Grace Mandel – GLOBAL HEALTH AGING

The Promises and Pitfalls of Global Health Volunteering

04/15/201711/19/2017Global3 Comments

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.

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

11/29/201603/13/2017Global1 Comment

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

11/20/201601/14/2017South America2 Comments

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.

A Brief Highlight of Older Athletes at the Summer Olympic Games

07/25/201607/25/2016Global, South America1 Comment

The 2016 Olympics in Rio de Janeiro, Brazil are almost here. Starting next week, athletes from around the world will perform amazing feats including older Olympians who are generally not reported in traditional media. Older athletes have always participated in the games. For example, Brazil’s 2016 Olympic qualifying tournaments had many athletes in their 30’s and a few well into their 40’s. This article will focus on older athletes with the hope that it inspires readers and challenges aging stereotypes.

There are many examples of older athletes to celebrate. In the 2012 Olympics, a 101-year-old marathon runner Fauja Signh carried the Olympic torch. Also in 2012, Hiroshi Hoketsu of Japan was a member of the Equestrian team at age 71. There is also the Senior Olympics – a biennial sports competition for adults aged 50+ – where the average age at the 2015 competition was 68 years old. As Global Health Aging states, “…the process of growing old is unique to each person.” Some people have loss of mobility or cognitive function… and some compete in the Olympics.

Athletes who have staying power lurk within many country teams. For instance, Robert Schedit, a 43-year-old member of Brazil’s sailing team, will compete in his sixth Olympic games! His first Olympics was the 1996 Olympic games in Atlanta, USA. Close behind him is Murilo Antonio Fischer who will compete in his fifth Olympic games at age 37. Fischer, a member of Brazil’s road cycling team, first participated in the 2000 Olympics in Sydney, Australia.

Competing in athletic events or getting up to exercise are in part based on psychology and willpower. My investigation into the Olympics has shown a new narrative, that individuals of all ages succeed in competitive athletics. These sports in addition to regular daily exercise are attainable. Hence society has to redefine expectations as it is possible to be a great athlete well into old age. And for those who do not wish to run a 5 minute mile, any kind of exercise is important!

Grace Mandel covers South America for Global Health Aging. She is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

The Impact of the Chavez Government on Pensions and Health Systems

04/22/201604/24/2016South America2 Comments

This is Part 2 of a two-part series on Venezuela’s economic crisis. In Part 1, the main focus was food shortages. In Part 2, pension programs and health systems are emphasized.

On the surface, the status of older adults in Venezuelan society should have been secure. The Chavez government had expanded pensions to cover all older adults regardless of work history in 2011. The program was particularly beneficial to women who often participate in the informal economy or are self employed. The government also subsidized home repairs and gave older adults preferential access to food, allowing them to skip the lines at grocery stores. These new programs were termed the most generous social programs in Latin America.

By 2014, at the very beginning of the economic downturn, older adults were already at heightened vulnerability. The Global AgeWatch Index noted that the health system was showing signs of dysfunction. Older adults had problems accessing doctors or medications, infectious diseases were spiking, and there were signs of difficultly in accessing basic care. By 2015, the Index ranked Venezuela 76^th out of 96 nations in security for older adults. Despite the “generous” pension program, the nation ranked 66^th out of 96 countries for income security. Safety was most concerning since Venezuela scored only 17 percent in this category. As the economic condition deteriorates through the year, the country is likely to perform even worse in 2016.

The health system has also collapsed, leaving older adults without necessary medications and treatment for chronic or acute diseases. Moreover, the Venezuelan government nationalized the pharmaceutical industry, but is still unable to keep up with demand. While news has focused on the Zika virus, other infectious diseases such as malaria and dengue are also reappearing. These diseases can be more deadly for older adults who may have other chronic illnesses. Human Rights Watch recently found a “shortage of medications to treat pain, asthma, hypertension…”, all conditions that impact older adults.

The shortage of doctors and nurses is a long time in the making, and not solely because of low wages. According to the Wall Street Journal, over 13,000 doctors left Venezuela between 2000-2003, and current treatments are often outdated. Women do not have access to radiation, and breast cancer is often treated with radical mastectomy compared to more modern treatments. Finally, as of April 2015, only about 35 percent of hospital beds were operational in Venezuelan hospitals.

Older adults are more likely to be poor, and the poor are less likely to be able to access medical care or pay for food on the black market. The combination of food and medical shortages, and safety threats leaves older adults vulnerable to the resurgence of diseases, creating an unfortunate cycle of dependency. Life expectancy fell after the collapse of the Soviet Union, and it is likely that a similar impact may be felt in Venezuela.

Many of the bloggers and commentators on the Venezuelan imminent collapse are pro-democracy advocates who place blame on the socialist nature of the government. While the socialist nature may be the underlying cause of Venezuela’s current crisis, stable democracies can collapse when faced with economic threats. For example, the University of Michigan Retirement Research Center noted that older adults in the U.S. faced housing insecurity, and were required to work longer in order to recover from the 2007-2009 recession. In an economic collapse, work is scarce and older adults who are already near or below the poverty line become destitute.

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

Venezuela’s Economic Crisis Puts Older Populations-At-Risk

04/15/201605/22/2016South America3 Comments

This article is the first part of a two-part series on Venezuela’s ongoing economic crisis. Click here to read Part 2.

Venezuela is in the midst of an economic collapse. Oil prices have plummeted and the bolivar (Venezuelan currency) has dropped in value compared to the U.S. dollar. The situation is rapidly becoming a humanitarian emergency due to inflation and devaluation of the currency, food shortages, and collapse of the healthcare system. Safety threats and violence have also escalated an already unstable event. While news coverage of these incidents focus on the impact on children or young adults, this crisis has serious implications for older adults who are often vulnerable in the face of disaster.

Food Shortage

One of the hallmarks of media coverage are the pictures of long lines at grocery stores and food banks. In response to the food shortage, the Venezuelan government has instituted a rationing system, in which individuals must appear in person to buy food on the day indicated by the last digit on their ID card. For older adults who lose mobility or cannot make it to the grocery store on their designated day, there are few alternative options. Even for individuals who make it to the grocery store, there is often no food available. In a video posted on YouTube, an older woman states that she is hungry and willing to buy anything. She says, “It is sad that at this age [old age] it has come to this”. (English translation)

A writer for Havana Times shared an experience in a Venezuelan grocery store, “I also saw many elderly people waiting for hours to be able to buy something…”. Older adults often support their family by reserving a spot in the long lines which have thousands of people waiting for hours to reach the front. Exposure to the weather alone makes the ordeal of grocery shopping in Venezuela a threat to the health of older adults. In January of 2016, the government decreed that individuals should engage in their own food production, a daunting task for older adults.

Safety has been a pressing concern, especially surrounding grocery stores and food. In August of 2015, Reuters reported the death of an 80-year-old Venezuelan woman in a supermarket, “possibly from trampling”. In addition to riots and stampedes, there are reports of shots fired and frequent assaults in lines at grocery stores. The army and national police have responded by guarding the lines, but it is unclear whether the people are being protected or controlled by security forces.

Conclusion

With recovery a long way off, there have been calls for other nations to come to the aid of Venezuela. Older adults and children can benefit from food and health assistance but President Nicolás Maduro states that the situation is not nearly as bad as portrayed in the media. For instance, Cuban doctors are helping to mitigate the healthcare crisis in Venezuela. The fact is that foreign aid may not even be enough, hence societies should have strong governments with smart fiscal policies to insure safety nets for older individuals.

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

The Flu in Focus: Epidemiology, History and Research of Global Influenza

03/04/201603/05/2016GlobalLeave a Comment

I live in Baltimore, USA and it has been getting cold here. The nippy winds have been turning my nose red and when I come inside, I always need to have a tissue handy. With the cold weather, there is a looming fear of the flu.

Even if it is not winter where you live, the flu is a serious concern especially for older adults. The flu season in North America generally peaks in the winter months, somewhere between December – February. In tropical climates, however, the flu can strike at any time of the year. As you can see from the map, huge swaths of the world including Russia, Australia, and parts of Europe and the Middle East are experiencing higher levels of the flu, and areas in South America, and South Asia and North Africa are experiencing moderate flu levels. Most of the recent flu outbreaks, including the much-feared Middle East Respiratory Syndrome (MERS), were particularly deadly for older adults.

For a healthy young or middle-aged adult, the flu will generally lead to physical discomfort and some sick days from work, but it is typically not a deadly disease. The flu can be very deadly for older adults. Older adults often have weakened immune systems that make it harder for them to fight off the flu virus. In addition, hospitals and nursing homes can provide an ideal environment for the transmission of the flu virus, even when nurses and doctors take proper safety precautions.

The flu is more than just a problem for older adults. For instance, the so-called “Spanish Flu” of 1918 was a worldwide killer that was particularly deadly for healthy young adults. The Spanish Flu resulted in the deaths of between 40- 50 million people worldwide, or approximately the modern population of South Korea. Take a moment to consider the implications of a virus so deadly that it could wipe out the population of a country in less than a year. With modern air travel, the danger of a new strain of the flu is even more acute. Approximately 250,000 to 500,000 people die in an average year with a normal flu season, according to World Health Organization (WHO).

The flu is a particularly challenging virus because it frequently mutates. Scientists originally believed that the 1918 flu mutated from a form of flu commonly found in pigs, and the “swine flu” has since been observed in different parts of the world. However, evidence has shown that the 1918 flu was likely an avian bird flu that transferred into humans. If you are interested in learning more about the scientific search for the flu virus, the book Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata is an excellent read.

WHO tracks the flu to try to predict the strain of flu that will be most common in a given year. In addition, WHO has a global action plan to increase the availability of the influenza vaccine. It is important that all countries, not just rich nations, have access to a flu vaccine. In India, Indonesia, Romania, Republic of Korea, and Thailand, new manufacturers are now producing the flu vaccine, thanks to WHO grants. Other developing countries such as Brazil, Mexico, and South Africa have also been given grants to improve flu vaccine manufacturing capabilities.

A flu pandemic should not keep you awake at night, but it is important that countries and international bodies are prepared for the possibility of a more deadly strain of the flu. Modern medical advances will likely increase the probability of surviving such a flu outbreak, but older adults and the immuno-compromised are always at higher risk of death or complications due to respiratory infections. The goal is to promote healthy-living strategies, such as good diet and exercise, to improve the immune system and protect at-risk populations from the flu virus and other infections.

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

Battling Beauty Stereotypes in Brazil’s Older Women

12/30/201502/06/2019South America2 Comments

If you have ever watched a Brazilian telenovela, you might notice that older women look unrealistically younger than the characters they portray, with the help of botox or other “medical miracles”. Older women in Brazil face pressure to look young, not gain weight, and maintain top physical appearance. As women age, their metabolism slows down and wrinkles tend to appear on their faces. This can lead to body image dissatisfaction, which is a distorted perception of appearance that leads an individual to unhealthy lifestyle, weight issues, and/or depression. Such distortion is common among older women in Brazil and having a negative impact on the mental and physical health of this population.

Body image dissatisfaction is often discussed in the context of teenage girls. It may cause eating disorders where girls may choose to eat less or vomit after eating, in an effort to maintain a certain physique. Thus, the choices made in adolescence can have a lifelong impact on the health of an individual. Anorexia nervosa and bulimia nervosa are eating disorders that have been linked to low bone mineral density and osteoporosis in teenage years. Both disorders also impact older women. In fact, anorexia nervosa is more likely to cause death in women over 65 than girls or women under 65.

Body image dissatisfaction is a direct result of ageism in society, and the fear of getting older. Older adults may feel less relevant or unwanted if they do not maintain youthful appearances. In a population-based study in southern Brazil, researchers found that women over the age of 50 were most likely to be concerned that they weighed too much. Older men were also more likely to be dissatisfied with their weight than younger men, but the magnitude of the dissatisfaction was smaller than women.

The need to look young in aging women has its roots in an ageist society, where older women are not valued as much as their younger counterparts. Changes in skin and weight are a natural part of aging but in Brazil, many women fear any weight gain. While the solution to this problem is unclear, the media can play a great role by portraying older women who have aged naturally. This population should be able to feel comfortable with their appearance as this may challenge beauty stereotypes and reduce the stigma of growing older. Media, however, is only a small part of the problem and it is clear that older women need to be valued for their contributions to society.

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

Employment Prospects Among Older Adults in South America

10/11/201511/19/2017South AmericaLeave a Comment

Many adults eagerly look forward to their “Golden Years” and one of the key features of this period is retirement. It is easy to imagine golf courses, beaches and time to catch up on reading lists. In reality, many older adults continue to work after age 65. The entirety of South America is undergoing a demographic shift due to an aging population. Thus, many countries are re-examining their existing government pension systems. While it is important to provide economic security in old age, it is also crucial to allow continued avenues of employment and meaningful engagement with society for older adults.

The quality of life in retirement is dependent on the financial resources of the individual. Adults aged 65 and over generally have income from four sources including government funded pensions, private pensions from employers, savings and employment. In the United States, adults with higher education and income potential will often remain in the workforce past age 65. In contrast, adults with lower income levels in low- and middle-income countries remain employed past age 65 to stay out of poverty.

There is a huge variability in percent of the aging population that is working in Latin America. Some Latin American countries, such as Brazil, Argentina and Columbia, have relatively low participation of older adults in the workforce. Such countries are similar to the United States, with only 10-15% of adults past age 65 engaged in paid work. In other countries, such as Peru, Paraguay and Ecuador, 40-50% of adults age 65 and older are still participating in paid work. These countries also have relatively low coverage levels by government and private pension plans, but the correlation between working and government funded pensions is not perfect.

Many countries in South America are re-examining government pension programs to accommodate the aging population. Recent reforms in Paraguay have instituted new rules that prevent individuals collecting government pensions from participating in paid work. Better pension systems may provide more security for older adults, but preventing work has problematic implications for the future role of older adults in society. Social engagement is correlated with improved health and employment can be a meaningful avenue of engagement.

Building strong government and private pensions that will allow a retirement free from financial hardships or poverty is important. However, building systems that prevent older adults from working is equally problematic. Older adults in countries with strong pension systems, such as the United States and Britain, are fighting to re-enter the workforce and be productively engaged in society. It is important that South American countries do not build a pension system that prevents older adults from contributing paid work to the economy.

Grace Mandel is a Masters of Public Health student in Health Policy and Systems at Johns Hopkins University Bloomberg School of Public Health.

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