No more asset test for Medi-Cal. Seniors and people with disabilities can get and keep free health coverage!
A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people under 65 with certain disabilities. Instead, their financial eligibility will be based solely on income, as it is for the millions of other people in Medi-Cal.
The elimination of the test will be a game changer for aging or impaired Californians who need long-term care but are caught in a common conundrum: They don’t earn enough to cover the high costs of ongoing nursing home care and can’t rely on Medicare, which does not cover extended nursing home stays. They can get that care through Medi-Cal, but they would have to wipe out their savings first.
The 2021-22 state budget deal includes several provisions that will make it easier to get on and stay on Medi-Cal, including the elimination of the asset test. Everyone 50 and over will be eligible, regardless of immigration status. And new mothers will be allowed to remain on Medi-Cal for one year after giving birth, up from 60 days.
The budget also includes $15 million over the next three years, starting this year, to develop online enrollment forms and translate them into multiple languages, and $8 million for counties to help some people who get in-home care stay enrolled.
California has a strong Medi-Cal takeup rate, with 95% of eligible people enrolled, said Laurel Lucia, director of the health care program at the Center for Labor Research and Education at the University of California-Berkeley. But of the remaining uninsured people, about 610,000 qualify for Medi-Cal, she said.
“We are doing well, but so many people are eligible and not enrolled,” Lucia said. “The barriers to Medi-Cal enrollment and retention are really multifaceted, so the solutions have to be as well.”
This is an especially volatile moment for the program, which covers 13.6 million Californians. The state is trying to improve the quality of care by renegotiating its contracts with managed-care insurance companies. At the same time, Gov. Gavin Newsom and the state Department of Health Care Services are proposing a massive overhaul that would provide more services to homeless people and incarcerated people and boost mental health care.
Meanwhile, Medi-Cal enrollment continues to grow: State officials estimate enrollment will balloon to 14.5 million this fiscal year, which began July 1.
The changes to Medi-Cal that were approved in the budget include an expansion that Democratic lawmakers have been seeking for years: California already allows eligible unauthorized immigrants up to age 26 to receive full Medi-Cal benefits. Starting next spring, that will expand to people 50 and up.
State officials estimate about 175,000 people will enroll in the first year, with an additional 3,600 people signing up every year thereafter, eventually costing the state $1.3 billion annually.
And, starting next July, new mothers will be able to stay on Medi-Cal for up to one year after giving birth. By 2027, the additional coverage is expected to cost the state about $200 million a year.
Assembly Republican Leader Marie Waldron (R-Escondido), who said she supports expanding eligibility for the program in limited circumstances, was the author of a bill to allow incarcerated people to enroll before they’re released that was ultimately folded into the budget and will take effect in 2023.
But she said the changes in this year’s budget go too far.
“Expensive government-run health care doesn’t really work, and most voters don’t want to pay for it,” Waldron said. “But California Democrats seem to think everyone will love it once they are on it, which is not true. It’s creeping socialism.”
The elimination of the Medi-Cal asset test for older Californians and those with certain disabilities, which takes effect July 1, 2022, marks a dramatic change to the program. Officials estimate it will cost the state roughly $200 million a year once fully implemented because of the increased enrollment.
Right now, these people can’t qualify for Medi-Cal if they have saved more than $2,000. For couples, it’s $3,000. Complicated rules dictate what counts as an “asset” and what doesn’t: A house doesn’t count and neither does one car, but a second car does. Engagement rings and heirlooms are fine, but other jewelry counts toward the limit.
Ultimately, the test favors individuals and families who can navigate the rules and find ways to hide money in exempt accounts, said Claire Ramsey, a senior attorney with Justice in Aging.
“You create administrative hurdles, which keeps people artificially off the program,” Ramsey said. “If it’s hard for the lawyers to understand all the rules, what does that mean for the average person who’s just trying to have health insurance?”
The federal Affordable Care Act eliminated the asset test for most Medicaid enrollees, basing financial eligibility exclusively on income, but left out people who qualify for both Medicaid and Medicare.
This is especially important when it comes to expensive long-term care, like nursing homes, which can cost $10,000 a month, said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.
Medicare covers nursing home care only in limited circumstances and for up to 100 days. After that, patients must find another way to pay, either out-of-pocket or through Medi-Cal. Because many people don’t qualify for Medi-Cal if they have too much money or other assets, they have to spend through their savings and shed their belongings before they can get on the program.
“Thousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. “You want free medical care? You’re going to have to spend every penny you have to get it.”
A state Assembly analysis estimated that 17,802 additional Californians would have become eligible in 2018 if the asset test hadn’t been required. Of those, 435 were in long-term care, and over the course of the year, 263 spent their money or gave away their assets to qualify for Medi-Cal.
Assembly member Wendy Carrillo (D-Los Angeles), the author of the asset test bill that was folded into the budget, sees eliminating the requirement as part of a larger movement toward universal coverage, in line with efforts to expand Medi-Cal to older unauthorized immigrants or establish a single-payer system.
“We need to aggressively and proactively work on legislation that gives more people coverage,” Carrillo said. “And until we have universal health care, these are the steps necessary to ensure that.”
I’ve been revisiting the rich teachings and wisdom of my Vedic heritage as I traverse my golden years. Examining them through the lens of the world around me today, I realize the need to re-interpret Vanaprastha and Sannyasa for myself, for the present day in which I live. Back in those ‘golden-olden’ days, society looked after an individual entering Vanaprastha; he or she did not have to worry about the next meal or a roof overhead. Today, so many of our fellow seniors cannot see beyond a meal for the day. How can they possibly contemplate transitioning from the obligations of a householder? How can they detach from society to enter introspection? How best can the more fortunate among us – those who have enjoyed a decent life, and are now reasonably secure in their circumstances – deal with the ‘emptiness’ of the transition from Grihasta?
Come and walk with me for a while on my quest to be a modern-day Yogi in today’s America, and I’ll tell you.
Historic path to self-realization
Patanjali’s Yoga Sutras is a collection of around two hundred statements, observations or truths that describe the science of Yoga in its entirety. The Yoga Sutras describe the Raja Yoga, or Ashtanga Yoga – the eight-step practice that enables individuals to attain self-control, discipline, internal clarity, peace and ultimately self-realization or Samadhi – the ecstatic union of the individual with the cosmos. Scholars believe these primary scriptures of Yoga were written around the 2nd century BCE. Through the intervening centuries, philosophers and learned sages have been pulling at the threads of Patanjali’s work, translating and explaining them for our consumption.
Each stage or limb of Ashtanga Yoga builds naturally on those that precede it. The first four limbs are designed to help us gain control over our bodies and become aware of ourselves. When you or I talk about ‘practicing yoga,’ we are referring to Asana, the third limb which follows Yama and Niyama. The postures we practice – often referred to as Hatha Yoga – help us maintain physical health and well-being. In addition, they promote self-discipline, focus and concentration, and prepare us for meditation. Pranayama, which literally means life-force extension, is the fourth limb of Ashtanga Yoga, and consists of breath-control techniques to rejuvenate the body and extend life. It is either practiced on its own, or integrated into Hatha Yoga routines.
The next three stages, Pratyahara, Dharana and Dhyana are preparation for the last, ultimate stage: Samadhi. They involve a conscious withdrawal from the outside world and an effort to transcend external stimuli to focus increasingly inward. This cultivation of detachment and an increased effort to concentrate and singularly focus inward, while leveraging the training in posture and breath control leads naturally to Dhyana: meditation or contemplation.
Meditation or Mindfulness?
In Eastern philosophy, cultures and tradition – whether it be the scientific path of Yoga or one of the more monastic forms of Buddhism, meditation is a practice that combines inward focus and concentration with controlled breathing, allowing individuals to follow their breath to an inner harmonious state. Harmony, peace, tranquility, and compassion both for self and others should follow.
The prevalence of meditation in other cultures and religions, including Judaism, Christianity, and Islam has traditionally been described by scholars as self-administered techniques for inner transformation. Attempts to link meditation and spirituality have created controversy. Western meditation typically involved the reading of religious texts, prayer, and contemplation. Worldwide interest in Eastern forms of meditation and their adoption began in earnest around the middle of the 20th century as travel increased. The same period witnessed a rapid decline of religion, especially Christianity, in the US, Europe, and most of the Western world. This trend, coupled with a marked increase in stress and mental-health issues induced by the unrelenting pace of modern life and work began to drive people to seek other sources for comfort and healing; to the practice of meditation and the health benefits that accrue from it. A growing body of scientific evidence verifies what Patanjali taught centuries ago: regular meditation improves physical and mental health; it reduces blood pressure, helps with digestive disorders, eases the symptoms of anxiety and depression, improves sleep, and promotes physical changes in the brain that promote better overall health.
We often hear the term mindfulness these days; some use it interchangeably with meditation. There are differences, however. Meditation is a practice, while mindfulness is a state or quality.
Dr. John Kabat-Zinn, creator of the Mindfulness-Based Stress Reduction (MSBR) program defines mindfulness as “the awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”
Mindfulness is a cultivated behavior, the process of focusing one’s attention. We can derive a lot of value by making it part of our way of life. Mindfulness and being in the moment are key to building resilience and overcoming adversity and stress. The essence of mindfulness is embedded in the practices of Ashtanga Yoga.
Whether you are on the Ashtanga path towards the ultimate goal of a Yogi, an agnostic, or a disbeliever; whether you practice this or that religion or are an atheist, whether you are on the modern-day treadmill seemingly getting nowhere, or attuned with Mother Nature with days filled with purpose, the regular practice of meditation is good for your body, your mind, and your soul. Regardless of what terminology you use – mindfulness or something else, the ability to focus your attention and be in the present moment with equanimity is worth developing. Attributions to East or West and distinguishing between shades of meaning may be interesting philosophically or may make for a robust debate, but they do not change the individual outcome. Meditation, pranayama, and mindfulness transcend culture, religion, and national or political boundaries. They have intrinsic value. Pranayama and meditation should be part of all stages of our life journey. I’m trying to make them part of mine.
Heading towards Liberation
In Vedic culture, the path of Ashtanga Yoga weaves through the four Ashramas or stages of spiritual life. Beginning with Brahmacharya or student life, the Ashramas set a living framework and define spiritual practices based on the duties and responsibilities required at each stage of life, as the individual progresses on a path towards ultimate self-realization or Samadhi. Brahmacharya sets the foundation, provides learning about family life and community, teaches spiritual practice, and provides yogic training. The second stage of life is spent as a Grihastha or householder – raising and supporting a family, following one’s worldly interests, continuing to drink from the fountain of Jnana, and carrying out the teachings of Bhakti and Karma Yoga. Once these responsibilities are fulfilled, the individual begins to withdraw from the world into the transitional stage of Vanaprastha, counseling the family and community while becoming increasingly more detached, with decreasing attention to the world and surroundings. Attention instead turns inward in preparation for the final stage: Sannyasa or renunciation, working towards the attainment of Samadhi, and ultimately seeking Moksha or salvation.
Every religion and culture addresses Moksha –liberation from the state of being human to become one with the cosmos or some higher power – in its own terms, and with its own descriptions and definitions of both the pathway and the ultimate end state. The Bhagavad Gita describes three margas or pathways: Bhakti (devotion), Jnana (knowledge), and Karma (duty or service). You will find proponents and devoted followers of each approach. The descriptions, discussions, and discourse on each alternative, and the relative merits of one versus the other would fill a small library.
While commenting on Adi Sankara’s renowned devotional hymn Bhaja Govindam, the elder statesman and writer C. Rajagopalachari stated “the way of devotion is not different from the way of knowledge or jnana. When intelligence matures and lodges securely in the mind, it becomes wisdom. When wisdom integrates with life and issues out in action, it becomes bhakti. Knowledge when it becomes fully mature is Bhakti. If it does not get transformed into Bhakti, such knowledge is useless tinsel. To believe that knowledge and devotion, jnana and bhakti are different from each other is ignorance.”
Intuitively, and from an objective viewpoint, one could argue – and I do – that ultimately all three paths overlap. I would leave the distinctions to philosophers and debaters.
Re-defining my path
This sets the stage for the central tenet I wish to present. Each of us is formed by our experiences. The older among us were born in India, growing up in an environment with traditional culture and roots, in society and familial environment that formed our values and guided our practices of daily living. We now live – either in India or relocated in our adopted countries – in a modern world that has transformed significantly in the space of a generation. During this transformation, we’ve had to adapt to a new way of life. We’ve changed in many ways and adjusted to different societal norms and thinking. The attitudes and practices of daily living have changed for most of us. I would argue that in either era – then or now, most people would not move all the way up the ladder of Ashtanga Yoga and attain a level of Yogic discipline and practice to be prepared and ready to renounce their way of life and enter Sannyasa in a quest for Samadhi. A few might, but not most. To the rest of us today, I pose the question: can we adapt the guidance of our ancient Yoga Scriptures and build for ourselves the model of a modern-day Yogi?
I posit that we should embrace the conceptual basis of Vanaprastha and Sannyasa spiritually, and adapt them for our modern times. We should treat Vanaprastha not as a time for transition and withdrawal, but as a time for liberation and increased activism. During this stage of life, Bhakti Yoga provides enrichment, courage, and support as we sustain ourselves in the face of the realities of aging. Let’s leverage this support to actively pursue the path of Karma Yoga –selfless service to others – and work for the benefit of our communities, always dipping into the ocean of Jnana to learn how better to serve our fellow man. Continue to find strength and comfort in Bhakti Yoga. By doing so, we will find our Sukham – joy and fulfillment. As we continue our service, we will slowly but surely embed tiny fragments of ourselves in our fellow human beings, and find our own salvation through each of them. We will successfully make our transition to an ecstatic union with the cosmos.
Mukund Acharya is a regular columnist for India Currents.
In a packed hall on one Sunday evening at the India Community Center-Milpitas here in the heart of Silicon Valley, South Asian folks of all ages sit in their traditional outfits and wildly cheer the naanis and naanas on the stage as they do an energetic “Jollywood” dance number to the song, Dus Bahane.
Naani-ma Pushpanjali Gangishetti, 74, in a bright sari, matching jewelry and barefooted, shakes her hips with gusto, one arm bent seductively behind her head, the other extended in the air in front of her, a broad smile on her face.
She clearly looked like she was enjoying the spotlight provided at the India Community Center’s (ICC) annual fund-raising gala. Ditto for at least a dozen other seniors who shared the stage with her, the men wearing fancy kurta-pyjamas, the women in sequined outfits, which anyone could see were tailored for the young at heart.
To an onlooker, it’s obvious why they call themselves the “Jollywood dancers.”
“I never thought that slipping into our dancing shoes and moving our legs would bring about such a change in us,” said 78-year-old Kanti Patel on a recent day, recalling that evening, as well as the continuing weekly dance sessions at the ICC.
He said he and his wife, Champa, have been taking full advantage of all the cultural activities the ICC offers seniors – singing, dancing, mono acting, doing yoga, aerobics, playing bridge, or simply shooting the breeze with their peers. “What we do here are wonderful stress busters.”
Indeed, it has been long documented that physical activity, especially dancing and singing, can positively affect elderly people’s bodies and minds, leading to better cardiovascular health, fewer migraine headaches, and a sharper brain.
“Music and dance create new networks in the brain,” explained India-born neurologist Dr. Joe Verghese, lead author of a continuing study on aging at the Albert Einstein College of Medicine in New York.
The study explored how dance and music slowed down cognitive decline in older people. It found that dancing helps prevent both Alzheimer’s disease and vascular dementia, the next most common form of dementia after Alzheimer’s.
Turns out, “all activities related to music can be beneficial to people,” noted Sarah Lenz Lock, AARP’s Senior Vice President for Policy and Brain Health, and Executive Director of the Global Council on Brain Health (GCBH). Engaging in music “is a powerful way to stimulate your brain.”
The meeting was held online because of the COVID pandemic.
She cited recent findings by the GCBH that showed that music impacts all regions of the brain and causes them to work together. It releases dopamine, an important brain chemical that influences one’s mood and feelings of reward and motivation. And the music that’s “meaningful to the individual is likely to have a greater dopamine response,” she said.
Lock said 20 to 40 percent of dementia could be reduced or delayed through changing modifiable lifestyle factors. Music can encourage healthy behaviors that can reduce your risk of dementia. So what kind of music should seniors, who had perhaps previously largely limited themselves to bathroom singing, or not sung at all, engage in?
“It’s all about individual choices and preferences,” Lock said, noting, “Any style or type of music can be beneficial for the brain.”
According to the GCBH report, there is evidence to suggest that music that is meaningful to the individual is likely to cause the strongest brain response and dopamine release, while at the same time new music can stimulate the brain and provide a new source of pleasure.
A 90-year-old woman (whose family did not want her to be identified) stricken with dementia had started showing little interest in her surroundings and sometimes even in family members who visited her. But whenever she heard her favorite songs of yesteryears, she would quickly brighten up, said a relative.
People who use music to connect with people understand why that medium is so important for people like this woman. Linda McNair, a board-certified music therapist at a senior facility in Missouri, is quoted as saying that when people with dementia engage with music, “they don’t dwell on other anxieties.”
Of the 11 different physical activities the Einstein team studied, social dance was the only one associated with less dementia risk – possibly because it is a complex activity. It demands sustained mental effort to master new steps.
That meant, it is not a one-and-done thing. “It has to be ongoing therapy,” Lock said.
Among the people who participated in the Einstein aging study, those who danced frequently – three or four times a week– showed 76 percent less incidence of dementia than those who danced only once a week.
Many people who dread exercising are more likely to use dancing as a way of overall physical improvement. While most exercises tend to use repetitive motions that may be found boring, dancing uses a wide variety of movements and has the additional advantage of social interaction with different people, Verghese said. As a result, it can provide greater self-confidence and self-esteem, enhance a general sense of wellbeing, and lead to more active social relationships.
Verghese, who is in his 50s, confessed he’s no fan of exercise, perhaps because of its repetitive motions. Ballroom dancing, on the other hand, with its wide variety of movements, is something he has embraced. It has helped his overall physical wellbeing, he said.
Music beneficial for Parkinson’s Disease
Neurologists say that music and dance can benefit the gait and balance of people with Parkinson’s disease and slow its march, possibly because they stimulate the production of dopamine and serotonin, neurotransmitters that are reduced in people with the disease. Singing uses the same muscle groups for swallowing and breathing, functions that are impacted as the disease advances.
After being diagnosed with the early stages of Parkinson’s a couple of years ago, a middle-aged techie in the Silicon Valley, who wished to remain anonymous, has become even more serious about learning Carnatic music, with its high-speed variations of pitch, unity of raga and tala, all of which he believes have helped slow down the advancement of the disease.
Verghese said the social and emotional elements of dancing and music are especially beneficial for Indian American seniors, particularly those who have migrated to the United States in their later years. For many of them, cultural and language barriers, as well as lack of mobility, have limited their social interactions in their adoptive countries.
That does not mean that while living in India they all had the mental stimulation older people need to keep their brains from cognitive decline, noted Sunitha Ramakrishnan, who manages the senior programs at the Mid-Peninsula chapter of the ICC.
“There is no way older people in India could do all the activities they so freely do here” without inviting criticism from their friends and family members, said Ramakrishnan, adding, “Singing perhaps yes, but dancing no.”
Shakuntala Saini, a widow of eight years, echoed this view. “In India, if I said I’m 78, people will simply say, ‘It’s time for you to go.’ ”
The ICC has a total of 600 senior members in its four centers – located in Milpitas, Cupertino, Mid-Peninsula, and Tri-Valley. The average age of the members is 70. Some drive themselves to the centers, others get dropped off at the center by family members, and some others use county-funded car services for a nominal cost of $2 per ride.
The COVID lockdown has not stopped them from accessing the social activities they enjoyed prior to the stay-at-home orders, noted ICC’s chief executive officer Raj Desai. As the lockdown began, ICC volunteers gave them a Zoom 101 course and they were off and running.
“In fact, there is more attendance in the classes now” than before the lockdown, noted Ramakrishnan.
On a recent day, Sunaina Jain, in her late 60s, was at a Zoom practice session with 27 other seniors at the class taught by Bollywood dance teacher Neetu Arora of the Mona Khan Dance Company.
“Come on Sunaina Aunty, arms down, hip-hip,” Arora coaxes, demonstrating what needed to be done. In Bollywood dance, she tells the students, “arm angles are really important.”
It’s Christmas Eve at the ICC and once again the stage is awash with colorful lehenga-cholis, salwar kameezes, and saris. The seniors are strutting their stuff through music and dance.
All of them hid the little aches and pains that come with advancing years. There was Indu Chabbra, 70, a widow and legally blind, doing her thing in a lehenga-choli.
Gangishetti, a widow of two years, is determined not to let her artificial knees keep her from having a blast.
“They tell me that dancing has given them a sense of accomplishment and built up their confidence,” said Ishika Seth, who is a professional dancer from the Mona Khan Dance Company and has been volunteering at the ICC for the last 10 years.
Viji Sundaram wrote this article for India Currents with the support of a journalism fellowship from The Gerontological Society of America, Journalists Network on Generations, and the Silver Century Foundation.
Let us face it. In your 50’s your body is not the same as it was in your 20’s and 30’s, as aging changes many things internally. However, exercising after your 50’s can add healthy years to your life, and it is important that you exercise caution and the right thing in the right way. And with the ongoing pandemic andlessons that COVID-19 is teaching us, there is no doubt that you need to be fit of all ages to battle new-age health challenges. While a significant proportion of Americans are active, less than 25% of adults meet national physical activity guidelines and 40% have obesity as per the ACSM American Fitness Index 2020report. And as you age fitness is harder while more necessary.
Know Your Body
As the body begins to age, it is not as receptive to unexpected changes and this becomes just another reason to work out and uphold a certain level of fitness.
“As you age, adapting an active and healthy lifestyle is of prime importance to help regulate and monitor your health base. Moreover, indulging in exercise and body workouts on a regular basis can guard you against unwanted heart ailments, diabetes and can also avert you from certain forms of cancer. Working out regularly can also lessen discomfort related to arthritis. By refining one’s stability and balance, suppleness, stamina, fortitude, and strength, older adults can live restored and healthier longer,” says Shalini Bhargava, Fitness Expert & Director atJG’S Fitness Centre.
Endurance exercises, such as low-impact aerobics, walking, using cardiovascular equipment such as elliptical trainers, cycle, and swimming based on the level of physical conditioning and current status of health at least five days each week is recommended.
The 50s are when chances of developing osteoporosis goes up and therefore it is imperative to add toning exercises; cardio alone is not enough. Pilates, yoga, and weight-training are some of the options to maintain muscle mass and tone up. These exercises should best be done under professional supervision to avoid injury. Swimming is yet another great workout for this age-group as the risk of injury is much less.
“I would suggest you do either 15 minutes of toning regularly or 45 minutes, thrice a week in combination with a cardio activity of course. During a cardio workout, you are bearing your own body weight, the bones work against gravity and hence reduce mineral loss. I am 52, so I ensure I weight train for two days, dance for two days, and walk for at least four hours a week,” says Suman Agarwal, Celebrity Nutritionist, Author, and Founder ofSelfcare India.
Since their movement becomes decreased at that age, they need to focus more on their flexibility and mobility.
“One should avoid strenuous training and sprinting on the treadmill. Not many chest movements should be done and overhead pressing movements should be avoided. Whenever one feels uncomfortable, they should stop immediately and not continue,” says Prosenjit Biswas, Fitness Manager,Skulpt gym, Kolkata.
Do it Right
Start slowly, especially when embarking on a new exercise routine, and ensure you have professional supervision.
Anjali Sareen,The Zone Mind & Body Studio avers, “Choosing a fitness program based on one’s own goals and needs is a must. Selecting fitness routines based on current popular trends or because your friends are doing them or out of convenience of location or price should not be deciding factors. A better option is to focus on personal training sessions with an experienced professional. These sessions can be customized to suit your fitness level, goals, and take into consideration any health concerns or injuries. An experienced professional will be able to include a diverse range of exercises and programming to cover all aspects of a complete fitness program from physical goals to energy and mind gains.”
“Active warm-up reduces resistance to stretch and increases elastic properties or ability to stretch where activity includes stationary cycling, fast walk, or rowing machine. “Proper breathing techniques are often helpful in relaxing and may help reduce stress levels and voluntary muscle tension to avoid internal organ injuries. Maintaining a neutral position of your spine, hips, shoulders, and neck can be greatly improved by using the hand not grasping the ankle to grab the back of a chair to maintain a balance. Gradually decrease in exercise intensity at the end of any cardiovascular exercise to allow heart rate and blood pressure to decrease,” explains Sujeet Kumar, Director & Coach,Fatcherry International Pvt Ltd.
Once over 50, it is best to avoid strenuous exercise like long-distance running, high-impact aerobics and weight-training exercises like deadlifts as these can put you at a higher risk of injury. As you age, your muscles shrink, hence opt for low-intensity cardio and toning activities. Avoid running on a treadmill or brisk-walking on an incline as both forms put pressure on the knees. Instead, jog on the ground.
Himay Chikani and Amrin Memon, Co-founders, AH Fitness opine, “Untrained seniors who begin exercising should start at a relatively low exercise intensity and volume. The early phase of the training program should be directed towards learning proper exercise techniques and minimizing the risk of injuries. Advanced and demanding exercises should be incorporated gradually into the program.”
Diksha Chhabra, Fitness Expert, Nutritionist & Founder,Diksha Chhabra Fitness Consultation adds, “High-intensity training, plyometric training, skipping, running or certain movements of weight training like Deadlift, Pull-ups, Leg extensions, and Heavyweight training needs more attention and care while performing as this is the age when your joints start showing signs of detrition and workouts with multiple joints involved or a moment of pressure can put unnecessary jerk on the joints can lead to a long term injury. Hence one must practice controlled momentum and intensity with or without weights for long-term activity.”
Always warm-up before starting your workout and cool down when you finish. When you injure yourself at a young age, recovery is much faster. At 50, injuries take longer to heal. Stretches are a must as shoulder, lower back, and knee pain are most common for those in the age bracket.
Sheetal Tewari, Holistic Health Coach, Yoga and meditation teacher, Sound Healer advises, “Do not overdo. The thumb rule is not overdoing anything just because you like it and it’s exciting to try new workouts. Don’t succumb to peer pressure. Choose what works for your body type not what everyone else is doing.” Do pay attention to your body’s signals and try new exercises but with complete precautions.
Dr. Ashish Jain, Orthopedic surgeon, P.D Hinduja Hospital & MRC, Mahim, Mumbai explains, “The aim now is to get into ‘anti-aging’ mode. Weight training must continue with maximum possible intensity to help maintain muscle mass and bone density. I suggest focusing more on leg workouts as they comprise the larger body segment and need to be strong for the coming years ahead. Squats, leg press, knee extensions, hamstring curls, and calf raises help in overall leg development. Some form of daily cardio is essential too and I suggest ‘low impact’ options like walks, swimming, cycling, and cross trainers.”
Consistency is the key. So, stay fabulous at 50 by staying fit.
Bindu Gopal Rao is a freelance writer and photographer from Bangalore who likes taking the offbeat path when traveling. Birding and environment are her favorites and she documents her work on www.bindugopalrao.com.
Imagine this scenario, perhaps a year or two in the future: An effective COVID-19 vaccine is routinely available and the world is moving forward. Life, however, will likely never be the same — particularly for people over 60.
That is the conclusion of geriatric medical doctors, aging experts, futurists and industry specialists. Experts say that in the aftermath of the pandemic, everything will change, from the way older folks receive health care to how they travel and shop. Also overturned: their work life and relationships with one another.
“In the past few months, the entire world has had a near-death experience,” said Ken Dychtwald, CEO of Age Wave, a think tank on aging around the world. “We’ve been forced to stop and think: I could die or someone I love could die. When those events happen, people think about what matters and what they will do differently.”
Older adults are uniquely vulnerable because their immune systems tend to deteriorate with age, making it so much harder for them to battle not just COVID-19 but all infectious diseases. They are also more likely to suffer other health conditions, like heart and respiratory diseases, that make it tougher to fight or recover from illness. So it’s no surprise that even in the future, when a COVID-19 vaccine is widely available — and widely used — most seniors will be taking additional precautions.
“Before COVID-19, baby boomers” — those born after 1945 but before 1965 — “felt reassured that with all the benefits of modern medicine, they could live for years and years,” said Dr. Mehrdad Ayati, who teaches geriatric medicine at Stanford University School of Medicine and advises the U.S. Senate Special Committee on Aging. “What we never calculated was that a pandemic could totally change the dialogue.”
It has. Here’s a preview of post-vaccine life for older Americans:
Time to learn telemed. Only 62% of people over 75 use the internet — and fewer than 28% are comfortable with social media, according to data from the Pew Research Center. “That’s lethal in the modern age of health care,” Dychtwald said, so there will be a drumbeat to make them fluent users of online health care.
1 in 3 visits will be telemed. Dr. Ronan Factora, a geriatrician at Cleveland Clinic, said he saw no patients age 60 and up via telemedicine before the pandemic. He predicted that by the time a COVID-19 vaccine is available, at least a third of those visits will be virtual. “It will become a significant part of my practice,” he said. Older patients likely will see their doctors more often than once a year for a checkup and benefit from improved overall health care, he said.
Many doctors instead of just one. More regular remote care will be bolstered by a team of doctors, said Greg Poland, professor of medicine and infectious diseases at the Mayo Clinic. The team model “allows me to see more patients more efficiently,” he said. “If everyone has to come to the office and wait for the nurse to bring them in from the waiting room, well, that’s an inherent drag on my productivity.”
Drugstores will do more vaccinations. To avoid the germs in doctors’ offices, older patients will prefer to go to drugstores for regular vaccinations such as flu shots, Factora said.
Your plumbing will be your doctor. In the not-too-distant future — perhaps just a few years from now — older Americans will have special devices at home to regularly analyze urine and fecal samples, Dychtwald said, letting them avoid the doctor’s office.
Punch up the Google Maps. Many trips of 800 miles or less will likely become road trips instead of flights, said Ed Perkins, a syndicated travel columnist for the Chicago Tribune. Perkins, who is 90, said that’s certainly what he plans to do — even after there’s a vaccine.
Regional and local travel will replace foreign travel. Dychtwald, who is 70, said he will be much less inclined to travel abroad. For example, he said, onetime plans with his wife to visit India are now unlikely, even if a good vaccine is available, because they want to avoid large concentrations of people. That said, each year only 25% of people 65 and up travel outside the U.S. annually, vs. 45% of the general population, according to a survey by Visa. The most popular trip for seniors: visiting grandchildren.
Demand for business class will grow. When older travelers (who are financially able) choose to fly, they will more frequently book roomy business-class seats because they won’t want to sit too close to other passengers, Factora said.
Buying three seats for two. Older couples who fly together — and have the money — will pay for all three seats so no one is between them, Perkins said.
Hotels will market medical care. Medical capability will be built into more travel options, Dychtwald said. For example, some hotels will advertise a doctor on-site — or one close by. “The era is over of being removed from health care and feeling comfortable,” he said.
Disinfecting will be a sales pitch. Expect a rich combination of health and safety “theater” — particularly on cruises that host many older travelers, Perkins said: “Employees will be wandering around with disinfecting fogs and wiping everything 10 times.”
Cruises will require proof of vaccination. Passengers — as well as cruise employees — will likely have to prove they’ve been vaccinated before traveling, Factora said.
Local eateries will gain trust. Neighborhood and small-market restaurants will draw loyal customers — mainly because they know and trust the owners, said Christopher Muller, a hospitality professor at Boston University.
Safety will be a bragging point. To appeal to older diners in particular, restaurants will prominently display safety-inspection signage and visibly signal their cleanliness standards, Muller said. They will even hire employees exclusively to wipe down tables, chairs and all high-touch points — and these employees will be easy to identify and very visible
The homecoming. Because of so many COVID-19 deaths in nursing homes, more seniors will leave assisted living facilities and nursing homes to move in with their families, Factora said. “Families will generally move closer together,” he said.
The fortress. Home delivery of almost everything will become the norm for older Americans, and in-person shopping will become much less common, Factora said.
Older workers will stay home. The 60-and-up workforce increasingly will be reluctant to work anywhere but from home and will be very slow to re-embrace grocery shopping. “Instacart delivery will become the new normal for them,” Dychtwald said.
Forced social distancing. Whenever or wherever large families gather, people exhibiting COVID-like symptoms may not be welcomed under any circumstances, Ayati said.
Older folks will disengage, at a cost. Depression will skyrocket among older people who isolate from family get-togethers and large gatherings, Ayati said. “As the older population pulls back from engaging in society, this is a very bad thing.”
Public restrooms will be revamped. For germ avoidance, they’ll increasingly get no-touch toilets, urinals, sinks and entrances/exits. “One of the most disastrous places you can go into is a public restroom,” Poland said. “That’s about the riskiest place.”
“What did you eat today?” my mother, Sarada, begins her phone conversation with my twenty-three-year-old daughter in New York. When my daughter explains that she made rasam and sautéed cauliflower over the weekend, Sarada’s face lights up. Later she tells me she’s happy that all her grandchildren love rasam, a staple broth from the south of India.
Eighty-six-year-old Sarada immigrated to America in her 70s, and finds equanimity performing activities and engaging in conversations that hinge around food. When she meets people she doesn’t know, she connects through food conversations, often recalling the piquant tastes of her youth.
Familiar flavors act as a barometer to her moods, often alleviating the stress of adjusting to a brand-new environment and she looks at food as the one constant in her new life, which she uses to bridge the gap between her past and present.
More importantly, when Sarada does not have access to familiar foods, she displays signs of acute emotional distress, appearing physically drained and listless.
Eating—A Social Event
Sarada entrenches socialization in the act of eating. It is true that in most cultures, meet and greets occur around food: we go to restaurants for dinner, have potluck get-togethers and have affinity gatherings where food is conspicuously on display. Sarada, who re-contoured her physical, geographical and cultural spaces later on in life, finds that she is unable to participate in these social gatherings because unfamiliar food becomes alienating.
What complicates the Indian experience is that the cuisines of the different regions are distinct, right down to the staples and vegetables. Southern Indian cuisine uses rice, tamarind and coconut gravies, which differ from the wheat breads and tomato-onion-ginger flavors of the north.
As she ages, Sarada has become more and more particular in her dietary needs, eschewing food that is not from her home state of Tamil Nadu in India. This has affected her socialization patterns, limiting her and isolating her, even within the Indian American community.
And she’s not the only one who feels this way.
What’s On Your Palate?
With over a decade of experience directing Stanford’s Aging Adult Services program, Dr. Rita Ghatak, a gerontologist and psychologist, is the associate director of Optimal Aging Center, and—along with her husband—is a caregiver for her father-in-law, Gopala Pillalamarri. She observed that her father-in-law’s biggest preoccupation is food, particularly food from India’s southern state of Andhra Pradesh, well-known for its tamarind and chili flavors.
While living in India, Pillalamarri, a former journalist, seldom went to a restaurant, preferring home-cooked meals. And on the rare occasions that he did go to a restaurant, it would often be to a restaurant serving the same dishes he was used to eating at home.
He moved to California to live with Ghatak and her husband in the ’90s, along with his wife. While she was alive, his wife regularly made food that satisfied his palate. At the time he would go on long walks with a cohort of older immigrants and seemed to have adapted to his new country. After his wife’s death, he began to gradually decline, socialized less and less and became increasingly insistent on eating foods that he’d enjoyed for most of his life.
“[Ghatak] makes Bengali food, and I taste it once in a while, but I don’t like it much,” Pillalamarri said, with an apologetic grin.
Other Cultures, Similar Stories: Give me kimchi!
Eighty-seven-year-old Korean American Chang Song Lim lives alone in an apartment close to Boston. Lim came to America in 1989 and his first job was as a factory assembler in Springfield. Within a year, the factory closed down and he was laid off. With his limited English skills, Lim has had to work many odd jobs, including dishwashing and cleaning.
Once he retired, Lim signed up for the government assisted meal service program. He had to choose from American, Russian, Italian and Chinese offerings. Figuring that Asian food was the closest to his Korean palate, Lim opted for Chinese. “It’s a different taste, a different style,” he told me. His body was not used to this type of food, Lim explained, adding that it was causing a serious problem for him. “I’m very skinny right now and I’m indirectly killing myself. I just want kimchi,” he said, the stress clearly audible in his voice.
“Older ethnic immigrants face greater challenges in alleviating their loneliness and social challenges because of their language and cultural barriers and small social networks,” said Megumi Inouye, a researcher at George Mason University, at the Gerontological Society of America’s (GSA) annual conference this year.
In a longitudinal study of a senior immigrant Japanese woman who was in long-term care in Boston, Inoue quoted the husband saying that his wife wasn’t eating much and had little appetite. But when a volunteer interacted with the woman, she asked the volunteer to “spend more time and bring Japanese food along.”
A Rising Trend
With the steady pipeline of older immigrants arriving and aging in the United States—in 2010, more than one in eight adults, 65 years and older, were foreign-born, according to the Population Reference Bureau—it’s critical to have conversations on what drives the emotional health of immigrant seniors, since emotional health affects physical health, and both these have economic costs associated with them.
And even among the foreign born, the older Asian population is growing definitively. Dr. Vyjeyanthi S. Periyakoil wrote in the Journal of the American Geriatrics Society (May 2019) that the older Asian American population is “projected to quadruple from 2 million in 2014 to 8.5 million in 2060. This ethnogeriatric imperative underscores the great and growing need for healthcare services that account for the cultural beliefs and behaviors of older persons.”
It’s evident that Sarada, Pillalamarri and Lim are part of a broader pattern among Asian and South Asian seniors. As an index to policies on older immigrant adults, it helps to examine how and why enjoying the food served becomes critical in staving off feelings of alienation and unhappiness.
The Science Behind It
Mai Takase, a Japanese researcher from the University of Tokyo, along with Tomoki Tanaka, Hiroshi Murayama and others conducted a study investigating the connection between food enjoyment and social connections among seniors. Displaying the work on a poster at the GSA conference, Takase explained that they interviewed 190 residents at an assisted living facility in Kanagawa Prefecture in Japan. Questions were asked about meal enjoyment, social engagement: Do you enjoy the meals? How many other facility residents (not a family member) can you talk to about your private life with ease? And the risk of depression was assessed.
The findings indicated that meal enjoyment was critical to emotional health, even if the senior had an extensive social network. “There was a higher likelihood of depression among those who did not enjoy the meal,” summarized Takase.
In a follow-up study at the same assisted living facility, the same group of researchers looked at whether eating with others, as compared to eating alone, in connection with enjoying the meal, had any influence on the respondents’ emotional moods. The subjects were broken into four different groups. Those who enjoyed the meals and ate with others; those who did not enjoy the meals, but ate with others; those who enjoyed their meals but ate alone; and those who ate alone and didn’t enjoy their food.
Takase explained that while cross-sectional studies found that seniors who eat alone are more likely to be depressed, this particular study concluded that not enjoying the meal was a significant contributor to depression, regardless of whether it was consumed alone or with others. “Our findings indicate that the feeling of enjoyment (a subjective aspect of dining style) is an important factor of eating in assisted living facilities: not enjoying meals may be a major risk factor for depressive mood,” wrote Takase.
Aligned with these conclusions, Sarada, Pillalamarri and Lim’s focus is not necessarily on eating with others, but enjoying their meals. Sarada consents to eating in company only if she is assured that the food being served is what she knows and likes. It’s evident that food desires reinforce cultural identity and drive cultural and emotional stability for these senior immigrants.
In contrast, there are other seniors who show remarkable food, cultural and social adaptability. So, it’s perhaps interesting to understand why that is the case.
“I’m not fussy about food”
Sita A. celebrated her 91st birthday recently. She has been living in New York with her daughter, Ashwini, since the 90s. Sita grew up in Coorg, a hilly town in the south of India. Her mother died eleven days after Sita was born and she was reared by the family nanny, Somaiya, who had three children herself. Somaiya was an excellent cook and Sita remembers breakfasts of akki roti with jams and chutneys and dinners of pork, chicken or mutton curry with rice and steamed accompaniments of jackfruit or bamboo shoots.
Later, when Sita moved to Chennai, a busy urban city, to raise her daughter on her own, necessity drove her to improvise. “It was tough being a single mother initially with no proper income,” she said. But she found her feet, selling her jewelry and finding a job. This gave Sita the training to adjust to new situations she encountered, particularly as she aged.
When I was a college student in Chennai, I used to visit Sita at her studio apartment down the road from my college campus. I recall once sharing her simply prepared dinner of soy nuggets and tomato soup. The taste of that meal has far outlasted the flavors of any meal I’ve had since.
Sita moved in with her daughter and son-in-law in the late ’80s and readily adapted to the places they’ve lived in, including France and Scotland, where she built a strong network of friends.
“I’m not fussy about food,” she told me when I visited her in upstate New York. She went through her daily food regimen with me, mostly stressing the time of day that she has her meals and how important her tea is to her. She enjoys eating with the family and is happy to sample whatever has been cooked, she said. I reminded her about her love for kohlrabi. “Yes, you know me well,” she agreed, “I love noolkol [kohlrabi] with mutton curry, and Ashwini makes it for me,” she said, the familiar tinge of pride infusing her tone when referring to her daughter.
The Priya Living Experiment
In the winter of 2015, my family and Sita’s family took a two-week vacation to the Bahamas. Sita agreed to accompany us on the vacation, but Sarada flatly refused. The idea of leaving an 82-year-old woman alone seemed irresponsible, so I signed up for a one-month stay for Sarada at Priya Living, a retirement community in Santa Clara, California.
I took Sarada to check the place out. “Look, you’ll have your own apartment and you’ll be with others your own age. There’s a full kitchen, and you can make sambar and kootu.” She looked stubbornly unhappy and said she was not going to cook and that I’d need to figure out her meals. There was a little evening get-together that day and I introduced Sarada to many who welcomed her into the community with a warm word and smile. Beyond nodding politely, she sat without saying a word.
Feeling perturbed, yet hopeful, I settled Sarada at her new place a few days before I was to leave and got a commitment from a young woman who lived a few doors down to check in on her at least once a day.
When I called the first time, Sarada complained about how the place was too quiet. When I suggested she attend the daily meet-ups in the lounge, she said she wasn’t interested in meeting anyone.
Before leaving I organized a daily meal program for her, a service that many others at the senior community center recommended. Sarada, however, didn’t care for the Gujarati (west Indian) food that was delivered.
All the while, at the beach resort, while I was worrying about Sarada, I observed Sita taking to the new environment, making casual conversation with strangers, and tucking in to risottos and salads with nary a murmur of discontent. The day I came back home from my vacation, I went to Sarada’s apartment. I found her by the door, packed and ready to leave. She told me she’d started packing four days before I was to arrive.
So what’s different about Sarada and Sita?
Sita and Sarada have different life experiences. Sarada grew up in Moncombu, in the state of Kerala and then migrated to Pandaveshwar in the state of West Bengal after she got married. Moving from the deep south to the north was traumatic for her, a young woman who’d lived a sheltered life, within the confines of her village. She found everything about the north Indian culture alien. Over the years, she began to adapt to her new environs. However, to be clear, she went from a small village in south India to a small village in north-east India. There was little in terms of restaurants serving non-local or global food options in these hard-to-access locales. And for most of her life, she had never been exposed to urban or western culture. These conditions inevitably shaped her response and reaction to brand new gastronomic offerings.
According to Ghatak, easing into a new food culture “depends on whether they tried different foods when they were in India.” Most often, in Ghatak’s analysis, it is those who’ve lived their lives in a particular way without traveling much or eating out who end up dependent on their palate for emotional stability in their new circumstances. In Sita’s case, her spirit of resilience was further enhanced when she had to negotiate a new city and circumstance on her own.
One Solution? Food delivery service that’s culturally relevant
Take the Meals on Wheels program. The program is a federal initiative to help meet older adults’ basic food needs and to help them age in place in their own homes. Research by Thomas and Mor in 2002 has shown how the Meals on Wheels program has kept older adults with low care needs out of institutions such as nursing homes.
In a randomized control trial on home delivered meals programs on participants’ feelings of loneliness published in the Journals of Gerontology, the authors, Kali S. Thomas,Ucheoma Akobundu andDavid Dosa concluded that home delivered meals reduce feelings of loneliness. The reasons for this reduction, the authors surmised, include the daily or weekly social contact as well as the food that’s delivered.
However, what the research failed to point out was what happens when seniors find the delivered meals dissatisfying. Essentially, what works for the native-born population will not necessarily work for the first-generation immigrant cohort.
“It’s pretty unreasonable,” remarked Myong Sool Chang, editor of the Boston Korea. “Lim’s is not the story of one old man.” Korean American seniors are not accustomed to speaking English, and so it’s a three-fold problem. “There’s a language barrier, there’s a cultural barrier, and there’s no contact point to ask for help.”
Food is a pipeline to mental and physical health and the lack of institutionalized culturally relevant options makes immigrant seniors very unhappy.
Lim craves Kimchi and Korean food and it distresses him immensely that he’s unable to get it.
Ghatak and Shyam luckily located an older immigrant lady from Andhra Pradesh in Milpitas, about 25 miles away, who prepares weekly Andhra meals for several senior clients. This catering service has plugged the food gap for Pillalamarri, much to Ghatak and her husband’s relief.
These days, Sarada is unable to cook full meals for herself and finds my experimental and less traditional cooking habits intolerable. So, a few months ago, when a friend told me about a south Indian food delivery service in the Bay Area called Mylapore Express, I decided to try it out.
As I unpacked the containers that were delivered one Wednesday morning, Sarada eagerly read the labels aloud, “vadai more kuzambu,” “murungakkai sambar,” “lemon rasam,” “beans paruppusili,” “kathirikkai karamadhu,” “pavakkaipitla.” Her face flushed as she saw the bounty displayed before her and she told me how much she loves kathirikkai (eggplant) and pavakkai (bitter gourd). There was no mistaking the thrum of excitement and animation.
Jay Jayaraman, the founder of Mylapore Express, remarked about the number of people who mention their parents when ordering food from his business. He related the story of a customer’s parent who’d gone out of town and on the day that was scheduled to return, upon finding out the Mylapore Express menu, asked his daughter to save the kathirikai for him. Another texted Jayaraman: “We mainly order for my father-in-law. He is happy with such freshness and taste of the food. The keerai masiyal, mixed veg, kootu, aviyal (just to name a few) are the toppers.” As we finished our conversation, I told Jayaraman that his food delivery service maintains the emotional balance in our house, and he chuckled, assuring me that I’m not the only one.
Typically, older immigrants have limited English proficiency, have weak ties to social institutions and little U.S. work experience, according to Judith Wilmoth of Syracuse University. Sarada fits the broad patterns of Wilmoth’s analysis. She arrived in the United States in 2006, became a citizen in 2013, has limited English proficiency, no U.S. work experience and is unworldly in most respects. But there’s little to nothing wrapped up in that description.
Sarada is a nurturer who smuggles fruits into my backpack on the mornings she sees me rushing to make my morning train. She does the dishes when I’m too tired to do it. She feeds the family dog, and worries about my adult children’s eating habits. In small and large ways, she is an essential link in the chain of my life and her happiness strengthens me.
It’s Wednesday and Mylapore Express has just delivered Sarada’s meals. I open the carton and begin taking out the containers. She comes rushing out of her room and asks excitedly, “what’s on the menu, this week?”
Jaya Padmanabhan is a journalist and author. She was previously the editor of India Currents.
This article was written with the support of a journalism fellowship from The Gerontological Society of America, Journalists Network on Generations and the Silver Century Foundation.”
As we become caregivers to our parents, many of us come face-to-face with Alzheimers disease for the first time. The impact of Alzheimers can be devastating on families, with patients, spouses, children and caregivers having to make tough choices from difficult decisions.
K.P. Unnikrishnan, a management consultant who lost his vibrant 70-year old mother to Alzheimers, eventually had to place her in a care-home and endure more than ten years of visits with a parent whose memory of him had faded completely.
Another family shared their story of a mother-in-law who was physically healthy but who kept trying to take a bus out of town.
As some of us approach middle age and are afflicted by a forgetfulness we laughingly blame on senior moments, there is an unspoken fear – what if this happens to me?
Alzheimer sufferers face a gradual decline in verbal skills, forgetfulness, memory loss, anxiety and depression, leading to frustration, irritability and helplessness. As symptoms escalate patients may tend to repeat words or phrases, have hallucinations, show changes in personality, get lost in familiar territory or wander off.
How it presents
Alzheimers presents in two forms. In early onset Alzheimers, symptoms appear before the age of 60. The second more common type is late onset Alzheimers that presents after the age of 60. Rarely does it strike individuals as early as 30, but after the onset of Alzheimers, the average life span is usually about 8 years, though some patients have lived for over 20 years.
What causes Alzheimers?
The cause of Alzheimers is not well understood. Currently tests can help determine what type of dementia some patients have (for those who have an awareness of their problem) and if any treatable action is necessary. Some patients undergo tests to rule out other diseases causing dementia – such as a brain tumor, infection, stroke or a vitamin deficiency.
Can it be prevented?
Despite recent advances however, there are no definite treatments available that have been shown to stop or reverse the progression of Alzheimers.
In the US, FDA-approved medications do help to manage symptoms and delay progression, but currently there is no prevention for Alzheimers.
In recent years, researchers have begun to explore behavioral interventions in preventing and slowing the progress of dementia. Evidence from observational studies show that when people participate in cognitive leisure activities in middle and late life, it may have a protective effect on the development and progression of Alzheimers disease and other dementias.
Research says, ‘stay active’
One prospective study from the New England Journal of Medicine tracked 500 subjects aged 75+ (without any baseline dementia) over a 5-year period; the study evaluated the risk of dementia against a baseline level of participation in leisure activities.
Results showed that those who regularly read, wrote, played board games, solved crossword puzzles, did arts and crafts, listened to music or played a musical instrument had a reduced risk of developing dementia. The study also showed that social dancing was the only physical activity associated with reduced risk.
Research has found that listening to music or playing an instrument can maintain and improve memory. Another excellent way to keep a patient active is to dance to music; it maintains gross and fine motor skills and helps improve balance. Participation in arts and crafts projects that stimulate creativity – molding clay, painting, stringing beads, knitting, crocheting, flower arrangement as well as hobbies like puzzles, reading and writing, – enhance a sense of pride and fulfillment and offer a venue for free expression.
A word of caution
Remember that these activities are not intended to keep a patient busy; rather, treat them as an aid to provide meaning in a patient’s daily life – tools that enable them to learn, play, contribute and interact socially while feeling safe with others.
It’s important too, that the leisure activity chosen is appropriate to the patient’s cognitive skills, language level, attention span and physical mobility limitations. If the activity is too difficult, it can frustrate the patient and if the activity is too simple he or she could feel humiliated and depressed.
The benefits of staying active
These activities have benefits; memory training, using memory devices like word lists or mnemonics, has been shown to have a positive impact in the area of the brain cells that processes memory.
Functional magnetic resonance imaging has shown reverse brain changes in mild cognitive impairment (a precursor state to dementia). The comparison of before and after images of memory training show increased activation and new recruitment of brain cells in this area of the brain.
Any activity that combines mental, physical and social stimulation offers the greatest benefit to patients in whom the illness has manifested. The success of such activities, however, depends on whether the task is meaningful, gives immediate pleasure and helps patients recapture their dignity and respect.
In the interim it seems prudent for those who are elderly and approaching middle age to continue to challenge ourselves in social and physical leisure pursuits and give ourselves a fighting change with the vagaries of aging and Alzheimers.
The information presented in this article is offered for educational and informational purposes only and should not be construed as personal medical advice. You should consult with your personal physician/care giver regarding your own medical care.
Meera Kymal is a contributing editor to India Currents
Once upon a time, our elderly were hard working, productive adults. Then, as they aged, society began to place less value on their existence; adding insult to injury, many elderly today often find themselves in the embarrassing position of being dictated to by their children or carers, without any recourse to self determination.
Self determination is the process by which a person controls their own life. In our youth we have this control and tend to underestimate its value. Only as people age and gradually lose their independence do they realize that self determination matters in how they live the remainder of their lives.
Traditionally in India, the joint family structure allowed for elderly family members to be taken care of organically. But, as industrialization, urbanization and migration changed how societies function, the bond that held families of various generations together began to fracture, become fragile or even become non-existent, leading to the rise of a new paradigm- that many families and communities everywhere face today – how do we as a society create a system that allows for our senior citizens to live their lives with dignity, independence and self determination but with the safeguards of physical and financial security? And how do we deal with the issue of depression that creeps in with social isolation and loss of purpose as people grow older?
After a long and successful career in the tech world, Archana Sharma started Samvedna in 2013 with the aim of making a discernible difference in the lives of seniors. This was very personal for her because her parents are fiercely independent and wanted to live in their own home, but started to find it difficult to do so without some help. Archana first started with a senior activity center but soon realized that many seniors do not have the mobility to avail of its services. It led to her to create her home service enterprise.
Archana defines her mission as “provid[ing] best in class senior care services for the elderly to help them live happy, active and independent lives, in the comfort of their home and community through interactive caregiving.”
Samvedna’s services are concentrated in the Delhi NCR region and have grown over the years to include elder care services, dementia care and counselling services for geriatric ailments, primarily to fulfill the need for in-place aging.
Elder Care services are companionship-based for seniors who live alone but want to live independently. Trained counsellors and social workers visit regularly and encourage activities based on the seniors’ interests. Home management services are also available for general house maintenance.
Another service called General Wellbeing helps seniors with bank visits, medical appointments, managing hospital stays and other social engagements. This service becomes invaluable when the social worker is able to understand and communicate the technical details of a senior citizen’s medical diagnosis.
Deepak, a Bay Area resident, has been using Samvedna for the past four years and says, “They have professionally educated staff who visit my parents regularly. It gives me peace of mind knowing that my parents are being taken care of, and I get a daily email with an update on their condition.”
Samvedna also provides in- home, long term care . In this case, caregivers often live with the family. The in-home attendants are screened by Samvedna and specially trained in the nuances of senior care with sensitivity, especially in cases of dementia.
Samvedna also provides services to help elderly people diagnosed with dementia, as well as support for their caregivers or family. Its comprehensive service starts with a thorough initial neurological assessment, and specific programs are then recommended to the client based on the results, whether it is cognitive stimulation therapy or social stimulation in a group environment. Each care plan is reviewed and monitored regularly within their team of multidisciplinary specialists.
But as Archana says, “early detection is key,” to diagnosing senior citizens accurately, giving them the right treatment and helping families cope with the disease. Unfortunately, either because of the stigma or a general lack of awareness in India, dementia is often not diagnosed until it has progressed to a moderate or advanced stage. Samvedna also has a support group for caregivers, which is invaluable because caregivers are often lonely, depressed, emotionally drained and physically spent while taking care of their loved ones.
The fact is, extended families of seniors lead busy lives, with demanding jobs and long commutes. This 21st century lifestyle has changed the social dynamic of families, whether they live in India, abroad, or even in the same house. As a society, we need to do a better job of acknowledging this and finding solutions to help our senior citizens live a meaningful and dignified life.
Entrepreneurs like Archana Sharma and Samvedna are doing just that.
Anjana Nagarajan-Butaney is a Bay Area resident with experience in educational non-profits, community building, networking and content development and was Community Director for an online platform. She is interested in how to strengthen communities by building connections to politics, science & technology, gender equality and public education.
When I was a young girl, I read the Reader’s Digest “All in a Day’s Work” section with interest. Contributors would submit humorous or poignant anecdotes about interactions with co-workers and customers. On labor day, I offer a similar “All in a Day’s Work” style article based on my own work experiences, whether paid or unpaid, salaried or volunteer.
Earlier this year, I had an opportunity to volunteer as a substitute senior yoga teacher at India Community Center in Cupertino. The site is in the heart of Silicon Valley, just a few miles from Apple. One of the yoga teachers was getting some remodeling done in her house, and Dr. Sachin Deshmukh, who runs the yoga program, asked me to be the substitute. The informal nature of the yoga teaching was evident in the rather ad-hoc manner in which I found myself in the role of a teacher, facing about 40 expectant seniors. My yoga training at Yoga Bharati had prepared me for this moment, I hoped. A lapel mike was fastened to my shirt, and just like that, we were off.
A common complaint was that I could not be heard. I tried to project my voice. The man who had affixed my lapel mike, and who was referred to as Dr. Krishna, came by again, his forehead creased with concentration as he fiddled with the sound system. I shot him a grateful look. In a room full of octogenarians and nonagenarians, my grey hair notwithstanding, I felt like a young upstart.
There were several levels of fitness in the room, and I tried hard to modify poses so that the wheelchair-bound could benefit from the gentle movements of yoga. I looked up videos of chair yoga on YouTube. The adage that yoga meets you at whatever level you are is relevant here. Those who were on a mat went through rounds of sun salutations with practiced ease. A lady with a large bindi on her forehead began chanting in Sanskrit: sahanau vavatu, sahanau bhunaktu, saha veeryam karvavahai, a vedic hymn that is traditionally an invocation for harmony between the teacher and the students.
The weeks flew by. As I got to know the yoga students, I learned their names and joined them for lunch. Ramesh Mathur, wearing a Gandhi cap, coordinated the program, keeping things moving smoothly. I learned that a bright-eyed lady, who always sat with her friend at lunch, was a rishtedaar, a relative. “This yoga teacher is my granddaughter’s sister-in-law,” she proclaimed proudly at the lunch table, as I smiled and nodded to my senior students.
The center was well attended. Several seniors carpooled, their children taking turns on different days to drive a small group to the center. Friends would bring small Tupperware containers to share food with each other, eating together and mischievously spurning the communal meal that was deemed too healthy or too unhealthy or too bland.
The aging parents of tech workers in Silicon Valley proved to be a varied bunch. Many were polyglots, fluent in several of the languages that are spoken in India. Many had a deep knowledge of yogic traditions and practices. A retired University professor offered to help me with my Sanskrit pronunciation, her eyes kind. There were retired government bureaucrats and scientists, retired school teachers, poets and artists as well as housewives. Most had children and grandchildren who were fueling the tech boom in California.
There were comings and goings. During holidays, attendance went down sharply as a result of family outings with children and grandchildren. Some returned to India to tend to ancestral homes or visit family.
One of the ladies was new to the program. I told her she looked like my grandmother. She seemed to be settling in well, making new friends. She impressed me by telling me a multilingual joke, switching from Hindi to Bengali to Marwari as I clapped with delight. But one day, she was in tears. She was missing her husband, who had passed away a few weeks ago. Dr. Sachin spoke to her gently, helping her with her grief. Her new friends spoke consoling words. Everywhere, there was community and connections. I thought frequently of my own aging parents and in-laws in India, too far to benefit from these senior yoga classes.
I see now that this was a rare opportunity to observe an aspect of the immigrant experience which lies ahead. The yoga, I saw, can be particularly helpful to create community and healing around this ancient tradition, and ease the pain of being in a new land. But I also learned something about my own place in this adopted homeland and had a glimpse of my own life down the road.
The substitute stint ended quite suddenly. As I hurried into the large, somewhat musty room, an attractive lady was already issuing instructions. The home remodel had ended, and the regular yoga teacher was back.
And just like that, my gig as a senior yoga sub was over.
Geetika Pathania Jain is Culture and Media Editor at India Currents. She is touched by the selflessness of volunteers. For more information about the ICC Senior program, go to http://www.indiacc.org/programs/seniors/