Final Portfolio Report, Essay Example

Helping older individuals achieve more fulfilling lives was the inspiration which led me into the field of gerontology.  Persons aged 65 and older are vital members of society and they have much to contribute.  However, they are often marginalized and overlooked because they are perceived in a negative manner.  By serving as an advocate for older individuals, gerontologists can help them to retain their rights, realize their potential and remain healthy and active.  When the challenges of aging are addressed, older individuals have the opportunity to enjoy their lives.  Being a successful gerontologist requires an extensive knowledge on not just the challenges associated with aging, but also an extensive knowledge in the most current research and literature.  The application of knowledge with compassion and determination are qualities which comprise excellent leadership skills for all gerontologists to aspire.

Older individuals face many challenges such as limited finances, physiological decline, and psychosocial difficulties.  Their needs are often neglected because of the negative perception that these challenges make them into less productive people.  As a result, policies were implanted to help older individual better handle these challenges, such as the Older Americans Act (OAA) and the Aging Network.  The OAA is a federal program which provides older individuals with services such as the Aging Network, which helps older individuals to live independently.  The Aging Network incorporates federal, state, and local organizations to provide funding with research programs, training, nutrition, home and community-based services.  It provides assistance to family and caregivers and informs older individuals of their basic legal rights.  In order to reach a greater number of older individuals, the OAA is continuously expanding to include more subpopulations, such as Holocaust survivors and the gay, lesbian, bisexual, and transgendered (GLBT) community.

Policies also protect older individuals regarding legal challenges of discrimination with employment and retirement.  Finances are often limited for older individuals, mainly due to minuscule retirement funds and the inability to retain suitable employment.  Because of the perception that older individuals are slow, unhealthy, and uneducated with technology, employers may be reluctant to hire or retain older employees, regardless of their qualifications or productivity.  Older individuals may be relieved of their positions ahead of younger employees because employers do not wish to pay for insurance or pension plans.  The Age Discrimination in Employment Act (ADEA) was implemented to fight discrimination against workers over the age of 40 and to prevent employers from retaliating against workers who have filed complaints.  The ADEA includes the federal government and its agencies, private employers with 20 or more employees, interstate and employment agencies, and labor unions.  The Senior Community Service and Employment Programs (SCSEP) is another program which helps older individuals on a limited income by providing them with training and employment.  Unemployed persons over 55 years of age have the opportunity to work 20 hours a week for at least minimum wage.  Preference is given to those over age 60, minorities, and veterans and their spouses.

Problems with retirement comprise a major problem with aging.  Pension plans are becoming more restricted and more people are retiring at a later age.  Social Security provides some income for older Americans; the amount is limited and it excludes many subpopulations, such as the GLBT community.  Medicare and Medicaid are both programs designed to help older individuals with their retirement.  Like Social Security, Medicare is a program people pay into it while they are working and is not based on individual income.  Medicaid is an assistance program meant for people with low income and is funded by both the federal and state government.  Unlike Medicare, it offers financial assistance to all in need and is not restricted to older individuals.  Unfortunately, neither Medicare nor Medicaid are designed to provide long-term care and require constant funding.  Even with financial assistance, many older individuals live below the federal poverty line.  Medicare provides acute and emergency care and does not accommodate long-term care in hospitals, retirement homes, and nursing facilities.  Even though Medicaid is not as exclusive, in order to receive benefits, older individuals must achieve a certain level of poverty.

Gerontologists have a responsibility to learn as much as possible about these challenges.  Most people, not just older individuals, do not possess an understanding of their basic legal rights.  While many are familiar with Social Security, Medicare, and Medicaid, it is unlikely that they are aware of organizations which exist solely to help them achieve employment and/or assist them with their financial problems.

Gerontologists must also have a solid understanding of the legal issues and competency

challenges faced by older individuals.  The physical and psychological impairments associated with aging can make caring for oneself difficult, creating prejudice and negative perceptions.  Because of this, older individuals are more likely to have their rights eliminated and be placed in the guardianship of their family members or the state.  Older individuals may lose their rights to make decisions regarding their property, health care, and direction of their lives.  They require legal advice and need to be informed of their options.  If they are declared incompetent, then their options may be limited about their lives and if they are placed into an abusive situation they may be unable to leave the environment.  Though abuse is illegal, there are no laws which force the government to ensure the safety of older individuals against their guardians.  Full guardianship is usually granted as opposed to partial guardianship, eliminating ability of older individuals to make important decisions for themselves.  According to a report from the American Bar Association (ABA) in concert with the American Association of Retired Persons (AARP) (2006), case reviews are infrequent (Uekert, Dibble, 2011,  pp.  10-11) and many judges grant guardianship with little or no educational training requirements.  All states have a two-part criteria for judging competence; a person’s eligibility to be determined competent or incompetent rests on their age.  The first criteria is age, reflecting the bias that competency decreases with age and the second criteria is individual’s ability to care for themselves (Gallo, 2008, p. 102).  Because of these lax requirements, many older individuals often fall prey to being declared incompetent and placed in the care of unsuitable guardians.

At my internship at Grace Pointe Assisted Living, I all too often heard stories about the abuse and problems many older individuals face.  The fear of not being able to support themselves and concern over their future care was very stressful for many residents.  One of the reasons I am excited about working at Grace Pointe Assisted Living after graduation is due to the high quality of care which was available for the residents.  Part of my personal responsibility to not only the residents of Grace Pointe Assisted Living as well as others is to help them be aware of their options regarding their health care, finances, and legal matters.

Negative emotions may be experienced due to declining physical health, loneliness, limited income, and loss of independence.  Loss of finances, friends and family, and independence can cause people to become withdrawn and sink into a deep depression.  Older individuals often struggle with the loss of friends and family and may find it difficult to form new relationships.  If older individuals are placed in retirement homes and nursing facilities, they may feel abandoned by their families.  One of the ways Grace Pointe Assisted Living helps to remedy this feeling of abandonment is by reducing the price of guest tickets, even though the food provided offers the residents a daily gourmet experience.

Coping with death and bereavement is a common issue for many older individuals.  I have found in both my previous work and at Grace Pointe Assisted Living, that many older individuals struggle with concerns about their own death or the loss of close friends and family.  Many people are uncomfortable speaking about death and I have realized that people often want a friend who understands their feelings and will support them.  The most beneficial act we can perform for a person after experiencing a loss is to simply be present and listen.  Experience has taught me that it is better to be quietly supportive as opposed to offering advice.

Families also require support after the passing of loved ones.  Understanding their loss and respecting their culture and customs are extremely important.  Forming relationships which offer support and inspire trust are truly an important part of my practice.  I feel honored that my mentors at Grace Pointe Assisted Living trusted me in my interactions with the residents and their families.

Consideration for the customs of others is important when working with different religions and subpopulations, such as with the GLBT community.  This specific group of older individuals has their own concerns which, due to lack of education and prejudice, often go unattended.  For example, older individuals with same-sex partners, the trauma of widowhood is complicated by the many legal issues surrounding their relationship.  Since in many states, same-sex unions are not recognized as marriage, benefits are often denied in cases of receiving their partner’s pension, life insurance, and Social Security.  Legal challenges occur because same-sex partners are also often denied the ability to make decisions regarding health care if one becomes ill.  As gerontologists, the only help we may be able to give is to offer support and be familiar with state laws concerning the rights of GLBT population.

Additional ways in which gerontologists can provide assistance to older individuals is to offer educational and instructional opportunities.  Knowing the relevant academic literature is not enough.  While it is important to keep oneself updated on the latest research and information, the knowledge must be used to help as many older individuals as possible.  Gerontologists can organize assistance programs, host seminars and presentations, and provide opportunities for older individuals to participate in research programs.  By increasing knowledge, it is easier to fight discrimination and provide better services for older Americans.  Information has the power to change policies regarding older individuals at both the local or federal level.

Research on issues related to aging is expanding, leading to better application of the skills necessary to improve the lives of older individuals.  The research can be applied to improving both physical and psychological health.  For example, hypertension is a common ailment faced by many older individuals.  This condition is dangerous because it stresses the heart and causes it to work harder to circulate blood throughout the body.  It increases the risk of developing heart disease, diabetes, cerebrovascular incidents, dementia, and Alzheimer’s disease, blindness, and kidney damage.  Older individuals may be more susceptible to hypertension due to increased arterial stiffness and calcification of large arteries (Franklin, Jacobs, Wong, L’Italien, & Lapuerta, 2001).  In Americans over age 65, hypertension occurs in 58% of women and 53% of men (Roger, Lloyd-Jones, Benjamin, Berry, Borden, Bravata…, & Turner, M., 2012).  The PowerPoint presentation on Reducing Hypertension in the Geriatric Population with Diet and Stress Management applied research to offer stress-management techniques and healthy dietary advice to inform people about regulating high blood pressure.  Emotional and physical health are interdependent on one-another and learning methods to better manage stress and psychosocial problems, can significantly impact physical health.  The health promotion program at Mountain-View Assistant Living worked with older adults to help them better manage their depression.  Many older individuals suffer from depression, which can lead to feelings of unremitting sadness and despair, social withdraw, and may contribute to thoughts of suicide.  Learning how to manage stress, anxiety and depression can improve the quality of life and may help to reduce the risk of conditions which are aggravated by stress, such as hypertension. The presentation on Reducing Hypertension in the Geriatric Population with Diet and Stress Management provided older individuals with mediation techniques to better manage their stress and reduce their blood pressure.  One study found that a higher risk of hypertension has a strong correlation with not only stress, but older age as well (Trovato, Pace, Martines, Trovato, Pirri & Catalano, 2012).  Another study by Waldstein et al., (2004) established the relationship of stress and its contribution to hypertension and cerebrovascular disease.  Results showed that both higher systolic and diastolic ratings of blood pressure were related to increases in small silent infarcts and more severe periventricular white matter hyper-intensities in the elderly.

Meditation is a natural method to help manage stress because it encourages inward reflection and increases self-awareness.  Meditation with the use of a mantra, a repeated word or phrase, has been shown to be an effective means to reduce stress.  In a study conducted by Lane, Seskevich, and Pieper (2007) exhibited the benefits of mantra meditation on stress levels and mood.  Anderson, Liu & Kryscio(2008) showed Transcendental Meditation (TM), a commercialized and expensive form of mantra meditation, can help to reduce both systolic blood pressure by 4.7 mmHg and diastolic blood pressure by 3.2 mm Hg.  A literature review conducted by Goldstein, Josephson, Xie, and Hughes (2012) found that the effects of TM had an overall reduction in blood pressure.

Mountain-View Assistant Living launched a pilot project which addressed the major concerns involving depression and nutrition and physical fitness with older individuals.  The depression portion of the program included therapy sessions to better understand their emotional states and stress factors.  Personal goals, stating positive affirmations and journaling helped to alleviate stress and improve self-esteem.  This program also encouraged activities which promoted cognition and social engagement.  Residents had the opportunity to engage in volunteer work and host events such as card games, board games, and watching movies.  The concentration required of these activities increases brain function and the social support system will foster an environment of trust and encouragement.  The program’s success at improving the health and wellness of its residents by 25% was monitored by subjective questionnaires were administered monthly and objective results were evaluated using DSM-IV-TR measures.

Stress management may also help to improve working memory and cognition.  The final examination for the GERO 625 class examines the biological and psychosocial research on the memory and learning abilities.  Working memory is the ability to process and access recent information in a state of heightened awareness and greater accessibility (Fingerman et al, 2011, p. 302).  Due to the accumulation of knowledge and experience, working memory decreases with age because less space is available for the storage of information.  Recent events or experiences may be inaccessible, while those in the distant past are clearly recalled.  The research of R.A. Thompson can be applied to implement better methods of working with older individuals suffering from memory loss and dementia-related conditions.  Even though the brain develops the most during gestation, with appropriate stimulation, these neurological pathways continue to develop throughout adolescence and adulthood.  Thompson’s work notes that brain development is continuous and constantly producing new neurons.  While it is important that older individuals work with their doctors to address prevention and treatment, it is also important for them to feel empowered.  If older individuals take an active role in keeping their memory healthy, they can gain confidence in knowing that they have the power to keep themselves healthy.  This sense of empowerment can help older individuals reduce the risk of developing depression.

Being able to help older individuals manage their mental clarity is a source of happiness for me.  After attending the monthly Alzheimer’s support group meeting luncheons at Grace Pointe Assisted Living, a major source of concern, not just for the residents, but also for their families, was the ability to retain the function of their memories and cognition.

Proper nutrition is essential in maintaining health and wellness.  In order to achieve this, state laws have been implemented to help ensure proper nutrition in nursing and retirement facilities.  Upon entering Grace Pointe Assisted Living, residents submit forms indicating allergies and any dietary or cultural food preferences.  Meals are based on the recommendations of a registered dietician and residents can choose from two options for every meal as well as from alternatives, such as soup and sandwiches.  The health promotion program at Mountain-View Assistant Living promoted a healthy diet by teaching residents nutrition skills based on USDA standards and how to plan and prepare simple meals.

One particular diet plan which provides nutritional benefit and helps to reduce hypertension is the Dietary Approaches to Stop Hypertension (DASH) diet.  Blood pressure is lowered with its “increased intake of vegetables, fruits, and low-fat dairy foods and reduced intake of fats” (Rankins, Sampson, Brown, & Jenkins-Salley, 2005, p. 259).  The diet includes fiber, whole grains and lean proteins such as fish, poultry, and nuts, while reducing the consumption of red meats, sweets and sugars.  Metabolism is regulated at a cellular level because the DASH diet balances sodium, potassium, magnesium, and calcium.  Sodium consumption is limited to levels of 1500-2300 mg/day.  Adherence to the DASH diet reduced both systolic and diastolic blood pressure in the study population of patients with hypertension (p. 259).   In a study by Champagne (2006), the DASH diet lowered both systolic and diastolic blood pressure significantly, compared to a generic diet based on the consumption of fruits and vegetables only reduced systolic blood pressure (p. 54).  It also reduced total cholesterol, and both high and low-density lipoproteins relative to the control diet which had no effect on the cholesterol levels (p. 55).  Another study by Harnden, Frayn, and Hodson (2009) tested the efficacy of the DASH diet in volunteers with clinically normal blood pressure.  The study emphasized maintaining a healthy weight by increasing the consumption of fruits, vegetables, and low-fat dairy, while restricting the intake of salt (p. 4).  The participants maintained their current exercise programs (p. 6) and the results showed significant weight loss and reductions in systolic blood pressure and diastolic blood pressure.  By the conclusion of the presentation, participants were able to identify at least two foods which they consume on a regular basis which contribute to hypertension and two foods which reduce it.  The participants were then able to create a meal plan using the DASH dietary guidelines.

Many any older individuals do not have access to nutritious foods.  If they are not living in a nursing or retirement facility or with a reliable care-giver, lack of transportation, mobility, and finances may prevent them from receiving the adequate nutrition they need in order to stay healthy.   The grant proposal Mindful Meals Foundation: Reducing Hunger Among Individuals 65 and Older illustrates a potential solution to this problem.  Persons aged 65 years and older would have access to nutritious foods delivered from restaurants, grocery stores delivered to them in a refrigerated truck.   It would serve older individuals in need in the Colorado areas of Vail, Avon, Edwards, and Eagle.  This project builds on programs such as Meals on Wheels, Full Bellies Food Rescue, and the Salvation Army to ensure that older individuals receive proper nutrition.

Excellent leadership skills are essential when coordinating these programs.  In the BAMG 554 class, many different types of leadership were discussed.  This class stressed the used of management strategies based on people skills and positive relationships over using fear-based tactics.  In my personal experience, I have found that the best way to guide and lead others is to first be of service.  Others are more likely to follow guidance when they know that they are being cared for and that their best interests are at heart.

One way to establish trust is to show sensitivity to personal needs and cultural values.  The location of the hypertension presentation demonstrates this fact.  A greater number of older adults were able to benefit from this presentation because the facility was handicap-accessible and the services of people fluent in sign language and Spanish were available to accommodate the hearing-impaired and the Hispanic population.

The ability to be compassionate and caring while remaining objective is an essential part of being an effective gerontologist.  At the 2013 Rocky Mountain Conference on Aging, I attended seminars which offered instruction on communication skills to better help older individuals understand and make choices regarding their decisions regarding health care and legal concerns.  Dr. Harry “Rick” Moody and his presentation on Ethics in an Aging Society: The Shape of Things to Come examined practically applied ethics and communication strategies in order to be better caregivers for older individuals.  It was helpful to learn more about the ethical aspects of communication and leadership because I know that I will require these skills throughout my life as a gerontologist. Dr. Paula Hartman-Stein discussed the process of cognitive decline in her presentation Effective Communication Strategies with Older Adults in Life-Altering Decision-Making.  The role of the family is important and Dr. Sara Honn Quall’s lecture provided information on how to better work with family members.  Being about to communicate with older individuals and their families about these sensitive issues is crucial in helping them make the best decisions regarding finances, legal issues, health care, and living arrangements.

It is my personal goal to provide older individuals the ability to continue their personal interests and live a life which both allows for success while preventing a sense of failure.  I will dedicate myself to expanding my experience and knowledge towards developing as a professional in the administration, management and marketing facet of the continuing care industry.  Winning the Henry H. Welch Scholarship through the Colorado Gerontological Society last November was an extreme honor.  Receiving recognition for my work made me feel happy that I was pursuing my passion and being true to myself.  When I see the positive impact which I can help to make in people’s lives, I am encouraged to continue.  I view each of these accomplishments and ideas as stepping stones which will allow me the ability to continue to help older individuals.

References

Anderson, J., Liu, C., & Kryscio, R. (2008). Blood pressure response to transcendental meditation: a meta-analysis. American Journal of Hypertension, 21(3), 310-16. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18311126?dopt=AbstractPlus

Champagne, C. M. (2006). Dietary interventions on blood pressure: The Dietary Approaches to Stop Hypertension (DASH) trials. Nutrition Reviews, 64(2), pp. 53-56. DOI: 10.1301/nr.2006.feb.S53–S56

Fingerman, K. L., Berg, C. A., Smith, J., & Antonucci, T. C.  (2011).  Handbook of Life-Span Development. New York: Springer.

Franklin, S., Jacobs, M., Wong, N., L’Italien, G., Lapuerta, P., & , (2001). Predominance of isolated systolic hypertension among middle-aged and elderly us hypertensives: Analysis based on national health and nutrition examination survey (nhanes) iii. Hypertension, 37, 869-64.

Gallo, N. R.  (2008).  Elder Law.  Belmont: Cengage Learning.

Goldstein, C., Josephson, R., Xie, S., & Hughes, J. (2012). Current perspectives on the use of meditation to reduce blood pressure. International Journal of Hypertension, 2012, Retrieved from http://www.hindawi.com/journals/ijht/2012/578397/

Harnden, K. E., Frayn, K. N., & Hodson, L. (2009). Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK population. Journal of Human Nutrition and Dietetics, 23, pp. 3-10. doi:10.1111/j.1365-277X.2009.01007.x

Hartman-Stein, P. (2013, May). Effective communication strategies with older adults in life-altering decision-making. 2013 Rocky Mountain Conference on Aging. Lecture conducted from the Ranch in Loveland, CO.

Honn-Qualls, S. (2013, May). Helping families navigate the minefields of history to make decisions today. 2013 Rocky Mountain Conference on Aging. Lecture conducted from the Ranch in Loveland, CO.

Lane, J., Seskevich, J., & Pieper, C. (2007). Brief meditation training can improve perceived stress and negative mood. Alternative Therapies in Health and Medicine, 13(1), 38-44. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17283740

Moody, H. (2013, May). Ethics in an aging society: The shape of things to come. 2013 Rocky Mountain Conference on Aging. Lecture conducted from the Ranch in Loveland, CO.

Rankins, J., Sampson, W., Brown, B., & Jenkins-Salley, T. (2005). Dietary Approaches to Stop Hypertension (DASH) intervention reduces blood pressure among hypertensive African American patients in a neighborhood health care center. Journal of Nutritional Education Behavior, 37, pp. 259-264.

Roger, V., Lloyd-Jones, D., Benjamin, E., Berry, J., Borden, W., Bravata, D., Dai, S., & Turner, M. (2012). Heart disease and stroke statistics – a 2012 update – a report from the American Heart Association. Circulation, Retrieved from http://circ.ahajournals.org/content/125/1/e2.full

Thompson, R. A.  (2008).  Connecting Neurons, Concepts, and People: Brain Development and its Implications. Preschool Policy Brief, 17, Rutgers University.  Retrieved from http://nieer.org/resources/policybriefs/17.pdf

Trovato, G., Pace, P., Martines, G., Trovato, F., Pirri, C., & Catalano, D. (2012). Stress, abdominal obesity and intrarenal resistive index in essential hypertension. La Clinica Terapeutica, 163(4), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23007813

Uekert, B. K., & Dibble, T.  (2011).  “Guardianship of the Elderly: Past Performance and Future Promises. “  The Court Manager 23 (4).  9-15.  Retrieved from http://www.guardianship.org/reports/Guardianship_of_the_Elderly.pdf

Waldstein, S., Siegel, E., Lefkowitz, D., Maier, K., Pelletier Brown, J., Obuchowski, A., & Katzel, L. (2004). Stress-induced blood pressure reactivity and silent cerebrovascular disease. Stroke, 1294-98. Retrieved from http://stroke.ahajournals.org/content/35/6/1294.long