Golden Years

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    • 00:07

      [MUSIC PLAYING][the way we live]

    • 00:32

      EDITH SADEWITZ: Good evening, everybody.Everybody's card's cleared.Let's play Bingo.Here we go for $0.50 a game.[golden years]G 48.G 4-8.G 49.

    • 00:55

      EDITH SADEWITZ [continued]: Very rare, that happens, one number after the other.O 65.O 6-5.B 2.B 2.

    • 01:08

      PLAYER: We have a winner.Bingo.

    • 01:10

      EDITH SADEWITZ: Bingo.We have a winner.Congratulations.

    • 01:12

      PLAYER: Thank you.

    • 01:15

      JAY LUXENBERG: This is not an assisted living facility.This is a nursing home.And there really is a difference in terms of the helpthat people need here.A very high proportion of our patientsneed assistance with very basic activities of daily living.[Jay Luxenberg, MD, Medical Director, Jewish Home] Helpgetting on the toilet.Help bathing themselves.Sometimes help feeding themselves.

    • 01:37

      JAY LUXENBERG [continued]: And so the institution is here to help peoplewith those needs.But what makes it different than other nursing homesis what it is able to offer on top of that.It's able to offer a living environment,so that you're not here to die.You're here to have as good a qualityof life, during the remaining time that you have,

    • 02:01

      JAY LUXENBERG [continued]: as possible.And so to foster that we have activities.

    • 02:07

      EDITH SADEWITZ: There are so many programsthat are offered here.I just was overwhelmed with what is offered.I call Bingo.That's on the lighter side, of course, but it's fun.And that keeps me busy.I am also very much involved and very

    • 02:27

      EDITH SADEWITZ [continued]: much like attending the Psalms, Songs,and Story Writing. [Edith Sadewitz] In this group,we read a psalm out of the bible and we interpretwhat our feelings are.And from that point, we write a song.

    • 02:50

      EDITH SADEWITZ [continued]: I am doing painting here, which is offeredto me, which I am learning.I've never held a brush in my hand before.And they said, you don't have to know.And they say that I'm doing nicely.And I do enjoy it very, very much.

    • 03:07

      CARL ROTHBLUM: I've always done a little artwork--drawing logos and things. [Carl Rothblum]When I came here, the art facility here, the room here,is absolutely fantastic.It's just wonderful therapy.And so I decided I had nothing elseto do with the rest of my life, be a great thing for me

    • 03:27

      CARL ROTHBLUM [continued]: to start to do some painting, which I had never done before.This is absolutely marvelous herebecause the department is so great.You can come and go as you please.This is my life now, and I'm having a lot of fun.

    • 03:43

      DANIEL RUTH: There is a misconceptionthat people come to nursing homes just to die.[Daniel Ruth, President/CEO, Jewish Home]I've been blessed to see, where residents come here and growand develop as individuals, that there'sa real sense of community.At any given time at the Jewish Home, we have writers,people have written songs, poets, artists.

    • 04:05

      DANIEL RUTH [continued]: And they work with the other residents.They help draw those residents out.They help them develop hidden talents.And so when people come to nursing homes, specificallythe Jewish Home, they continue to grow and developas individuals and they contributeto the sense of community that exists here at the home.

    • 04:24

      CARL ROTHBLUM: I'll be 92 in three months.And I've been here 12 years.And it's a great, great senior facility.I think probably the finest senior facility in the UnitedStates, probably the world.And you have to be very fortunate to get here.

    • 04:45

      CARL ROTHBLUM [continued]: So I love my life here.

    • 04:49

      NARRATOR: Not all nursing homes offer the quality of careor the rich array of program at San Francisco's Jewish Homeprovides its 400 plus residents.In large part, the biggest challengefor most such facilities is financial.Attracting and retaining quality staff members,and creating an environment that is both stimulating

    • 05:11

      NARRATOR [continued]: and nurturing, is expensive.

    • 05:13

      JAY LUXENBERG: First step at improving carefor people who need this type of careis to provide adequate resources, enough moneyfor food, enough money for nursing,to pay adequate salaries to staff so that they don't quitand need to be replaced so frequently.On a secondary level, I think one reasonthat we provide better care than most other facilities is

    • 05:36

      JAY LUXENBERG [continued]: our medical staff.I used to run the training program in geriatric medicineat the university.And I hired my graduates.So our medical staff are trained geriatricians.That's really unusual.So that the attention that individual people get here,

    • 05:56

      JAY LUXENBERG [continued]: early in the course of an illness, is wonderful.

    • 05:59

      NARRATOR: At the Jewish Home and elsewhere,meeting the needs of America's growing populationof elderly adults is a challenge that becomesmore pressing every day.This is due, at least in part, to what some have calledthe longevity revolution.

    • 06:15

      LINDA GEORGE: Well, the longevity revolutionrefers to the fact that life expectancy-- thatis the average length of life for American citizens--has nearly doubled since 1900.In 1900, the average life expectancywas right at 47 years.Currently, life expectancy is about 78 years for males

    • 06:40

      LINDA GEORGE [continued]: and about 82 years for females. [Linda K. George, PhD,Duke University] That's a tremendous increase, justan incredible increase.Personally, I think that's the probably greatestaccomplishment of the 20th century.

    • 06:54

      NARRATOR: While the number of elderly Americanshas risen steadily over the past century,there's some disagreement about whether the qualityof their later years has kept pace with the quantity.

    • 07:06

      LINDA GEORGE: Quality of life can be a difficult issueto assess.There are objective indicators of quality of life.Are people healthier?Are people richer?Are people less isolated?On all of those kinds of objective indicators,today's older population is substantially better off

    • 07:26

      LINDA GEORGE [continued]: than at 30 to 50 years ago.Medicare came into being in the middle '60s-- 1960s--and was a tremendous boon to the economic stability of olderadults, not just their health services,but their economic stability in termsof not being bankrupted by out of pocket health care costs.

    • 07:48

      LINDA GEORGE [continued]: The current older population are the parentsof the baby boomers.So they are not isolated.

    • 07:55

      GLEN ELDER JR: I think our health has improved,our nutrition has improved, and so a person who is 75 todaymight look like someone who is 65 20 years, 30 years ago.And in the Midwest, we asked people, what would you saywas the beginning of old age?When does somebody become old? [Glen H. Elder

    • 08:16

      GLEN ELDER JR [continued]: Jr, PhD, University of North Carolina at Chapel Hill]And almost to a person, they said 75.Now 40, 50 years ago, I think that wouldhave been 65 or maybe earlier.

    • 08:28

      JOHN MACIONIS: There are plenty of people who are in their 70sand yet don't consider themselves yet to be old.[John J. Macionis, PhD, Author, Sociology]So it's clear that old age is a time that beginssomewhat later than it used to.And, of course, people are livingmuch longer than they used to.Any generalizations about old agetoday are difficult to make because there are simply

    • 08:51

      JOHN MACIONIS [continued]: too many differences among people of that age group.Many people are active in their jobsright into their 70s or even their 80s.

    • 09:00

      DEBORAH GOLD: The fastest growing group in our populationare the 85 plussers, which is a remarkable thought if you thinkabout it. [Deborah T. Gold, PhD, Duke University Medical Center]And in fact, there's a group of themwho are certain to live to 100 because they stay active,they stay involved, and again their health is good.

    • 09:16

      NARRATOR: While there are more elderly people in the USnow than at any time in the past, and more of themare living active, full lives, long-held stereotypesabout seniors remain largely unchanged.

    • 09:28

      LINDA GEORGE: Common stereotypes of the elderlyare very difficult to combat because thereis, in fact-- as is true, I think,of all stereotypes-- a kernel of truth in them.One of the best ways I know of making sense of stereotypes--where they're wrong and where they are right--

    • 09:49

      LINDA GEORGE [continued]: is the distinction between what we call the young oldand the old old.Old age now, if one uses the conventional definingpoint of age 65, is a very long period of time.It's often 30 years or more.And, really, those 30 years encompass

    • 10:09

      LINDA GEORGE [continued]: a lot of change, development, growth, decline, and so forth.Stereotypes of the elderly as poor, lonely, poor health,isolated have very little truth in general.But they certainly have virtually no truthfor the young old.That is people we might arbitrarilydefine as age 65 to 80.

    • 10:32

      LINDA GEORGE [continued]: And the stereotypes are very damaging because they keep usfrom recognizing that these people are productive.

    • 10:40

      NARRATOR: Stereotypes and misconceptionsabout the elderly are more problematic in the USthan in many other societies where older adults are not onlyvalued but revered.

    • 10:51

      JUDITH TREAS: Some societies have longput an emphasis and a premium on respect for the elderly.[Judith Treas, PhD, University of California, Irvine]And a classic example would be China,with its Confucian tradition of authority and hierarchy.

    • 11:05

      WARREN LIPSON: In some societies,a senior is revered as a storehouse of knowledge,and wisdom, and also as a childcare provider,and passer of traditions to the grandchildrenand great grandchildren. [Warren Lipson, University of SouthernCalifornia] In some societies, the seniorsactually run the societies.

    • 11:24

      DAVID BENNETT: One has always heard of the elders in Africawho come together to make decisions about the communityand are highly respected and their opinionsare sought after.

    • 11:32

      JOHN MACIONIS: In traditional societies,agrarian societies, pre-industrial societies,the oldest people are typically those with the greatest amountof power, often the greatest amount of wealthand the greatest amount of social prestige.The term that those societies use is elders.And elder is a term that has a positive connotation.

    • 11:53

      NARRATOR: Some sociologists contendthat cross-cultural differences in the treatment of the elderlyare directly related to whether a society placesmore value on the individual or on the common good.

    • 12:05

      LINDA GEORGE: And that basically breaks downto Western societies versus eastern societies,such as the Japanese, the Chinese, and so forth.The major underlying ideology of those culturesis that they are collectivistic cultures,that the collectivity is what is important,

    • 12:25

      LINDA GEORGE [continued]: that as an individual in that society,I would suppress my personal desiresand wishes for the greater good of the collectivity.Adult children here often say they reallyoften grapple with the question of how muchdo I owe my parents.To what extent should I really put my life on hold

    • 12:48

      LINDA GEORGE [continued]: in order to care for them?Those questions simply tend not to come upin the collectivistic cultures.That's not a question.You do it.And that will be done for you in turn.

    • 12:58

      DEBORAH GOLD: Well, in those far eastern countries,the oldest son is required to take care of his parentsuntil they die.There's no such thing as a nursing home,or a very, very few nursing homes in Korea.We aren't honoring our elders in this country.

    • 13:14

      NARRATOR: While there are cultural differencesin the way the elderly are perceived and treatedfrom one society to the next, thereare certain changes that take place as people age,no matter where they live-- changes that presentsome very definite challenges.

    • 13:28

      LAURA MOSQUEDA: Without question, poor healthis the biggest challenge any people face as they age.But common diseases in the elderlyare some of the what are called neurodegenerativediseases. [Laura Mosqueda, MD, University of California,Irvine] These are diseases that affect the nervous system,like Alzheimer's disease, like strokes, like Parkinson'sdisease.

    • 13:49

      LAURA MOSQUEDA [continued]: So these are more common in the elderly than in younger people.Heart disease, particularly things like congestive heartfailure where the heart pump isn't working very effectivelyalso becomes more common.

    • 14:02

      NARRATOR: One serious and all to common conditionthat specifically targets the elderly is osteoporosis.

    • 14:08

      DEBORAH GOLD: Osteoporosis is a bone disease,the most prevalent bone disease in the United States,that can affect all the bones in your body except your skull.And it literally means porous or thin bone.And what happens is that-- bone is a very active tissue.We don't think of it that way.We think of it as strong.But in fact, it's being replaced and replenished all the time.

    • 14:31

      DEBORAH GOLD [continued]: Every seven years, your entire skeleton is replaced.When one develops osteoporosis, the cellsthat take away old bone are working fasterthan the cells that are building new bone.And as a result, we have a loss of bone that goes on.The loss of bone itself is not the problem.The fractures that occur from that loss of bone

    • 14:51

      DEBORAH GOLD [continued]: are a problem.

    • 14:53

      NARRATOR: And, in fact, it's a problemthat's more widespread than is generally understoodby most members of the public, whooften assume that only Caucasian women are at risk.

    • 15:04

      DEBORAH GOLD: Just about everybody in the United Stateswho's over the age of 21 is at some risk of osteoporosis.It is a myth that this is an old white women's disease.One in five people with osteoporosisis male, for example.And African-Americans, Latinos, Asiansare all at substantial risk of this disease.

    • 15:24

      DEBORAH GOLD [continued]: So it's something we're trying to enlighten peopleabout and have them recognize that this is a terriblydebilitating disease.

    • 15:33

      NARRATOR: While physical ailments do present challengesto the elderly, in many cases thereare ways to eliminate or greatly reducethe severity of many such ailments,including osteoporosis.

    • 15:44

      DEBORAH GOLD: The presence of calcium and vitamin Dis critical.And everybody needs to be gettingsomewhere between 1,200 and 1,500 milligrams of calcium.Most of us don't.The second thing is exercise-- weight bearing exerciseand strength training exercise.And I know when I say weight bearing to audiences,they have a vision of this heavy set of weights

    • 16:05

      DEBORAH GOLD [continued]: that people have to lift above their head,but in fact walking is the very best weight bearing exercisethat you can do.And then medication when appropriate.

    • 16:16

      NARRATOR: Along with the physical changes thatcome with aging, there are sometimesaccompanying emotional issues that also present problems.In many cases, for example, older adultsare troubled by a gradual loss of independence.

    • 16:29

      DEBORAH GOLD: As we grow older, we're no longer able to drive.Sometimes we're no longer able to be functional, go outand do our shopping and take care of ourselves.That's embarrassing.That's humiliating.In addition to being a problem that wehave to solve with money, which is not somethingmany older people have.

    • 16:47

      LINDA GEORGE: I think the major challengesat the individual level for older adults are,in fact, health and economics.The greatest fear and worry of older adultsis that their money will not last for their lifetimeand that they will become economically dependent, perhapsphysically dependent as well, but economically dependent.

    • 17:10

      NARRATOR: One of the most pressing concernsof older adults is whether or notthey'll be able to afford the care and assistance that maybecome necessary as they age.But in many cases, their anxiety extends beyond simply money.

    • 17:24

      FRANCESCA CANCIAN: I don't know anyonewho wants to spend their last days in one of those homes.I think it's a real panicky fear for people to thinkthat's what's waiting for them.On the other hand, the old systemwas to have the family do it.But guess who that was. [Francesca Cancian,PhD, University of California, Irvine] It wasn't the family.It was the women doing it.

    • 17:44

      FRANCESCA CANCIAN [continued]: So it was the woman, maybe having a bit of a job,feeding her kids, taking care of her relatives,and his relatives.So the old system wasn't that great either.

    • 17:55

      LAURA MOSQUEDA: Families continueto play a very critical role in the care of disabled olderpeople.At the same time, we have a numberof programs, which also assist families,from Medicare, Medicaid, various social services,senior centers, home health care agencies, and the like.

    • 18:16

      LAURA MOSQUEDA [continued]: Perhaps the difficulty is we have too many programs thatassist older people.We have a balkanization of servicesthat are difficult to access and difficult to coordinate,each with their own eligibility and benefit criteria.And so we haven't figured out howto have a seamless service that helps link families

    • 18:36

      LAURA MOSQUEDA [continued]: and communities and the broader society together,all in providing a coordinated support of an older individualwho's in need of help.

    • 18:47

      NARRATOR: In the case of the Jewish Home and its residents,that critically important coordinated supportis provided, pieced together from a variety of sources.

    • 18:57

      JAY LUXENBERG: 85% of the residents heredon't have the money to pay for care.[Jay Luxenberg, MD, Medical Director, Jewish Home]So they are under our state's Medicaid program.In California, they call it MediCal.And the amount of money that MediCal paysis between $10,000 and $12,000 a year less than what it costs.

    • 19:19

      JAY LUXENBERG [continued]: And since it costs more money to provide the care than weget from the state, we need to make that difference upin charitable donations.

    • 19:28

      DANIEL RUTH: The Jewish Home with San Franciscois really unique and is in a very fortunate positionto have the level of community support, philanthropic support,that allows it to provide the diversity of programs, thatallows it to provide a level of care and staffingthat is unsurpassed in most of the nursing homes.

    • 19:49

      DANIEL RUTH [continued]: If we were to only rely on the level of governmentsubsidization and reimbursement, wewould not be in a position to provide the kinds of programsand services and facilities that we areable to offer to our community.

    • 20:04

      NARRATOR: But even with all the resources available here,including a dedicated and nurturing staff, residentsof the Jewish Home like aging adults everywhere,must cope with a variety of difficult issues.Among the most challenging is the realitythat their lives are coming to a close.

    • 20:22

      LINDA GEORGE: American society is not a societythat likes to confront death.Compared to other cultures, for example,we exhibit higher levels of death anxiety,of wanting not to talk about it-- either in general,in terms of public dialogue or personallyin terms of our own personal hopes, fears, wishes.

    • 20:44

      DEBORAH GOLD: The fact that we havethis expectation that physicians can cure anythingis also a problem. [Deborah T. Gold, PhD, Duke UniversityMedical Center] So we see people bringing in 95and 100-year-old patients who've been demented for years, whohave kidney failure and whatever else,and they want and dialyzed and kept alivebecause that's important.To me, quality of life is really the entire message.

    • 21:06

      DEBORAH GOLD [continued]: And if you want to sustain life, youshould be sure it's a quality that peoplewill want to live with.

    • 21:13

      LAURA MOSQUEDA: A lot of the moneythat we spend on the elderly, especially with fancy testsand procedures that occur in the last year or two of life,wouldn't happen if we spent more time talking to people,understanding their values and what they want.We waste a lot of money doing things that people

    • 21:33

      LAURA MOSQUEDA [continued]: didn't want done anyway.

    • 21:36

      NARRATOR: At some point, whether last minute medicalintervention has been brought to bear or not,the inevitability of death becomes undeniable.Ideally, decisions have already beenmade about what to do once this point is reached.

    • 21:50

      ALEX CAPRON: The real issue is being stimulatedto talk about this with your physicianand get some sense of the things you should be thinking about,the kinds of choices that might arise.And then being able to talk with a spouse or your childrenand so forth about that so that-- it'll neverbe easy for them, but that it would

    • 22:12

      ALEX CAPRON [continued]: be easier if they had some sense of what your wishes wereand they had talked it through.

    • 22:18

      WARREN LIPSON: And I think it is important,while you're mentally with it and younger,to set down advance directives-- what you do not wantand what you do want done with yourself if youshould be incapacitated.And also set up a durable power of attorney with peoplenot only who are relatives, but people whohave like minds as yourself.I've seen situations where the senior obviously

    • 22:40

      WARREN LIPSON [continued]: had certain wishes, and the personwho had durable power of attorneyhad ethical, religious, and moral differenceswith what that person wanted.And that's a very difficult situation.So in addition to having fairly defined advance directives,I think having a durable power of healthcare in the hands of someone who knows exactly where you're at,

    • 23:00

      WARREN LIPSON [continued]: I think is extremely important.People aren't going to live forever.And people want to have dignity when they die.And sometimes putting someone in intensive care unitfor a period of time with tubes in themis not what they had in mind.

    • 23:15

      DAVID BENNETT: I think that in the United States,we have the belief-- the firm belief--that we should have access to the very best serviceswhen we should want them.And I think it's a relatively new recognitionthat perhaps people might not wantto have the ultimate measure applied to save themin their last days.

    • 23:36

      NARRATOR: Unfortunately, however, in some casesthe dying person's wishes are ignored.

    • 23:42

      GREGORY WEISS: In many situations,in hospitals, if a physician is dealing with a patientand there is a living will, and the living will clearlyspells out this patient would like treatmentto be stopped at this point, but the surviving familymembers disagree and urge the physicianto continue treatment, in almost every case

    • 24:03

      GREGORY WEISS [continued]: the physician continues the treatment.This is contrary-- completely, of course--to the idea of patient autonomy, to the idea of an advancedirective.Physicians would say that they aretrying to do the compassionate thing hereby tending to the wishes and desires of surviving family

    • 24:24

      GREGORY WEISS [continued]: members.It's clear they're probably also concerned about lawsuits.The dying patient is not going to file a lawsuit.The surviving family members might.

    • 24:35

      NARRATOR: Even when there are no disputes about how a person'slife should end, there's no way to minimizethe fact that death is not somethingmost people look forward to.But the experience of growing olderis nonetheless often a rich and rewarding time of life,or at least it can be.

    • 24:53

      DANIEL RUTH: Sometimes when people look at older adults,they can't get past the wrinkles, and the grey hair.

    • 25:01

      JAY LUXENBERG: One thing that's very, very importantto keep in mind is that in spite of their physical appearanceand in spite of their chronologic age,older people feel like they're younger people.They're us.

    • 25:14

      DEBORAH GOLD: Most of the cities in North America put fluoridein their water to help kids' teeth.I would love to be able to put somethingin the water that would make people recognize that our olderadults are the best natural resource we have.I think if we can enable more older whoare healthy to stay in their jobs, to be active

    • 25:35

      DEBORAH GOLD [continued]: and participating members of communities, churches, schoolsystems, et cetera.And if we can teach the kids about howwonderful grandparents and great grandparents can be,we can make a change here.[MUSIC PLAYING]

    • 26:26

      NARRATOR: the way we live is a 22 part series about sociology.For information on this program and accompanying materials,call 1-800-576-2988 or visit us online.

Golden Years

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Abstract

This documentary focuses on the golden years and lifestyles common to the elderly American population. Interviewees discuss the differences between elder care in America and other countries, with an emphasis on stereotypes of elderly. Elder care has a strong focus on quality of life, changes that occur during the aging process, and coordinated support to ensure the best end-of-life care.

Golden Years

This documentary focuses on the golden years and lifestyles common to the elderly American population. Interviewees discuss the differences between elder care in America and other countries, with an emphasis on stereotypes of elderly. Elder care has a strong focus on quality of life, changes that occur during the aging process, and coordinated support to ensure the best end-of-life care.

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