Empathy in Healthcare

Would you describe yourself as a person with empathy for supporting emotional needs of others? Were you born with this ability? It may surprise you to know that you were not. This fundamental force of morality, this psychological phenomenon is actually a learned behavior. Scientific testing with animals, infants, adults and robots suggests that empathy viewed as an automatic process that catches the feelings of others is actually constructed in the course of development through social interactions, not through genes.

The ability to empathize is especially important in healthcare professions where biases can contribute to healthcare disparities. Sometimes the bias is overt, even intentional. Other times, it is done implicitly, unconsciously, but still doing harm. Healthcare providers must be able to better recognize situations where they can offer empathy in addition to problem solving. Patient care is more than just physical healing. Good healthcare includes building a connection that encompasses a patient’s mind, body, and soul. It includes standing in someone else’s shoes, feeling what that person feels, and responding in the appropriate manner.

One way of learning empathy in general living is by consciously putting yourselves in the position of others in an effort to better understand what they experience. Older adults are a growing population that more people are having contact with as caregivers and in general living. By simulating the experiences of many older adults, everyone and especially young people can develop deeper understanding of various issues of old age that they may not have considered. This helps them develop more empathy for the older adult population and a better understanding of how they can navigate their own aging.

Frances Shani Parker is author of Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes available in paperback and e-book editions in America and other countries at online and offline booksellers. Her blog is Hospice and Nursing Homes Blog. Visit her website at http://www.francesshaniparker.com.

Social Robots: Caregiver-Older Adult Senior Evaluations (Research, Video 2: 54)

Before I begin sharing the wonders of social robots used to support caregiving, allow me to address any concerns you may have about robots replacing people or not being that important. Robots can’t replace people, but they can provide services that allow people more time to be caregivers. They give care recipients more opportunities to be supported and stimulated in daily living activities. They allow technology to accurately assess and evaluate their progress. Robots help older adults with dementia gain a degree of independence that encourages them to complete activities. 

But probably the best evaluators of how successful social robots can be are older adults and caregivers themselves. That’s when research such as this can be valuable. This research review on social robots aims to summarize the effectiveness of social robots on outcomes (psychological, physiological, quality of life, or medications) of older adults from randomized controlled trials. Eight databases were electronically searched including a total of 13 articles from 2,204 articles with these results:

1.    Social robots appeared to have positive impacts on agitation, anxiety, and quality of life for older adults.

2.    Results from a narrative review indicated that social robot interactions could improve engagement, interaction, and stress indicators, as well as reduce loneliness and the use of medications for older adults.

3.    Social robots appeared to have the potential to improve the well-being of older adults, but conclusions are limited due to the lack of more high-quality studies.

What kind of role will robots have in the future of older adults?  In this video, Rudy the robot is designed to be more affordable, to help around the house, be an interactive companion, and generally help older adults stay in their homes so they can be more independent. Here’s Rudy!

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

Unbefriended Older Adult Seniors (Research, Video 3:02)

Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended. Being unbefriended jeopardizes a fundamental concept of American healthcare. These adults require public guardians.

Available research on unbefriended older adults in Canada and the United States is very limited. In fact, no Canadian studies or reports were located. Three things we do know about them are these: Unbefriended older adults are childless or have fewer children, are more cognitively impaired, and are older than older adults who were not unbefriended. We also know that more research on them is urgently needed.

Unfortunately, the process for making decisions on behalf of unbefriended patients is complicated and varies throughout the country. An example is this case of an unbefriended hospital patient admitted with cardiac arrest. The patient suffered significant brain damage and was in a vegetative state. This case occurred in a state where, unless an unbefriended patient will imminently die despite medical therapy, all measures must be taken to prolong the patient's life. With no surrogate with whom healthcare professionals could have a goals-of-care discussion, they were obligated to continue aggressive management despite knowing it would prolong, but not improve the patient’s condition. Prolonging life included a feeding tube and being transferred to a long-term care facility.

The importance of having early healthcare discussions regarding treatment and written advance directives including a surrogate (durable power of attorney) to make medical decisions cannot be stressed enough. If you were dying right now, would you be unbefriended? Would you be protected from overtreatment or undertreatment? Dr. Eric Widera explains solutions to this problem in this video brought to you by members of the American Academy of Hospice and Palliative Medicine.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog

When Older Adults, Seniors Want to Die (Hospice Nursing Home Story, Research)

Some people think being around dying patients must always be sad because everybody fears death, and no one really wants to die. As a hospice volunteer, I have had several patients who could prove them wrong. These nursing home residents actually stated they looked forward to death and gave reasons that had nothing to do with depression. This is what hospice patient Rose said to me about her upcoming death:

“How old did you tell me I was?” Rose asked.

“You’re ninety-nine, and you’ll be a hundred years old on your next birthday.”

“A hundred years old is too old. I don’t think I want to be that old.”

“There are three other ladies in this nursing home who are older than that. One is a hundred three. We talked to her last week during your wheelchair ride.”

“How much longer will it be before I make a hundred? I don’t know if I want to wait too much longer.”

“It’s only one more month. I remember you said you had spiritual talks with your minister. If you decide to wait, I’ll get you a big balloon that looks like a birthday cake.”

“I guess I could wait. Yes, I think I will wait. That way I can celebrate my hundredth birthday. When I do get to heaven, I can tell everybody I lived to be one hundred.”

And that’s exactly what she did.

(Excerpt from Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes)

But wanting to die is not always that simple. According to this VU University Medical Center research study in Amsterdam about older adults’ death thoughts and wishes, 81.3% never had them. Among those who did, 67% had depressive symptoms, and 20% suffered from a depressive disorder. Wanting to die was associated with depressive symptoms, a depressive disorder, lower perceived mastery, financial problems, loneliness, small network, involuntary urine loss, being divorced, and having a speech impediment.

What can we learn from this research? Certain situations increase the likelihood that an older person wants to die. Although the desire to die may not be related to depressive symptoms, depression should be cause for investigation about death wishes and should be treated.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Nursebot Pearl, a Robotic Assistant for Older Adults (Video 5:21)

Meet Nursebot Pearl, a robot that will make you rethink your vision of how a caregiver can look and interact with you. Whenever I mention the use of robots for improving the quality of life of older adults, someone feels compelled to remind me that robots can’t replace people. I totally agree. But the reality is that people are living longer, and the population of older adults with ongoing health concerns continues to increase. Those living at home with chronic disorders are particularly in need of support that robotic technology can provide.

Several years ago, researchers from the University of Pittsburgh and Carnegie ‎Mellon University started the Personal Robotic Assistants for the Elderly project, an inter-‎disciplinary multi-university research initiative focused on robotic technology for the ‎elderly. The project goal is to develop mobile, personal-service robots that assist older adults suffering from chronic disorders in their everyday lives. Pearl continues to be researched and improved. The National Science Foundation funds her development.

A talking robot, Pearl’s face has interchangeable parts that display various emotions. Among many tasks, she can help seniors maintain their independence by reminding them about hygiene, medications, doctor’s visits, and other important information they might forget. She can send information remotely to caregivers and provide needed strength for manipulating objects. A major benefit for older adults living alone is the social interaction they can enjoy in her company.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Volunteer Program for Older Adults: RSVP (Retired and Senior Volunteer Program, Video 3:45)

Years ago, I shared a conference keynote speaking engagement with Arun Gandhi, Mahatma Gandhi’s grandson. Although we had not met before, we both spoke highly and at length about how our grandparents’ example had inspired us to embrace service.

Mahatma Gandhi was the spiritual leader of India during the Indian independence movement against foreign domination. He implemented a nonviolent philosophy of civil disobedience that inspired civil rights movements globally. Growing up in apartheid South Africa, Arun Gandhi had already learned from his grandfather the power of transforming the opponent through love and suffering.

My grandmother modeled service in her daily living. I observed her caring for others many times in ways such as giving food to strangers who knocked on her door. I recall comments some observers made about how she was being used, and she shouldn’t be giving her food away to strangers. But I saw her smiling as she looked out the window and watched recipients gobbling up her sandwiches and fruit. And she kept right on giving, never knowing that one day her granddaughter would praise her on something called the Internet. If she were alive today, she would be telling everybody at her church.

Thank goodness for all the older adults who continue to strive to make the world a better place by giving service to others. Fortunately, they don’t have to look far to find an organization like RSVP that can channel their enthusiasm into volunteer programs where their many skills can be matched appropriately with others’ needs. RSVP means Retired and Senior Volunteer Program. This federal program, which partners with local agencies across most states, is administered locally by both public and private organizations that serve the public in some way. Because of the wide range of services available, over 500,000 RSVP volunteers choose services they feel confident and comfortable in doing. Free training is included when necessary.

Of course, true service is always a win-win opportunity. Volunteers benefit with improved self-esteem, better health, more social interactions, and more learning experiences. They can also get reimbursed for some job-related costs. Research studies indicate that volunteering leads to a more positive mental attitude and to a longer life. This video explains the many services and rewards of volunteering with RSVP:

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Fears of Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults: Healthcare Staff Training and Housing (Research, Video 5:11)

Lesbian, gay, bisexual, and transgender (LGBT) older adults living in nursing homes, long-term care, assisted living, and even those receiving home care from healthcare workers have increasingly been discriminated against and abused by staff and fellow residents. Damage to their emotional and physical health has been so devastating that some LGBT residents have resorted to suicide.

In a study at Yeshiva University in New York, elderly participants in community and long-term care settings reported the following fears:

1) Fear of being rejected or neglected by healthcare providers, particularly personal care aides

2) Fear of not being accepted or respected by other residents

3) Fear of having to go back into the closet and pretend their sexual orientation is different

Important solutions to this problem include a national drive to train long-term care providers in equitable and compassionate care. University of Iowa findings from a nationally representative mail-in survey of over a thousand nursing home and social service directors revealed that three-fourths of the sample had not received even one hour of homophobia training over the past five years. Directors with the most experience reported having the least training. More development and dissemination of homophobia training is critically needed along with policy changes that positively impact the quality of life of LGBT older adults.

A move for separate, but equal housing is another solution that has been implemented to counteract the inequities many LGBT seniors experience. The nonprofit, 104-unit Gay and Lesbian Elder Housing (GLEH) Triangle Square in Los Angeles, California is the first affordable housing facility for lesbian and gay seniors. “A Place To Live - The GLEH Triangle Square Story,” a film by Carolyn Coal and Cynthia Childs, chronicles the journey of seven seniors attempting to secure a home there before it opened a few years ago.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Older Adults/ Seniors and Technology Stereotype (Research, Video 2:58)

What percentage of adults over age 65 use the Internet? If you’re like most people, you may have bought into the stereotype that the percentage is very low. Actually, 42% of adults over age 65 use the Internet. This statistic has increased 11% over the past year and continues to grow.

What are they doing on the Internet? Young people might say they are looking for sales on walkers or Viagra sources. They could be right, but older adults are looking for so much more and finding it. I personally know an older adult who has found love on the Internet twice at a matchmaking website. Researchers at the Georgia Institute of Technology report that older adults’ positive attitudes about technology outnumber their negative attitudes. They believe that positive attitudes support many activities that older adults find convenient and useful.

Is there anything older adults don’t like about the Internet? Like many of all ages, they worry about Internet security. With all the hacking and scamming that target older adults, they should be concerned. They dislike some of the inconvenience and unreliability that holds hands with technology sometimes. But they mostly like the benefits they get from the technology experience such as Internet browsing, learning new information, social networking with family and friends, and even planning trips on their own.

Put the technology stereotype to rest. There’s a big world out there in cyberspace. Education can encourage even more older adults to explore the many wonders technology has to offer. If you're a senior who wants to learn more about traveling in cyberspace, contact your local Area Agency on Aging, a senior center, or your public library for information on where you can attend classes. Have a great trip!

At the age of 91, Naomi Long Madgett, Poet Laureate of Detroit, MI, enjoys using technology. Her good choices with the "new stuff" enhance her quality of life. You can read more about Naomi and iPad research with older adults here:

https://www.linkedin.com/pulse/selfie-detroit-poet-laureate-techie-91-ipad-research-parker?trk=mp-reader-card

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes

Hospice and Nursing Homes Blog

Older Adult/ Senior Bullies in Long-Term Care and Senior Communities

Some people wake up and change. Others just roll over. I’m referring to the bullies of our pasts and others who have become older adult bullies. These bullies are now terrorizing residents in long-term care and assisted living facilities, senior centers, and retirement communities around the country.

Welcome to the irony of older adults practicing ageism. The first time I witnessed older adults bullying others was at a senior center where, after a great deal of resistance from members, the age for joining the center had finally been lowered from 62 to 55 years old. Most local senior centers had already lowered their membership age years before this center. Several older members were openly rude to younger members who joined. At lunchtime, I watched them “reserving” tables for their older friends and leaving leftover seating for younger members. I overheard negative comments about “those new young people” stated loudly enough for everyone to hear. I even witnessed an attempt to get a younger member in trouble. I reported all incidents I witnessed to the administration. They said they were “working on the problem, but change takes time.” Unfortunately, many older adults don’t have a lot of time ahead of them. No one should have to spend their golden years being victimized daily by mean-spirited bullies.

These are some hurtful actions of “mature” bullies:

1.    Block off seats for their little cliques at mealtimes and events.

2.    Criticize, ridicule, and lie about those who don’t meet their standards of acceptance regarding race, ethnicity, sexual orientation, religion, economic background, and any other criteria they condone.

3.    Steal and destroy property to flaunt their power and harass victims.

4.    Physically abuse victims by pushing, hitting, punching, or kicking them. They sometimes justify this as an “accident.”

A former school principal, I know bullying is a problem that only gets worse when it’s ignored. Too often the victims are vulnerable and defenseless. Some, such as those targeted because of their sexual orientation, become so depressed they commit suicide. Observers are often too afraid themselves to take a stand. The administration must be seriously involved. These are some guidelines that can help solve problems of bullying:

1.    Commit to and promote principles of equality and respect for all residents/members.

2.    Do a confidential needs assessment on bullying to determine how severe the problem is. General needs assessments should be done annually.

3.    Have open discussions involving residents, staff, and community members about bullying, its causes, and solutions. Consultants with expertise in bullying, conflict resolution, diversity, etc. can be especially helpful.

4.    Provide extensive staff training in how to handle bullying among themselves and those they serve.  Continue to educate residents/members. Victims need the support, and bullies need to be reminded that eliminating bullying is an ongoing priority.

5.    Review and change procedures that can decrease the power of bullies. For example, eliminating reserved seating and implementing another seating procedure can prevent bullying cliques from saving blocks of the best seats for themselves.

6.    Create and disseminate a zero tolerance policy on bullying along with channels for reporting incidents and resolving them.

7.    Keep in mind that the goal is to create a culture where no bullying is the standard embedded in how the institution operates. There must be consistency in implementation and visible recognition of everyone’s dignity and rights.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog

Eldercare Robot: CareBot Companion and Caregiver for Older Adults (Video 2:19)

We can pretend that robots are only for sci-fi movies, but they are already being created to make life easier for older adults. Artificial intelligence of robots makes them especially good companions for older adults living alone or those in need of caregiving attention. What is artificial intelligence? This means the robot not only has the ability to navigate safely in its surroundings, but it also has the intelligence to do meaningful caregiving.  Maybe that’s why they are called CareBots.

The GeckoSystems CareBot is a robotic eldercare system that allows family members to care for older adults from afar. According to Martin Spencer, President/CEO of GeckoSystems, CareBot is a new kind of companion that “always stays close to the care receiver, enabling family and friends to care for them from afar. It tells them jokes, retells family anecdotes, reminds them to take medication, reminds them that family is coming over soon (or not at all), recites Bible verses, plays favorite songs and/or other music.” Even the voice can be customized.

From a security point of view, a CareBot alerts family members when unexpected visitors or intruders are present. It notifies designated caregivers when a potentially harmful event has occurred such as a fall, fire in the home, or even if no one has been present for too long. It responds to calls for help and notifies those persons that the caregiver has designated.

Referred to as Emily, the CareBot in this video serves as a helpful companion to Doris by keeping track of her taking medicines, reminding her about TV shows, and performing other tasks that improve the quality of Doris’ life.

What do you think about having Emily or another CareBot living with you or helping an older adult in your family?

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes

Hospice and Nursing Homes Blog

Older Adults Make Safe Sex Video (2:22)

You know what’s frightening? Nearly one-third of all people living with HIV/AIDS are aged 50 and older. According to the Centers for Disease Control, 115,000 of the 475,000 people living with HIV/AIDS in the United States are 50+. That’s nearly double the number in 2001. The real numbers are likely higher because many people with HIV/AIDS remain undiagnosed.

Undiagnosed and infected people are estimated to cause two-thirds of infections.  Because many senior women are postmenopausal, they may not use condoms with the vigilance they would for preventing pregnancy. More sexual experimentation among seniors, including some increased by drugs like Viagra, also promote the likelihood of unprotected sex. 

You know what’s great? More seniors and others are paying attention to these statistics. They are understanding that rising rates of HIV/AIDS in their population require diligently using condoms, no sharing of needles, testing for HIV, and discussing HIV/AIDS with their doctors and others. They can make good use of resources available such as the National Institute on Aging.

But so much more can and should be done to get the message out about safe sex for seniors. Like any change, people can begin wherever they are to become part of the solution.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes

Hospice and Nursing Homes Blog

Can Older Adults With Dementia Enjoy Life? (Research, Arts Video 3:04 mins.)

I have a friend whose mother has Alzheimer's disease. He and his father are her primary caregivers at home. He says that people generally feel sorry for them. When his mother’s name comes up in conversations, the tone changes to one of sadness. They also assume that his mother must be an unhappy person because of her mentally impaired condition. The other day, I smiled at his response when I asked him how she was doing. He said, “Mama is doing just fine. Pops and I focus on keeping her healthy and active. Most of the time, she is as happy as she can be.”

A research study in the “International Journal of Geriatric Psychiatry” supports that assessment. Consisting of interviews with 1,620 community-dwelling older adults, the study examined the following:

1) Overall life satisfaction with material circumstances and with social circumstances of older adults with no cognitive impairment, with cognitive impairment without dementia, and with dementia

2) The effect of cognition on life satisfaction across a broad spectrum of cognition

3) The effect of factors such as depressive symptoms, functional impairment, education, and social support.

While participants with dementia and participants with cognitive impairment without dementia did have lower life satisfaction than those with normal cognition, the effects were relatively small. The study concluded that, although cognition is associated with life satisfaction, older adults are generally satisfied with life.

Older adults with dementia have varied days like everyone else. Happy memories and enriching activities can slow dance into their realities and fill them with joy. This video titled “I Remember Better When I Paint: Treating Alzheimer’s Through Creative Arts” shows how creative arts activities can enhance the quality of their lives. A longer DVD version can be purchased at amazon.com, frenchcx.com, artistsforalzheimers.com, and hilgos.com.

Frances Shani Parker, Author

"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”

“Hospice and Nursing Homes Blog”

Seniors and Casino Gambling: Who’s Really Winning?

Across the country, the numbers of seniors visiting casinos are growing faster than any other age group. Casinos are estimated to take as much as 65% of their revenue from those aged 65 and older. Detroit, Michigan has three major casinos that get plenty of business from seniors in Michigan and beyond. They love to take field trips to casinos as a social activity, but is it really just social?

Research from the Institute of Gerontology at Wayne State University in Detroit causes serious concerns about seniors and casino gambling. Including 1,410 randomly selected adults, aged 60 and older, the study concluded that one in five older adults who enter a casino eventually displays problem gambling behaviors. Peter Lichtenberg, Ph.D., director of the Institute of Gerontology and one of two authors of this study published in the “Journal of Aging Studies” said, “Urban elders are especially vulnerable to problems because higher percentages of them have low income, few social supports, and poor mental and physical health.” Symptoms of problem gambling include compulsive gambling and lying about  time and money spent.

Findings from this study should be taken very seriously, particularly when considering serious health and financial problems among older adults in the future. Expected consequences related to seniors’ increasing participation in casino gambling are “financial loss, the erosion of personal relationships, depression, suicide, substance abuse, and personality disorders.” No winners there.

Full Article Citation:  

Zaranek, R. & Lichtenberg, P. (2008).  Urban elders and casino gambling:  Are they at risk of a gambling problem?  "Journal of Aging Studies," 22, 13-23.

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Hospice and Nursing Homes Blog