Elder Caregiving Webinar with Richard Lui

 I was prompted to do this post about caregivers and their role in helping the elderly either at home or in a care facility by today's webinar sponsored by Nebraska AARP, and hosted by journalist and news anchor for MSNBC and NBC News Richard Lui.

After the webinar, I'll do a summary, plus add some important resources as well. Stay tuned.

UPDATE: I was able to watch the first half of this webinar, which I thought was a very good presentation on the current state of caregiving for elders.

The moderator (I'm sorry I didn't catch her name) began by sharing some statistics. It is estimated that there are 53 million caregivers in the US, about 21.3% of the population. This is compared to 43.5 million in 2105. In Nebraska, there are 240,000 unpaid caregivers whose labor is estimated at a worth of $2.9 billion.

You can get download the 2020 report "Caregiving in the U.S." prepared by AARP and the National Alliance for Caregiving.

Richard Lui was introduced and started by saying "little things are big things." The decisions, the hugs, the touches, finding out what's good for the person you're taking care of. He said his 84-year-old father is now 8 years into his Alzheimer journey. He found that just be touching him on his forehead, it allowed his father to recognize him. This little thing had become a grand gesture.

Lui went on to say there's "a lot of joy in the difficulty" of caregiving. In most cases you don't sign up for it, and while helping others it helps you become more human. "Everybody is their own expert," he said, emphasizing that each person brings a unique perspective to this type of work. It can be stressful work, but he said, "I still try to enjoy the laughter of life."

He said that caregiving is not fully appreciated in our culture. One would think it is mostly female, but males also contribute making up 4 out of 10 caregivers. He says that he is part of the sandwich generation, Gen Y & Z, who play a significant role. He cited that students make up over 5 million caregivers, as well as children, those under the age of 18.

Coming to terms to his commitment to his father and to his employer, MSNBC, seemed daunting at first. He works at a job where's he's on call, and not in a position to refuse appearing in a broadcast. He was faced with coming up with a plan that would allow him to become a long-distance caregiver. AARP helped him with the idea of an Employee Resource Group (ERG) in approaching his employer, which had a successful outcome.

ERGs and BRGs (Business Resource Group) serve the function of "voluntary, employee-led groups that foster a diverse, inclusive workplace aligned with organizational mission, values, goals, business practices, and objectives. Other benefits include the development of future leaders, increased employee engagement, and expanded marketplace reach," as stated on the Catalyst.org website.

In regard to Covid-19, Richard said that we already have been facing a "Care Pandemic." The moderator stated that Federal and State programs realize a savings when the elderly can age in place, and this should be factored in when funding is considered.

Lui stated that 4 years ago he began work on a documentary film, Sky Blossom, which features families working through caregiving including Richard and his parents, Stephen and Rose Lui. His father grew up in a large family with 13 siblings, one of whom contacted Richard when Stephen starting not recognizing them. Stephen initially worked as a Pastor, a youth minister, and later became involved with social work for the next 25 years.

 At present, Lui says, "he's an 84-year-old child," requiring constant care, but now that he's in an assisted living facility, he sees his father once every 3 weeks, or twice every 4 to 5 weeks. Initially he was flying back to San Francisco from his job in NYC on a weekly basis.

I'll keeping adding resource links to this blog post, as I hope this becomes a hub for significant information about the challenges of caregiving and the elderly.

"3rd Act Journey" YouTube Channel

 

"A society grows great when ELDERS plants trees whose shade they will never enjoy."

This is my modification of an ancient Greek saying that serves as a slogan for my new YouTube channel: "3rd Act Journey." I think the tree motif works well with connotating wisdom achieved through a long life.

Nebraska’s state nickname before the “Cornhusker State” was the “Tree Planter’s State.” Settlers coming to the prairie were ambitious in planting trees because they had a vision for a better life. It is for this reason that this state is the home of Arbor Day.

The seniors in our society have the responsibility to use their wisdom and perspective to begin initiating changes for which future generations will benefit, something very similar to tree planting.

For this reason, my organization Elder Lives and its YouTube channel 3rd Act Journey use images of trees to represent the needed long-term solutions.

The next step in my journey is to develop my online media and engage in speaking opportunities, as well as write a book to share my vision, engaging and inspiring others to have a purpose of creating a better future.

"The Good Ancestor: A Radical Prescription for Long-Term Thinking" by Roman Krznaric

 I received an alert from the "Talks at Google" YouTube account concerning a new video about Roman Krznaric and his recently released book:  "The Good Ancestor: A Radical Prescription for Long-Term Thinking."

After a quick investigation, I realized that this was the perfect read for developing the direction of my Elder Lives blog and organization.

“A society grows great when ELDERS plant trees whose shade they will never enjoy,” is my version of an supposedly ancient Greek aphorism, and conveys my feeling about my current mission.

Nebraska’s state nickname before the “Cornhusker State” was the “Tree Planter’s State.” Settlers coming to the prairie were ambitious in planting trees because they had a vision for a better life. It is for this reason that this state is the home of Arbor Day.

The seniors in our society have the responsibility to use their wisdom and perspective to begin initiating changes for which future generations will benefit, something very similar to tree planting.

For this reason, my organization Elder Lives and its YouTube channel 3rd Act Journey use images of trees to represent the needed long-term solutions.

The next step in my journey is to develop my online media and engage in speaking opportunities to share my vision, engaging and inspiring others to have a purpose of creating a better future.

Here's the blurb from YouTube: "Philosopher Roman Krznaric discusses his most recent book "The Good Ancestor: A Radical Prescription for Long-Term Thinking". Krznaric explores six ways we can expand our time horizons to confront the long-term challenges of our age— from the threats of climate change to the lack of planning for a global pandemic. Do we have what it takes to become the good ancestors that future generations deserve?"

I'll be doing a full review of this book for another blog post, but I'm glad this serendipity happened today, and it will be the best read for this Thanksgiving Day week. Gratitude is important, but it's just as important to have an eye towards the future, and how to make it better for our descendants, if we want to be good ancestors.

"How Covid-19 Will Change Aging and Retirement" WSJ Report

 

"How Covid-19 Will Change Aging and Retirement: Among other things, expect more aging in place and a wave of innovation," is the title of the supplement in the November 16th edition of the WSJ.

Aging in Place: Growing Older at Home

More will age at home, or so this report predicts. Here's a good guide from the NIH National Institute on Aging.

Ai-jen Poo is part of the organization National Domestic Workers Alliance. In this report, she's quoted: "40% of Covid-related deaths in the U.S. [are] occurring in long-term-care facilities.,"

Ai-jen Poo

Technology will play a key role for the elderly

"The most dramatic change under way is the growth in tele-medicine, facilitated in part by Medicare's decision since March to expand reimbursement to doctors for virtual visits."

Healthier lifestyles will help support biological age

While age is the considered the primary risk for mortality from Covid-19 , it's better to look at biological age to assess this risk. It will be up to clinicians to help determine this for each patient, and ways to alter behavior.

Elders begin to focus on purpose and better use of their time

This is the main focus of this blog, to help elders lead a flourishing life in the true spirit of the ancient Greek concept of eudaimonia. By having a purpose, whether it be a hobby or a loftier goal of serving others, you can develop the will to overcome the problems the aging, and not distracted by them.

Planning for end-of-life care becomes important

The Conversation Project website talk about the April 16th National Healthcare Decisions Day. They have a special page dedicated to Covid-19 and advance care planning, which includes links to resources in 40 US states.

More savings are needed for retirement

According to some financial advisors, retirees in the past relied on the 4% rule, "which says you can withdraw 4% from your savings in the first year of retirement, and then give yourself an annual raise to account for inflation, without running a big risk of running our of money."

Now, the safe-spending recommendation is between 3 to 3.5%, meaning those who want to retire safely need to save $1.2 million over the previous recommendation of $1 million.

The 401(k) no longer have to highest priority for saving, because in perilous times, it can be hard to withdraw funds before retirement. Instead, employers are now offering a flexible savings account "that lets workers funnel salary deferrals to more than one goal, including emergencies and retirement."

One prediction is that the government will eventually apply the current tax advantage for retirement savings to them.

Lifespans will shorten

For the elderly that succumb to the negative effects of isolation will face a greater risk of "death, cognitive decline, depression and heart disease."

The elderly will work longer

Laura Carstensen, Director of Stanford University's Center on Longevity, is quoted: "There's so much uncertainty about the future... most people are going to continue to work as long as they can."

The WSJ adds, "...the percentage of people 55 and older in the labor force has risen steadily, to 40% in 2019 from 29% in1993, according to the U.S. Bureau of Labor Statistics."

Ageist stereotypes will be challenged

One of the benefits of the stressful times of Covid-19, optimistically speaking, is that ageist stereotypes will be challenged. It's time to dispel the notion that elders are frail and need to be isolated, as the only strategy for the pandemic. As the vaccines emerge from Phase III trials, we will see a more hopeful view for elders.

While elders are often characterized as being more psychologically resilient compared to those younger, it can't be assume that they can face challenges on their own. It may be beneficial for the younger set to embrace the perspective of their older acquaintances to help achieve the wisdom and perspective a long life brings.

Much thanks to WSJ's Anne Tergesen for contributing to this report.

I'll follow up each of these topics in-depth with future blog posts.

Music Training for Seniors

 I tell people, yes, I did take piano lessons for a short while. Then I add it was over 54 years ago.

What got me thinking to make it a better effort this time was my interest in music theory, and the questions that have always bothered me, such as why is the 12 semi-tone scale called an octave, i.e., why the 8 notes selected as the consecutive white keys on a piano for the C major scale. I think I found the best explanation on YouTube and will include it in a later post. (Interesting to note [pun intended] that historically other modes besides the major and minor scales were used: The Medieval Church Modes, Dorian Scales & Mixolydian Scale.) 

I began looking into YouTube posts from which I picked up some finger exercises, but more importantly found some very useful resources:

Leonard Bernstein’s Young People's Concert: "What is a Mode?" with the New York Philharmonic

Rick Beato is a music professor and Rock music studio engineer who provides music theory lessons, but also explores classical music. In one video he expresses his admiration for the 79-year-old pianist Martha Argerich (see next).

(from Wikipedia) Martha Argerich  (born June 5, 1941) is an Argentine concert pianist. Her aversion to the press and publicity has resulted in her remaining out of the limelight for most of her career. She has given relatively few interviews. As a result, she may not be as well known as other pianists of similar calibre. Nevertheless, she is widely recognized as one of the greatest modern-day pianists.

Lisa Witt's Pianote provides an online piano course, which I discovered on YouTube, and I'm currently a member. I'll be evaluating my experience in upcoming blog posts.

I have to thank Dr. Marie Rubis Bauer, Archdiocesan Director of Music and Cathedral Organist at Saint Cecilia Cathedral in Omaha, who sat with me at a grand piano to give me a few pointers on how to restart my music interests.

Anyway, so to begin again I purchase a used 66-key, Yamaha electronic keyboard from the Guitar Center in Danvers, MA. I found this item with an online search and had it sent to me here in Omaha. Kudos to the people who were great in packing and shipping this keyboard:

For music books, I purchased "For the Older Beginner: Accelerated Piano Adventures" by Nancy and Randall Faber.

Another instrument to consider, which I picked up, is the harmonica. It's a good breathing exerciser, and might be beneficial for those with COPD or the elderly in general. 

"BAM-la-nih-VAH-mab" or Bamlanivimab, FDA-approved monoclonal Antibody for Covid-19

 I see physicians online have taken to call this recently-approved monoclonal antibody treatment the "B-word." Just say BAM-la-nih-VAH-mab.

From the November 9th FDA news release: "Today, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients. Bamlanivimab is authorized for patients with positive results of direct SARS-CoV-2 viral testing who are 12 years of age and older weighing at least 40 kilograms (about 88 pounds), and who are at high risk for progressing to severe COVID-19 and/or hospitalization. This includes those who are 65 years of age or older, or who have certain chronic medical conditions."

As Dr. Lawler mentioned in the interview I covered in another blog post, this is an much needed out-patient treatment.

Important to note that the safety and effectiveness evaluation is still ongoing. But so far, "bamlanivimab was shown in clinical trials to reduce COVID-19-related hospitalization or emergency room visits in patients at high risk for disease progression within 28 days after treatment when compared to placebo."

Bamlanivimab has not shown a benefit to patients hospitalized due to COVID-19 or require oxygen therapy, therefore is not authorized for these patients.

The FDA news release goes on to warn: "Monoclonal antibodies, such as bamlanivimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation."

What is a monoclonal antibody? 

"Monoclonal" means that all these antibodies are identical. In the body, an immune response results in the production of a wide variety of antibodies with different binding strengths. You want your treatment antibody to have high specificity or strong affinity for the invading virus.

A very interesting process is used to manufacture these antibodies. The image at the right starts with mouse immunological spleen cells put in contact with the virus or parts of it believed to elicit an immune response.

These cells are then fused with cancer cells, because the myeloma cells used are virtually immortal, growing prolifically in culture through many generations.

This hybridoma is allowed to grow in culture after which cells producing the specific antibody desired are selected. These cells produce the monoclonal antibodies which are harvested and used for treatment.

Dr. James Lawler of UNMC on Covid-19 Vaccine, Treatment and Testing

This morning, on the local talk radio station KFAB, Dr. James Lawler, Associate Professor of the University of Nebraska Medical Center, was interviewed about Covid-19. He mentioned the progress on the vaccine front, saying that the drug companies are now compiling data on the tens of thousands of subjects who took the vaccines or placebo to judge safety signals based on the adverse events. He said the efficacy rates for these vaccines look to be higher than expected.

For current treatment options, Dr. Lawler said that this involves basic supportive care and high flow oxygen or mechanical ventilation when needed. He also said a new, monoclonal antibody product with good efficacy in the out-patient setting will be rolled out across the state. He emphasized that out-patient treatment like this therapy is preferred.

When asked about false negatives in testing, he said that the virus has an incubation period of up to 14 days after exposure. A person getting testing in the early part of the infection might test negative, so the advice is to test after 3 to 4 days from exposure, and then tested again later.

UPDATE: I did get confirmation from UNMC that the monoclonal antibody Dr. Lawler is referring to is bamlanivimab, which has just been approved for emergency use authorization (EUA) by the FDA.

I have another post with more detail on bamlanivimab.