The Promises and Pitfalls of Global Health Volunteering

Hoping to Help: The Promises and Pitfalls of Global Health Volunteering, written by Judith N. Lasker, shines light on healthcare-based volunteering in developing contexts. While it does not explicitly focus on aging, this book poses a bold and poignant question: Does international medical volunteering really help patients?

Developing countries struggle with both acute diseases such as malaria that are less prevalent in developed countries, as well as many of the same chronic diseases, such as diabetes, that routinely affect people in nations like the United States. According to the World Health Organization, chronic diseases, which often impact older adults, are the leading cause of death or disability in the world. Many medical professionals who volunteer abroad often end up treating patients with such chronic diseases.

For example, International Volunteer HQ – a large volunteer-host connection service – offers North American medical tourists the opportunity to work with older adults in Argentina, Colombia, Guatemala, Sri Lanka and Zambia. Another NGO, UBELONG, offers short term volunteer trips to Ecuador, Costa Rica, and Peru. Other programs, such as the volunteer surgeons who perform cataract operations, also target diseases that primarily impact older adults.

In Hoping to Help, Lasker investigates the impact of global medical volunteerism on patient health. She finds little evidence that global medical volunteer trips are actually helpful to the patients:

  • Lasker points out that most trips have no follow-up. Thus it is impossible to determine whether the patient benefited from medical care.
  • Most trips do not provide long-term solutions to chronic diseases; many individuals were prescribed medication –for example, blood pressure – without having access to a sustainable supply of the medicine. Once the volunteer leaves, the patient may become worse. Even a seemingly innocuous treatment, such as medication to reduce hypertension, can lead to a rebound hypertensive effect.
  • Finally, volunteer medical students or nurses will often conduct procedures or give treatment that is outside their scope of practice in their home countries.

The positive or negative effect on the health of patients treated by these practitioners are not well known, but it is safe to say that the impacts of global health volunteering are not all positive. There are many debates about the possible good or harm international medical volunteers can do to host communities – while some have compared the practice to colonialism, others have defended the noble intentions of these programs. What this debate leaves out, however, is the patient’s version of the story.

For individuals who wish to volunteer and contribute to aging in developing nations, Lasker’s book serves as a useful guide. She clearly delineates the positives and negatives of the programs. Volunteering is one way to help aging individuals in developing countries, but an investment in infrastructure development in the health sector will have a more meaningful, long-term, and sustainable impact.

Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

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The Power of Health Literacy in Later Life

What is Health Literacy?

Health literacy refers to the ability to access, understand, communicate, and act on information related to health and disease. People who are health literate can find and understand health information, discuss concerns with medical professionals, and act on decisions to improve health and manage conditions. As a social determinant of health, health literacy is related to social factors, such as culture, education, or socioeconomic status.

It is an important factor in public health as health literacy rates affect health systems and the health services they provide. People with high levels of health literacy show healthier lifestyles, have fewer chronic illnesses, are more adherent to treatment, report better health, and live longer lives. In contrast, people with lower levels of health literacy have less use of preventive health services, are at higher risk for misdiagnosis, experience difficulties managing chronic conditions, medications, and treatment adherence, and have poorer health outcomes.

Health literacy affects everyone—even people with good literacy skills can have low health literacy. Most people will have difficulty understanding health terms or information at some point in their lives. Sometimes, people first hear specific medical terms or health information when they or a loved one has a serious health problem.

Health literacy has been shown to affect rates of illness and death, use of health services, and health outcomes. Low health literacy may account for up to five percent of overall healthcare costs. To address this, the European Union (EU) financed the European Health Literacy Survey, which revealed that nearly 50 percent of the population have a poor understanding of healthcare, disease prevention, and health promotion.

Why Does It Matter to Older Adults?

Health literacy is population-focused rather than individual-focused. Like many regions in the world, Europe is experiencing an increase in chronic conditions. It is the leading cause of mortality representing 77 percent of all deaths. When people manage multiple health conditions, they need to understand complex health information and navigate healthcare systems. Research finds that people who have the most difficulty with limited health literacy are older adults, recent immigrants who may not understand the regional language, those with lower levels of education, and ethnic minorities. For some older adults, using the internet to find health information or services is a struggle, and for others using basic math to schedule medications is challenging.

With populations growing older, more people will live with chronic conditions and may not have the skills to access, understand and act on health information. Although Europe has a relatively high socioeconomic status, up to half of its citizens have a poor understanding of their health, which means that health literacy is a crucial factor to active and healthy aging. Improving health literacy supports people in taking responsibility for their own lives, to make better decisions about their personal health, and to have the capacity to live longer lives in better health.

Increasing health literacy means addressing the knowledge and skills of people with low health literacy, their families, and communities. It also requires teaching health professionals how to provide health information that is understandable for individuals and how to help their patients understand what that information means for their own health. Improved health literacy empowers individuals to further engage in their healthcare and take a more active role in their personal health. In turn, this will have positive impacts on health promotion, disease prevention, and better treatment outcomes.

Carrie Peterson is a gerontologist and consultant in eHealth and Innovation.

 

Open Your Eyes: A Journey from Darkness to Sight

Open Your Eyes is a recently produced documentary on the impact of cataract surgery in Nepal. The film shows the transformation of health-related quality of life for older adults with access to medical care. In the film, Manisara and Durga make the long journey to get cataract surgery. Both husband and wife are blind and depend on family members for their most basic needs. Despite being blind, Manisara and Durga help care for their grandchildren and have an important place in the family. Their journey to the city is filled with nervous trepidation, but after the surgery, both are able to see their grandchildren and contribute to valuable work that benefits the entire family and community.

Open Your Eyes highlights the successful use of foreign funds to combat treatable diseases. The funding helps develop sustainable infrastructure and pays for many public health interventions such as cataract surgeries. In a previous article titled Hoping to Health, Global Health Aging reviewed the impact of NGO’s working on health including the effect of global health volunteering. Such efforts look very different in the Lions Club of Nepal – a club established by the service membership organization Lions Clubs International – where medical volunteers are Nepali citizens.

Overall, some questions were not addressed in the documentary. It was unclear if there was adequate follow-up care to prevent infection. And while Manisari and Duraga had no complications, both would have been virtually unreachable if they needed medical attention after they returned home. Cataract surgeries have a positive health impact due to their low complication rate and high degree of efficacy. It is not clear, however, that this model would translate for more risky procedures. In the end, Open Your Eyes does not discuss the challenges of bringing medical care to rural areas. Instead, it makes a compelling case for older adults as valued members of society who deserve quality care. Check out the trailer!

 

Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

Migrant Health: What About the Elders?

By now, most have heard about the migrant crisis, where around 1 million people migrated to Europe due to war, persecution, and other unfortunate circumstances. Many efforts to provide aid and support have focused on children, which is typical of most disaster and emergency responses. This is appropriate for the situation in Europe as children and unaccompanied minors comprise around 25 percent of migrants.

But what about the older migrants? Are they also receiving quality, targeted, and culturally sensitive care?

In disaster and emergency response, older adults have distinct needs that many relief organizations are ill-equipped to address. In fact, there is clear evidence that older people are often overlooked, neglected, or even abandoned. The main issues that such migrants face are health effects, housing issues, and pension challenges, which are significantly worse when compared to native groups of the same age. In addition to the psychological issues of being displaced, separated from family and community, and in violent situations, there are basic physical issues which make migration difficult for older adults. Temporary housing is often inadequate and cognitive conditions such as depression, dementia, and delirium all play a part. For some, reduced mobility impedes evacuation, while others may suffer from fatigue or frailty that affect balance when standing in lines for food, water, and medical care.

Both medical professionals and individual migrants face challenges in health consultations since cultural and linguistic backgrounds are very different. This can lead to older adults being less likely to seek out medical advice and care and the health sector having trouble in accurately diagnosing and treating those who do seek help due to the language and culture barriers. There is also the consideration that care services will not meet the (often different) needs of elderly migrants who receive health and social care or accommodate the cultural tradition of parent-child relationships.

Quality, targeted, and culturally sensitive services are required to meet the needs of older migrants. Likewise, training services are needed for health and social care professionals to develop these competencies. The age-specific information on migrants is growing, but more information is needed.

In Denmark, The Migration School is the largest training programme for the care of minority groups in Scandinavia and the first research project in Europe focused on diagnostic methods associated with dementia. In the Netherlands, Pharos has two programmes called Health for the Elderly and Asylum Seekers and Refugees. Both programmes focus on physical activity to prevent falls, supporting (migrant) carers for people with dementia, improving preventive care for asylum seekers and refugees, and the responsible use of medicine.

The global proportion of older adults is increasing. Older people will outnumber children under age nine by 2030 and people under age 25 before 2050. The majority of older people live in low‐ and middle‐income countries, where some are prone to disasters and emergencies. Not only will there be more older adults to be affected by disasters, but more older adults will also provide aid in the aftermath. It is thus important to address ageism and the ethical responsibilities of non‐discrimination in disaster and emergency management – older adults’ lives matter and should not be disregarded when distributing aid and planning services.

Carrie Peterson is a Gerontologist and Consultant in eHealth and Innovation.

Can the Arts Promote Health-Related Quality of Life in Australia?

As the global population ages, it is important to start designing strategies to address quality of life among older adults. The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Designing programs and policies to encourage quality of life across the age spectrum should not focus solely on addressing health issues as they arise, but rather promoting positive ways of living that can impact health in all realms – physical, mental, and social – throughout one’s life.

Strategies for healthy aging should include promoting activities that foster both individual growth and community participation. One such option is participation in the arts, which has shown to have a positive impact on both the individual and society.

Studies have shown that participating in visual arts, music, dance, drama, storytelling, etc. can improve mental and physical well-being, provide increased opportunities for friendship and meaningful social contact, foster a sense of social cohesion between different age groups, and break down stigmas associated with aging.

In Australia, several initiatives have been put in place to encourage “creative ageing,” which is defined as “the utilisation of the arts to excite imagination and support older people to age well.” For example, creative ageing was included in the Eastern Australian state of New South Wales’ Ageing Strategy, where community-based organizations such as the Creative Ageing Centre and Institute for Creative Health were established to encourage older adults to engage in the arts.

Results from the 2014 report titled Arts in Daily Life: Australian Participation in the Arts showed that participation in the arts increased from 41 percent to 48 percent since community arts centers became part of health policy. Among adults aged 55-64, participation increased from 36 percent to 44 percent.

The number of Australians aged 65 and over is expected to increase to 6.2 million by 2042, up from an estimated 3.4 million in 2014. Australia’s population is ageing. Now, more than ever, is the time to think creatively about aging and how these innovative strategies can have positive effects beyond for both the individual as well as society as a whole.

Diana Kingsbury is a doctoral student and graduate assistant in prevention science at Kent State University College of Public Health.

Monthly News Roundup – December 2016

It’s that time again! This may be our last monthly newsletter before we make it quarterly or just regularly.


We published our second book review titled Alone Together: Why We Expect More from Technology and Less From Each Other as well as a great piece on dance and health-related quality of life. “Movement can not only improve quality of life, but certain exercises like Tai Chi, can reduce the risk of falls.”


Our selected journal article showed that increased P3 amplitude was linked to improved performance; however there was no direct association between adaptive training and improved performance.


From dance to cinema, painting to theatre, the Bealtaine festival showcases the talents and creativity of both first-time and professional older artists. The festival offers participants opportunities to discover talents, make unique and challenging work, communicate traditions between generations, and showcase dormant skills in a new outlet. This video shows the wide range of activities taking place at the festival.


And here’s a quote to keep you inspired till next time!


Connect with Global Health Aging on Facebook, LinkedIn, Google Plus, Twitter and YouTube.

Alone Together: Why We Expect More from Technology and Less From Each Other

Sherry Turkle is a professor at MIT who views artificial intelligence and technology through a sociological and psychological lens. In the first half of her most recent book, Alone Together: Why We Expect More From Technology and Less from Each Other,  Turkle addresses the impact of technology on older adults. Technology advances such as robotics and assistive technology are making headway in society, especially in elder care. These new technologies can provide some comfort or care for older adults with chronic diseases. Turkle’s focus, however, is on the substitution of robots for human interaction and the emotional aspect of care performed by another human being.

Turkle conducts experiments where she brings different types of robotic technology such as AIBO, My Real Baby, and Paro the Seal into nursing homes. These robotics provide companionship and not practical assistance. For instance, many older adults began speaking to their robots, going over important life events and reminiscing about old times. They found that spending time with the robot reduces anxiety and isolation. The impact of My Real Baby, an “interactive learning doll”, was particularly significant in experiments because it gave older adults a sense of purpose. The My Real Baby doll needed comfort, changing, and other activities that made older adults feel needed (105). This promotes higher quality of life for older people.

Turkle also conducts research involving children, where children discuss the role of robotic technology in their lives. The children profiled in the book worry about technology replacing real human interaction. One child says, “that grandparents might love the robot more than you… They would be around the robot so much more.” (75). Another child worries “that if a robot came in that could help her [grandmother] with falls, then she might really want it… she might like it more than me.” (75). In her discussion of experiments conducted in nursing homes with the doll, My Real Baby, Turkle finds that older adults do not want to give the doll back at the end of the experiment (111). One grandmother even ignores her grandchild who is visiting to take care of the hungry doll (118).

What Turkle does best in this book sharply contrasts the ideal situation of having loving children or family who can visit and provide social interaction to the reality of isolation in many older adults. While Turkle acknowledges the barriers to artificial intelligence and technology as companionship for older adults, they surpass the alternative of no social interaction at all. She notes, “If the elderly are tended by underpaid workers who seem to do their jobs by rote, it is not difficult to warm to the idea of a robot orderly”. (p. 107).  She then points out that when given the choice between interacting with robots and interacting with a member of the research team, almost all of the older adults chose a member of the research team (p. 105). At the end of the day, these robots are not capable of producing the same amount of interaction and support as a human being. Turkle muses, “An older person seems content; a child feels less guilty. But in the long term, do we want to make it easier for children to leave their parents? Does the ‘feel-good moment’ provided by the robot deceive people into feeling less need to visit?” (p. 125). Robots providing clinical care may be an ideal solution to the shortage of workers caring for an aging population, but are no replacement for social interaction.

Grace Mandel is the project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (BFRIEND) at the Baltimore City Department of Health.

Effects of Dance on Health-Related Quality of Life

https://pixabay.com/en/dance-living-room-pink-black-641672/
With the weather getting warmer in Sao Paulo, Brazil, many Brazilians are getting ready to get out and dance in celebration! One dance group in particular, Arte Par Dancar, has been garnering a lot of media attention for their dance moves… and for their age.

Apart from being fun, dance and movement is a form of exercise that has proven health benefits for older adults. Movement can not only improve quality of life, but certain exercises like Tai Chi, can reduce the risk of falls.

A team of scientists in Brazil set out to understand how specifically dance can benefit older adults. They found that eight weeks of ballroom dancing significantly strengthened the leg muscles of the women who participated in their study. Weak leg muscles are correlated with falls; therefore, strengthening leg muscles is a positive impact of dance. Older women seem more likely to take up dance as an activity, although it is unclear why this trend exists.

Another research study compared the health benefits of Tai chi to those of ballroom dancing. It found that senior ballroom dancers had better balance with their eyes closed, and seniors practicing Tai Chi had better dynamic balance including exponentially improved speed.

While different forms of dance and movement have varied benefits, studies show that dancers of all types have lower BMI’s, longer stride lengths, and higher bone mineral density. In addition to the physical benefits of dancing, there are clear psychological benefits, such as greater connectedness, improved mood, and higher levels of energy.

Recreational older dancers have also noted feeling more engaged in their community, and feeling a greater sense of purpose. An Arte Par Dancar member stated, “Now I am happy here, I dance. I have fun with everyone.” Another 86-year-old member of the dance troop said, “We move a lot doing lots of things. We already passed through our old person stage, now we are young.”

Dance and movement-based exercise is a fun way for older adults to become healthier and widen their social networks. This trend has proven so beneficial that Brazil is not the only country where older adults are learning to Samba!

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

Monthly News Roundup – November 2016

One Child: The Story of China’s Most Radical Experiment is our first book review! Written by Mei Fong, the book presents a compelling analysis of the impact of China’s “One-Child Policy” on older adults.


We published Part 2 of our series on elder abuse in South Africa highlighting societal responses from both public and private sectors.


From longevity to technology, these news articles further shape public conversations on aging.


Over 6,000 professionals in gerontology and geriatrics are expected to attend the World Congress in San Francisco. Participants will share in the latest science, research, training, technology, and policy development presented by experts from around the world. In 2017, the theme “Global Aging and Health: Bridging Science, Policy, and Practice” will bring representatives from medicine, nursing, social science, psychological science, finance, policy fields, and other disciplines to address the latest approaches to improving the quality of life of the world’s older adults. Register today!


The RAND Center for the Study of Aging is our featured company. Its research agenda focuses on the interrelationships among health, economic status, socioeconomic factors, and public policy. Center staff conducts objective, independent, behavioral research on older populations worldwide. For more information, visit RAND Center for the Study of Aging.


And here’s a fun article, “Inside a Musician’s Aging Brain,” about the benefits of music for brain health! Written by singer-songwriter Jim Walsh, we hope it keeps you inspired till next month.


Connect with Global Health Aging on Facebook, LinkedIn, Google Plus, Twitter and YouTube.

Government Response to Tackling Elder Abuse in South Africa

This is Part 2 of a two-part series on elder abuse in South Africa. In Part 1, the main focus was raising awareness of elder abuse. In Part 2, societal responses from both public and private sectors are stressed.

As a result of recent news reports on elder abuse, the South African Human Rights Commission (SAHRC) visited KwaZulu-Natal from Aug. 15-19 to examine human rights matters impacting older adults and individuals with disabilities. The five-day visit was led by Commissioner Bokankatla Malatji who manages the portfolio on disability and older persons.

The government’s prompt response to elder abuse suggests that this problem is not being taken lightly. Elder abuse is any form of mistreatment that results in harm or loss to an older person. It is one of many challenges faced by older people in South Africa. In fact, elder abuse is expected to rise as the population ages. This is not necessarily the case but societies that have no regard for elders will need to anticipate elder mistreatment if it is not tackled beforehand. Much like other nations around the world, the silver tsunami has left many nations ill-prepared; even the most developed countries are struggling to find solutions for the foreseeable challenges of the future. It is therefore the responsibility of both public and private sectors to make dignified and healthy aging a leading priority.

Dr. Matshidiso Moeti, the World Health Organization (WHO) Regional Director (RD) for Africa, states that “only with full, strong political will and commitment by governments, participation of communities, families and individuals can we achieve the vision of a continent in which everyone can live a long and healthy life.” Hence societies must hold governments accountable to ensure expedient and beneficial outcomes.

As the global population continues to age, reaching an estimated 2 billion by 2050, it is imperative that nations take a multifaceted approach to ensure the protection of older adults. Elder abuse is not reserved exclusively for citizens of developing countries. It is a public health problem that goes beyond regions, languages and ethnicities.

WHO believes that in order to adequately address the issue of elder abuse across continents, citizens must utilize approaches that are “placed within a cultural context and considered alongside culturally specific risk factors.” Such methods, with the collaboration of “both primary care and social service sectors,” can enhance the comprehensiveness of future programs, policies and legislation.

Andria Reta-Henke is a Credentialed Professional Gerontologist and Professor of Health Administration.