren and neighborhood kids they care deeply about. The interests of all these different people intersect in some way or another, and sometimes those interests can be served in tandem. If you are affiliated in any way with the aging network, you have probably have heard of Foster Grandparents, Senior Companions, and RSVP, the Retired Senior Volunteer Program, which are wonderful programs whose full potential has never been realized due to underfunding. However, there are plenty of other innovative ways to involve older people in their communities, and many of them are quite inexpensive. Take Experience Corps, for example. It started as a small pilot program in Baltimore and has expanded to include over 2,000 older adult volunteers in 20 cities, including Grand Rapids right here in Michigan. The older volunteers work with their local public elementary schools to tutor young children in reading. Research has shown that those types of volunteer efforts boost student performance, reduce truancy and behavior problems in schools, help reduce the burden on teachers with crowded classrooms, and most importantly for our purposes, increase the mental and physical well-being and life satisfaction of the older volunteers. Everybody needs a reason to get out of bed in the morning, especially those who have retired from work and whose children are grown. It may be a cliché, but programs like Experience Corps create a win-win situation for everyone.
There are plenty of other good examples of ways in which intergenerational synergies can be developed to help serve older adults, children, and families together. In my next blog post, I’ll review a few other intergenerational programs that can address multiple problems simultaneously, and I will urge aging service providers to break out of the time-worn molds that have held them back and reduced the effectiveness and efficiency of the services they deliver.
This essay was adapted from the keynote address by Thomas B. Jankowski, PhD, at the Midland County Council on Aging Annual Meeting and Senior Services 50th Anniversary Dinner, November 12, 2013.
Our IOG Insider blog posts provide a glimpse into the IOG and the people inside to learn more about what led them to the field of aging and to the Institute of Gerontology. This month showcases the warm and talented Dr. Lisa Ficker currently a postdoctoral fellow who works closely with Dr. Peter Lichtenberg on a variety of projects. Read on to learn more about how she got her start in aging and the journey that led her here.
Can you tell us about yourself and the work you do at the IOG?
I first came to the IOG as a student volunteer while taking undergraduate classes in psychology in Fall, 1998. Peter Lichtenberg had just been made the interim director. So, I feel like I’ve been at the IOG since the beginning! I helped interview seniors in a data collection for a graduate student’s dissertation. After I was accepted to graduate school, I studied at the IOG and the department of psychology and eventually, I had other students help me on my dissertation. After graduating in 2010 with a PhD in clinical psychology, I was hired to help manage various research projects at both the Merrill Palmer Skillman Institute and the Institute of Gerontology: a study of Detroit grandparents caring for grandchildren, an evaluation of a substance abuse prevention program in 200 Michigan high schools, and I’m currently helping Peter on his financial decision making study. The goal of this study is to develop a tool to identify seniors who are vulnerable to financial exploitation. I also have a private practice in Macomb County that focuses on issues that senior face: adjustment to widowhood, family issues and marital therapy, depression and anxiety, particularly among caregivers. During all of these years, I have raised three children and I enjoy Jazzercise, ballroom dancing, and attending any cultural event involving live theater. Alvin Ailey dance company is my favorite!
Where did you grow up?
I was born in New York City and moved to San Francisco at the age of 12. I feel like I got to experience the best of both coasts! My parents were theater, ballet, and opera fans and we always had subscription seats as well as being frequent visitors to museums of all sorts. I trained to be a professional ballet dancer and my first job was dancing in the Nutcracker at the San Francisco Opera House every Christmas.
Why did you choose to study at Wayne State University?
I chose WSU for graduate school because their clinical psychology program has such an excellent reputation as well as its urban mission and outreach. I had a friend on the faculty of University of Michigan who urged me to apply there but I preferred WSU because of its diversity. After living in the Detroit area for the past 22 years, I feel committed to helping to make Detroit’s renaissance a reality. This is a wonderful city!
What led you to psychology?
I decided to become a psychologist when I was 13 years old and I read “I Never Promised You a Rose Garden” but as a young woman, I balked at the many years of graduate training required. I worked in technical writing and technical support in Silicon Valley when I lived in California. The 80s were a big boon time in the computer industry and jobs were so plentiful. After my husband accepted a transfer to Michigan, our lifestyle changed and I felt that I had more room to choose what I wanted to do rather than focus on the financial needs of the family. I was able to finally begin my graduate studies in psychology when I was almost forty years old and all of my children were in school.
How did you end up in aging?
A desire to work with older folks and understand the aging process through research and clinical training led me to the IOG. I am here to contribute in any way I can to the seniors of Detroit. I love interacting with the volunteers and workers of the Healthier Black Elders Center, doing analyses of research data to learn about aging, giving presentations to enhance the health of body and mind to Detroit seniors and professionals who work with them, and engaging seniors one-on-one in memory exercises and interviews for data collection. What I love most about my job is the variety of opportunities!
To learn more about Lisa click here.
To learn more about the IOG click here.
I am a recent graduate of the Wayne State University Department of Psychology’s Ph.D. program in behavioral and cognitive neuroscience, and of the Institute of Gerontology’s pre-doctoral training program. My research has focused on changes in brain structure and cognitive abilities that occur over the adult life span in healthy adults. We measure brain structure using different types of MRI scans, and we assess cognitive abilities using a variety of different tests of memory, attention, or reasoning. We know that some regions in the brain shrink over time, even in healthy people. However, not all parts of the brain show the same vulnerability to atrophy, and some regions seem to shrink more or to start declining earlier in life than others. In addition, this shrinkage appears to be related to changes in attention and memory. We also know that a host of different disorders ranging from increases in blood pressure or blood glucose levels to different genetic markers can exacerbate these declines. The reality is that age-related changes in the brain and mental abilities are very complex. We are currently trying to better understand how genes may interact with health and lifestyle factors to be either protective or to make people more vulnerable to this decline.
As we all get older, we tend to notice certain things – our memory is not as good as it used to be, or we are slower mentally and physically. Awareness of these changes can be alarming, even if it is not an indication of pronounced problems like dementia. In response to this growing awareness, we are willing to try anything that might possibly stop or reverse these declines in advancing age. We have seen a multitude of products that claim to undo the negative effects of aging. These range from ‘brain training’ software and smartphone apps to vitamins and supplements. Unfortunately, these claims are often based on limited research or from findings from studies using mice or rats that are not substantiated in humans.
Most people have heard the expression, “Correlation is not causation.” This simply means that although two things are related, one does not cause the other. For example, just because increases in homelessness are associated with higher crime rates, does not mean that increased crime is because of homeless people – both tend to increase when the economy is poor. Those selling anti-aging products capitalize on our lack of understanding of this very phenomenon. Similarly, the next time you see an ad or hear a friend talk about how taking a supplement of wahoo-berry extract is associated with better memory, it is important to ask “But does it actually cause memory to improve?” Here’s a link to a site with some more great examples of false or “spurious” correlations: http://www.tylervigen.com/.
By now, you may be asking yourself, “If the claims made by all those anti-aging products might be misleading, then is there anything we can do?” Fortunately, there are some things that have been shown to be particularly helpful to limit the effects of age on our brains and cognition. Unfortunately, they actually require effort, and may require some lifestyle changes as well, and many people struggle making such changes. The biggest protective factor is cardiovascular fitness. The brain is packed with blood vessels, and anything that affects the vascular system can affect the brain. There is also some strong evidence that a large part of the effects of Alzheimer’s disease is related to the impact of the disease on the brain’s vascular system. In addition to physical exercise, cognitive and social engagement and learning new skills seem to be more protective than playing brain training games. Learning a new language, or learning how to dance, how to use digital photography or other skills that integrate social, cognitive, and physical systems seem particularly promising approaches in combatting the effects of age.
In addition to these new activities, it is extremely important for those with chronic conditions like high blood pressure and diabetes to closely monitor their health and to take prescribed medications to keep these in check. Stress is another factor that can negatively affect our brains and cognitive abilities. Because of this, activities like yoga, mindfulness and meditation can help to reduce the stress hormones in our bodies and limit the negative effects on our brains.
Before you go out and plunk down your hard-earned money on products claiming to undo the effects of age, go for a walk, visit with friends, learn a new skill – it will serve you far better.
Disclaimer: The opinions expressed here are solely those of the author and do not reflect the views of Wayne State University, the Institute of Gerontology, its employees, directors or programs.
Our spring newsletter has released with a focus on cognitive neuroscience. Our Editor Cheryl Deep, MA shares details from the Paul B. Baltes International Conference on Lifespan Cognitive Neuroscience that resulted in a special journal section of the Neuroscience & Behavioral Reviews journal on neural and cognitive plasticity. The newsletter also highlights the dissertation defense of former IOG student and newly robed Dr. Andrew Bender titled, Changes in Cerebral White Matter, Vascular Risk and Cognition Across the Lifespan. Read on to learn more about awards, events and our partners.
A recent study by researchers at La Trobe University and Monash University in Melbourne, Australia, suggests that working women “need more managerial support [while] going through menopause.” This “Women at Work” study explored the health and wellbeing of working women and women’s satisfaction at work, yet focused on working experiences in or around menopause. The lead researcher, Professor Gavin Jack, reports that “menstrual status did not affect work outcomes” but that “if a woman had one of the major symptoms associated with the menopause — for example weakness or fatigue, disturbed sleep or anxiety, then this did influence how they regarded work.” Jack is further quoted as saying: “What is really important is not the fact of going through the menopause in itself, but the frequency and severity of symptoms which women experience, and how these factors affect their work.”
This study has been described in several news sources over the past few weeks, such as the International Menopause Society, Science Daily, and IrishHealth.com. I have many reactions to this research, both positive and negative.
I’ll present my positive feelings first: I appreciate the fact that researchers are talking about the fact that menopausal women are a large part of the workforce and that menopausal experiences matter for individual women. I also applaud the attention given to the fact that workers are human beings with bodies, and that bodies matter. The idea that employers should recognize that paid workers have bodies and that paid workers may be affected by their bodies is an excellent one. I agree that employers should be educated to be more sensitive to menopause and other bodily experiences that their paid workers might have, and simple adjustments in work policies and work environments can go a long way in making employees happier and more productive (plenty of research has already shown this). Finally, and maybe most importantly, as one article in Science Daily notes, “Not enough attention is paid to the experiences which people go through at different stages of life — the workplace treats this very unevenly.” I couldn’t agree more. Especially when it comes to midlife and aging, we forget that paid workers are still dealing with bodily transitions. We forget the range of chronic illnesses that paid workers might have at midlife and beyond, as well as the many normal health transitions that any midlife or aging individual deals with. Anything from the acquisition of bifocals (and learning to see differently through bifocal lenses) to the hassles of dealing with back pain, neck pain, arthritis, hearing impairments, insomnia, etc., can affect one’s work. Not to mention menopause, prostate conditions, and other aging health concerns that can involve a range of different signs, symptoms, and stages. Starting at midlife, it is also much more common to deal with caregiving for elderly parents, divorces and remarriages, putting kids through college (or putting up with adult kids living at home), deaths of parents and spouses/partners, and other social transitions, and all of these things will impact how a paid worker feels and acts on the job. There is much to pay attention to about paid workers in their 40s, 50s, 60s, and beyond, and I believe that this research is a good start on that. Middle-aged paid workers may be reaching the peaks of their careers and may be excellent at their jobs, but they’re still dealing with a multitude of other life circumstances at the same time. And if they’re not performing well on the job, it may well be because of these very same issues. Paid workers are people, with full lives and physical bodies that they can’t leave at home (no matter how much they try).
I do have to offer my negative reactions to this research as well, however: Whenever I see menopausal women picked out and studied specifically for their difficult symptoms, I worry about how those results will be used by others. Someone skimming the news reports might assume that this research shows that menopausal workers are harder to deal with, or aren’t ideal workers. So, let’s make sure we read this research appropriately: this research does NOT report that the quality of women’s work decreases when they reach perimenopause or menopause. This research only reports that women feel differently about their workplaces and sometimes wish their employers were more supportive of menopausal symptoms. If we don’t read carefully, then we might assume that being menopausal is more deviant than it really is. Working While Menopausal is not typically a negative status, or at least not for most women. Quick news reports also don’t always portray research in full, and I think it’s important to note that women are not always bothered by menopausal signs and symptoms (some are, and some aren’t). This was a study that asked primarily about women’s feelings about their workplaces and how health and wellbeing impacted work satisfaction. It is not a study that can give us comprehensive information about women’s menopause experiences. Finally, let’s remember that menopause is just one of many, many health and illness experiences that can affect how people feel and act on the job. Menopause is not necessarily a reason for employers’ alarm, any more than divorce or elderly caregiving or arthritis or back pain is. Rather, employers should be sensitive to the health and wellbeing of all paid workers across the lifespan and recognize that different groups of workers face different health and wellbeing issues.
I think that the most positive contribution of this research is that it reiterates that paid workers have bodies. Employers need to recognize that paid workers have a variety of bodies and that those bodies represent a variety of life stages. Sure, the ideal worker might not have a body but that ideal worker doesn’t exist. We bring our bodies to work!
This blog entry was originally posted by Heather Dillaway on re:Cycling, the blog for the Society of Menstrual Cycle Research (original post on 5/23/14).
The Detroit River has long been a valued food source for locals, but the fish caught there may not always be safe. Wayne State University researchers Drs. Donna Kashian, Mark Luborsky, and Andrea Sankar started an educational program – Eat Safe Fish — to address the dangers of consuming contaminated fish. Retirees and interns volunteer to increase community awareness by walking the Detroit River and talking to anglers face-to-face.
The Riverwalkers advise anglers about the polychlorinated biphenyls (PCBs), dioxins and mercury found in Michigan fish, which fish are safest to consume, and how to safely prepare the filets. This community educational program hopes to reach 5,000 anglers over two years to improve community health.
To access materials regarding consuming safe fish visit the Michigan Department of Community Health website @ https://www.michigan.gov/mdch/0,4612,7-132-54783_54784_54785—,00.html
To learn more about research conducted at the Institute of Gerontology, please click here.
This program was funded by a grant from the Fred A. and Barbara M. Erb Family Foundation.
Students, researchers, and children will learn about the exciting work that neuroscientists at Wayne State University do when they attend Brain Day at the Michigan Science Center on March 15. Attendees will be able to meet neuroscientists, learn about their labs, and even hold a human brain.
What better time to showcase our neuroscientists and the important research they’re doing at the Institute of Gerontology:
Dr. Naftali Raz is Director of the Lifespan Cognitive Neuroscience Program at the Institute of Gerontology. His Cognitive Neuroscience of Aging Lab focuses on:
-Age-related changes in the brain’s structure and function
-The impact of aging on learning, memory, and reasoning skills
Dr. Raz studies how the brain changes with age and how these changes are related to changes in memory and problem-solving skills in older adults. Since 2001, his lab has been conducting a long-term longitudinal investigation into normal brain aging. Using MRI, his team analyzes changes in brain structure in healthy adult volunteers age 18 to 90. They also study age-related differences in cognitive abilities such as memory, problem solving and spatial navigation. Since 2005, a large portion of Dr. Raz’ work has been funded through a multi-million dollar MERIT (Method to Extend Research in Time) award from the National Institute on Aging.
The award, given only to researchers with consistently high research achievement, allowed Dr. Raz to concentrate on his Neural Correlates and Modifiers of Cognitive Aging project for 10 years without the need to continue to apply for funding. Dozens of research papers have resulted from this investigation, which continues to track the effects of vascular risk factors like hypertension, and genetic modifiers like the ApoE E4 gene variant on changes in the brain and cognition among healthy adults.
Dr. Noa Ofen founded the Ofen Lab which focuses on:
-The development of basic cognitive abilities, learning and memory
-Changes in brain structure and function between childhood and young adulthood
Dr. Ofen studies the neural underpinnings of learning and memory in children, adolescents and adults. Research in her lab combines tests of cognitive abilities with neuroimaging techniques to probe how brain structure and function shape human cognitive functioning across development. In particular, she has worked to explore the structure and function of a small but powerful sliver of brain tissue crucial to memory: the hippocampus. Recent work from the Ofen Lab identified robust differences in the structure of the hippocampus from childhood to adulthood.
Her work to-date, and as a post-doctoral associate at MIT, investigated structural and functional brain development in a wide age range of typically developing children and young adults. At WSU her research is expanding to include the study of atypical brain development which underlies the emergence of many psychiatric disorders. The structure and function of the hippocampus, for instance, is altered in a number of psychiatric disorders with a developmental course, making Dr. Ofen’s research well positioned to address clinically significant questions. She recently received honors from the Society of Biological Psychiatry where she chaired and presented a symposium highlighting the importance of her work to the study of schizophrenia.
Dr. Jessica Damoiseaux is new to the Institute of Gerontology from the Netherlands and founded Connect Lab that focuses on:
-Structural and functional brain changes in healthy older adults
-Early detection of Alzheimer’s Disease
Dr. Damoiseaux came to WSU from Stanford University in April. She arrived with a grant from the Netherlands Organization for Scientific Research to conduct a four-year study into functional and structural brain connectivity changes in healthy older adults (age 55 to 75), some who are complaining of memory problems and some who are not. People who report cognitive problems – despite tests that do not show an obvious cause – are five to six times more likely to develop dementia than people who report no problems. Dr. Damoiseaux wants to understand the correlation. “That initial subjective awareness of cognitive impairment might be our earliest indicator,” she said. If imaging can uncover these precursors, early interventions to slow or stop the dementia might be possible.
Attend Brain Day at the Michigan Science Center on March 15 to learn more about the brain with topics focusing on addiction, development and aging, and head safety.
The event is free with paid general admission to the center, and coincides with the Dana Alliance for Brain Initiatives’ Brain Awareness Week, March 10-16, a global campaign to increase public awareness of the progress and benefits of brain research.
The Michigan Science Center is located at 520 John R Street in Detroit.
What brought Ms. Fritz to the IOG: Heather Fritz completed her PhD from the University of North Carolina at Chapel Hill in March 2013 before joining the IOG in August 2013. Heather is a Post-Doctoral Research fellow working under the mentorship of Drs. Cathy Lysack and Mark Luborsky and was attracted to the IOG because of the culture of autonomy, scholarship, and collaboration. Heather is also an occupational therapist with expertise in adult and geriatric populations. Heather’s work focuses on addressing the challenges of illness self-management and health promotion in low income and minority population. In particular she is interested in how individuals with diabetes become better self-managers through time, and the role of habits, routines, social and cultural context, and daily occupations in the process.
Hobbies: When Heather is not working on her research she enjoys cycling, cooking, and spending time with friends and family. She is also a mother of a very handsome Doberman Pincher.
Interesting Facts: Heather initially attended Ohio State as a veterinary medicine major (with agricultural construction as a minor) and later dropped out of Ohio State and started a small landscape design company which she ran for a few years before moving to NC.
Work: Heather has worked some very interesting jobs including: working on the carnival and in food trucks while in high school, as a bus driver while at Ohio State, and as a parking enforcement office (writing parking tickets) while at UNC.
Travel: Heather lived in Monterrey Mexico in 1999 while studying at ITESM and is still (fairly) fluent in conversational Spanish and enjoys all things Latino and Hispanic especially food, music, and dance. She Recently traveled to Denmark and Sweden where she spent time with faculty and PhD students at University of Southern Denmark and Lund University. We may have lost her in the canal had it not been for this sign!!!
To learn more about Heather visit her profile page @ http://www.iog.wayne.edu/profile/heather.fritz/ or email her @ firstname.lastname@example.org
Reporter Jeanette Brown of ElderBranch interviewed Institute of Gerontology Deputy Director, Dr. Cathy Lysack (pictured), to discuss her paper, “Falls efficacy and self-rated health in older African American adults,” which she wrote along with Dr. Chad Tiernana of Husson University and Dr. Stewart Neufeld, Dr. Allon Goldberg, and Dr. Peter A. Lichtenberg of Wayne State University.
Why did you decide to study falls, falls efficacy, and self-rated health in older African Americans. Why is this important?
Falling in general is really important to older adults because we have a fair bit of evidence now that older adults fall quite a bit. Of community-dwelling adults over the age 65, about one in three falls every year on average. That’s a lot of falling. So it is really a very serious problem. And for a small number of older adults, it’s that step into a downward spiral where the serious fracture means a hospitalization, and then that immobility coupled with maybe a series of other health conditions makes it really difficult to get back out of the hospital and certainly out of the hospital in as independent a mobile state as everyone would like. So it’s a big issue period, and it is understudied – like so many issues – in ethnic minorities.
While it is true that African-Americans who fall are less likely to have a hip fracture compared to their elderly white counterparts, we still don’t know much about the stats and facts of ageing for this group. And, in particular, we know very little about this very interesting dimension of falls efficacy, which is our confidence in our ability not to fall. So it was worthy of study.
Please describe your study. What methods did you use in order to achieve meet your objectives?
We used a telephone survey methodology. Here at our Institute of Gerontology at Wayne State University we have a large number of older African-Americans who are research volunteers that come from the community, so we did a sample from our database of seniors in the Detroit area, and then we had a trained set of older adults themselves conduct the telephone data collection interview.
What were your key findings?
Well, one key finding was that approximately one quarter of our sample reported falling within the past year. That wasn’t very different from the national numbers. It was a bit lower, which is good, since no one wants older people to fall.
That said, our second major finding was how high their confidence was in not falling. That was rather curious. How can you have these two things go together?
What conclusions did you draw from that or what further questions did it raise?
It is known in general that there is an optimism in survey results gathered from older African-Americans. It is not always present, but often compared to white samples there is a stronger sense and stronger reporting from this group that things are “alright.” So at one level it wasn’t really surprising.
What was even more important, though, was to look at the linkages between the self-reported health of the people responding and how that figured into falls efficacy and actual falling. What was surprising to us – you might expect that people who report poor health are the fallers, for example – but that isn’t what we saw.
However, we saw that people who had poor self-rated health also were the folks with the lowest confidence in their ability not to fall. So, in other words, people who were not particularly well physically had low confidence. And that is what you might expect – maybe they know they are a little bit unstable. But this is really important because when people are not well, particularly when they lack confidence in their walking, they tend to do it less. That is a real problem because when you walk less, exercise less, you get less fit. And if you are less fit, you are more likely to fall. There is a spiral effect that we really need to better understand so we can stop it.
Would you make any specific recommendations to nursing homes or others who are working with older African-Americans as result of your findings?
The most important thing I would stress is how important it is to remain as physically strong in your lower extremities as you can for as long as you can. My background is occupational therapy, and I work closely with colleagues in physical therapy. One of the prime therapeutic things that we focus on in those settings is making sure that the ambulation and transfers from bed to chair to toilet to shower, etc. is safe. Again, the stronger, in particular, your quadriceps are – those muscles that you use in squatting down, standing up, squatting down – those muscles are so, so, so important. If individuals need assistance with walking, we need to give it to them. Because lying in bed is really, really bad for you and sitting is bad for you.
Short story: exercise, walking, and maintaining quad strength are incredibly important. When you think of the biomechanics of walking, the first motion is flexing at the hip. So there are tiny little muscles in the groin area that cross the hip bone that begin the step, and that lifts up the knee. But then all of the weight of the motion of walking is shared right across the top of the thigh and over an insertion into the front of the knee. That big, long strap muscle needs to be strong or you see the stumbles and the shuffling and the falling forward, which is the typical injurious fall.
What are the next steps to further your work in this area?
A big question is whether or not we can modify confidence. We have just been talking about modifying physical activity in a positive sense, i.e. doing more exercise and being more fit and strong and having more balance. But an interesting question is what about modifying our confidence not to fall? Could that actually be beneficial?
Could we do something with older adults that would enhance their self-confidence, which in turn would lead to participating more in physical activity and walking. Again, this is because of this fear of falling leading to falling negative spiral that I talked about earlier. We don’t know the answer to that right now, but there is a lot of interest by researchers to see if there can be particular skills training that will boost confidence. Because if you are more confident you’ll go out and walk, and if you’re not confident you may not.
Are there other things that came up in the course of this study that you want to highlight? Things that surprised you or were particularly noteworthy?
Yes, I would say one more thing. There is this question that researchers use all of the time with older adults and other people, this so-called self-rated health question. Basically, it’s where you ask an individual how they would rate their health today and they have five choices: poor, fair, good, very good, and excellent.
We asked that question in our study, like many other researchers have, and it was just a reminder once again how powerful that one single question is and how correlated one’s self-rated health is with other things like depression, physical activity, and even more global questions of life satisfaction and well-being. We talked about it on our research team, and we’ve come to the conclusion that clinicians should really ask this question in practice much more often than they do.
Often you are doing a thorough particular assessment of walking or balance or strength – but even getting an answer from an older adult that falls into one of those categories, we now know from the scientific literature how tightly that answer is related to other important health outcomes. So we would really like to encourage clinicians – whether they are occupational therapists, physical therapists, nurses, physicians – just one quick question can really highlight a group that may be at risk. It is very, very telling when older adults slide down from very good to good and into fair. The curve just dips so, so significantly. So we need to really work at having “excellent” be the response people give when asked to rate their own health.
Cathy Lysack, Ph.D., OT(C), is the deputy director of the Institute of Gerontology and a professor of occupational therapy and gerontology at Wayne State University in Detroit, Michigan. An occupational therapist by profession, she received her Ph.D. from the University of Manitoba, in Winnipeg, Canada, and joined Wayne State as an assistant professor in 1997. Her major research interests include the social and environmental influences on health and understanding how older adults and people with disability redevelop active and meaningful lives in the community after illness and injury. She has studied aging and depression, the independence and safety of older adults who live alone, the impact of spinal cord injury on community participation, mobility loss after hip fracture, and downsizing residential moves in later life.
Questions or comments? Contact Jeanette @ email@example.com or @ (551) 655-3079.