White House Conference on Aging

Yesterday, we had a great lecture about the Aging Network, which touched on the history of the AOA, Administration on Aging. The AOA, which oversees the Aging Network, was created as a result of the passage of the OAA, the Older American's Act in 1965. According to the site, the OAA:

The original legislation established authority for grants to States for community planning and social services, research and development projects, and personnel training in the field of aging.

Ever since the passage of the OAA and subsequent creation of the AOA in 1965, there has been a once-a-decade White House Conference on Aging. President Bush was notoriously absent from the most recent White House Conference on Aging, which was held in December, 2005. Instead of having a speaking at the conference, as all of his predecessors have done since its inception, President Bush was stumping the successful passage of the Medicare Part D law.

The website for the White House Conference on Aging is pretty thin on info... essentially a splash page that doesn't so much as highlight successes of conferences past. It does, however offer a webcast of the most recent conference... I find it more than mildly disturbing that the webcast is hosted via "Kaisernetwork.org." Can you say "conflict of interest" anyone?

The main takeaway from the White House Conference on Aging site is the executive summary the most recent, 2005, conference, which was entitled "The Booming Dynamics of Aging." Here's the direct link, should you prefer to copy and paste:

http://www.whcoa.gov/Final_Report_June_14nowater.doc

TR Reid Commonwealth Club

In our class discussion yesterday, someone mentioned TR Reid's September 14, 2009 speech at the California Commonwealth Club, entitled "Can We Really Fix US Health Care?"

I haven't listened to it yet - I like to download podcasts and listen to them on my commute in to class! Here's the direct link, if you prefer to copy and paste.

http://castroller.com/podcasts/CommonwealthClubRadio/1232943

Second Bill of Rights

I haven't seen Michael Moore's new movie yet, on Capitalism, but I guess it makes reference to FDR's idea of creating a Second Bill of Rights.

Here's a quick quote:

In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.

Among these are:

The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

The right to earn enough to provide adequate food and clothing and recreation;

The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;

The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

The right of every family to a decent home;

The right to adequate medical care and the opportunity to achieve and enjoy good health;

The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

The right to a good education.

All of these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.

America’s own rightful place in the world depends in large part upon how fully these and similar rights have been carried into practice for our citizens.

Also, here's a clip (audio, but hosted on YouTube) of Roosevelt' speech.




This is unbelievably powerful. If Roosevelt had succeeded, what would things look like now? In order to make these "rights" realities, we would have had to have made some hard choices... One of my first thoughts is that we certainly couldn't have globalized our markets nearly as much as we have. Secondly, in order to secure "the right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad," we must have limited corporate power to some extent. Finally, and unpopularly, it seems that in order to provide many of these rights, we would have had to limit our population growth, which would have meant further immigration quotas than already exist.

Thoughts?

The Effectiveness of Smoking Bans

I saw this article about how effective smoking bans have been. I wanted to put it here because it relates to a pet interest of mine - High Fructose Corn Syrup (HFCS), or, more specifically, how it's in everything.

Clearly, the success of the smoking ban is largely due to reductions in second-hand smoke deaths, and there isn't a correlative "innocent bystander" in eating, but the study does demonstrate that banning substances can have a big impact on public health.

Unrelated Example of the Power of the People

We spend a LOT of time in our Social Policy class discussing the present debate over a national health care plan. It's pretty grim, the stakes are very high, and I, personally, have small faith that Congress is going to do the right thing. I'm sure some bill will pass, that it will be sweeping and effect major change... only... I don't think that the "change" will ultimately benefit we, the people.

When the discussion becomes dour, our esteemed professor rallies us with the notion that we can influence Congress via letters, phone calls and educating our peers. After all the readings we're doing, which are pretty rife with references to how large the system is, and how the government is increasingly controlled by institutions, not people, it's hard muster faith that individuals have power in the US, much less voices.

I read this article today - it's totally unrelated to Gerontology, but quite uplifting as a story of people effecting chance on Congress:

http://www.marinij.com/ci_13416510?source=most_viewed

Mother Kills Daughter / Self at Nursing Home

I wanted to update this post with a link to the letter Diana Harden sent to the local news channel. You can find it here, at the California Advocates for Nursing Home Reform (CANHR): http://canhr.org/newsroom/newdev_archive/2009/Noyes-nursing-home-letter.pdf

------------------------

This is a tragic situation - last week a 64 year old mother entered the nursing home where her 43 year old, disabled and brain damaged daughter lived, and killed her daughter and then herself. The whole event is a tragedy - not just the two women's deaths, but also what seems to have led up to the act.

I read the initial report of this crime the day it happened, and thought that it related to Gerontology studies for three reasons:

1. The mother was aging and it appeared that she was largely motivated to commit this crime because of ailing health, which would have ultimately limited her ability to advocate for her daughter. Aging and not being able to care for dependent loved ones is a Gerontology issue.
   
2. The daughter was in a nursing home and vulnerable. Though she's not of the "aged" cohort, she is within the same system of care that so many of our aging population fall into. Therefore, the issues of quality of care that were implied in the crime relate to Gerontology.
3. Even in the initial crime report, it seemed that this crime was motivated by some version of quality-of-life-motivated suicide that's often the fodder for assisted suicide and euthanasia arguments that we will only be seeing more of in the years to come.
   

This most recent article, which alludes to details that were given in the mother's letter to a local news channel, confirms a lot of my suspicions. Again, this tragedy is rife with all the things that can go wrong in caring for people in fragile economic and health states, and the numerous ways that government oversight can let things fall through the cracks. Perhaps the daughter would have been unhappy no matter where she stayed - it seems part of her brain damaged condition led her to be a pretty difficult patient. However, the fact that so many complaints have been registered against this home and so little official censuring (lots of confirmation, but little punishment) occurred will always leave a shadow (or pall) of doubt as to whether the outcome and quality of life could have been different had the checks and balances worked correctly here.

What are your thoughts about this in relation to Gerontology?

NYT Article on People Leaving Nursing Homes

A great deal of the reading we're doing in the Social Policy class talks about how the present structure of public policy tends to force elders into institutions and poverty (if they weren't already impoverished to begin with). Recently, some states have been working on ways to redistribute Medicaid money so that more people can stay at home rather than nursing homes.

This article from the New York Times (linked here in the mobile version, which has less banner ads, etc), does a pretty decent job of going over some of the high-level pros and cons of these "Money Follows the Person" programs.

Some main points:

• PRO: people are thrilled, thrilled, thrilled to escape having their final days in a nursing home
• PRO: it looks like people moving out of nursing homes costs less money
• CON: the "less money" part is most likely due to family members doing labor that is paid for in nursing homes. The article implies that this is a problem, or at least potential hardship for family members, but doesn't delineate that most of the burden of care falls on... you guessed it... women.
  

The article is very good also because it touches on how devastating things can be in older age - a slip and fall can rapidly lead to being shuttled into a nursing home and never getting to go home, much less wrap up your possessions. Life is so very fragile.

Finally, the article mentions:

A recent study by researchers at the University of California, San Francisco, found that home care costs taxpayers $44,000 a year less than a nursing home stay - though this number cannot be used to estimate total savings, because often home-based services replace family care, not nursing home care.

I'd bet that Carroll Estes is somehow related to that study!

(the article noted in this post is "Helping Elderly Leave Nursing Homes for a Home" by John Leland)

National Bureau of Economic Research

One of my questions about study on Universal Mid-Life Crisis seems is a little satisfied. I'd asked why economists were performing the study. What I meant by that was why economists and not psychologists, since it seems to be about a relatively "soft" topic of subjective states, as opposed to "hard" definable topics like numbers.

The study looks like it was done at the NBER via their

Here are some handy links:
http://www.nber.org/programs/ag/ - Great synopsis, state of the state-type overview of economics and aging in the "Program Report" on this page.

Also, you can sign up to receive a free email copy of the quarterly Bulletin on Aging and Health here

You can view the latest copies of the Bulletin here.

Finally, you can request a CD of 3 years' worth of related studies here.

Follow up on Mid Life Crisis Study

Here's an abstract on the Universal Mid-life Crisis study I posted about:

Recent research has argued that psychological well-being is U-shaped through the life cycle. The difficulty with such a claim is that there are likely to be omitted cohort effects (earlier generations may have been born in, say, particularly good or bad times). Hence the apparent U may be an artifact. Using data on approximately 500,000 Americans and Europeans, this paper designs a test that makes it possible to allow for different birth-cohorts. A robust U-shape of happiness in age is found. Ceteris paribus, well-being reaches a minimum, on both sides of the Atlantic, in people's mid to late 40s. The paper also shows that in the United States the well-being of successive birth-cohorts has gradually fallen through time. In Europe, newer birth-cohorts are happier.

NBER Bulletin on Aging and Health

Mid-Life Crisis is Universal?

This article in The Financial Times discusses a recent study that claims mid-life crisis is universal.

I found this article to be interesting on a number of levels. First, it's interesting that women appear to have the crisis earlier in life. I wonder if there's a correlation between dwindling biological reproductive prospects and the depression of mid-life crisis.

Second, why are economics professors doing a study on mid-life crisis?

Third, both of the readings from the classes I'm taking referenced how perspectives on aging have shifted since gerontology began. The initial belief was that as we age, we disengage from society and life. Two newer perspectives are that we either have successful aging, wherein we are active and get more involved in life after retirement, or that we simply experience an extension of ourselves throughout the life spectrum. The quote below from the article seems to reference this last perspective as having been a point now refuted by the study:

"...the findings contrasted with many previous studies and with applied psychology textbooks – suggesting that, on average, our mood stays relatively consistent as we age."

The article also gives a few descriptions of the aging process that are very interesting, again, considering that the observations are coming from economists:

The most likely explanation, the researchers speculate, is that people “learn to adapt to their strengths and weaknesses, and in mid-life quell their infeasible aspirations”. Minor contributing factors might include a “selection effect”, with people living longer if they are cheerful than miserable, and – towards the end of life – a “comparison process” in which people count their blessings as they see their old friends dying off.

“For the average person in the modern world, the dip in mental health and happiness comes on slowly,” said Prof Oswald. “Only in their 50s do most people emerge from the low period. But, encouragingly, by the time you are 70, if you are still physically fit then on average you are as happy and mentally healthy as a 20-year-old. Perhaps realising that such feelings are completely normal in mid-life might even help individuals survive this phase better.”

Social Structures

Estes mentions the term "social structures" a number of times in the second chapter of Social Policy and Aging. Here's a specific quote:

A more recent dimension of this theory is the concept of structural lag, wherein social structures (e.g. policies of retirement at age 65) do not keep pace with changes in population dynamics and individual lives (such as increasing life expectancy).

Social Policy and Aging, p 30

Wikipedia has a good definition about it here:

Social structure is a term used in sociology and anthropology to refer to relationships or bonds between groups of individuals (e.g. societies). Whereas 'structure' refers to "the macro", "agency" refers to "the micro". (See also: Structure and agency)

In a general sense, the term can refer to:

• entities or groups in definite relation to each other,
• relatively enduring patterns of behaviour and relationship within a society, or
• social institutions and norms becoming embedded into social systems in such a way that they shape the behavior of actors within those social systems.

By the 1930s, the term was in general use in social science^[1], especially as a variable whose sub-components needed to be distinguished in relationship to other sociological variables.

Wikipedia

It looks like Estes is using the term in the third sense here - that of "social institutions and norms becoming embedded into social systems in such a way that they shape the behavior of actors within those social systems. I think she also means it in a bigger sense, that social structures can be institutional - such as companies having a standard retirement age of 65.

Handy Glossary of Terms

I found this great glossary of terms while hunting for a good description of normative vs. interpretive perspectives.

http://website.lineone.net/~tmheath/glossary.htm

I like that this glossary was created by someone who was posting their notes and assignments while studying for their master's in Education. Great minds, I guess.

Self-efficacy

Estes mentions self-efficacy here:

...more recent studies focus on understanding the process of aging from the perspective of the life course and the relation of coping, social support, personal control, self-efficacy, and focus on the behavioral dimensions of aging.

Social Policy and Aging, p 28

Wikipedia has a really clear-cut description of "self-efficacy:"

The concept of 'self-efficacy' is an important one in the self-management of chronic diseases because doctors and patients often do not follow best practice in using a treatment. For instance, a patient using combined oral contraceptive pills to prevent pregnancy may sometimes forget to take a pill at the prescribed time; thus, while the perfect-use failure rate for this form of contraception in the first year of use is just 0.3%, the typical-use failure rate is 8%

Wikipedia: self-efficacy

Normative vs. Interpretive Perspective

Normative models of social research hold that human behaviour is law-like and should be investigated by natural science's techniques of observation. Behaviour is determined by the past. General theories are sought to account for social behaviour.

Interpretive models work explicitly from within the human perspective. Action, i.e. future-oriented intentional behaviour, is emphasised and theories are emergent, multi-faceted, and attentive to the meanings created by the participants.

Cohen, Manion and Morrison (2000)

Normative
Concerned with rules, recommendations or proposals, as contrasted with mere description of the statement of matters of fact.

Interpretive sociology
Any sociological theory or approach that emphasises that humans give meaning to social reality before deciding how they are going to act, requiring explanations to refer to the subjective states of social actors.

Estes states:

Another classification dimension of different gerontological theories (also consistent with the larger disciplinary social sciences) is the "normative" versus the "interpretive" perspective...

Social Policy and Aging, p 25

WSJ Article on Shopping with "Senior Eyes"

The Wall Street Journal had an interesting article today about special training programs for people who do merchandising for health-related stores, such as drug stores. The program is run by the Kimberley-Clark Corp. Sadly, the WSJ doesn't allow full access to articles older than a day, unless you have a paid subscription.

Here's the link anyway:
http://online.wsj.com/article/SB125288402995807243.html

Modest Universal Transfers

We also briefly talked about Modest Universal Transfers in class.

I'm still confused on this, as it seemed that a universal transfer could be the dispersement of your wealth to your heirs prior to your death, as a means of "spending down" to qualify for Medicaid. Technically, I think this is a transfer, but I found some economics-based definitions of "transfer payments" to be helpful:

Transfer Payments definitions:

The Congressional Budget Office:
Payments made to a person or organization for which no current or future goods or services are required in return. Federal transfer payments include Social Security and unemployment benefits.

In this context, "transfer payments" definitely relates to spending down on a micro level. It doesn't account for the "modest universal" part of the term I'm trying to understand though... does Social Security count as this?

World Bank:
Payments from the government to individuals used to redistribute a country's wealth. Examples are pensions, welfare, and unemployment benefits.

Means-tested Assistance - Discussion

We talked about Modest Universal Transfers and Means-tested Assistance in class the other day and I have a much more clear understanding of what these terms mean now!

When a person gets "means-tested assistance," they somehow qualify for it, such as Medicaid. You need to have limited means in order to qualify for the assistance. Means-tested assistance is frequently associated with stigma because, well, if you're getting X assistance, then it's known you qualify for it by X means, as in, low income.

The discussion went on to point out that in order for people to qualify for the long-term care that is provided by Medicaid, they need to "spend down," by divesting of their savings and investments (home, properties, stocks, etc).

--------

Social Security, on the other hand, is not a means-tested assistance. It is an institution that goes to all who contributed to it. Often, women exit the workforce to raise children and therefore the Social Security program is a social policy structured against women.

Modest Universal Transfers & Means-tested Assistance

This isn't really a definition... it's just the main source quote I could find about it... it doesn't delineate the difference between "modest universal transfers,""means-tested assistance" and modest social-insurance plans."

...the liberal welfare state, in which means-tested assistance, modest universal transfers or modest social-insurance plans predominate. Benefits cater mainly to a clientele of low-income, usually working-class, state dependants. In this model, the progress of social reform has been severely circumscribed by traditional, liberal work-ethic norms: it is one where the limits of welfare equal the marginal propensity to opt for welfare instead of work. Entitlement rules are therefore strict and offer associated stigma; benefits are typically modest. In turn, the state encourages the market, either passively - by guaranteeing only a minimum - or actively - by subsidizing private welfare schemes.

The Welfare State, a reader, p 162

Source Quote:

How public policy defines citizen rights is highly determinative of the "life chances" available to members of society, including the elderly. In liberal states such as the United States, there are modest universal transfers and means-tested assistance with strict entitlement rules, often associated with stigma... In contrast to the "largely individualistic and sometimes asocial views of the New Right" in which citizen rights are based largely on labor market participation and property, the opposing concept of "social rights" emphasizing notions of independence and solidarity...

Social Policy and Aging, p 11

Deficit Spending

Deficit spending is the amount by which a government, private company, or individual's spending exceeds income over a particular period of time, also called simply "deficit," or "budget deficit," the opposite of budget surplus.

Rational Unfreedom

Unfreedom is the "domination of one's instincts, domination that society makes into second nature and that perpetuates the institutions of domination. But civilized unfreedom is oppression of a particular kind: it is rational unfreedom, rational domination. It is rational to the extent that it makes possible the ascent from a human animal to a human being, from nature to civilization..."
(The Essential Marcuse, p. 168)

Quote from "The Sex/Gender System" section, Social Policy and Aging text:

According to Brown... women face the "rational unfreedom regulated by the state" versus their state of "nature" in which there is arbitrary violence by men against them as women. The state meets the requirement of men to protect women from the violence that men cause. The role of dependency in the health and aging of women is explored in greater detail in both Chapter 6 and Chapter 7.

Social Policy and Aging, p. 9-10

Subjugation

The act of obedience or servitude being forcible imposed.

Post-Industrial Capital