Education As Preventative Medicine

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I always enjoy “meeting” someone on the internet who seems to hold the same views that I do and just recently, I came across an interesting article, Lifelong Learning and Wellness One Component to the Enlightened Gerosphere, in which the author, Paul David Nussbaum, Ph.D., Director, Neurobehavioral Services at St. John Center in Mars, Pennsylvania, put forth the suggestion that just as exercise and healthy eating are preventative, education can be a means of avoiding the dreaded Alzheimer’s.  As he writes:

Imagine an America where health insurance companies paid for attendance at church or synagogue, enrollment in higher education, residence within technologically advanced homes (smart homes) which can relay health information directly to the primary care physician, and even sustained employment. This approach to wellness stands in sharp contrast to the current model that incentivizes annual, invasive procedures such as a pap smear. While these ideas may render a humorous response, we must remember that the total dollar allocation for health care in this country is approximately one trillion dollars, and that one third (33%), or 300 billion dollars, of that total cost is for services delivered to the older adult. Despite this, Medicare and Medicaid are financially unstable. Imagine running a business in which you invest 300 billion dollars and yet the business is bankrupt! Perhaps we are not approaching the care of older Americans in a proper manner!”

I totally agree with Dr. Nussbaum’s assessment that nursing homes are not an answer, as I have written in previous posts, but because he writes it so eloquently, I will share what he writes:

Older Americans do not need high technology medicine, should not be treated in acute care centers as they suffer chronic illness, should not be forced to choose a nursing home, and should not be forced to retire or withdraw from a personal role and purpose. Instead, older Americans should have access to geriatricians who are afforded the same status of primary care physician as are pediatricians, should have access to a chronic care system, should be afforded multiple long term care options which do not include institutionalization and consequent family/financial death. Further, older Americans should be incentivized (financially) to remain well by promoting the social/human factors of health listed above.

I have championed the need to end the existence of nursing homes in the United States as I believe they represent the neglect of a great country to care for a vulnerable and needy segment of our population. Nursing and other services can be delivered without the cement walls of an institution. Nursing homes were built post-World War II and represented a warehousing model of care. Think about where nursing homes are located and you can understand the resulting removal of individuals from the vitality of life. My beliefs have nothing to do with the quality care and hard work that occurs every day in most of our nursing homes. In contrast, the United States must awaken to the fact that nearly one third of Americans would rather die than enter a nursing home, and the market has demonstrated consistently that potential employees seek work elsewhere— human beings do not want to live or work in nursing homes!

Again, Dr. Nussbaum so nicely summarizes the reality of aging in our society today:

Today, the United States has an extremely primitive understanding of aging. Our country maintains a negative perception about getting older, one that reflects a genuine misunderstanding of the facts regarding aging. For example, our entire social and legislative policy is based on an invalid age-threshold of 65. Clearly, we need to increase this age-threshold to reflect more accurately the expected lifespan of Americans. Most people are not aware that age 65 was employed for social benefits by Chancellor Bismarck in Germany over 100 years ago.  Americans believe that advanced age leads to poverty, illness, Alzheimer’s disease, nursing home placement, depression, and loneliness. These entrenched perceptions exist despite facts that nearly 70% of older adults (those living beyond 65) are independent, financially stable, happy, healthy, and productive. Further, the vast majority of older Americans do not have Alzheimer’s and do not live in nursing homes.

So my blog is entitled “education as preventative medicine”  Where does this part of the article begin.  Right here!  Dr. Nussbaum states that

Fortunately, researchers interested in neurodegenerative disorders such as Alzheimer’s disease (AD) which affects four million Americans, and costs the country 100 billion dollars annually in direct care and 30 billion dollars in indirect care related to caregiver illness, have underscored the importance of education as a potential preventative factor against AD. Multiple studies have demonstrated a reduced risk of AD for those with advanced education. The neurobiological explanation of this has been labeled Reserve Theory. Essentially, information which is learned must be processed by our brains, itself a physiological event. Such learning promotes development of new neurons and neural pathways. The theory advances that with increased cell density and cell volume, a progressive disease such as AD will not impact the brain or will impact the brain at a later age because the disease will have to destroy a greater number of cells to manifest clinically. The increased volume of cells in the brain provide a reserve to fight off invading diseases such as AD. Interestingly, the Reserve Theory has been advanced for other etiologies of dementia besides AD.

Although there is more in Dr. Nussbaum’s article on studies demonstrating more proof, I would refer the reader’s to his article, as I have reached my word quota for this particular blog.  Thank you, Dr. Nussbaum.

Copyright Yvonne Behrens 2014

 

 

 

 

 

Self-esteem in the Elderly

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Self-Esteem for sale

Self-Esteem for sale (Photo credit: fran6co)

My colleague, Denise Scruggs, and I will be giving a workshop on promoting self-esteem in older adults at the Southern Gerontological Society Conference in Nashville, TN.

One might ask, “Why?”  Boomers, the next aging population, are known to have higher self-esteem than their parents or grand-parents apparently had, aren’t they?

But according to a recent study, those facing the big six-0 will also be facing a decline in the value they place upon themselves.  That’s the broad conclusion of a new study showing changes over the human lifespan based on interviews with a total of 3,617 Americans over a 16-year period from 1986 to 2002  (Orth, Trzesniewski, Robins).

Because we boomers, as a group, have had the tendency to be in denial with regard to our aging, that decline could be dramatic. Stop with the hair coloring, stop with the face lifts, stop with marrying someone younger than you, stop all those super athletic recreational activities, stop one’s role in the work place and what is left?

The above mentioned study found that the factors that had the largest influence on one’s sense of self include:

*Income and health.  In our money oriented society, it follows that we would associate money with power.  It also follows that if our independence becomes eroded by health issues, this would affect our sense of self in a negative way.

*Education plays a major role in maintaining self-esteem. Participants with higher education outranked those with less education throughout their lives.

*  The study confirmed that women had lower self-esteem than men through most of their lives, but the two genders were about equal by the time participants reached their 80s.  I suppose that men in their ’80′s have probably lost pretty much everything by which they defined themselves earlier in their lives.  One might reflect on the statement that it is at this time that men and women “were about equal” in their self-esteem.

*The self-esteem of whites and blacks differed only a little at age 25. However, black participants declined more sharply than white participants from about age 60. A further study to look into the factors that cause this discrepancy would be warranted

Beyond these global attributions to the loss of self-esteem, there are also factors of daily living.  The loss of loved ones, in particular spouses, can have an impact on one’s self-esteem.  In fact, findings from a study conducted by Julie Ann McMullin and John Cairney (2004) showed that single people have lower self-esteem than married people demonstrating that receiving feedback from a significant other helps promote a positive self-image.  When that person, with whom you could confront major challenges, bounce ideas off of, share life’s moments with, or was your biggest fan is no longer there and you do not receive regular feedback of your existence, that can erode self-esteem.

What about finding yourself not being able to keep up with the rapidly changing world you used to be a part of?  How would that make you feel?  Pretty worthless, no?

Or, and this is probably the saddest of all, being an old person that people are not interested in because, well, let’s face it, ageism is alive and well in our society.

So this is why Denise and I plan to present tools to our colleagues by which they can help promote positive self-esteem to those confronting that change of life: aging.

I will let you know how it went.

© Yvonne Behrens  2012

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