Internship on Age-Friendly Cities Initiative

Internship with the World Health Organization’s Global Network of Age-friendly Cities

In January, 2013, I started a 3-month internship with the World Health Organization Regional Office for Europe. I will be working on how to incorporate eHealth in the Age-friendly cities initiative. I will be posting some updates here on how the internship is going and how gerontechnology will be playing a role in Age-friendly cities.

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8 Smart Ideas for Aging in Place

 |  By : 03/05/2015 

For related information, see my post on my work with the WHO on the Global Network of Age-Friendly Cities.

Baby boomers have long proclaimed their desire to stay in their homes post-retirement, a practice known as aging in place. They want to stay in the communities where they have friends, know their way around and have a support network. Cities and communities have “heard” them and many places are preparing for the groundswell of what happens when their residents creep up in years. Building a senior citizen center is nice, but clearly there’s more to it than having a place to play Bingo. Here are a few of the programs and trends that are making a difference in the lives of the nation’s aging population.

1. Solve the “driving is my independence” problem once and for all.
Older drivers have slower reaction times and more vision issues. Per mile traveled, fatal crash rates increase starting at age 75 and increase notably after age 80, according to the Centers for Disease Control. But the ability to drive is synonymous with independence and independent living, so many older people are reluctant to give up their automobiles.

Twenty years ago, inspired by a desire to keep unsafe drivers off the road after an 84-year-old motorist struck and seriously injured her toddler son, Katherine Freund started the Independent Transportation Network. ITN was launched in Portland Maine and has now spread to 25 cities. People who are 65 or older (or visually impaired), pay a modest fee and are provided a ride to where they need to go, a door-to-door escort and assistance. Forty-six percent of ITN customers have an annual income of less than $25,000 and only 2 percent found the service too expensive.

Best of all, seniors can trade in their cars and earn ride credits. Rides are available 24 hours a day, 7 days a week, for any purpose.

2. Acknowledge the need to sit down.
Age-Friendly NYC wants to encourage older adults to get out to walk, shop and socialize. So the goal of this program is to install 1,500 park benches throughout the city for people to sit on. Before you scoff, remember that New York is the city that doesn’t sleep. It also doesn’t stop and rest much. There are 1 million people over 65 living in NYC, and by 2030 this number is expected to increase by 50 percent, according to the program’s website. Age-Friendly NYC also connects older New Yorkers to opportunities at NYC-area colleges and universities.

3. Make it easy to keep the brain active.
The Bernard Osher Foundation has established Lifelong Learning Institutes for adults 50 and older on 119 college and university campuses. Many community campuses allow those 65 or older to audit free uncredited courses.

Publications are printing more large print books too. Large-print crossword puzzles and word-solving games are also available.

4. Understand that eating healthy food keeps people healthier.
While everyone knows about Meals On Wheels, which delivers already prepared meals to shut-ins, not everybody wants to stop cooking for themselves. Buying groceries though can involve the need to drive and/or carry heavy bags home. In 2014, the Food For Free programs in Cambridge Massachusetts distributed 1.5 million pounds of food. It began its home delivery program in 2001, serving 12 clients that first year. Now it’s up to about 100 housebound elders. It gives seniors and people with disabilities more control over their meals, while providing a supportive service that helps them to stay in their own homes, says the group’s website. Two 40- to 45-pound food deliveries are made each month to clients and half the food delivered is fresh produce.

And there’s Mom’s Meals, which for less than $7 a meal will deliver freshly made meals that just need to be heated up and can keep up to 14 days. Mom’s Meals ships by FedEx and offer menus for diabetics and heart patients, vegans and those who are gluten-free.

5. Doctors who make house calls.
While doctors making house calls used to be a common practice a few decades ago, it’s practically unheard of now. But it’s enjoying a second life in North Carolina. Doctors Making Housecalls is a medical group of 52 clinicians who make more than 75,000 home visits a year in private residences, retirement communities, apartments and assisted living facilities in North Carolina. This is an idea that’s bound to spread, along with some routine medical procedures being handled online.

6. Encourage the building of more lifelong housing.
Rogue Valley, Oregon, has a “lifelong housing” certification program whereby home builders and sellers can have their homes certified as such. The checklist of desirable housing features includes a no-step entry, a first floor full bath, etc. The certification levels are noted in MLS listings so homebuyers seeking age-friendly/multi-generational housing can more easily find appropriate housing and housing creators will hopefully be more encouraged to create age-friendly housing, says AARP.

7. Build a park and they will come.
A vacant field in Wichita, Kansas, was turned into a grandparents park — an outdoor space that children and grandparent (caregivers) could enjoy together. http://www.aarp.org/livable-communities/info-2014/grandparents-park-wichita-kansas.html

8. Help keep people active.
Brownsville, Texas, has a very poor, overweight population with high diabetes rates. One in four residents is age 50 or older. The city hosts several “CycloBias” a year in which streets are closed off to cars so that people can walk, bicycle and participate in health-targeted activities.

The World Health Organization and the Global Alzheimer’s Movement

I came across a short article on the US Against Alzheimer’s website, where they pose the question:

Can WHO Lead the Global Alzheimer’s Movement?

And I was relieved they asked it! I had also been thinking about this over the past week but had been hesitant to post about it. I guess I didn’t want to seem jaded since my internship with the WHO on the Global Network of Age-Friendly Cities was a bit on the disappointing side. But, I am glad to see I am not the only one who is skeptical about the WHO leading a global Alzheimer’s movement. Wait…

…I am going to call it a dementia movement. Alzheimer’s disease is the most common type of dementia. But, around 50% of people who meet a dementia diagnosis criteria don’t ever get a diagnosis, so we can really only say that Alzheimer’s is the most diagnosed type of dementia. There are many people who do not have Alzheimer’s disease and will benefit from this movement…

Back to the WHO. They are certainly a global leader in addressing health issues and health promotion, and that the work they do is challenging and important. But large scale, challenging, and important work occurs over a long-term of research, planning, and implementation. Shaping policy and all the work that goes behind that takes a long time. This will be a great help – large scale, challenging, and important work that will affect MILLIONS of people. They can affect the movement in their own way, but I hesitate to call them THE leaders.

In addition to the long-term project cycles, and to the criticisms in the article below, I also wonder:  Isn’t there already a global dementia movement?

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Crowd-sourcing age-friendly locations

AGE-CAP (AGE-FRIENDLY COMMUNITIES ASSESSMENT APP)

 
The Intelligent Assistive Technology and Systems Lab (IATSL) at the University of Toronto (Department of Occupational Science and Therapy) has developed a smart phone app to create a crowd-sourced database of age-friendly locations, called Age-CAP. They are a multi-disciplinary group of researchers (engineering, computer science, occupational therapy, speech-language pathology, and gerontology) who aim to develop zero-effort technologies (technologies that require zero effort from the “user”) that are adaptive, flexible, and intelligent.
You can read more about their work (and participate in a research study in the Toronto area) on their website.

Age-CAP is a cross-platform smart phone application which aims to create a crowd-sourced database of age-friendly locations. It consists of survey-style forms which allow users to quickly rate the age-friendliness of a location or service. The criteria for rating was developed using the World Health Organization’s Global Network of Age-friendly Cities guidelines (which I also worked on during my internship with the WHO in Copenhagen), and age-friendly community initiatives in other North American cities.

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Aging and the Life-course

Report on life-course theory

I was asked to attend a WHO meeting on life-course theory as part of my internship with the World Health Organization’s Regional Office for Europe. While I was there, I was working on the topics of eHealth and the Global Network of Age-Friendly Cities (and trying to bridge the two). I was working in the Division of Non-communicable diseases and health promotion – Ageing, disability and long-term care. The team I was part of worked on the full spectrum of life, from before conception to aging, all with a focus on health promotion and reduction of non-communicable diseases.

This particular meeting was a brainstorming session on how the WHO is using the life-course perspective to address health promotion. I was particularly excited to attend because of my background in psychology and gerontology, where life-course theory has it’s roots.

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Telehealth terms defined

Glossary of telehealth terms

I drafted this glossary as part of my internship with the World Health Organization Regional Office for Europe. There, I was working on the topics of eHealth and the Global Network of Age-Friendly Cities (and trying to bridge the two). Much of this material, I first gathered when I was teaching a Master’s Engineering course on Telemedicine Techniques and Aspects for Aalborg University Department of Electronic Systems in 2010.

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A Brief History of Telemedicine

A Brief History of Telemedicine

I compiled this with my internship report for the World Health Organization Regional Office for Europe, as a part of my work on eHealth and the Global Network of Age-Friendly Cities. Much of this material, I first gathered when I was teaching a Master’s Engineering course on Telemedicine Techniques and Aspects for Aalborg University Department of Electronic Systems in 2010.

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Alzheimer’s disease death rate by state

A look at the most common causes of death by state

Article By 

Two months ago, I wrote about the fun and the pitfalls of viral maps, a feature that included 88 simple maps of my own creation. Since then I’ve written up a bunch of short items on some of those maps, walking through how they can both illustrate great information and hide important details. At one point, I said I was done with these. Well, I wasn’t. Here’s another, on death. Enjoy!

The data used to create the table below are from a 2008 CDC report that’s based on numbers from 2005. Ideally, we’d have more up-to-date information, but their page on mortality tables indicates that there’s nothing more recent on state-by-state causes of death.

Blatt_Death_1

Data source: Centers for Disease Control and Prevention. Map by Ben Blatt/Slate.

How communities can help people with dementia

In the professional side of dementia care, there has been a push in recent years to reduce the stigma associated with having dementia and being a caregiver for someone with dementia. This is often referred to in the academic literature as “normalizing dementia,” or making it more normal for people with dementia to be part of their communities. On the large-scale end, the World Health Organization has formed a Global Network of Age-Friendly Cities (which you can read more about in my post on my Internship on Age-Friendly Cities), which sets guidelines, milestones, and recommendations for communities who would like to be part of the network (you can read more about that here). While the focus is not on dementia only, guidelines and policy making are a step in the right direction so that citizens and residents of all ages and ability levels can truly be a part of their community.

5 Crucial Ways Communities Can Help People With Dementia

What would you think of a community that acknowledges the potential of people who have dementia? What about a community in which business and service workers have the skills to help people with dementia use their services safely and successfully?

Communities in the US and the UK are doing just that. In a town in Wisconsin, local businesses have formed the Watertown Dementia Awareness Coalition. Employers are working to make their environments “more dementia friendly and easier to navigate for a person with memory loss.” Employees are getting awareness training, and people with dementia are attending Memory Cafes, or gatherings filled with laughter, learning, and friendship.

In England, East Staffordshire is set to become dementia friendly. One of 20 communities that the UK’s Alzheimer’s Society is working with to be more inclusive of people with dementia by 2015, the district aims to provide people with sensitive care and support. A hospital in Burton has a head start: Staff at Queen’s Hospital have been recognized for improving their care of people with dementia, and each ward has a dementia champion who works with staff to help them understand and honor the needs of people living with condition.

Building Dementia-Friendly Communities: A Priority for Everyone, a guide from the Alzheimer’s Society, outlines a number of ways in which any community can better support people with dementia. Methods include ensuring that:

  1. People have access to early diagnosis and support.
  2. Health and social care services deliver sensitive care.
  3. People both at home and in care have access to all the help they need.
  4. Transport services and professionals are consistent, reliable, and respectful.
  5. Leisure and entertainment activities are inclusive and accommodating.

Here, you can find more resources to help you provide high-quality dementia care.

The biggest barriers for taking dementia on vacation

We all enjoy getting away and having a break from the normal day-to-day. Including people with dementia.

Typically, the largest barriers for taking someone with dementia on vacation or other travel include:

  • Mobility difficulties, like getting in and out of vehicles
  • Anxiety, not knowing where they are going or why
  • Care issues, that they need full-time care while on vacation
  • Financial constraints, because it is expensive to hire a caregiver to come on vacation with them
  • Lack of appropriate places to go on vacation, because people with dementia will have different needs than a traditional vacation spot – stairs or uneven surfaces, confusing hallways, bathrooms that are too small, crowds, and over stimulation are very real concerns when taking a person out in a community

These are some of the primary concerns that caregivers and family members have when planning a getaway with someone with dementia.

But, there is hope!!

Trees in Nørresundby Kirkegård

Trees springing to life in Nørresundby cemetary

Many researchers and professionals who deeply care about making life better for people with dementia (myself included!) are working on ways to keep them integrated into the family and society. There are even international efforts to promote that places be accessible for all people – including those with dementia.

And you can help!

Since there are very few places that are designated as vacation destinations for people with dementia, most of our understanding on the barriers to vacations with dementia are based on what families and caregivers find out the hard way. If you have been on a vacation or traveling with someone with dementia, I would really appreciate if you shared your experiences. If you are thinking of traveling with someone with dementia, I would also appreciate if you shared your concerns and hesitations. Even though I have worked as a caregiver for several years, I know that the full-time, family caregivers (often a wife or daughter) are the true experts in dementia care.

Speaking up about dementia, sharing our experiences, and voicing our concerns are one of the fastest ways to break down stigmas surrounding dementia and caregiving AND to ensure that services designed for them are addressing the real issues.

AgeCAP is an app that is being developed so that users can rate the age-friendliness of a location or service. Users can also read the ratings to find suitable places. (I have downloaded this app for Android and it doesn’t seem to be fully functioning yet – I will be sure to update this post once it is). You can read about their work (and participate in a research study in the Toronto area) on their website. Age-CAP is a free download in iTunes and Google Play (the links will take you directly to the app).

Age-CAP is a cross-platform smart phone application which aims to create a crowd-sourced database of age-friendly locations. It consists of survey-style forms which allow users to quickly rate the age-friendliness of a location or service. The criteria for rating was developed using the World Health Organization’s Global Network of Age-friendly Cities guidelines (which I also worked on during my internship with the WHO in Copenhagen), and age-friendly community initiatives in other North American cities. Users are also able to browse submitted ratings to assess the age-friendliness of locations in their neighborhood, providing them with information that would otherwise be unavailable.

You can read more about the World Health Organization’s Global Network of Age-friendly Cities and the cities that have joined. Heck, if you want to really make a difference in the lives of others, write your local mayor and suggest your city join the network!

“An age-friendly environment fosters active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age”

Similarly, the AARP has a guide on age-friendly communities, and serves as the coordinating point for the USA in the Global Network of Age-friendly Cities.

Dementia Adventure (no connection with this blog, other than a passion for improving the lives of people with dementia) is an organization that lists dementia-friendly venues (all in the UK, for the moment). They also offer consulting and training services, so that locations can become more dementia-friendly. Truly, a up-and-coming social service!!

Thanks for reading this post, and please take a minute to answer the poll or to post your experiences and concerns in the comments. I will even get the ball rolling…..

When I was a caregiver in Denmark, we (myself and another caregiver) accompanied the woman on holiday in Spain. It was a great trip, we had a lot of fun, enjoyed getting away and seeing new things, trying new foods, watching new people. The largest barrier we faced was that many places weren’t wheelchair accessible. This meant we had to lift the chair up stairs to get into restaurants or bathrooms, carry the person up flights of stairs and then go back down for the wheelchair and luggage, and we even found the elevators were out of order at the train station when we first arrived! (This was one time when Danish women were a little happy for the Spanish machismo) – After about 3 flights of stairs and another 3 to go to get above ground, I welcomed the help! Looking back, I would do it all over again. We all had a good time and these challenges in public spaces are kind of part of the job – plus they really opened my eyes to barriers I hadn’t noticed before. It was hard work, but there were no major meltdowns, no one got sick, and no one was any worse for the wear. We all had a good joke that we “needed” our nightly ice cream so we didn’t work ourselves to the bone 😉