Findings, A Better Old Age, Fall 2013 by University of Michigan School of Public Health

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A B e t te r O ld Ag e

Public health has added an estimated 25 years to the human life span. What kinds of years will they be?

INSIDE > The pros (and cons) of retirement p. 8

| The art of lastingness p. 26 | A guide to thriving p. 30

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FINDINGS

38 Departments

W On the Web

From the Dean A Better Future

From Our Readers

44 First Responder

On the Heights

45 The Finish Line

45 A Father's Lesson

Research News

46 In Memoriam

46 CareerWatch

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Back cover: Participants take to the pool in an aqua energizer class at the Health & Fitness Center at Washtenaw Community College (Michigan). The class mostly draws retirees who have flexible schedules, says instructor Ann Kehn, who notes that water exercise benefits older adults in a number of ways. It puts less stress on the heart than weight-bearing activities and allows greater freedom of movement, but its top benefit, she adds, may be psychological. “With aging, you’re often restricted—physically, mentally, socially. Water changes that.” Maxine Cline, who’s taken aqua energizer classes for the past six years, says it keeps her young and

Alumni Network 42 An Enduring Friendship

socially engaged. When she turned 90 in April, 40 of Cline’s classmates helped her celebrate. SPH alumnae Rosemarie Rowney, RN, MPH ’77, and Sue Ann Faust, MPH ’73, are also longterm participants in the center’s water exercise program.“It saves your joints because the water suspends you,” Rowney says. Front cover: This Illustration by John Kachik is inspired by a famous World War II poster (“We Can Do It!”), produced in 1943 for Westinghouse Electric to help boost worker morale. The poster is generally thought to be based on a photograph of then-Ann Arbor resident and factory worker Geraldine Hoff.

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Volume 29, Number 1 Fall/Winter 2013 Produced by the U-M SPH Office of Marketing and Communications

12 F e at u r e A rt i c l e s

A Better Old Age 12

Voice of Experience

The author of Successful Aging reflects on what it means to be 95.

15 Ideas for a Better Old Age Advice from the experts on how to add life to our years.

Rivertown Neighborhood

Detroitâ&#x20AC;&#x2122;s groundbreaking solution to affordable long-term care.

Staying Power

What artists have to teach us about aging. S p e cia l S e c t i o n :

A Guide to Thriving

A new approach to healthy agingâ&#x20AC;&#x201D;at any age. U N I V E R S I T Y

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> FROM THE DEAN

hanks to public health initiatives, the human lifespan is now an estimated 25 years longer than it was at the turn of the 20th century—but, as the cover of this issue of Findings suggests, we have not yet found a way to ensure that those years are good ones. For its 2012 World Health Day, the World Health Organization coined the phrase “Good health adds life to years.” This, to me, sums up one of our greatest challenges. Shakespeare understood the downside of a too-long lifespan. In his famous “seven ages of man” speech in As You Like It, a morose Jacques describes the final phase of life as “second childishness and mere oblivion, sans teeth, sans eyes, sans taste, sans everything.” A spate of new books would seem to support this bleak view, among them Katy Butler’s Knocking on Heaven’s Door: The Path to a Better Way of Death and Jane Gross’s Martin Philbert A Bittersweet Season: Caring for Our Aging Parents—and Ourselves. Both works provide first-person accounts of an experience all too common among my generation—that of caring for an elderly parent, or parents, who are suffering from catastrophic illness and/or disability. Other recent entries in this genre include reporter Joe Klein’s “The Long Goodbye” (Time, June 11, 2012) and Michael Wolff’s “A Life Worth Ending” (New York Magazine, May 20, 2012). At the opposite end of the spectrum are the hopelessly romantic images of old age we see so often in TV commercials and magazine ads—the Viagra-touting grandparents holding hands as they gaze off into a Hawaiian sunset; the nonagenarian parachuting from 5,000 feet; the 80-year-old winning her fifth marathon. Where does reality lie? Somewhere in between, it seems, as research by U-M’s own Robert Kahn (featured on page 12) demonstrates. In their landmark 1998 book, Successful Aging, Kahn and co-author John W. Rowe report that, contrary to popu-

lar myth, older Americans are generally healthy. But health in older age depends on such critical factors as access to nutritious foods, safe places to exercise, and affordable health care. One of our primary goals in public health must be to help guarantee that these ingredients so necessary for “successful” aging are made available to the widest number of people possible—not just the affluent. Another key factor in healthy aging, as research by SPH Professors Neal Krause and Vic Strecher underscores, is a sense of purpose in life. People who perceive their lives as purposeful tend both to make healthier choices and to cope better with the stresses of aging. Again, public health has a vital role to play here by fostering the means for people to age as healthily as possible, at all stages of life. A strong public health infrastructure is a critical component of what I think of as a truly healthy society—one that provides a majority of its people with the opportunity to find a lifesustaining sense of purpose. Equally important, a healthy society regards aging as a normal part of life—not an aberration. And a healthy society fosters a powerful sense of community. Rare is the individual who can age healthily in isolation, as study after study demonstrates.

Aging is more than just the passing of time—it’s a complex dynamic involving biology, environment (both social and physical), socioeconomic status, and mental health, among other factors. Although technology has given us the means, for perhaps the first time in human history, to live healthily with disease, the phenomenon of what many call “successful” aging is about so much more than simply treating disease. If we are truly to create a “better old age” for all the world’s people, we need to maximize opportunities for the elderly to thrive. Instead of keeping our fragile elders out of sight and mind— and deepening our own detachment from the wisdom of the ages—we must recognize and celebrate their extraordinary potential. We have a resource in the elderly that goes largely wasted in Western culture. By creating a better old age, then, we will create a better future—a better life—for all of us. For as members of the human community, we are all connected. The elderly have merely gone further down a path that many of us are destined to travel. The more connected we are with them, the more connected we will be with ourselves. <

People who perceive their lives as purposeful tend both to make healthier choices and to cope better with the stresses of aging.

Martin Philbert Dean and Professor of Toxicology

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A Better Future

> F R O M O U R RE A D ER S Means of Communication > I just received my

copy of Findings, and it is good to read about the happenings and good to see the connectedness via Facebook, YouTube, etc. But this issue of the magazine (“Love’s Touch,” spring/summer 2013) has far too much text and fonts that are much too small. It’s not fun to read and even more difficult to scan. I know how proud everyone is of their accomplishments, but the editor needs a very sharp pen. When it comes to communicating health information, you may want to consider animated video, which has major WOW factors—factors not in your print edition. Animation hits the viewer in a very personal way and has huge potential in not only medicine but public health. Just think about the possibility of animated videos showing the dangers of smoking, drunk driving, texting while driving, or the dangers of not follow diabetic regimes or using sun protection. Since this form of communication is relatively inexpensive, scalable, and readily available on Twitter and YouTube, it is also possible to reach the “heretofore impossible” teenage and young adult segment via channels they accept. If anyone can reach this segment, then health education really has positive ROI. This form of communication could redefine public health as we know it. Neilson Buchanan, MHA ’68 Palo Alto, California

SPH at the Forefront > In your most recent issue, the articles

by Allison O’Donnell (“Healing Powers”) and about Meg Riordan (“On the Front Lines of the Tobacco Wars”) provide the U-M SPH universe the opportunity to see what we at the Campaign for Tobacco-Free Kids observe every day—extraordinary Michigan public health alums taking leadership roles in the critical public health fights of the 21st century. Both Meg Riordan and Allison O’Donnell are devoting their careers to ending the tobacco epidemic, and offer powerful examples of how to turn the world-class education offered at U-M SPH into a challenging and meaningful career that can make a real dif-

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ference to the lives of real people. With the help of Meg and Allison and our other outstanding staff at CTFK, we can aspire in this century to eradicate lung cancer and reduce heart disease, diabetes, and other chronic conditions caused by tobacco. U-M SPH has justifiable pride in these graduates, and we continue to be grateful they have chosen to put their talents to use in this difficult but winnable battle. Susan M. Liss, U-M LSA ’73 Executive Director Campaign for Tobacco-Free Kids Washington, D.C.

Mountaintop Removal > Before Maria Gunnoe gave her talk as the

> I saw [Maria Gunnoe] testify on C-SPAN early in the a.m. hours awhile back on TV to legislators in a hearing on mountaintop removal dangers etc. I applaud her efforts.

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Appalachia, but recently I saw the documentary called The Last Mountain, and I sure do now know what Maria [Gunnoe] has gone through battling the big coal companies. She is a true warrior!! Geoff Gerster

> God bless you, Maria Gunnoe. We are at your side—even though far away. Arlena Bora

Love’s Touch > Dean Martin Philbert’s message about

22nd Wallenberg medalist, I knew virtually nothing about mountaintop removal coal mining (“Mountains on Her Mind,” spring/summer 2013). Soon I found out that most of my friends and colleagues were equally uninformed about this devastating practice of extracting fuel for the modern conveniences we totally take for granted. Mountaintop removal not only destroys the land, forests, and streams but also has devastating effects on health and livelihood of the people who love and wish to sustain the land they live on. This story in Findings shocks us out of our ignorance and informs that a large percentage of our electric energy is extracted in ways that that harm and often kill those who live near the source. “Mountains on Her Mind” makes us wonder, as responsible citizens, what can/should we do? Irene Butter U-M SPH Professor Emerita Ann Arbor, Michigan

> I did not know much about the struggles in

the power of love (“What’s Love Got to Do with It?” spring/summer 2013) hit the nail on the head. Thank goodness for the power of love, with catastrophes like the shootings at Sandy Hook, the east coast hurricane devastation, the Boston marathon bombings, and the tornadoes in Oklahoma fresh in our minds. In each instance, we can see the huge outpouring of community response—and we are reminded of how the day-to-day commitment of people to their jobs, especially in public health, makes a huge difference. It certainly does restore our faith in the basic goodness of mankind. Kudos, too, to the faculty and staff at SPH for their contributions! Jean Chabut, RN, MPH ’68 Lansing, Michigan

In each instance, we can see the huge outpouring of community response—and we are reminded of how the day-to-day commitment of people to their jobs, especially in public health, makes a huge difference.

> In the modern-day world of iPhones, texting, Facebook, and other social media, [Madeline Diehl’s] story (“Betting on Love,” spring/summer 2013) brings to light the importance of actual physical human interaction and its role in our social well-being. Bravo Ms. Diehl. Martha Kersey

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Love’s Touch cont’d > It is unfortunate that [Madeline Diehl] was

not able to include an additional part of the amazing story of her daughter, Amelia’s, recovery. Years after Amelia was born, Ms. Diehl had a chance encounter in another city and state with the neonatal pediatrician who was “on-call” the night Amelia's lifeless body was delivered. Upon seeing the doctor, Madeline asked the woman, “Were you ever an emergency room doctor in 1994 at the University of Chicago hospital when a baby girl was delivered

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dead on New Year's Eve?” The doctor not only remembered, but told Madeline she always wondered what had happened to the baby girl, had she lived? Or had she died? She remembered working all night long to revive and save the baby’s life without knowing the final outcome. The doctor was treated to a meeting with Amelia so she could see for herself. I am the sister, Peg, mentioned in the article. Margaret Bachrach Bethesda, Maryland

In Memoriam > On May 25, 2013, the U-M SPH community lost a distinguished alumnus, Professor Hillel

Shuval, MPH ’52, HSCD ’03, who died in Jerusalem, Israel, after a long illness. Hillel was head of the Division of Environmental Health Sciences at Hadassah Academic College, Jerusalem, and the Kunen Lunenfeld Emeritus Professor of Environmental Sciences at the Hebrew University of Jerusalem. More importantly, he was a world leader in research on the health aspects of water reuse; a dedicated peace activist who promoted cooperative projects and dialogues among Israeli, Palestinian, Egyptian, and Jordanian researchers; and a leader in the struggle for civil rights, freedom of religion, and pluralism in Israel. When I first met Hillel in 1962 in Chapel Hill, North Carolina, I was a student from Alexandria, Egypt, studying for my doctorate. Hillel was the first Israeli I had ever met, and I was most impressed by him. Eventually he invited me to visit Israel, and for over a decade we conducted a series of research and training projects addressing wastewater treatment, reuse applications in aquaculture and agriculture, and the management of groundwater resources shared by Israelis and Palestinians. Under Hillel’s guidance, we provided a friendly, effective environment where Arab and Israeli scientists and engineers could conduct collaborative studies. Hillel will long be remembered for his outstanding contributions to public health, civil rights, and peace in the Middle East. Khalil Hosny Mancy Professor Emeritus of Environmental Health Sciences, U-M SPH Dana, North Carolina

> We write with sadness to inform the U-M SPH community of the death of Alison McIntosh

on August 7, 2013, at the age of 87, in Melbourne, Australia, where she had retired. Alison served on the SPH faculty until her retirement in the 1990s and for a number of years managed the U-M Population Fellows Program. Her research focused on population policy formulation, and her 1983 dissertation, “Population Policy in Western Europe: Responses to Low Fertility in France, Sweden, and West Germany,” has become a valuable guide to policymakers everywhere whose countries are facing population decline or stagnation. She had a rich and varied career, beginning with her training as a nurse, which led her to country assignments with the World Health Organization in Africa before she decided to take a new direction and pursue study at Michigan. Although she never had a family of her own, she created one through the warm friendships she maintained all over the world. We will miss her. Jason Finkle Professor Emeritus of Population Planning, U-M SPH Ann Arbor, Michigan

Barbara Crane Executive Vice President, lpas Chapel Hill, North Carolina

Update on Eastern Congo > The U-M Provost’s Office has awarded

SPH alumna Lisa Peters, MPH ’08, and U-M faculty members Paul Clyde, Jane Hassinger, and Janis Miller a Global Challenges for a Third Century grant to launch an International Center for Advanced Research and Training in the eastern Congolese city of Bukavu. In September, the U-M team held a planning meeting in Ann Arbor with physician Denis Mukwege, medical director of Congo’s Panzi Hospital, and partners from the Democratic Republic of Congo, Norway, and Sweden.

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Recent Awards “Why Michigan Matters,” the spring/summer 2012 issue of Findings magazine, won a gold award for Special Issues and a bronze award for Periodicals Design in the 2013 Circle of Excellence competition, a global awards program sponsored by the Council for the Advancement and Support of Education (CASE). A panel of experts selected Findings from among 40 Special Issues entries and 46 Periodicals Design entries from university, college, and professional school magazines.

> ON THE HEIGHTS Spring Commencement The New SPH Teaching Lab To Retire or Not? Point/Counterpoint

A Conversation with Bob Kahn

6 7 8 10

… if zombies invaded your space? Or in public health terms, if a sudden disaster hit your community? That was the serious message behind the first-ever U-M SPH “Zombie Apocalypse” last April, the culmination of a semester-long course in public health preparedness taught by SPH faculty member Eden Wells. The two-hour disaster-simulation exercise involved over 100 students and faculty and generated worldwide coverage in more than 200 media outlets, including the Associated Press, the Singapore Straits Times, and regional affiliates of CBS, NBC, and Fox News. Wells and her students based the simulation on a public health awareness and preparedness scenario developed by the U.S. Centers for Disease Control as a way to highlight the need for individuals, families, and communities to have a plan in the event of disasters, both natural and manmade. Shown here: SPH Dean Martin Philbert surrounded by zombies. For more on the CDC’s program: cdc.gov/phpr/ zombies.htm. U N I V E R S I T Y

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What Would You Do

> ON THE HEIGHTS

In more than one way, second-year SPH student Sarah Lindenauer is following in the footsteps of her grandmother Marilyn Lindenauer, an SPH alumna (MPH ’76). As a Michigan undergraduate, Sarah took Professor Kenneth Warner’s “Introduction to Public Health” course in 2011—a decision that helped inspire her to follow her grandmother’s example by pursuing graduate studies in public health. Marilyn Lindenauer also studied with Warner—and in fact took the first-ever course he taught at SPH, in the winter term of 1973. Warner calls the coincidence “pretty cool” and says that while he’s taught a few other students from different generations of the same family, no pairing dates back to his “earliest days” as the Lindenauers do. n Matthew Boulton, director of the Preventive Medicine Residency at SPH, is the new editor-inchief of the American Journal of Preventive Medicine, an international peer-reviewed medical journal. Boulton’s research interests include applied epidemiology, public health practice, infectious illness (especially vaccine-preventable diseases), assessment of the public health workforce, and public health in China and India. n SPH Dean Martin Philbert has been admitted a Fellow of the Royal Society of Chemistry (RSC). Located in Cambridge, England, the RSC is the largest organization in Europe for advancing the chemical sciences. Philbert’s research focuses on the development of flexible polymer nanoplatforms for optical sensing of ions and small molecules for the early detection and treatment of brain tumors. Other research interests include the mitochondrial mechanisms of chemically-induced neuropathic states.

Shoe photos by Peter Smith

balmy May 2 brought out the whimsy in the U-M SPH class of 2013, whose 413 members included physician Johmarx Patton—the first-ever recipient of a U-M Master of Health Informatics degree. If footwear is anything to go by, the school’s newest alumni have both substance and style (though the public health implications of some choices may warrant further study). <

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SPH DIGEST

Peter Smith

Best Foot Forward

Like Mother, Like Daughter Over lunch shortly after graduation, mother and daughter—and fellow members of the SPH Class of ’13—Charlene Babcock and Marie Kotenko reminisced about the past two years, during which Babcock, an MD, completed her MS in the school’s executive education program in clinical research design and analysis, while Kotenko, a soon-to-be medical student at Michigan State University, earned her MPH in environmental health sciences. Charlene: I was the oldest person in my class. A lot of times when I questioned if I could do it, Marie told me, “You’ll be fine. You’ll be fine.”

Marie: I often thought, “If my mom can do it, I can do it.” Charlene: I got all As. Marie: She pushed me. If she’s getting all As, I thought, I can too. Charlene: It was a little bit of a competition. Marie: She’d text me scores, and I’d text her mine. Charlene: We’d both celebrate. Marie: I had questions in biostats, and by then she was so far ahead it was really easy to ask. Charlene: I had questions about computer issues, and she helped me. Marie: Graduation was so fun. Charlene: Graduation was really cool. Marie: (Pause) I’m going to miss it all. Charlene: (Pause) Me too. <

On the Heights

Then and Now:

The SPH Teaching Lab New and brighter lighting New epifluorescence microscope New incubators

Students unpacking new equipment donated by NIH.

New pipettors New microscopes New storage space New benches

Peter Smith

New sinks

ewly renovated last year, the SPH Teaching Lab introduces approximately 25 students a year to general microbiology and gives them hands-on practice with the characterization of microorganisms, biochemical and genetic testing, growing and evaluating biofilms, broad sociomicrobiological concepts and techniques, and the role of polymicrobial communities in health and disease.

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The refurbished lab is significantly brighter than its predecessor and has new sinks, benches and storage space, new CO2 and large-format incubators, and 14 new microscopes, both compound-light and stereo. Also “new” is high-tech equipment from the National Institutes of Health donation program. The remodeled lab “enables us to perform experiments more effectively and in greater detail,” says Alex Rickard, an assistant professor of epidemiology who teaches Epid 504: Polymicrobial Communities Laboratory, one of two lab-based classes for students specializing in hospital and molecular epidemiology. During the final four weeks of Rickard’s course, students pursue individual projects examining microbial communities in domestic and

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hospital environments, including showers, refrigerators, and food. Last year, a student project on antimicrobials and dental biofilms was published in a peer-reviewed journal.

The SPH Teaching Lab before renovation.

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FINDINGS

Insights and advice from SPH faculty

To Retire—or Not? “My advice is to work as long as you can— persist!” Arnold Monto, Thomas Francis Jr. Collegiate Professor of Public Health

“Rather than retire, I chose a second career on the basis of what I thought was my unique strength, and I put all my efforts behind it as if I were starting à nouveau.

My advice for retirement is to get involved. Try to find a group that shares some of your interests. You may have to do a little exploring yourself. Rely on some of your friends who have connections. It seems to me there’s a big menu to choose from. You just have to try to choose what you think is going to be the most—maybe not beneficial— but satisfying to you.”

In retrospect, I had always tried to find a unique niche in health care that was not already crowded. So I pursued a topic that no one wanted to touch, telemedicine—medicine at a distance. My colleagues in health management did not think much of it. Some thought it was a waste of time, and some thought I was a fool. It took three decades for the rest of the world to discover it, and now it has become part of mainstream health care. Lucky for me, I lived long enough to see this transformation. When I was ready to retire, the chief of clinical affairs at the U-M Health System asked if I would like to join them. I couldn’t refuse. They created a new place and position for me. For a while, I thought maybe I’d died and was dreaming all this. I have never looked back.”

Robert Gray, Professor Emeritus, Environmental Health Sciences; Database Technology Volunteer, Ann Arbor Kiwanis Club

Rashid Bashshur, Professor Emeritus, Health Management and Policy; Executive Director, U-M Health System eHealth Center

“I’ve gone from professor to dean to ‘busy volunteer.’ My work week sometimes is as full now as it used to be, in terms of hours.

“Basically, I retired from the things I didn’t want to do and continued doing the things I wanted to do, a lot of which are professionally related. I think Bob Kahn’s book [Successful Aging] has pretty good advice. If you want to summarize it in two words, I think it says, ‘Keep moving.’” John Griffith, Professor Emeritus, Health Management and Policy

“A lot of people just can’t handle it, having no structure, no place to have to be.

“I think we’re very lucky if we can ease into retirement. If you hang around the university, you can.

I rather enjoy it, because I busted my duff for many, many years, and it’s kind of nice to not have to worry about what you’re going to do in a given day. All of us were raised with the mores that you’ve got to stay busy, you’ve got to keep contributing. Well, you don’t gotta. But we get so caught up in it that.”

If you’ve been doing research, and you have a lot of stuff to write up, you make that transition very gradually, and it’s a luxury to have time to sit and think and write. You also have the opportunity to enjoy many more outside activities and can indulge in them to a greater extent than you can when you’re working.”

James Martin, Associate Professor Emeritus, Environmental Health Sciences

Millicent Higgins, Professor Emerita, Epidemiology and Internal Medicine

On the Heights

For more thoughts on retirement from emeriti professors, see a video at sph.umich.edu/findings.

“I’ve become convinced that retirement works best when you’re moving toward something, not just letting go of things.

“My retirement was somewhat premature, in the sense that I was still fully active. But my wife’s long illness, and eventually her death, wore me down and made me think hard about priorities. Through her long journey I received a new sense of perspective—that my career was relatively insignificant. Which raises the question of mortality. As I approached the end of my career, I began to realize that, no matter how distinguished any of us are, or think we are, we become forgotten relatively quickly. Immortality is reserved for the likes of Einstein or Beethoven, so why strive for it when it will never be there? One or two more papers, one more book will not do the trick at this stage. So when I retired, I decided to focus on other things—my family, other types of writing, music (and my Steinway concert grand!), etc. I rarely think about science these days. It was great while it lasted. But there’s more to life.”

In my case, I have this other life as an artist, which I’ve pursued for most of my life, to varying degrees of intensity. I’ve painted, done experimental video, and for the last 20 years, photography, and I just felt like I wanted to spend more time doing it. Maybe it comes from knowing life is not a rehearsal—you only get one shot—but I feel this really strong pressure to express myself in ways that I can only partially express doing science. If I focused on what I was giving up, it seems to me that’s psychologically much more difficult than to focus on where I’m going and, now that I have time, what I can do with it.” George Kaplan, Thomas Francis Collegiate Professor of Public Health Emeritus; Professor, Epidemiology; Founder, Center for Social Epidemiology and Population Health; Research Professor, Survey Research Center

“When you really love your work and it fills your life, you haven’t had time to develop anything else, even friends. For some of us, our work is our community—so how do you find a different one? I envy the people who say, ‘I can leave it all behind, and I’ll go write children’s books.’ I might do some of that, but I’m not quite ready to take that leap yet. So I’m grappling with retirement.” Jean Shope, Research Professor Emerita, Health Behavior and Health Education; Research Professor Emerita, Transportation Research Institute U N I V E R S I T Y

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James Vincent, Professor Emeritus, Environmental Health Sciences

“For me, it’s been mostly new beginnings. There are times I feel I’m just as busy as I was when I was working, and I’m very grateful for that. One of my favorite volunteer projects is to work at the Back Door Food Pantry [in Ann Arbor], which is sponsored by St. Clare’s and Temple Beth Emeth and Muslim Social Services. There’s three religions—that makes it attractive. I went through a period in my life when I suffered intensely from hunger, and I’ve never forgotten it. It’s a great source of satisfaction to distribute food to people who would otherwise be hungry.” Irene Butter, Professor Emerita, Health Management and Policy

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By the Numbers: Retirement Today

Percentage increase since 2003 in age of retirement for U.S. women, aged 70–74

Percentage increase since 2003 in age of retirement for U.S. men, aged 70–74

Percentage of U.S. women aged 70–74 still working

Percentage of U-M faculty in their 60s, 70s, or beyond

Percentage of U.S. men 24 aged 70–74 who still work Number of U-M employees 40 80 years or older Average age of retirement 62 for U-M staff Average age of retirement 66 for U-M faculty

Age at which people can receive full Social Security benefits

Source: Susan Rosegrant, “The New Retirement: No Retirement?” ISR Sampler (spring 2013). S P H . U M I C H . E D U

FINDINGS

Point:

by Linda Chatters

CounterPoint:

By Kyle L. Grazier

The “Choices” We Make

The Money We Save

ecently I signed up for a program at my local Y for people over 50, majority of U.S. households headed by retirees have no pension called “You’ve Still Got It.” The title says much about our current or savings. As more and more baby boomers approach retireemphasis on “successful or optimal aging.” But it’s also a sign of how ment, and as health care costs continue to rise, we face a growing we tend to emphasize individual responsibility for behavioral choices crisis—not only for individuals and their families, but for hospitals and over social responsibility—as if the broader social and economic envihealth care delivery systems, which will increasingly be called on to ronments in which people live have nothing to do with their health. subsidize the cost of retiree care. Marketing of consumer products and services for successful agSaving for retirement has always been a challenge for U.S. workers, ing is directed toward relatively affluent (and healthy) aging baby especially in recent years, with the downturns in the economy and the boomers. Clearly, money can be made by playing to the “worried reduction in employment-sponsored pension or retirement accounts. well.” But what about the vast numbers of older adults who don’t have Recent changes in the tax law have also complicated employee decithe resources and advantages many of us take for granted? Are we sions on how best to plan for the everyday and unexpected expenses willing to say they’re “unsuccessfully aging”? Research shows that that arise as people age. Happily, a growing number of employers, individual behaviors are clearly important among them U-M, are actively addressing to our health. But so are zip codes or charthe challenges that lie ahead. acteristics of the places where we live. It’s With the growth in health care costs time we think collectively about our responcontinuing to outpace the growth in our sibility for “successful aging”—especially in earnings, Americans will need to save the U.S., which has resources and wealth far even more for retirement in order to cover surpassing many parts of the world. out-of-pocket health costs such as co-pays In a 1999 article I often use in my classes, and diagnostic tests not covered by MediMeredith Minkler of the University of Calicare or the health insurance exchanges. fornia, Berkeley, writes that “holding the inMost investment houses and many benefit dividual responsible for health choices is paroffices estimate that those retiring in ten ticularly problematic in the case of the poor, to 15 years will need far more than they since poverty itself is among the most sighave planned for. nificant risk factors for illness and premature Many employers require or provide the death.” We know, too, that racial disparities means for employees to invest a percentin society are linked to health disparities. As age of their income in retirement savthe late Marshall Becker so cogently—and ings. Some “match” that investment with With the growth in health correctly—observed, when we redefine “beemployer contributions. If more employers care costs continuing to ing ill” as “being guilty,” we run the risk of took on this vital social responsibility, retirstigmatizing “the disabled, the elders, peoees would be better protected against the outpace the growth in our ple who are overweight, and other already burden of rising health care costs. earnings, Americans will devalued groups in our society.” More worrisome still, of course, are Much of our health-promotion work fothe millions of employed Americans who need to save even more cuses on individual behavior change without receive no retirement benefits. In a recent for retirement. a full appreciation that health “choices” are report, the Institute of Medicine called constrained by social conditions such as povfor action by employers and employees to erty, limited education, and access to services. So as we think about the encourage savings. Mandatory rather than voluntary contributions individual health choices we’re making, let’s also examine the choices to retirement savings accounts and provision of subsidized long-term we’re making as a society. From food and health policy to zoning laws care insurance would protect all workers—particularly low-income and education, there is much we can do to give all Americans—not just workers—from joining the 60 percent of retirees who rely solely on the affluent—a fair shot at a “successful” old age. Otherwise, if we conSocial Security benefits and/or who lack sufficient money for extinue on the course we’re now following, we’re not going to make it. < penses as they age. However one looks at it, we face grave problems, as a nation and as individuals, if we do not begin saving more now. < A psychologist and gerontologist by training, Linda Chatters is a professor A member of the U-M Committee on Retirement Savings Plan and Retiree in the U-M SPH Department of Health Behavior and Health Education Health Benefits, Kyle L. Grazier is the Richard Carl Jelinek Professor of and the U-M School of Social Work. Health Services Management and Policy and chair, U-M SPH DepartW See a video interview with Linda Chatters at ment of Health Management and Policy. sph.umich.edu/findings.

“We turn not older with years, but newer every day.” — E m i l y D i c k i n so n

“We turn not older with years, but newer every day.” —Emily Dickinson Each September the people and Each September the people gov-and government of Japanand honor ernment of Japan honor and thank thetheir thank the country’s elders for country’slifelong elders for their lifelong contributions to society contributions to society and offer wishesand for offer their longevwishes for their longevity. occaity. The occasion, aThe national sion, a national holiday called Respect holiday called Respect for the for the Aged Day, might inspire us all. Aged Day, might inspire us all. As the global population of people aged 60 and upAs approaches two billion—a the global population of people figure we’re projected toapproaches reach by two aged 60 and up 2050—we have yet, as a society, to billion—a figure we’re projected to create an environment where a majorreach by 2050—we have yet, as a ity of older adults seem to prosper. As society, to create an environment the 20th-century newspaper columnist a majorityobserved, of older adults Frank A. where Clark famously seem to prosper. As helping the 20th- “We’ve put more effort into century newspaper columnist folks reach old age than into helping Frank them enjoy it.” A. Clark famously observed, “We’ve put more effort into What willhelping it take folks to achieve kindthan of reach the old age old age Emily Dickinson envisions, into helping them enjoy it.” a time of renewal and hope and joy—not What will itbut takefor to all achieve just for the well-off, the the kind of old age Dickinson world’s citizens? That isEmily our charge, both individually collectively. On envisions,and a time of renewal and the following pages, you’ll see how hope and joy—not just for the some people and communities well-off, but for all the are world’s making acitizens? start. That is our charge, both individually and collectively. On the following pages, you’ll see how some people and communities are making a start.

Shown here, a 73-year-old tofu maker in Okinawa. National Geographic/Getty Images U N I V E R S I T Y

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Ken Orvidas c/o theiSpot.com

“There’s so much in the world, not to mention the rest of the apparent universe, which is a total mystery to us. I don’t see that admitting ignorance about it is particularly frightening.”

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by Susan Rosegrant

At 95, the author of Successful Aging shares his thoughts on life, death, family, and Spinoza’s God.

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obert Kahn is 95 years old. But as he leans back in his office at the University of Michigan Institute for Social Research to consider a question, or avidly discusses a research problem with colleagues in the hall, hands gesturing, his age seems irrelevant. Kahn came to U-M in 1948 to pursue a PhD in social psychology and to join the early founders of the Institute for Social Research (ISR). Over the next 40 years, until he was obliged to retire in 1988 at the age of 70, he built an illustrious and far-ranging career as a professor of psychology and public health and as a research scientist whose areas of interest spanned organizational and social psychology, electoral politics, survey methodology, public health, and aging. After his official retirement, Kahn continued to work at ISR, writing grants, conducting research, and analyzing data. Kahn’s 1998 book, Successful Aging, written with John W. Rowe, MD, challenged the notion that genes are the primary determinant of how well people age. Instead, the authors pointed to exercise, social engagement, self-efficacy, and social support. Kahn and his wife, Bea, relied on all of those when they faced a daunting recovery in 2006 after being hit by a car in an Ann Arbor parking garage. In a 2008 interview, at the age of 90, Kahn described how their daughters and extended family took leaves of absence to help them in their recovery. “The emotional effect of that is beyond words,” he said, adding that after living through the experience, “I think I could do a better chapter on social support.”

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Most recently, Kahn has been studying whether applying the principles of Successful Aging could enhance and extend the physical and mental health of seniors. With the backing of Lawrence Landry, the former chief investment officer of the MacArthur Foundation, Kahn and fellow ISR researcher Toni Antonucci helped design a program to create a successful aging culture in older adult communities. Landry launched Masterpiece Living (see p. 17), as it was called, in two Florida retirement communities in 2002. The communities improved residents’ diets, offered tailored exercise programs, gave medical feedback, and created peer support groups, among other measures. The program worked and has since been extended to 70 communities nationwide. With the growing success of the original project, Kahn and Antonucci now have an $886,000 grant from the MacArthur Foundation to see whether the approach can accomplish as much for low-income seniors. Eventually, Kahn would like to make the array of health opportunities and advantages available to all of the elderly, whether in retirement communities or not. In October 2012, Kahn sat down with writer Susan Rosegrant to build on an interview they had done four years earlier. Following is an edited version of that conversation. Editor’s note: One month after this conversation took place, Kahn’s wife, Bea, died after a short illness at the age of 94.

Susan Rosegrant: What has changed in the last four years? Are you still exercising regularly?

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Robert Kahn: I do a half-hour on a treadmill at a modest pace. It used to be running; now it’s walking slowly—two-and-a-half miles an hour. And then I push weights for another half hour. The weights are not as heavy as they used to be, but they feel as heavy. My cardiologist tells me that I’m not trying to build muscle. He gives me advice, which is not as Robert Kahn brief as what Angus Campbell [the first director of ISR] always used to give me when I would ask about something, but close: “Don’t do anything dumb.” SR: Over the last four years you’ve seen more friends and relatives die. Has that changed your feelings about your own life or death? RK: No. Not really. There’s so much in the world, not to mention the rest of the apparent universe, which is a total mystery to us. I don’t see that admitting ignorance about it is particularly frightening. I ran across an interesting exchange between Benjamin Franklin—some months before he died, as it turned out—and Ezra Stiles, who was then the president of Yale University. Franklin was giving his library to Yale, and Stiles, who was also a minister, was questioning Franklin in their written correspondence about whether he was in fact a believer in the afterlife. Franklin was pretty clearly among the deists in our so-called cohort of founding

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Excerpts from Successful Aging by John W. Rowe, MD, and Robert L. Kahn, PhD (1998):

“Decades of research clearly debunk the myth that to be old in America is to be sick and frail. Older Americans are generally healthy.” “Three key features predict strong mental function in old age: 1) regular physical activity; 2) a strong social support system; and 3) belief in one’s ability to handle what life has to offer. Happily, all three can be initiated or increased, even in later life.” “Research shows that it is almost never too late to begin healthy habits such as smoking cessation, sensible diet, exercise, and the like. And even more important, it is never too late to benefit from those changes.”

Ken Orvidas c/o theiSpot.com

“We view the aged as sick, demented, frail, weak, disabled, powerless, sexless, passive, alone, unhappy, and unable to learn—in short, a rapidly growing mass of irreversibly ill, irretrievable older Americans. To sum up, the elderly are depicted as a figurative ball and chain holding back an otherwise spry collective society. While this image is far from true, evidence that the bias persists is everywhere around us.”

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fathers, and Stiles pressed him to say what he believes. And Franklin replied that he hasn’t given these questions a great deal of study, and now at this late stage in his life, he doesn’t plan to undertake such studies, especially since he will shortly be getting the answer directly. [Laughs] It’s not an exact quote, but it comes close. SR: How much of successful aging is luck? RK: I think there’s a big element of luck. When you and I last talked about the accident that Bea and I had had, the medical expertise and the familial support which we talked about was, I suppose you could say, a different kind of luck. If you look at life expectancy and medical costs internationally, you know that the United States is not doing well. We spend more and we get less. So that’s not luck, unless you assume these political decisions are also a crap shoot. That’s within our control societally, but not individually. So there are the things we can do for ourselves, there’s the availability of expertise to help us, and then there is indeed the random event. SR: Is there any research on aging that hasn’t been done that you’d like to see undertaken? RK: What I want is to see what it would take to enlarge the health opportunities for people regardless of where they’re living and what their income is. So that’s very applied stuff. In contrast to that, I’ve read some articles of E.O. Wilson’s on consilience, and I’m now toiling through his book on that subject. Essentially he’s an eminent biologist who is trying to think about what combination of disciplines it would take to bring everything together—to have a single set of concepts that describes everything we know about the world. He thinks natural science has been moving along these lines. Social science by and large has not. If you look at the vocabularies of the different disciplines, sociologists are talking one language and psychologists another and political scientists a third, and they’re all looking at the same world that they’re trying to explain. So I think Wilson has a good point

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when he says we’d better work our way out of separate and limited languages. It’s relatively easy to point out that we’d like to get past that; it’s not at all easy to think about how to do it. SR: I was going to ask about one of the best books you’ve read recently, but it sounds like that would do it. RK: But for more recreational reading there’s a professor of philosophy at Princeton named Rebecca Newberger Goldstein who wrote a book, which I think is only partly successful but very interesting, called 36 Arguments for the Existence of God. The book is fiction, but each chapter is an argument that philosophers have been debating. Newberger Goldstein is a student of [Baruch] Spinoza [the 17th-century Jewish-Dutch philosopher]. That interested me because Einstein at some point was asked whether he believed in God and he said, “I believe in Spinoza’s God.” So that led me to go rummaging around to see what I could learn about Spinoza. I hadn’t known much, except the family was Sephardic Jews who came out of Spain and eventually landed in the Netherlands, as many people did looking for tolerance. So he was a philosopher and he certainly believed in God, but he did not believe in a God that was interested in the specific behaviors of individuals or who had selected any particular bunch of people as chosen. God was what he saw in nature. So when Einstein said he believed in Spinoza’s God, that’s what he meant, that there was something that explained this impossibly complex universe that we have only a little fragment of knowledge about. SR: Do you believe in Spinoza’s God?

SR: In health care for the aging, is there a specific advance that you think is most needed, or is it an array of services that would come through something like the Masterpiece Living approach? RK: I don’t think the single payer approach or any version of it—even if we were about to

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have it, which seems most unlikely—would solve all our health care problems. Other countries, while they’re doing better than we are, still have the problem of greatly increasing costs. I noticed that England recently has decided that they will not cover the costs of Aricept and other drugs that are currently used for Alzheimer’s. The drugs are very expensive and they don’t work. The most that can be claimed for them is some alleviation of symptoms in some cases. You get lots of expense, lots of side effects, and very little impact. So I think various tough decisions have to be made. That doesn’t prevent people from buying that stuff if they have the money and

If you look at life expectancy and medical costs internationally, you know that the United States is not doing well. want to, but it kind of sets limits on what will be provided, and I think we’ll have to do that. Our current arrangement, which has 45-plus million people without health coverage, should be a national embarrassment. SR: Some older people talk about feeling invisible out in the world as they age. Do you think that’s a common perception among seniors?

RK: Yeah, I think that’s pretty good. But I think that qualifies you as kind of agnostic.

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RK: I must have heard of this, but I haven’t thought about it. It’s not something I’m experiencing. As I walk around the halls here at ISR I can imagine somebody a few generations younger saying, “Who’s that old character staggering around the place?” But that strikes me as more humorous than threatening.

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SR: Do you feel like the Western view of aging is particularly bad? Sometimes we hear that in Eastern countries, there’s a better perspective, more respect, perhaps. RK: I really don’t know to what extent that’s true, although we’re a pretty youth-oriented society. SR: You don’t walk around thinking, damn those Western-society attitudes towards aging, they’re making my life miserable? RK: [Laughs] Life is not like that. My life is not like that.

It’s easy to say that one piece of advice is to have frank talk, but how about families where there hasn’t been any such talk for the last 50 years? How do you start? SR: We talked last time about how your daughters helped you and your wife recover after that bad car accident, and you said it gave you an even deeper appreciation for the importance of social support. Has your sense of that increased even more in the last four years? RK: It’s certainly not diminished, and in some ways it’s increasing. Bea and I moved from a large house that I can now see was terribly inconvenient for older people to a condominium at the age

of 70. A long time ago. And we deliberately looked for a condominium that was in walking distance of the campus, which was on a bus route, in case we could no longer drive, where the units were on one floor. So now I think we have to consider what’s the next move. At what point do we no longer want to be doing our own shopping, cooking our own meals, and so on. And, to pick up your point about social support, we are in the very fortunate position of having daughters and a son-in-law who want us to move in and be a multigenerational household. It could happen in Vermont [where one daughter lives], but it won’t, for reasons of geography and climate. It will be in Madison [Wisconsin], because we turn out to have quite a cluster of family there now. We’ve just come back from two weeks there. That would be the next move. And I think gradually the visits will get longer, and we’ll see what happens.

SR: Any advice for your peers?

SR: What advice would you give adult children facing the aging of their parents?

RK: That’s a very easy question. The answer is clearly within the family. When I think about it, in spite of the hours and effort that I’ve put into my own career, what I most wanted to be—more than a successful researcher or successful ager—was a successful father and husband. On the whole, I think we’ve been lucky. <

RK: One obvious answer is for the adult children to find out what the situation looks like to the parents. What would they really like, what do they need now, what do they think they might need? What are they worried about? SR: Those conversations probably don’t often happen. RK: I think they probably don’t. And there needs to be a clear exchange about what each needs and wants. Some of our old friends, near contemporaries, have already been very careful in laying out with their kids who wants this, who wants that. We have not done any of that. On the other hand, we want our daughters to have unlimited powers of attorney. In some families there’s not enough trust to do that. The absence of specific plans of that kind can make things very complicated. So it’s easy to say that one piece of advice is to have frank talk, but how about families where there hasn’t been any such talk for the last 50 years? How do you start?

RK: [Chuckles] I was tempted to give you Angus’s quote again: “Don’t do anything dumb.” I think the main advice to my peers would be to urge candor in speaking to their children. What people want is very different. Our son-in-law’s mother said that she wants to know exactly what’s going on [if she’s ill or near death]. “Even if I’m in a coma, I want you to talk to me.” And she wants life to be continued under any circumstances. Bea and I have made very different decisions. Don’t resuscitate. Don’t do any unnatural prolongation of life. But when I think back to my own grandfather and father—my mother died too suddenly—I don’t think we had those conversations. And I don’t think they’re easy, but I think they’re worth trying. SR: What things in your life give you the greatest pleasure?

Susan Rosegrant is a contributing editor at the U-M Institute for Social Research and a lecturer in creative writing at the U-M Residential College. Robert Kahn is a professor emeritus of health services management and policy at the U-M School of Public Health; professor emeritus of psychology in the College of LSA; and a research scientist emeritus at the Survey Research Center, Institute for Social Research.

W See a slide show of Robert Kahn at sph.umich.edu/findings.

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Ken Orvidas c/o theiSpot.com

asterpiece Living was founded in 1999 to create a system to keep the elderly healthy in body and mind. The company began working with retirement communities in 2002 by applying the results of a ten-year study of aging by the MacArthur Foundation, as well as the findings of Successful Aging, the 1998 book by Robert Kahn and John W. Rowe, MD, that drew on that research. According to the MacArthur research, lifestyle, not genes, determines 70 percent of physical aging and 50 percent of mental aging. The goal of the Masterpiece Living program is to improve the lifestyles of seniors by changing the cultures and expectations of retirement communities. Residents who live in a community that has implemented Masterpiece Living have

access to programs that support four areas of aging: physical, social, intellectual, and spiritual. Services and offerings include:

► Nutritional information ► Improved fitness areas ► Trained fitness/health coordinators ► Assessments of medical and behavioral risk factors, such as independent mobility

► Volunteer activities ► Computer availability ► Small feedback groups ► Goal setting Researchers affiliated with Masterpiece Living report that residents in their late 60s to 90s who participated in the program

remained more stable over a three-year period—in contrast to expected physical and mental declines among the general population in that age group. Many seniors also self-report gains in areas such as balance, strength, and mental outlook. Most of the 70 retirement communities that have adopted Masterpiece Living serve more affluent clientele. Kahn and fellow ISR researcher Toni Antonucci now want to see if the same approach can work in retirement communities serving low-income residents. A two-year study of two affordable housing communities in Los Angeles, as well as a nearby comparison group, should shed light on the feasibility of offering Masterpiece Living programs more widely. < — Susan Rosegrant

The goal of the Masterpiece Living program is to improve the lifestyles of seniors by changing the cultures and expectations of retirement communities.

Where Next? A s a doctoral student at SPH, Sara McLaughlin, PhD ’08, found Robert Kahn’s research on successful aging to be “transformative. Instead of decline, he and his colleague John Rowe focused on the potential for older adulthood, not on disease.” Inspired by Kahn’s and Rowe’s work, McLaughlin, now an assistant professor of gerontology at Miami University of Ohio, wrote

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a dissertation examining the prevalence of “successful aging” in older adults in the United States, with a focus on how successful aging differs by gender, socioeconomic status, race, and ethnicity. She found that while people of higher socioeconomic status are more likely to experience successful aging, some individuals with lower SES also enjoy a healthy old age. In the near future, McLaughlin plans to look more

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closely at factors that may explain how successful aging occurs in the context of disadvantage, and what we as a society can do to make it easier for everyone to age healthily. “It may be that we have to look at larger policy issues,” she says, adding that part of the challenge is to first develop a better understanding of what it means to experience healthy aging. <

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Ideas for a Better Old Age If we’re going to add life to years—and not just years to life— a few things need to change. Here are some suggestions.

15 Ideas for a Better Old Age

Changing Attitudes 1. Scaffolding Harry Campbell c/o theiSpot.com

If we want to improve people’s health in old age, we must make sure their health at any given point in time is good. And we must work to minimize the rate of decline to a point where they can stay as healthy as possible as long as possible. This is quite consistent with the kind of life-course perspective on health that is widely advocated by both the U.S. Centers for Disease Control and Prevention and the World Health Organization. A life-course approach means that if people want to age healthily, they need to begin practicing health-promoting behaviors when they are young—don’t smoke, use alcohol moderately, exercise, watch your diet, and so forth. That’s very straightforward. Jersey Liang, Professor, Health Management and Policy; Research Professor, U-M Institute of Gerontology; Faculty Associate, U-M Institute for Social Research

Society hasn’t provided any structural “scaffolding” for aging. There are all sorts of guides for the first part of the lifespan, but nothing for the person who says, “I’m 75, now what?” If we’re going to create a better old age, we need to find ways to help older people lead meaningful lives. Meaning can come from any number of directions. One is volunteering—older adults volunteer more hours than any other age group. Another way to foster meaning is reminiscence therapy, which helps older people make sense of their lives and let go of certain things. One of the biggest issues for older adults is forgiveness, often in the context of family.

In early 2013, the Institute of Medicine issued a report on the health of people in the U.S. as compared to 17 peer countries. The report underscores the need to adopt a life-course perspective on health: if we want to improve the experience of aging, we have to start prenatally. The report also highlights the fact that social determinants of health are shaping future cohorts of the elderly. So much of our narrative around optimal aging is still focused on individual responsibility for your health, as opposed to changing society in ways that support healthy practices—things like health-care financing, walkable cities, access to healthy foods, the elimination of poverty. The list is long. It’s much easier to tell someone you should eat this or do this than to say, “We need to overhaul the entire system.”

Neal Krause, Marshall H. Becker Collegiate Professor of Public Health; Senior Research Scientist, U-M Institute of Gerontology

2. A Lifespan Approach To prevent difficulties in old age, you need a lifespan perspective. A primary care provider needs to work across the age range. So does any specialist. I’m not saying there shouldn’t be people who know a lot about gerontology or midlife issues, but it’s impractical to have separate gerontology units in health systems, except perhaps in very large systems like Michigan’s. Nor am I sure that, theoretically speaking, it’s appropriate. If a health practitioner who’s seeing an older patient needs expert advice or consultation, then he or she should have it—but do we really want to set up a system where there are gerontology nurses, case managers, diagnosticians, and so on? Children are different—their diseases manifest differently—so I believe we need pediatrics specialists. But when it comes to adult medicine, a lifespan approach is the way to do it. And so far, our system is not set up for that.

Linda Chatters, Professor, Health Behavior and Health Education; Professor, U-M School of Social Work

3. Retire

from Driving

Our studies show that older drivers have higher crash rates per mile driven than most other segments of the population. Older drivers are also frailer and therefore more vulnerable to injury. This suggests we should all plan to “retire” from driving when we get older, much as we retire from other things. But few people plan for that. Many people are downright naïve and in retirement move to a mountaintop, which means they’re dependent on driving.

Noreen Clark, Myron E. Wegman Distinguished University Professor of Public Health; Director, U-M Center for Managing Chronic Diseases

Better public transportation would help. Livable cities, where you can get your needs met without having to drive, would also be good. In the meantime, the best idea I’ve heard about is a group of older people in Maine who got together and decided to share ownership of a car and to share a driver. It’s still a private car, but it’s not the senior shuttle, and it’s not a van for the disabled. It seems to me this is a plan many of us could adopt. Jean Shope, Research Professor Emerita, Health Behavior and Health Education; Research Professor Emerita, U-M Transportation Research Institute

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Changing Environments 5. Social Life Social engagement is a critical component of healthy aging, so in thinking about aging, and in designing both clinical and policy interventions, we need to pay attention to the social life of older adults. When we design residential facilities and care programs, we need to recognize that the social component of those facilities and programs is an important— and positive—attribute. When we’re creating an intervention to promote mobility and exercise, we should think about including an obvious social component that encourages and facilitates social connections. Walking groups in malls or parks or neighborhoods, for example, give people the opportunity to connect with one another while exercising. Carlos Mendes de Leon, Professor, Epidemiology

James Fryer c/o theiSpot.com

6. Age-Friendly Cities

4. Rethink Dementia We’ve invested a lot of energy and resources into the effort to find new drugs and means of earlier detection of Alzheimer’s and dementia, instead of looking for more holistic ways to care for those who already have the disease. The British psychologist Thomas Kitwood wrote at length about the importance of working with the existing capacities of people with Alzheimer’s. Kitwood’s aim was to understand, as far as possible, what care is like from the point of view of the person with dementia, and he identified a number of psychological and social factors that must be met in order for people with dementia to maintain wellbeing—chief among them comfort, attachment, inclusion, occupation, and identity. Kitwood’s influential 1997 book, Dementia Reconsidered, is still widely used—and applicable. Closer to home, Anne Basting of the University of Wisconsin, Milwaukee, offers a cultural critique of dementia care in her book Forget Memory (2009). Basting stresses the importance of engaging persons with Alzheimer’s and other dementias in activities that focus on the present, and she includes examples of innovative programs that stimulate growth, humor, and emotional connection. In The Moral Challenge of Alzheimer Disease (2000), Stephen Post of Stony Brook University takes an ethical look at the way we treat people with Alzheimer’s and dementia and criticizes our “hypercognitive society” for placing inordinate emphasis on people’s powers of rational thinking and memory. Scott Roberts, Associate Professor, Health Behavior and Health Education To learn more: On Anne Basting: forgetmemory.org/about/ On Stephen Post: muse.jhu.edu/books/9780801870156 Thomas Kitwood, Dementia Reconsidered: The Person Comes First (1997)

Populations worldwide are aging rapidly, and it’s incumbent on cities and communities to strive to meet the needs of this growing demographic. Through its Global Network of Age-Friendly Cities and Communities, the World Health Organization is identifying those cities around the world that are actively trying to better meet the needs of residents over 60 by integrating an aging perspective into urban planning and creating age-friendly urban environments. Cities and communities in the network are of varying sizes and involve a range of cultural and socioeconomic contexts, but they are linked by a common commitment to reducing or eliminating barriers and expanding services in such key areas as housing, transportation, communication, health care, and outdoor spaces and buildings. Brant Fries, Professor, Health Management and Policy; Research Professor, U-M Institute of Gerontology To learn more: who.int/ageing/age_ friendly_cities

7. Better Nursing Homes

Without common quality measures and agreement on definitions, it’s hard to assess what’s happening in nursing homes across the U. S.—let alone across the world. What constitutes diabetes? How do you define incontinence? What do we mean by a nursing-home “bed”? For the past two decades, my research group has been working to establish standard measures for nursinghome assessments. We’ve developed international standards and at least 20 measurement instruments that are being used by nursing homes around the world. We’ve developed clinical assessment protocols, or CAPS, that help identify major problem areas and offer guidelines on how to address

15 Ideas for a Better Old Age

8. Home Care Increasingly, we’re trying to help move people out of nursing homes or not put them in nursing homes in the first place. My research group is working with several states to develop algorithms and instruments to determine who needs to go into a nursing home, who’s eligible for care, and who can be cared for outside of a nursing home. States are looking for ways to reduce Medicaid expenditures, and one way to do that is to identify those individuals who could be cared for equally well in a different setting, or with fewer resources. Globally, whole nations are adopting these same instruments.

those problems. Our work now extends far beyond nursing homes and is being applied in the areas of mental health, pediatrics, intellectual disability, palliative care, and prison populations.

Brant Fries, Professor, Health Management and Policy; Research Professor, U-M Institute of Gerontology

Brant Fries, Professor, Health Management and Policy; Research Professor, U-M Institute of Gerontology In the broader world of long-term care and nursing homes, there’s much discussion of the need to move away from what Dr. Bill Thomas, founder of the Green House Project, describes as “a factory, assembly-line approach to care” and toward a more diffuse, communityoriented approach that “enriches all of our lives, caregiver, family member, and elder alike.” As Thomas argues, “We do damage to people of all ages when we fail to honor and care for the frailest and chronic, most chronically ill among us.” Thomas is convinced the baby boom generation will force a change. When baby boomers were kids, he says, there were just three flavors of ice cream. Now there are thousands. Today there are “just a few flavors of long-term care for the elderly.” But when the boomers work their way through the system, “there will be a thousand flavors. And that’s the way it should be.”

Home care is clearly a growing trend. Many countries are asking how they can provide a continuum of services to let people age healthily at home rather than in institutions. In England, there’s talk of substituting home care for costly skilled care in nursing homes. The Scottish National Health System is working to develop a telephone triage system to help keep seniors from overusing emergency-room services—an important factor in

Scott Roberts, Associate Professor, Health Behavior and Health Education To learn more: pbs.org/thoushalthonor/eden thegreenhouseproject.org

Jon Krause c/o theiSpot.com

We need to examine—and find ways to reduce—the use of antipsychotic drugs in nursing-home patients. Between 60 and 70 percent of nursing-home residents have dementia—often in combination with depression—and as recently as four years ago, one in four of them was on antipsychotics. There is substantial literature on how to treat the behavioral symptoms of dementia without resorting to psychotropic drugs. Nursing staff members need to be trained and encouraged to do that. A promising trend is the recent emergence of nursing home physician-specialists—sometimes referred to as SNFists, or Skilled Nursing Facility specialists. Similar to hospitalists, SNFists exclusively manage patients in skilled-nursing facilities and also follow patients from the hospital into post-acute care in nursing homes. Patients benefit from the consistency in care, and there are signs that SNFists help reduce hospital readmission rates.

making it easier for older adults to live at home. But since both home care and assisted living are much less regulated than nursing-home care, we need to examine the quality of care people receive in home settings and identify problem areas.

Jane Banaszak-Holl, Associate Professor, Health Management and Policy

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Changing Systems 9. Experience Corps

A promising idea to promote social engagement among older adults is a program called Experience Corps, launched by Columbia University epidemiologist Linda Fried and her colleagues. A community-based volunteer program that pairs older adults with school kids, Experience Corps is designed to bolster the academic success of children while promoting the health and well-being of seniors. This kind of intergenerational program is precisely the sort of intervention we need to be developing. Carlos Mendes de Leon, Professor, Epidemiology

10. Long-term care If there’s one best-practice idea we should adopt in the U.S., it’s social insurance for long-term care. Japan has had it since 2000 or 2001, Germany since 1995, and the Netherlands for even longer. South Korea started a mandatory long-term care insurance program a couple of years ago, and Taiwan is considering doing the same. Clearly the U.S. is not ready to take on another major new initiative like long-term care, but we should be thinking about it. On average, older Americans can expect to spend three years in need of assistance for functional disability. According to the most recent figures, the average cost of full-scale nursing care in the U.S. is $82,000 a year. You can easily become destitute. High-income Americans can presumably afford the high cost of care, and low-income Americans have Medicaid, so it’s primarily the middle class who will suffer. Jersey Liang, Professor, Health Management and Policy; Research Professor, U-M Institute of Gerontology; Faculty Associate, U-M Institute for Social Research

11. Multiple Chronic Conditions Because of the specialization that defines our medical care system, our overall system is set up to deal with chronic conditions one by one by one—but it’s not uncommon to find older adults who have ten or more chronic conditions. To make real progress on dealing with the challenges of multiple chronic conditions, or MCCs, three things must happen: 1) We need to improve our data-sharing systems and induce health care providers to share information among different specialty groups. 2) We need to adopt a community-based approach to chronicdisease management—which we can do in part by training, certifying, and supervising community health workers to work across conditions and be part of a clinical care team that isn’t specialty-oriented. 3) We need to find creative ways to close the gap between what happens to a person in the clinic and what happens in day-to-day life. Health care providers can work with local supermarkets, for example, to provide educational sessions and healthy-food coupons to people with chronic conditions, and with park and recreation facilities to lower admission fees and even donate services. Noreen Clark, Myron E. Wegman Distinguished University Professor of Public Health; Director, U-M Center for Managing Chronic Diseases In 2010, the U.S. Department of Health and Human Services issued a framework for addressing multiple chronic conditions, and that effort has inspired a great deal of research, much of it focused on the need to develop clinical practice guidelines for people with co-morbidities. Often, what doctors prescribe for managing one disease will contradict or counteract the regimen prescribed for another condition. Patients can easily feel overwhelmed and depressed. In fact, depression is higher in patients with MCCs, and with depression comes a host of problems— including lack of motivation for self-care. We need to address that. Mary Janevic, Assistant Research Scientist, Health Behavior and Health Education; Faculty Associate, U-M Center for Managing Chronic Diseases To learn more: hhs.gov/ash/initiatives/mcc

15 Ideas for a Better Old Age

12. No More Fee-for-Service

United States HealthCard iss u e d b y t h e U . S . D e pa r t m e n t o f H e a l t h and H u m an S e r vic e s

Theodore Roosevelt

James McCune Smith

If we’re going to control both Medicare and private spending for senior health care, we need to move away from a strong fee-forservice orientation and toward a system that gives both hospitals and physicians greater incentives for thinking about efficiency. The Affordable Care Act has created some momentum for this, and there’s some acknowledgement on the provider side that the old system is going away, but this may not be enough to move the needle.

Sarah S. Anderson 3758 4503 2771 8643

Thomas Buchmueller, Waldo O. Hildebrand Professor of Risk Management and Insurance; Professor, Health Management and Policy; Professor of Business Economics and Public Policy, Stephen M. Ross School of Business

13. Telemedicine Telemedicine can connect older adults with health care providers regardless of location, time, and geography. The most significant recent development is “telehome care”—or in-home monitoring of chronic illness—which can range from a simple alert system for people who find themselves in an emergency situation, to ongoing monitoring of conditions like diabetes and congestive heart failure, to the design of unobtrusive environments for detecting and measuring health issues like food or liquid intake.

14. National Health ID Some countries, like Belgium, have adopted a national health I.D. system that uses electronic records, so that providers can, with permission, access a patient’s personal health history. So if an older person shows up at a hospital in a confused state, a provider can find out whether that person has dementia or some other condition that might explain his or her confusion. This can be critical to saving lives and determining treatment. It’s a system the U.S. should consider. Brant Fries, Professor, Health Management and Policy; Research Professor, U-M Institute of Gerontology

15. Advanced

Directives That Work In general, our system in the U.S. is not equipped to help people efficiently and expeditiously draft advanced care directives for end-of-life treatment, including Do Not Resuscitate orders, or DNRs. As I discovered when I set out to draft an airtight advanced directive for myself, each individual state has its own requirements, and few have any language to deal with the issue of intellectual disability. We need a more accessible and systematic way of helping people set up advanced directives for end-of-life care. < Steven Levine, Professor Emeritus, Environmental Health Sciences

Chronic illness is on the rise, and more people are living to older age, so this technology is likely to become more common. And in-home devices are becoming less expensive. Rashid Bashshur, Professor Emeritus, Health Management and Policy; Executive Director, UMHS eHealth Center U N I V E R S I T Y

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Rivertown Neighborhood When it comes to affordable care for low-income seniors, Detroit is leading the nation.

ot far from the Detroit River, across the street from the headquarters of the UAW-GM Center for Human Resources, in a repurposed brick building formerly occupied by Parke-Davis, a quiet revolution in senior care is taking place. The first affordable continuing-care retirement community of its type in the nation, Rivertown Neighborhood now offers both assisted living and health care services to more than 190 Detroiters aged 55 and up, and in the next two years will offer independent-living to at least 50 more. A skilled-nursing facility with space for 24 older adults is in the planning stages. John Thorhauer, president and CEO of United Methodist Retirement Communities, which operates Rivertown Assisted Living, says the development is fast becoming a model for the country at large. “Nationally there’s a lot of discussion about the future of providing GM Renaissance Cent er

Michael Thompson/Real Vision Studio

ambassador bridge

Detroit River

► Rivertown’s four-story, 80-unit assisted-living facility provides one-bedroom and efficiency apartments for up to 100 Detroiters ages 55 and older who meet certain criteria. Residents pay no more than $605 a month for meals, care, and housing, and some pay as little as $102.

► When one new resident first saw the library on the fourth floor of Rivertown’s assisted-living facility, she asked, “Who gets to read these books?” “They’re for you,” she was told.

Michael Thompson/Real Vision Studio

Peter Smith

leases an enclosed green space to Rivertown so that residents can have an inviting place to walk. Future plans include walking paths, benches, and a sculpture garden.

Peter Smith

► The UAW-GM Center for Human Resources

► The ground floor of Rivertown’s main facility

► The Center for Senior Independence is one

► Located across the street from the UAW-GM

includes a facility run by the Center for Senior Independence (CSI). CSI is a Program for AllInclusive Care for the Elderly, or PACE, whose chief goal is to allow senior citizens in nearby communities to continue living independently in their homes. CSI provides up to 300 lowincome Detroiters with daily meals, snacks, activities, personal care, and a range of health services, including dental care, mental health care, recreational and physical therapy, and routine checkups as well as urgent care.

of 83 PACE facilities nationwide (Michigan has six, including two in Detroit). PACE facilities are jointly funded by Medicare and Medicaid. The PACE model is especially attractive to Medicaid, because of the significant cost savings that come from coordinating care across the entire health continuum. Key partners in CSI are Presbyterian Villages of Michigan and the Henry Ford Health System.

Center for Human Resources, Rivertown is funded by a combination of sources, including United Methodist Retirement Communities and Presbyterian Villages of Michigan, as well as other foundations and community and governmental agencies and organizations. A total of 17 sources provided $17.7 million to fund Rivertown Assisted Living, the first phase of the overall project, with philanthropy accounting for $3.1 million of the total cost.

Rivertown Neighborhood

Rivertown Neighborhood ►

according to recent statistics, elderly Detroiters die five years younger than people elsewhere in Michigan—in part because the city offers so little access to affordable care in quality settings. “It’s really a tragedy there haven’t been more options for people in Detroit,” Banaszak-Holl says, adding that this is true of low-income communities throughout the U.S. “Hopefully this model of affordable assisted living will increase in prevalence.” <

bridge belle isle

services to seniors in affordable housing,” he says. “A lot of models are being attempted, but none are as extensive as this, with multiple levels of services and more stable funding sources.” When all phases of construction and program implementation are complete, Rivertown Neighborhood will serve 700 seniors. It’s a far cry from the roughly 125,000 Detroiters Thorhauer estimates may be eligible for Rivertown’s housing or services, but a crucial first step. “Our goal is to take people who’d otherwise be in a nursing program and keep them at home as long as possible.” SPH Associate Professor Jane Banaszak-Holl, who serves on the board of United Methodist Retirement Communities, notes that

UAW - GM

Peter Smith

Belle Isle

► Detroit’s only affordable assisted-living

► Before moving to Rivertown, many residents

► The assisted-living facility at Rivertown also

facility—and one of just two in the state of Michigan—Rivertown Assisted Living provides residents with two meals a day as well as basic utilities and access to round-the-clock care. Many apartments offer river views.

in assisted living were sleeping on relatives’ couches—or worse. One resident told a staff member her favorite “room” at Rivertown is the hallway where the mailboxes are located— “because I didn’t have an address before.”

includes a pharmacy, social room, two bathing suites, and a beauty salon/barber shop, where one resident gets his hair cut every week before church.

► Rivertown Neighborhood is the first re-

► An affordable independent-living facility for

► Rivertown is in the final stages of planning a

low-income seniors, subsidized by the U.S. Department of Housing and Urban Development, is currently under construction next door to Rivertown Assisted Living. The new facility, which will feature 50 one-bedroom apartments as well as a rooftop greenhouse and walking paths, is expected to open in late 2014.

two-story, 24-bed nursing unit adjacent to its assisted-living facility. The new unit, which will follow a more residential, “Green House–style” model, will provide skilled nursing care and rehabilitation.

tirement community in the nation to bring together this range of different services designed for low-income seniors. Ultimately, Rivertown’s four facilities—independent living, assisted living, skilled nursing, and a day center with clinical services—will provide care to 700 Detroiters.

Photos courtesy of UMRC except as noted

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Seventy-four-year-old Henri Matisse in his studio, 1944. ÂŠHenri Cartier-Bresson/Magnum Photos

PoweR

Staying Power

What can the great artists teach us about aging? character in the 1950s—the heavyset, bigbellied Ralph Kramden—would seem a svelte performer on television now. The epidemic of obesity that threatens to make our generation the first to live less long than its parents is a new phenomenon, engendered by “junk” food and insufficient exercise. “Assisted Living” compounds and “Home Health-Care Givers” are new phenomena also, and will almost surely increase. Laura Gilpin

merica grows older yet stays focused on its young. Whatever hill we try to climb we’re over it by 50—and should that hill involve entertainment or athletics we’re finished long before. There are exceptions to this rule, of course, but supermodels and newscasters, ingénues and football players all yield to the harsh tyranny of time. Still, we join the workforce older; we get married and have children older; we live, the actuaries tell us, longer than ever before. And if younger is better it doesn’t appear that youngest is best; we want our teachers, doctors, generals, and presidents to have reached a certain age. Our oldest elected chief executive, Ronald Reagan, famously quipped he wouldn’t hold his opponent’s youth against him. In context after context and contest after contest, we’re more than a little conflicted about elders of the tribe; when is it right to honor them, and when say, “Step aside”? We keep our teeth longer, our backs are less bent. Central heat, indoor plumbing, and air conditioning have changed the expectations attaching to hygiene and therefore health. X-rays and antibiotics have materially improved our physical condition; Viagra and Cialis and an arsenal of face creams promise perpetual youth. And, as TV ads for pharmaceuticals constantly remind us, “You’re only as old as you feel.” Yet if you study photographs of soldiers in the Civil War or look at those who stand on breadlines in the Great Depression, you’ll see a different national profile than that of our nation today. Our waistlines have enlarged. We drive and fly great distances but rarely walk more than five miles. Jackie Gleason’s sitcom

Georgia O’Keeffe Issues of physical health and life expectancy enter in; what does it mean to be old in the 21st century as opposed to the 16th? During the Roman Empire and in the “Pax Romana,” the average life span of the citizen is thought to have been 28; today, in the “Pax Americana,” the average citizen expects 50 additional years. As recently as 1900, the average life expectancy was a mere 45. And, as those who deal with Medicare and Medicaid and the Social Security Administration more and more urgently remind us, the fastest-growing segment of

the American population is the elderly. Our aging populace constitutes a major shift of emphasis within the “body politic,” and the effects are just beginning to come clear. Here is where and why the field of public health grows central and seems crucial. These questions have been newly raised and need to be newly addressed. Is thirty thirty, forty forty? The meaning of such numbers may itself have changed. Anthropologists and archaeologists and paleontologists and forensic experts have accumulated evidence of bone and body mass in the young or elderly in previous times; we have some understanding of what it entailed to enter into combat in Thermopylae or Carthage or in the Ninth Crusade. We know about lead poisoning and calcification in hips. But it’s impossible to truly know—to inhabit, as it were, the bodies of the ancient dead and feel what they were feeling when they made their morning oblation or drank their cup of wine. It’s natural enough for us to imagine that Achilles and a contemporary actor or Helen of Troy and a modern movie star are similar of stature—that the hair and legs and breasts and waistlines of our famous ancestors look more or less equivalent in those who portray them today. But a visit to the Catacombs or a Hall of Armor dispels that illusion in terms of size; we’re larger as a species and will no doubt continue to grow. If our breadth and bones have altered, if matters of shelter and nutrition transform the way we sleep and defecate, why would it not be also true that our ways of feeling young and old have changed?

by Nicholas Delbanco

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Sophocles

Francisco de Goya

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T he s e men a n d w omen p er s onif y Giorgio di Chirico

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s t a y in g p o w er w e s ee in non - a rti s t s as well. Pablo Casals

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Staying Power

ubie Blake, the ragtime pianist, was 100 years old when he died. Blake stayed quick-witted, nimble tongued—and nimble fingered in his musicmaking till the very end. At his centenary celebration, the pioneer of boogie-woogie said, “If I’d known I was gonna live this long, I’d have taken better care of myself.” Grandma Moses did take care, dying at 101. Photographs and video clips of the spry, white-haired old lady suggest she loved the role she played: America’s bespectacled witness, painstakingly outlining hayfields and snowfields and horses and barns and fruit trees and, from household chimneys, smoke. Self-taught and wholly familiar with the world she memorialized, “Grandma” appeared to take late fame in stride; journalists would seek her out, not the other way around. Many great artists lived long. We know that Titian (Tiziano Vecellio) died in the city of Venice on August 27, 1576, having been for 60 years the undisputed master of the Venetian School. Although a large proportion of his thousand canvases were worked on by assistants, he remains among the most prolific and accomplished painters of all time. His color sense was sumptuous, his compositions unerring, and his fleshly nudes and “Titian-haired” beauties still appear to breathe. The portrait of Pietro Aretino hanging in the Frick Collection is a masterpiece of psychological acuteness; shave the man and change his clothes and he could be paying a visit to that museum today. Titian claimed to have been born in 1477, which would make him 99; birth records of the period are inexact, however and he may have been a stripling who died in his eighties instead. Nonagenarians are frequent in the history of art. An incomplete sampling would include the Italian painter Giorgio di Chiri-

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co, and the Greek dramatist Sophocles, who wrote Oedipus at Colonus near the end of his very long life. According to a probably inexact tradition, Sophocles demonstrated competence—disproving his son’s accusation that he had grown feeble-minded—by reciting entire speeches from the Colonus while a rapt audience wept. So what interests me is lastingness: how it may be attained. How might the sheer fact of continuity result in a promise delivered? For obvious reasons, this has become a personal matter; I published my first novel in 1966 and very much hope to continue. Too, such hope feels representative: a “generational” problem in both senses of the word. An ever-growing number of Americans are middle-aged or elderly; no natural catastrophe has thinned our swelling ranks. And the habit of creation does not die, so there are more who paint the sunset or take piano lessons or hunt the perfect endrhyme at day’s end. Our generation, like all others, yearns to produce some something that continues—and the generative impulse, when artistic, lingers on.

mong those men and women I profile in my book Lastingness: The Art of Old Age, there’s the model of Pablo Casals—who shifted from performance but continued making music till his death at 96. There’s the example of Giuseppe di Lampedusa (the author of The Leopard) who commenced his masterpiece (and only novel) when old. There’s Francisco José de Goya y Lucientes, locked into his deafness and apocalyptic vision, who in his eighties fashioned art we now see as prophetic of the present age. There are career trajectories like those of Georgia O’Keeffe and Franz Liszt, who at a certain point withdrew from public view, yet continued to paint and compose. There are innovative masters

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like William Shakespeare and Ludwig von Beethoven, dead in their fifties, or Johann Sebastian Bach and Rembrandt van Rijn, dead at 65 and 66, who did not reach what we would now call senior status but in their time were old. There’s the example of Henri Matisse, who enlarged upon what went before; of Claude Monet, embarking on the project of the Nymphéas; and that of William Butler Yeats, whose poetry grew great. It can of course be argued that greatness defies expectation—that by its very nature it violates the norm. But these men and women personify a kind of staying power we see in non-artists as well; there are many vital “elders” who don’t write, compose, or paint. The creative impulse is a common denominator in those who cook or cultivate their gardens, and satisfaction can be found in work never intended for show. It’s not, I mean, a sine qua non of productive old age that there be art produced. When the work as well as the worker can claim lastingness, however, there’s a confluence of maker and thing made. There are 20 names to name for every one I’ve mentioned, and the survey has barely begun. Indeed, To Be Continued is my inquiry’s clarion call. “Life force”—that inexact but suggestive phrase—is in this sense renewable, a component part of character that somehow does survive. Chill, it still generates heat. < Nicholas Delbanco is the Robert Frost Distinguished University Professor of English at the University of Michigan, where he also directs the Hopwood Awards Program. His most recent work of nonfiction is Lastingness: The Art of Old Age; his next, The Art of Youth: Crane, Carrington, Gershwin, and the Nature of First Acts, is to be published this fall.

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w ho le -b od y • w ho le -l if e

a guide to thriving At any age!

y O p ti m iz ati o n M ea n in g • En er g • M in d fu ln es s R el ati o n sh ip s lle Se Guest-edited by Miche

gar

Michelle Segar, PhD, MPH ’97, guest-edits this special section offering a whole-body, whole-mind approach to lifelong healthy living. A behavioral sustainability researcher, Segar is the associate director of the Sport, Health, and Activity Research and Policy Center and a 2013 fellow with the Center for Healthcare Research and Transformation at the University of Michigan. A frequent speaker on methods to rebrand health as well being, she is at work on a book about using these new ideas to improve behavioral sustainability in health-care and health-promotion contexts. Sources: Bethany E. Kok, et al. (2013) “How Positive Emotions Build Physical Health: Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone.” Psychological Science (24) 1123–1132. Carol D. Ryff. (2013) “Eudaimonic Well-Being and Health: Mapping Consequences of Self-Realization.” In A.S. Waterman, ed., The Best Within Us: Positive Psychology Perspectives on Eudaimonia. Washington, D.C.: American Psychological Association, 77–98.

his special section of Findings offers a whole-body, whole-life approach to health as we age. So much of what we’re told about health and healthy aging is negative and/or punitive: Stop smoking, stop eating fat, exercise more. Drawing on new research across many fields, this “Guide to Thriving” asks whether we might better foster the healthy outcomes most of us seek by taking a different approach—one that emphasizes human functioning and well-being as the primary reason and motivation for self-care, rather than the desire to prevent or treat disease. These questions have never been more important, as nationally and globally we search for ways to create healthier populations and lower health care costs. Equally important, new research suggests that factors like personal growth, selfacceptance, purpose, and positive emotions build both intra- and interpersonal resources and protect people against the health challenges that often accompany social inequality and aging. Psychologist Carol Ryff writes, “To the extent that individuals can cultivate skills for seeing and savoring the positive in themselves and their lives, much in the The English word for “health” same way stems from the Old English hale, that people meaning “wholeness, being whole, can learn to sound or well.” Hale, in turn, comes practice good from the Proto-Indo-European root nutrition, they kailo, meaning “whole, uninjured, would have of good omen.” tools at their disposal to draw on in times of distress or adversity.” In addition to continuing to advance policies to eradicate the racial and economic disparities that contribute to illness, as a society we should also strive to create new policies, environments, and opportunities that promote human functioning and positive emotions.

Health = Wholeness

hale

— Michelle Segar

A Guide to Thriving

our most important motivator

Part 1:

meaning

From Gratitude to Meaning to Health

In a new study on virtues and health, SPH Professor Neal Krause is looking at the role that positive virtues play in social relationships, and how these in turn affect health. Based on findings from a nationally representative sample of people 50 and older, he believes humility is “the fundamental virtue. People who are humble understand the flaws enhanced quality of life of their own lives, and the pain that’s associated with those, as well as the flaws in other people’s lives and the pain that’s associated with that—and that makes them more compassionate. More compassionate people help others. When you help other people, you come down to ome type of meaning is embedded in a deeper sense of meaning in life.” everything we do, whether we realize it What’s meaning got to do with health? or not. Public health can—and should— People with a strong sense of meaning tend to leverage this idea. It’s easy to say that being be grateful, and Krause’s research shows that healthy is important, but it’s another matter engrateful people have better health. They’re tirely to make health-related behaviors a mustmore likely to take care of themselves. They do on a daily basis. By shifting the focus—and have better mental health and deal better with meaning—of healthy behaviors from biometstress—and because they have a deep sense of rics and future outcomes to well-being and meaning, they have something to live for. daily quality of life, we can infuse behavior with a more profound purpose and better achieve lasting motivation and sustainable behavior. Research shows that people are more likely to stick with healthy behaviors like physical activity when they reframe such behaviors as a means of self-care that enhances daily life, rather than as an antidote to disease. When we view our behavioral choices as evolving from and fostering growth and development, the meaning of health changes. It’s no longer about medical prescriptions and biomarkers as it is about wellbeing, self-realization, and relationships. New York Times columnist Jane Brody sheds light on the power of feelings in driving Sources: healthy decision-making. “If you ask me why Michelle L. Segar. (2013) “Health Promoters [I exercise], weight control may be my first Should Stop Promoting Health: New Science of Behavioral Sustainability.” White paper available answer, followed by a desire to live long and at bit.ly/18ocjwE. well,” she writes. “But that’s not what gets me out of bed before dawn to join friends on Wijnand A.P. van Tilburg, et al. (2013) “On the Meaningfulness of Behavior: An Expectancy x Value a morning walk ... It’s how these activities Approach.” Motivation and Emotion (37):373-388. make me feel: more energized, less stressed,

Decision-Making

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Quote/Unquote On Purpose “Epidemiologically, we know that people who have a purpose live longer and have far lower risk of Alzheimer’s disease, heart attack, stroke, and depression. People who develop a purpose even have greater repair of their DNA. Victor Frankl talked about man’s search for meaning—he felt that we had a basic need to find purpose in our lives. In my own work, I’ve been thinking about motivation in ways I never had before. I was used to focusing my attention on disease and death as motivators, but flipping the arrows around, we might think that life, rather than death, can be a motivator—that purpose and meaning in life, as Frankl said, can be our most important motivator for positive health behavior change.” —Victor Strecher, Professor and Director for Innovation and Social Entrepreneurship, U-M SPH; author of On Purpose (2013)

more productive, more engaged and, yes, happier—better able to smell the roses and cope with the inevitable frustrations of daily life.” Brody’s insights demonstrate why it is so important to emphasize the emotional “benefits” of decisions that favor health instead of just their logic-based utility. She also shows how the decisions we make— about everything from diet to sleep to movement—reflect our core values and create meaning in our lives. To learn more: Jane E. Brody. (2012) “Changing Our Tune on Exercise.” The New York Times. August 27, 2012. Hannah H. Chang, et al. (2013) “Affect As a DecisionMaking System of the Present.” Journal of Consumer Research (40):42–46. Michelle L. Segar, et al. (2011) “Rebranding Exercise: Closing the Gap Between Values and Behavior.” International Journal of Behavioral Nutrition and Physical Activity (8):94.

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Your body as energy center

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magine what would happen if we considered our bodies as energy centers that need to be maintained, managed, and fueled on a regular basis in order to better enjoy and succeed at what we care about most. Research suggests that three “health” behaviors that health professionals traditionally cite as tools for preventing disease and reducing obesity—sleep, movement, and healthy eating—are also powerful ways of optimizing daily energy and deepening our sense of well-being.

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energy optimization

To learn more: Jim Loehr and Tony Schwarz. (2003) The Power of Full Engagement: Managing Energy, Not Time, Is the Key to High Performance and Personal Renewal. theenergyproject.com

Sleep Is Your Friend

sleep • movement • healthy eating

The single best predictor of daytime performance is the quality of the previous night’s sleep. Here’s what recent research shows:

► Sleep is a central component of stress restoration—it repairs cellular damage and helps return us to baseline levels of physiological activity.

Give Yourself a Microbreak When she teaches workshops and classes on energy management, SPH alumna and mindfulness expert Sandra Finkel, MPH ’88, stresses the importance of the microbreak. “We tend to have lives that are organized more like marathons as opposed to a series of sprints. But we’re better designed to deal with a series of sprints. Microbreaks are a way to revitalize and re-energize.”

► Naturally occurring poor sleep appears to have both an immediate and a cumulative effect on cognitive, affective, and physiological responses to stress. ► Poor sleep is associated with increased health care use, work absenteeism, and reduced work productivity, together with a growing list of adverse health outcomes—including immune functioning, susceptibility to infectious disease, metabolic syndrome, inflammation, and coronary artery calcification. ► Recent studies indicate that poor sleep both stems from and in turn disrupts other stress processes in a feed-forward fashion. ► Even minor sleep restriction in normal sleepers has a cumulative negative effect on executive functioning. ► When people lose sleep, they tend to eat more and gain weight.

► The negative effects of sleep disruption may be even more pronounced in older adults and individuals with existing sleep disorders.

Paula G. Williams et al. (2013) “The Effects of Poor Sleep on Cognitive, Affective, and Physiological Responses to a Laboratory Stressor.” Annals of Behavioral Medicine (46):40-51. Kathi L. Heffner. (2013) “Nighttime Sleep and Daytime Stress—Tangled Bedfellows: A Comment on Williams et al.” Annals of Behavioral Medicine (46):7-8. Stephanie M. Greer, et al. (2013) “The Impact of Sleep Deprivation on Food Desire in the Human Brain.” Nature Communications (4):1–7.

Movement A growing body of research suggests we don’t need to carve out 30 minutes for a run in order to boost daily energy and a sense of well-being—that by simply reducing the time we spend sitting, we gain physiological health benefits. If we get up from our desks and move, we can also generate energy and well-being. That boost might grow exponentially if we were to combine such movement with being outside in nature. Studies by Rachel and Steven Kaplan of the U-M School of Natural Resources show that when we spend time in the natural environment, mental fatigue is reduced, and the vital bodily resources that have been depleted by stress are replenished. So moving our bodies outdoors might offer multiple benefits for mood and energy. What’s the takeaway? Get up from your desk at regular intervals. Take the stairs when possible. Walk over to speak with your coworker instead of sending an e-mail. Do some jumping jacks. Walk in nature. You may get an energy boost and mood lift like the lift you’d get from a half-hour jog—or a good cup of coffee. To learn more: Maher, et al. (2013) “A Daily Analysis of Physical Activity and Satisfaction With Life in Emerging Adults.” Health Psychology (32): 647–656. Bossmann, et al. (2013) “The Association between Short Periods of Everyday Life Activities and Affective States: A Replication Study Using Ambulatory Assessment.” Frontiers in Psychology (4): 102.

A Guide to Thriving

Healthy Diet, Healthy Aging In his book In Defense of Food, writer Michael Pollan famously advises, “Eat food. Not too much. Mostly plants.” It’s sound advice, says Ana Baylin, an associate professor of epidemiology at SPH who studies the effect of nutrition and genes on cardiovascular disease. According to current research, the best diet for delaying age-related disease is one low in calories and saturated fat and high in wholegrain cereals, legumes, fruits, and vegetables, and one that maintains a lean body weight. But it’s not just older adults who need to eat healthily—healthy aging starts in childhood, and even before, in utero. So while it’s never too late to adopt healthy eating habits, it’s best to start early. It’s also critical that public health and health care professionals work with policymakers to eliminate so-called “food deserts” and make healthy foods available to people of all income levels and geographic locations. Baylin offers these tips for nutritional thriving:

► The more colorful your diet, the more vital vitamins, minerals, and micronutrients you’re getting. ► Focus on food, not supplements. Unless a doctor has told you you’re deficient in some essential vitamin or mineral, avoid supplements—get what you need through food.

► Avoid trans-fatty acids and saturated fatty acids, which are bad for you. Increase your intake of polyunsaturated fatty acids, which largely come from plants.

► Avoid processed foods, which are usually loaded with sodium and sugar.

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► Avoid processed foods that are “fortified” with vitamins, micronutrients, antioxidants and the like. You don’t need processed food—you need an apple or an orange. ► Get kids cooking. We all need to stop depending on pre-packaged processed foods. What kids learn about cooking and eating during childhood creates the foundation of their food attitudes and practices. ► Lower your sodium intake. As we age, we become more sensitive to salt, and our kidneys may not be able to handle the high levels of sodium that are typically found in processed foods. ► Avoid sugar-sweetened beverages, one of the biggest contributors to obesity. ► Call on the food industry to make fresh foods more widely available and to stop supersizing portions. ► Practice mindful eating. Too often we eat because we’re bored or because it’s a habit, not because we’re hungry. Take time to savor your food. To learn more: Jill Castle and Maryann Jacobsen. (2013) Fearless Feeding: How to Raise Healthy Eaters From High Chair to High School. Brian Wansink. (2006) Mindless Eating: Why We Eat More Than We Think. mindlesseating.org Walter C. Willett, MD, with Patrick J. Skerrett. (2005) Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. Mollie Katzen and Walter C. Willett, MD. (2007) Eat, Drink, and Weigh Less: A Flexible and Delicious Way to Shrink Your Waist without Going Hungry.

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Sexuality Few older adults care as much about whether they have a “perfect sexual experience” as whether or not they’re regularly in touch with each other. Your skin is the biggest sensual organ on your body, so touching is one of the kindest things you can do for yourself. One way for partners to do this is to get into bed several times a week and spend as little as five minutes together, skin-to-skin, just reconnecting. The experience will trigger bonding and relaxing neurochemicals in the brain. Especially these days, with our mania for living online, skinto-skin contact literally puts us in touch with our lives—and improves our capacity for wellness. Orgasm—which can continue well into people’s 90s—releases neurochemicals for bonding, stress reduction, and pleasure in the brain. It’s good for physical health, too, because it contracts the muscles in the reproductive and genital regions, which, like all other muscles, need to be used. Masturbation is also key to healthy sexuality. Whether one is partnered or not, regular masturbation will increase sexual awareness, pleasure, and orgasmic potential. Another key to a healthy sex life for older adults is vitality. There’s a positive correlation between better sex and regular exercise. —Sallie Foley, Faculty Associate, U-M Center for Sexuality & Health Disparities (SexLab); Director, Sexual Health Certificate Program, U-M School of Social Work; Co-author, with Sally A. Kope and Dennis P. Sugrue (2013), Sex Matters for Women: A Complete Guide to Taking Care of Your Sexual Self (2nd ed.)

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Family • Friends • Community • Pets

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a nationwide longitudinal study aimed at quantifying the impact of religion on health. Chatters has found that support from fellow church members often complements support from family members—especially in African-American churches, where members are considered part of one’s “church family,” and terms like “Brother,” “Sister,” and “Mother” are commonly used. Her data show that church support among African Americans is related to lower levels of depressive disorders— suggesting that involvement in church networks is protective of mental health. African-American churches have also historically functioned as health care advocates, particularly in places with little or no access to health care.

relationships

network • volunteer • participate

hen it comes to health, communities matter. In fact, research shows that the stronger our communities are, the better our health outcomes tend to be. One reason for this is that we draw on friends and family when we need help— whether that help is material or emotional. Another reason is that we often rely on social relationships for health information.

SPH Professors Linda Chatters and Neal Krause have both conducted studies showing the positive impact that religious communities can have on our health. Krause has found that older adults who are involved in religious activities tend to enjoy better physical and mental health—and he’s now embarking on

redefinition relates to family transitions such as divorce, remarriage, and cohabitation. But there are lots of ways that families change and kin relationships evolve, including chosen kin within LGBT groups.” Given ongoing demographic changes, new families in America will increasingly be blended, semi-extended, and inclusive of fictive kin. To learn more: Linda M. Chatters, et al. (1994) “Fictive Kinship Relations in Black Extended Families.” Journal of Comparative Family Studies, 25:3. 297–312. Neal M. Krause. (2008) Aging in the Church. How Social Relationships Affect Health. West Conshohocken, Pennsylvania: Templeton Foundation Press. Robert Joseph Taylor, et al. (2013) “Racial and Ethnic Differences in Extended Family, Friendship, Fictive Kin, and Congregational Informal Support Networks.” Family Relations (62, 4):609–624. Marieke Voorpostel. (2012) “The Importance of Discretionary and Fictive Kin Relationships for Older Adults.” In Rosemary Blieszner and Victoria Hilkevitch Bedford, Handbook of Families and Aging. Praeger, 244–259.

Fictive Kin It’s important to remember that the term “family” doesn’t necessarily mean people to whom we’re related by blood or marriage. In fact, recent research has shed light on the powerful—and often positive— role that “fictive kin” can play in our health and well-being, especially as we age. “Fictive kin” refers to those individuals we’ve come to regard—and treat—as family, with all the expectations the term implies. It’s a way of redefining family relationships and is seen in a number of cultures, including MexicanAmerican communities, where compadrazgo, or coparenthood, is a ritual fictive kinship system. “Fictive kinship is an increasing phenomenon in contemporary life,” says SPH Professor Linda Chatters. “We are individually thinking of new ways to define kin, and maybe even to supersede blood and marriage in the ways we think about kinship. Some of this kin

In Joy and in Sorrow, the Importance of Touch Touch is a deeply significant part of people’s lives, says U-M’s Sallie Foley, a faculty affiliate of the U-M Center for Sexuality & Health Disparities (SexLab) and director of the School of Social Work’s Sexual Health Certificate Program. Many people report that after the loss of a loved one, or during periods of acute loneliness, touch is particularly soothing and contributes to health and well-being. People who are recently widowed or have gone through a divorce find that getting regular massages— whether full-body or simply a foot, shoulder, or scalp massage—or any kind of reflexology helps them stay healthy in their bodies and mindful of their sensuality.

A Guide to Thriving

Be Social, Be Healthy Years of research have taught Carlos Mendes de Leon, professor of epidemiology, that social connections and engagement may be beneficial to our health. “In general, older adults who have a greater number of social relationships and are more socially engaged tend to live longer, have less disability, and show somewhat less cognitive decline.” What’s not known is precisely how social engagement contributes to healthy aging, and Mendes de Leon is working to answer that question. “It’s possible that it’s reverse causation— that better health leads to more socialization,” he says. “At the same time, I think it’s quite plausible that there are reciprocal effects. If you start the aging process in better health, that allows you to be more socially engaged, which in turn provides some protection against decline.” Consider these ways to strengthen social ties—and boost your health:

Where Gardens Flourish, Health Blooms The research is clear—people who help plan, plant, cultivate, and harvest community gardens eat more healthily and are more physically active. But what researchers Katherine Alaimo and Tom Reischl discovered in a study of urban gardens in Flint, Michigan, in the early 2000s went further. Participation in community gardens, they learned, deepens social connections in ways that benefit both the community at large and the health and well-being of individual participants. People who garden together feel more connected to one another and their community and enjoy a deeper sense of purpose and meaning.

► Take part in a walking group ► Join a local group in a church, community center, or neighborhood

► Volunteer for a community-based organization

► Participate in organized-group trips ► Take a class

And Don’t Forget Pets … The health benefits of pets are well known. “Some of the most dramatic positive therapeutic results are for populations where one wouldn’t necessarily expect close relationships,” says Cathleen Connell, professor of health behavior and health education. “Kids with autism, for example. Or children who are undergoing extended hospital stays due to chronic illness.” Connell’s own research has documented the positive role pets can play for adults with dementia and their caregivers. Caregivers report that dogs and cats are often as much help to them as they are to the patients they’re tending. U N I V E R S I T Y

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“The idea is that gardens may be a way to build community in places where community is disappearing,” says Reischl, an associate research scientist at SPH. Not coincidentally, many community garden volunteers are senior citizens, who draw special pleasure and meaning from working in a multigenerational environment. Not long after Alaimo’s and Reischl’s work, Michigan lawmakers passed legislation allowing county governments to assume ownership of foreclosed properties. It’s one reason community gardens are flourishing in cities like Flint and Detroit.

“Pets don’t really care if your memory’s tanking,” Connell explains. “They’re still there for you, and having something close,

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and having something that gives you comfort, is just such a relief to both caregivers and patients.” Connell cautions that because they require care themselves, pets aren’t for everyone. “There are certain circumstances where pets may no longer be appropriate.” But more often than not, pets are a boon to health and well-being.

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li st en to yo ur bo dy ’s m es sa ge s

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mindfulness

Inner

Technology

indfulness might sound like something only yogis should care about. But that assumption is dead wrong. We arrive at destinations without any memory of driving there. The phone rings as we are walking out the door, and without any intention of doing so, we pick it up. In fact, there’s quite a bit of research showing that we mortals make decisions, pursue goals, and live our lives often unconsciously. Instead of responding thoughtfully to things, we react out of habit. Being mindful is the antidote to our crazed way of living—nonstop rushing around on autopilot. Jon Kabit-Zinn, one of the pioneers of integrating mindfulness into Western society, refers to mindfulness as an “inner technology.” As implied by his clever metaphor, “mindfulness” reflects a know-how, a skill set that improves with intention and regular practice. Being mindful means being present, alert, and very discerning. It’s about taking our minds off autopilot and instead making

fresh new choices aligned with what we care about most. Instead of judgmental self-talk, a mindful perspective fosters appreciation of where we happen to be in the moment, despite where we’d like to be or where we think we should be. Mindfulness fosters compassion toward ourselves and our lives—a necessary ingredient for well-being. And a necessary ingredient for health. These days we prioritize being in constant contact with others but ignore the instantaneous messages sent from our own bodies when we’re tired or stressed. Learning to genuinely listen to and be mindful of our bodies’ messages—instead of ignoring them—is a key to sustaining healthy lives.

Mindfulness May Help Veterans with PTSD A collaborative study from the U-M Health System and the VA Ann Arbor Healthcare System shows that veterans with post-traumatic stress disorder who completed an eight-week mindfulness-based group treatment plan showed a significant reduction in symptoms as compared to patients who underwent treatment as normal. Veterans in the mindfulness treatment groups participated in in-class exercises such as mindful eating; “body scanning,” an exercise where patients focus on physical sensations in individual parts of the body; mindful movement and stretching; and “mindfulness meditation,” including focusing on the breath and emotions. The participants were also instructed to practice mindfulness at home through audio-recorded exercises and

during the day while doing activities such as walking, eating, and showering. “Mindfulness techniques seemed to lead to a reduction in symptoms and might be a potentially effective novel therapeutic approach to PTSD and trauma-related conditions,” said lead author Anthony P. King, a research assistant professor in the U-M Department of Psychiatry.—UMHS News Service

Meditation, Purpose, and DNA Nobel laureate Elizabeth Blackburn and her research team have found that meditation and other contemplative activities foster a sense of purpose and direction in life, which in turn increases the activity of telomerase— the enzyme that repairs telomeres, the protective caps at the ends of our chromosomes. Blackburn compares telomeres to the tips of shoelaces, noting that “if you lose the tips, the ends start fraying.” As the ends of our chromosomes wear down, telomerase comes in to repair them. Studies by Blackburn and her colleagues have shown a link between low telomerase and stress-related diseases. Thus meditation and other mindful activities that can help alleviate stress and deepen our sense of transcendent purpose can actually protect our DNA and slow the process of cellular aging. Source: Claudia Dreifus. “Finding Clues to Aging in the Fraying Tips of Chromosomes.” The New York Times. July 3, 2007.

A Guide to Thriving

In Practice: Being Mindful While she’d probably be the last to take credit for the success of the U-M Men’s Basketball Team in the 2013 NCAA Men’s Division 1 Tournament, SPH alumna Sandra Finkel, MPH ’88, admits that the meditation and mindfulness techniques she taught members of the team may have helped fuel their run to the final. “When athletes are able to be focused on the right things, and be really present and aware of their surroundings, they get better results,” she says. “And if it’s true for is also for athletes, is it Mindfulness not true for the rest of us?” In addition to the men’s basketball team, with whom she’s worked for the past two seasons, Finkel has brought her mindfulness techniques to the U-M Health System, MHealthy, and organizations and executives throughout southeast Michigan. Her key message? Mindfulness can reduce stress and boost overall health. “The myth is that when we live this very stressed lifestyle, we’re more productive. But that’s not true.”

9 Ways to Incorporate Mindfulness into Your Daily Life

Activate the Senses

1. Pay attention to more moments as they are unfolding, as opposed to thinking ahead to the future or holding onto the past. 2. Let your breath anchor you to the present moment. Don’t fret if your mind keeps going— just keep focusing on the breath.

3. If you’re having trouble sleeping, lie down and focus on your breathing.

4. Do a mental body scan. Pay attention to different parts of your body, starting with your feet and working your way up to your head. By bringing awareness to a part of the body that’s holding tension, you naturally relax.

1. Practice active listening. Often when someone else is talking, we’re formulating what we’re going to say in response instead of listening. Try the opposite: in conversations with others, be truly present and attuned. 2. Instead of regarding outside sounds as an annoying distraction that intrudes on your peace, try regarding them as part of your overall experience and letting that be okay.

5. Take microbreaks. Sit still and quietly

3. Be mindfully

watch your breath for five minutes, or do a quick body scan.

aware of what you’re tasting when you eat and drink. Slow down and savor the experience from first bite to aftertaste.

6. Take mindfulness breaks even if you have to do it incognito. If you’re stuck at a computer terminal, pretend you’re working and actually be mindfully in your body, even with your eyes open. 7. Go mindfully into nature. 8. Turn off the technology. Impose a non–cell phone or pager portion of group meetings— and then reward yourselves by shortening the meeting.

9. Instead of thinking “I’m bored,” and turning to your cell phone—or the refrigerator—tell yourself, “Here’s a chance to be mindful.”

4. Try a walking meditation. Unlike normal walking, where you’re often multitasking—talking, listening to music—just be in your body and pay attention to what you’re hearing, feeling, and seeing. Further Reading: “Athletes Who Meditate: Kobe Bryant & Other Sports Stars Who Practice Mindfulness,” Huffington Post, May 30, 2013 Elizabeth Robinson, Sandra Finkel, and Elizabeth Jackson. (2011) “Psychosocial Interventions: Meditation.” In Psychiatry and Heart Disease: The Mind, Brain, and Heart. Ed. Michelle Riba, Lawson Wulsin, Melvyn Rubenfire, and Divy Ravindranath (John Wiley & Sons).

Getty Images

W See a video on the mind-body benefits of the natural environment at sph.umich. edu/findings.

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What’s Joy Got to Do With It? Reports suggest that joyfulness and other positive emotions can have a profound impact on life satisfaction and health as we age, although it’s sometimes hard to separate cause and effect. Gerontologists suspect these traits have strong genetic components. Through the Sardinia Project, an ongoing research collaboration between the U.S. National Institute on Aging and the Italian Research Council, SPH biostatistician Goncalo Abecasis and colleagues are attempting to identify the genes that underlie such personality traits as extroversion, openness to experience, and agreeableness.

Old Age

New Genetic Insights into Age-Related Macular Degeneration

oncalo Abecasis, the Felix Moore

Abecasis says that once researchers succeed in identifying those genetic variants that specifically modulate personality, they’ll be able to track individuals who possess those variants and disentangle the health consequences of personality traits. <

Collegiate Professor of Biostatistics at SPH, and SPH researcher Lars Fritsche are members of a groundbreaking international team who recently discovered seven new genetic markers associated with increased risk of age-related macular degeneration (AMD). An estimated two million Americans who have AMD— which affects a region of the retina responsible for central vision—are at risk for blindness. The study, funded by the National Eye Institute, Abecasis a part of the National Institutes of Health, brings hope to patients and scientists alike, who may be able to better understand and target those who reach the most severe stages of the disorder.

“The current study broadens our understanding of disease biology and provides many new targets for intervention,” says Fritsche.

An estimated two million Americans who have AMD are at risk for blindness. “It is exciting to think that detailed analysis of these candidates will lead to the development of new treatments for this debilitating disease.” For more, see bit.ly/eye-disorder. —Laurel Thomas Gnagey <

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FutureFindings Neal Krause, the Marshall H. Becker Collegiate Professor of Public Health and associate chair, Department of Health Behavior and Health Education, has received an $8 million grant from the John Templeton Foundation to conduct a landmark spirituality and health survey aimed at generating solid explanations for why religion has both positive and negative effects on human physiology. <

Improved Quality and Lower Costs for Hip and Knee Replacements O

ver one million people undergo hip and knee replacements across the U.S. each year, and it is expected that more than four million people will have these procedures done annually by 2030. Increasing the quality of care and reducing costs for this extensive network of patients are critical public health issues. As director of research for the American Joint Replacement Registry (AJRR), SPH alumna

Caryn Etkin, PhD, MPH ’97, is collaborating with SPH Professor Hal Morgenstern to address both issues. Morgenstern is lead epidemiologist for the U-M–based Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), a group of orthopedic surgeons and medical professionals devoted to improving the quality of care for patients

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undergoing hip and knee replacement procedures in Michigan. “As a national registry, AJRR will be able to provide the most accurate and complete picture of the arthroplasty experience in the U.S.,” Etkin explains. “By providing benchmarking and monitoring the outcomes of arthroplasty, we can advance the efforts of patient safety and quality of care.” Working together, Etkin and Morgenstern hope to improve followup, decision-making, and early detection. After starting formal operations in 2012, AJRR has enrolled over 200 hospitals from 46 states and hopes to capture data on 90 percent of all total joint replacements being performed in the U.S. with assistance from organizations such as MARCQI. —Rachel Ruderman < To learn more:

AJRR ajrr.net MARCQI marcqi.org

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Older adults with asthma face unique challenges, among them atypical asthma symptoms and an inability to distinguish asthma from other medical conditions. Under the direction of Alan Baptist, an assistant professor of health behavior and health education, a team of researchers in the U-M Center for Managing Chronic Disease is embarking on a study to implement and evaluate a self-regulation asthma intervention for adults 55 and older who have persistent asthma. Study participants include residents from inner-city, suburban, and rural communities. Funded by the National Institutes of Health, the randomized control trial will assess the impact of the intervention on quality of life, asthma control and symptoms, lung function tests, and health care utilization. < Carlos Mendes de Leon, professor of epidemiology, is examining racial and ethnic differences in the rates of decline among older Americans, with the hope of determining whether minority populations have more adverse aging-related declines than the majority non-Hispanic white population. Mendes de Leon says the evidence to date is mixed, and that “while minorities tend to experience greater declines in health before reaching older age, the rate of overall decline in older age itself is not necessarily worse than in older non-Hispanic whites.” <

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Art Therapy for Dementia Caregivers: An MCubed Project In the U.S. at least five million people suffer from age-related dementia, which manifests itself in many forms and is generally defined as a decline in cognitive performance. The stress from this disease, especially on caregivers, can be detrimental to health. Cathleen Connell, associate chair of the SPH Department of Health Behavior and Health Education, and Associate Professor Anne Mondro of the U-M Penny W. Stamps School of Art & Design, have been awarded an MCubed grant to explore the benefits of creativity through art on both caregivers and patients with age-related dementia. MCubed is a two-year seed-funding program designed to empower interdisciplinary teams of U-M faculty to pursue new initiatives with major societal impact. Connell Connell and Mondro are also collaborating with Lydia Li, associate professor of social work, and Elaine Reed, bedside art coordinator U-M Health System’s Gifts of Art program.

Old Age

Nursing Homes: Cost of Care and Planning for Care E

very nursing home in the U.S. uses a case-mix system developed by SPH Professor Brant Fries and his research team to establish payments rates to cover the cost of care for individuals on Medicare. Additionally, more than half of the 50 states use the same system for people on Medicaid. The novel case-mix system adjusts the rates that facilities are paid according to the complexity and difficulty of caring for individuals. As Fries explains, “If you’re providing care for a person who requires a Fries great deal of care, you ought to get more money. People whose needs are not so burdensome should cost less.” It’s all about distributing resources logically and equitably, he says.

Communication between caregiver and care recipient is often improved as part of an enjoyable shared activity. The six-week intervention Connell and Mondro have designed includes individual work with caregivers as well as collaborative exercises with both caregivers and patients. Connell explains that self-expression and creativity can have direct health benefits, and that “communication between caregiver and care recipient is often improved as part of an enjoyable shared activity.” Connell and Mondro hope the intervention will help determine whether art therapy can improve the quality of the caregiver/care recipient relationship, reduce distress, and ultimately support caregivers in their work. —Rachel Ruderman < To learn more about the project, visit: bit.ly/mcubed-creativity.

“If you’re providing care for a person who requires a great deal of care, you ought to get more money. People whose needs are not so burdensome should cost less.” With an eye toward lowering costs, Fries and his team are also working with state governments to determine who, exactly, should receive long-term care, and what kind of care they’re currently receiving. His team found out that the state of Louisiana, for example, had three home-care programs with different eligibility criteria and vastly different reimbursement rates for each. As a result of their work, the state has been able to consolidate programs and reduce its expenditures. Abroad, policymakers in Finland are using the same methodology to develop a cost-effective long-term care system for the entire country. <

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Long-Term Care: Home vs. Nursing Home?

A comprehensive analysis recently published in The New England Journal of Medicine suggests that dementia care costs are among the highest of all diseases, reaching $159 to $215 billion annually in the U.S. This study was the result of a collaboration between researchers from the RAND Center for the Study of Aging and SPH Professor Kenneth M. Langa, a U-M physician and researcher. The study, funded by the National Institute on Aging, suggests that the costs tied to dementia may be financially debilitating for patients and families.

lthough the technical challenges are daunting, Brant Fries and his research group are working to compare outcomes in individuals who receive care in nursing homes versus those who receive care at home. “You can’t do a randomized control trial,” Fries points out. But thanks to a system for common measures that Fries and his group have developed, it’s now possible to compare the care received in nursing homes against that received at home.

Thanks to a system for common measures that Fries and his group have developed, it’s now possible to compare the care received in nursing homes against that received at home. “We found that when we can compare, home care seems to be better,” he says, adding that the research is both highly nuanced and highly controversial. He and his team are working to refine their methodology and test it in a variety of states. Given the growing desire of people to receive care at home rather than in nursing homes, the research is critical. “It sets up the question, ‘What is the right setting for people?’” Fries says. “What kind of care do they need? How do we identify the risks for individuals so that these risks can be better addressed?” As health professionals across the country start to move toward more integrated systems, these questions become even more significant. <

“Ignoring these long-term care costs leads to a huge under-counting of the true burden that dementia imposes on our society.” Langa explains that the majority of costs result from “the long-term daily care and supervision provided by families and nursing homes, often for many years.” He continues, “Ignoring these long-term care costs that build up steadily day-after-day leads to a huge under-counting of the true burden that dementia imposes on our society.” The implications of this hefty financial burden, coupled with the emotional costs of this disease, suggest a burgeoning public health issue that will only become further exacerbated with the aging of the baby-boom generation. —Beata Mostafavi < To learn more: bit.ly/dementia-costs.

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RESEARCH DIGEST

Dementia Care Costs Among Highest of All Diseases

42 FINDINGS AL U M N I N ET W OR K > ON THE JOB

A Friendship Strengthened by Time

Atlanta, December 30, 2012.

Phields Photography

Standing, from left to right: Marsha Broussard, MPH ’83, DrPH, Program Director, School and Adolescent Health, Louisiana Public Health Institute; and Terri Wright, MPH ’83, Director, Center for School, Health and Education, Division of Public Health Policy and Practice, American Public Health Association. Seated, left to right: Neysa Dillon Brown, MHSA ’83, Senior Vice President, Desir Group Human Capital Management; and Linda Blount, MPH ’89, Vice President, Program Impact, Community Engagement, United Way of Greater Atlanta (Georgia).

Alumni Network C L A SS N O TES

ver the past 30 years, they’ve come together to celebrate birthdays and weddings and the births (and later graduations) of their children. They’ve shared parenting tips and career advice and business practices and home remedies. They’ve vacationed together and collaborated professionally and promoted each other’s organizations. They’ve stood by one another through illness and divorce and the loss of loved ones. “I call them my sisters,” says Terri Wright, MPH ’83, of the three women she befriended at the School of Public Health in the early 1980s and with whom she has remained close ever since. When they first met in Ann Arbor, there were few African-American students at SPH, and so the four women drew together, convinced that with each other’s help they could find the wisdom and stamina they needed to get through school. All four later joined the SPH Alumni Board of Governors, and for years Ann Arbor “served as our gathering place,” remembers Neysa Dillon Brown, MHSA ’83.

“We have been each other’s rock.” Brown adds that professionally and personally, the four share “a very deep commitment to improving the health status and access to services for individuals who are in need.” Collectively, they’ve used their public health training and education to improve the health and well-being of people in Michigan, Louisiana, Georgia, New York, Connecticut, and the Caribbean. Last December, the four got together again with their respective families to celebrate the holidays—and three decades of friendship. Wright says it’s been especially gratifying to experience the aging process together. “How special it is to share our experiences growing older—what we love, what pains us, what we would have done differently, what makes us laugh out loud, the memories that we share—the ones that are great and the ones that are not so great. We have been each other’s rock,” she says, “and that was created through our experience at the School of Public Health.”

W Read more about the public health careers of these U-M SPH alumnae at sph.umich.edu/findings. <

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Joan Ellison, MPH ’73, has retired after 34 years as public health director of Livingston County, Michigan.  In his new book, Choosing a Career in Development: My 5 Decades in International Public Health (2013), Barry Karlin, DrPH ’74, explores international career opportunities for those interested in public health.

1980s

Renee Bayer, MHSA ’85, is associate director for engagement at Michigan State University’s CREATE for STEM Institute, a university-sponsored research institute with a broad mandate for collaborative research in education, assessment, and teaching environments (CREATE) in the fields of science, technology, engineering, and mathematics (STEM).  Jane S. Grover, DDS, MPH ’88, is director of the Council on Access, Prevention and Interprofessional Relations in the division of Government/Public Affairs at the American Dental Association.  Joanne Sheldon, MHSA ’86, health services administrator for the Michigan Department of Corrections, has been appointed to the newly created Mental Health Diversion Council of the Michigan Department of Community Health.

1990s

Deborah Bach-Stante, RN, MPH ’91, MSW, is director of the Office of Nursing Policy (previously the Office of the Chief Nurse Executive) at the Michigan Department of Community Health.  The National Indian Health Board and the National Congress of American Indians have nominated former head of the Indian Health Service Charles Grim, MD, MHSA ’92, to serve as U.S. Surgeon General.  Leon Haley, MD, MHSA ’96, is the Emory School of Medicine’s new Executive Associate Dean of Clinical Services for the Grady Health System and Chief Medical Officer of the Emory Medical Care Foundation. Haley serves on the board of the U-M Griffith Leadership Center.  Anthony (Tony) Keck, MPH ’93, director of health and human services for

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South Carolina Governor Nikki R. Haley, has been appointed to the Institute of Medicine’s Committee on Governance and Financing of Graduate Medical Education. Keck is completing his doctoral thesis in health systems management at the Tulane University School of Medicine Department of Family and Community Medicine.

2000s

El Salvador native Karen Menendez Coller, PhD, MPH ’02, is the new executive director of Centro Hispano of Dane County, Wisconsin.  Formerly a senior program officer at the Robert Wood Johnson Foun dation, Brenda Henry-Sanchez, MPH ’01, PhD ’07, is now director of research for special projects at the New York City–based Foundation Center, the leading source of information about philanthropy worldwide.  Jillian Murphy, MPH ’09, is an associate managing editor of the American Journal of Preventive Medicine.  The U-M Comprehensive Cancer Center has named Alon Weizer, MD, MS ’09, as medical director with responsibility for managing the dayto-day clinical outpatient operations at the center. Weizer is an associate professor of urology at the U-M Medical School.

2010s

Brigette Bucholz, MPH ’13, one of the first graduates of the U-M SPH Certificate Program in Healthcare Infection Prevention and Control, is manager of infection prevention and control at Northwest Community Healthcare in Arlington Heights, Illinois.  Indiana University has named Jay L. Hess, MD, MHSA ’12, vice president for university clinical affairs and dean of the Indiana University School of Medicine. Hess was previously the Carl V. Weller Professor and chair of the Department of Pathology and professor of internal medicine at the U-M Medical School.  Nikita D. Shah, MHSA ’10, MBA, is director of Care Redesign for the Baylor Health Care System in Dallas, Texas. <

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FINDINGS M A K I N G A D I F F E R ENCE

When I walk down the street now and see other people in the city, I think, “That’s why I’m doing this.”

First Responder N

ot long after finishing her last School of Public Health class, Jillian Reich, MPH ’12, took a job as an emergency preparedness educator with Boston’s DelValle Institute for Emergency Preparedness, a program of the Boston Public Health Commission and Boston Emergency Medical Services. Reich’s first major assignment was to work a medical tent at the finish line of the Boston Marathon on April 15, 2013. The events of that day are well known. Less known is the impact it had on those, like Reich, who stayed on the scene after the bombs exploded to help gather information and communicate with families of the injured. Although she’d always wanted to do emergency public health work, Reich never imagined she’d be so directly “in the thick of things.” Three weeks after the bombings she told members of the SPH class of 2013, “If I had to wake up tomorrow and relive the 15th of April over again, I would. The only thing I would do differently is to find a way to do it better. … That is what sets public health apart from the rest.” Reich spoke to Findings in June about the marathon and its aftermath.

Findings: It’s hard to imagine a more powerful introduction to real-life public health practice than the one you experienced in Boston. How have the events of April 15 changed the way you feel about your profession?

Jillian Reich: It’s deepened my desire to do my job and protect the health and safety of others. Certainly it’s made public health more personal. When I think about what happened, I think about the victims. In the midst of everything, we were recording people’s names and injuries, and then two days later I’m watching CNN, and I see one of the names I’d written down giving an interview. I don’t think a lot of times in public health you get to see the people you’re working for, but I feel so connected to the marathon victims and their families. Even though they have no idea who I am, I feel as if I know each and every one of them. When I walk down the street now and see other people in the city, I think, “That’s why I’m doing this.” If anything, it has made this career—this whole field—much more real to me. I really got the opportunity to see the impact I could have, saving lives.

F: Are there specific lessons you learned at SPH that came into play that day?

JR: In that moment, after the explosion, I really didn’t rely on any specific education or

training. I didn’t think about any class—all that goes out the window. What stays is your character. And I think that really is what Michigan helped shape. That’s something I would want fellow public health professionals and students to think about as they go through their careers—character-building. All the small things, the teamwork skills you use in group projects and presentations, the leadership skills you learn—again, through work on a group project or working with an organization—the communication skills, all the things you gain from Michigan through your classes, your program, your extracurricular activities. Those are the things that build your character, and in a time of crisis, that’s what you rely on.

F: What advice might you give to someone who tells you she’s interested in public health but not sure she’s ready to commit?

JR: One of my mentors told me that if you’re willing to put your heart, soul, time, and effort into helping individuals who may never know your name or face, then the public health community would be lucky to have you. That’s what I would say. For more on the DelValle Institute for Emergency Preparedness, or to access an online emergency-preparedness Knowledge Base, visit delvalle.bphc.org. <

Alumni Network

A Father’s Lesson

Quote/Unquote

April 15, 2013: The Finish Line

evin Frick’s long-standing dream of running the Boston Marathon began to come true in the fall of 2012, when he learned he’d qualified for the 2013 race. A resident of Baltimore, Maryland, where he is a professor and vice dean for education at the Johns Hopkins Carey Business School (and a former faculty member at the Bloomberg School of Public Health), Frick, PhD ’96, went to Boston six months later for the run of his life. He began the race at 10:05 on the morning of April 15 and crossed the finish line at 1:21 p.m., exultant at having completed the course in just over three hours. At 2:49 Kevin Frick, far right, with fellow runners on the p.m., Frick was on the morning of the Boston Marathon. subway, heading back to his hotel to celebrate, when he learned that two bombs had gone off at the finish line, injuring scores of bystanders and killing three— among them a boy the same age as Frick’s son. Three days later, desperate to glean some meaning from the chaos and terror of that day, Frick began drafting a series of essays about the marathon—26 in all, one for each mile. Below, an excerpt from “Mile 24—Brookline”:

s director of the U-M Health Management Research Center, Michael P. O’Donnell, PhD ’94, MBA, MPH, is dedicated to expanding the “health span”—as opposed to “life span”—of Americans, an achievement he believes could yield billions in savings for the country’s overburdened Medicare and Medicaid systems. O’Donnell’s primary aim is to reduce the onset of disability by addressing three factors that contribute more than any others to poor health outcomes: smoking, excess weight, and inactivity. For over 30 years, O’Donnell, who is also a clinical professor in the U-M School of Kinesiology, has been working to do this by developing health-promotion programs in the workplace. “If employers can do a better job of reaching out not only to their employees but also to those employees’ families, we can make progress,” he says, adding that he’s a fan of the slogan O'Donnell “make the healthy choice the easy choice.” In a 2012 article, excerpted below, O’Donnell described how positive health practices allowed his father to remain “fully functional” until just one month before his death, at age 86: “[My father] did what we all hope to do; he died young as late in life as possible. Why did he pass so fast? Why was his period of morbidity so short? Why was he so healthy and vital for so much of his life? Part of it was that he was at peace, emotionally and spiritually, with the situation. Part of it was genetic. Part of it was chance. But part of it, I think, was that he had made so many positive lifestyle changes in his [My father] midlife and was doing so many things to did what we keep himself healthy in his later years. all hope to do;

“Finish lines are usually black and white. I am either on one side of the finish line or the other. I know exactly where it is. I know whether the tape has been broken or not, and whether I have any chance of being first. … When I crossed the finish line in Boston, I thought it would be black and white. I was not finished, and then I was. But the attackers’ actions led to a much different outcome.

But deep inside somewhere, the pain and anger and helplessness that I felt that first afternoon will always be there.

“[…] If we can improve the health of the he died young population through lifestyle change, as late in life we may be able to reduce the financial as possible. burden of Medicare, Medicaid, and Social Security and enhance the fiscal solvency of the nation. […] The savings from improving health may be as important in restoring the fiscal solvency of our nation as a robust economy, avoiding future wars, or reforming tax policy. Of course, maintaining the fiscal solvency of the nation is not the only important outcome of improved health. Enhanced sense of well-being and improved quality of life are equally valuable outcomes.”

I can appreciate so much better how people who have suffered a tragic loss talk about things like how finding the accused and achieving a conviction make them feel better but don’t necessarily bring closure. When we finally get all the details of the investigation, when we finally understand—as best we ever will—the motivation of the brothers, when we finally have some legal outcome to the case, then I will feel like I have come very close to the finish line. But deep inside somewhere, the pain and anger and helplessness that I felt that first afternoon will always be there. And if there is a black and white, I am not sure that I will ever cross the finish line and achieve complete closure on this one. The best I can hope for is to be within sight of the finish line, with no one moving the line ever again. I’m not sure when I will be there.” <

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Source: Michael P. O’Donnell. (2012) “Compression of Morbidity: A Personal, Research, and National Fiscal Solvency Perspective.” Editor’s Note. American Journal of Health Promotion 27(2):iv-vi. <

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FINDINGS

CareerWatch:

Aging-Related Careers

IN MEMORIAM

An ongoing Findings series about trends in public health jobs and careers.

Overview

Careers related to aging are diverse, spanning health care, research, policy, advocacy, philanthropy, and direct service, but all center around the goal of developing big-picture solutions to serve the needs of an aging population. With 10,000 Americans turning 65 every day, employees in the aging-related career sector perform the increasingly important role of understanding how to manage the health and wellness of this population, whose needs and demands are growing.

In Practice

Aging-related research touches on ways to better organize the health care system and address the needs of older adults, while advocates and policymakers translate this research into policy. Direct-service employees engage with older adults in health care settings, helping them navigate the care system, or they serve in a management capacity to oversee the institutions and services that support older people. With aging-related careers, a multidisciplinary approach is essential not only to understand the myriad issues affecting older populations—such as cognitive impairment and obstacles to access—but also to use this information to make improvements at both the individual and system level.

Job Opportunities

Job opportunities in this field are varied and include desk or field positions in health care systems, community-based organizations, universities, nonprofits, labs, think tanks, and philanthropic organizations. While there is an incredible need for more frontline service professionals and the managers who oversee them, there is also a vast need for universitylevel faculty who can teach about how the public health system can better support older adults. Also needed are experts who can work collaboratively to create a more personcentered system offering care for older adults in their homes and communities, where they prefer to reside. The growing older population will need greater financial resources to meet rising health care costs, so there will be a critical need for professionals who can find innovative ways to address this issue.

Skill Set

All disciplinary paths can lead to a career in aging. Although skill sets will vary according to the specific job, the most important skill for working in any aging-related career is the ability to understand the needs of older populations. Other useful skills include the ability to conduct research and perform data and/or policy analysis, grant-writing expertise, an understanding of government institutions and the organization of the health care system, and strong writing and presentation skills. Technological expertise is also a plus, since older adults are often less mobile and may therefore be more reliant on technologybased solutions to their health care needs.

Takeaway Quote

“In my tenure at The SCAN Foundation, I’ve been able to see a lot of success in our work to better support older adults, but we’re still battling this enormous system that operates in silos. With a variety of job opportunities related to aging out there, and the fact that our older population is living longer and growing, now is the time to consider a career in aging.” —Lisa Shugarman, PhD ’00, Director of Policy, The SCAN Foundation, Long Beach, California

To Learn More:

The SCAN Foundation: TheSCANFoundation.org Gerontological Society of America: geron.org American Society on Aging: asaging.org American Public Health Association, Aging & Public Health: apha.org/membergroups/ sections/aphasections/a_ph/ < SPH student Nora White interviewed Lisa Shugarman for this article.

1940s Josephine Baldwin, MPH ’47  March 8, 2011 Gilbert Groff, MPH ’42  March 9, 2013 Evelyn Lavrenz, BSPHN ’47  June 29, 2013 Mary E. Medcalf, BSPHN ’42  March 30, 2013 Ralph C. Pickard, MPH ’47  June 3, 2013 Charles L. Williams, MPH ’4 5  January 5, 2013

1950s Lillian H. Bajda, MPH ’51  April 6, 2013 Ardath H. Emmons, MS ’54; PhD ’60  July 20, 2013 Edwin R. Hakala, BSPH ’53  March 28, 2013 Walter R. Lalor, MPH ’52  September 9, 2013 Sundra J. Moyyad, MPH ’53  April 19, 2013 Patricia A. O’Connor, MPH ’58  February 27, 2013 John H. Schmidt, BSPH ’52; MPH ’60  June 4, 2013

1960s Max Alderson, MPH ’64  September 18, 2013 Jon E. Aker, MHA ’63  August 18, 2013 Roger H. Carlson, MS ’66; PhD ’76  May 15, 2013 Helen A. Crowley, MPH ’69  June 6, 2013 Wayne F. Echelberger, MPH ’60  January 19, 2013 Charles L. Eveland, PhD ’69  February 17, 2013 Eugene C. Goeller, MPH ’67  August 6, 2013 Evangeline Hebbeler-Whitley, MPH ’68  September 5, 2013 Louis R. Jacoby, MPH ’67  July 5, 2013 Esther R. Kelly, MPH ’64  February 9, 2013 Charles C. Kidd, MS ’67; PhD ’70  December 10, 2012 Lee Anne Malott, MPH ’69  July 2, 2013 Treka D. Oakley, BSPHN ’63  July 16, 2013 David M. Perlman, MPH ’69  February 8, 2013 George E. Pickett, MPH ’66  September 14, 2013 Leonard R. Remick, MHA ’60  April 5, 2013 Rose M. Roncone, BSPHN ’63  June 27, 2013 Louise F. Salisbury, MPH ’65  July 21, 2013 Jack Weiner, MPH ’65  July 5, 2013

1970s Peter R. Brayton, MS ’76; PhD ’80  February 27, 2013 Jack E. Damson, MPH ’72  February 9, 2013 Gregory C. Rosenberger, MPH ’70  June 7, 2013 Nancy L. Tigar, MPH ’71  March 11, 2013

1980s Frederick P. Dodson, MHSA ’83

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July 4, 2012

2000s Michelle M. Packard, MPH ’02

New on the web online

sph . u m ich . e d u

> Ready, Get Set, Go!

A brand-new SPH student competition, “Innovation in Action: Solutions to Public Health Challenges,” kicked off this fall, with competing teams announced in October. Aimed at stimulating novel solutions to real-world public health problems, the competition focuses on three areas: detecting disease and risk control, empowering the underserved, and technology-enabled health and wellness. Follow the action at sph.umich.edu/iia. Winners will be announced in March 2014.

> Through a Student’s Eyes

Want to view SPH and public health from a student’s perspective? Check out our student blogs, where you’ll meet some of the people who’ve come here to study and find out what they’re thinking: sph.umich.edu/news_events/studentblog.html. Or visit umsphfrontlines.org, where public health students report on internships and other experiential learning opportunities.

J uly 6–2 5, 20 14

Graduate Summer Session in Epidemiology Now in its 49th year, this internationally recognized program provides instruction in the principles, methods, and applications of epidemiology. A certificate program as well as online and e-learning courses are available. For more information visit SummerEpi.org.

> SPH Partnerships in India … For a firsthand account of an October visit to India by SPH Dean Martin Philbert and a team of SPH faculty who are helping to launch new initiatives in that country, check out umsphglobal.org.

> … and Israel

K EE P I N T O UC H Want to share your real-world knowledge and experience with current or prospective students? Need a job or have one to fill?

Read about the school’s newest partnerships in Israel. Visit an ongoing blog by U-M SPH alumna Danielle Taubman: global.umich.edu/2013/08/exploring-israel-with-publichealth-professors.

> SPH Career Connection

> Something to Say?

Comment online on any story in this magazine and learn what other readers have to say at sph.umich.edu/findings.

matches SPH students and grads with companies and agencies. Check out umsphjobs.org or e-mail sph.jobs@umich.edu.

> If you would like to be part of Are you attending a conference, professional meeting, or other event where prospective students could learn about the University of Michigan School of Public Health? If so, complete our Alumni Materials Request Form at sph.umich.edu/scr/alumni/recruit.cfm, and the SPH admissions team will get you the items you need.

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Ask an Alum, please send an

email to sph.inquiries@umich.edu.

> Update your SPH contact info from our home

page at sph.umich.edu. Or indicate changes on the address label and mail to the address on the back cover.

H E A L T H

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Peter Smith

> MF I YN D ISN GPS A C E

Michigan League Ballroom, backstage during a performance of People, Power, Place: Health, Race & Equity in Our Neighborhoods. A Research-Based Drama of the Stories Behind the Statistics “I’ve done theater all my life, onstage and behind the scenes, and since 2006 have facilitated theater workshops in a women’s prison in Ypsilanti. So when the U-M Educational Theatre Company asked me to perform in an original theater piece about health disparities in Washtenaw County, I said yes. We presented the show to the SPH community as part of a semester-long exploration of race at U-M. Afterward people told us things like, ‘you really brought those stories to life,’ ‘that was so powerful,’ ‘I really get it.’ “I’m very interested in figuring out ways to communicate health information to people, and theater can be a really effective tool— especially in resource-poor areas. Anybody can do theater. It’s not about doing it perfectly, it’s about storytelling. “I think theater is all the more important today because human connection is one thing that gets lost in all the electronic conversations we’re having. There’s a lot to be said for technology—it’s very useful and can be extremely cost-effective. But anything that takes a real experience and turns it into a performance, or has the audience come up and act out the solution to a problem—anything like that really sticks in people’s minds. The places where health information is most needed are often places that don’t have access to smartphones, for example. Theater’s free. It’s easy. It’s a human-to-human connection, and that feels very important.” —Carol Gray, second-year MPH student, health behavior and health education

Findings is published twice each year by the University of Michigan School of Public Health Office of Marketing and Communications. Dean Martin Philbert Director of Marketing and Communications Rhonda DeLong Editor Leslie Stainton Staff Writers Rachel Ruderman, Nora White Video Editor Brian Lillie Web Editor Mari Ellis Art Direction/Design Hammond Design

Copies of Findings may be ordered from the editor. Articles that appear in Findings may be reprinted by obtaining the editor’s permission. Send correspondence to Editor, Findings, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, or phone 734.936.1246, or send an e-mail to sph.findings@umich.edu. Findings is available online at sph.umich.edu/ findings. ©2013, University of Michigan To opt out of receiving the print version of Findings and read our publication exclusively online at sph.umich.edu/findings/, e-mail us at sph.optout@umich.edu. Include Opt-Out in the subject line and your full name in the text.

Regents of the University of Michigan Mark J. Bernstein, Ann Arbor Julia Donovan Darlow, Ann Arbor Laurence B. Deitch, Bloomfield Hills Shauna Ryder Diggs, Grosse Pointe Denise Ilitch, Bingham Farms Andrea Fischer Newman, Ann Arbor Andrew C. Richner, Grosse Pointe Park Katherine E. White, Ann Arbor Mary Sue Coleman, ex officio The University of Michigan, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of Michigan is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity, and Title IX/Section 504/ADA Coordinator, Office of Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734.763.0235, TTY 734.647.1388. For other University of Michigan information call 734.764.1817.

IN THEIR WORDS:

SCHOLARSHIPS MAKE THE DIFFERENCE

In fields as diverse as health communications, human nutrition, hospital administration, infectious disease prevention, and environmental safety, graduates of the University of Michigan School of Public Health are transforming our world.

“Thanks to scholarship funding, I was able to complete a summer internship with the Infection Control Department at the U-M Health System. The experience gave me a new respect for the department and the way they have to adapt to challenges to ensure patient safety—and it was humbling to see the complexity of a hospital. Without scholarship support, I would not have had this fantastic experience. I am a different person because of it.” BRIGETTE BUCHOLZ, MPH ’13 Infection Control Practitioner, Northwest Community Healthcare, Arlington Heights, Illinois Recipient, Marvin and Harriet Selin Scholarship, U-M SPH

To find out how you can help make the difference for an SPH student, contact Gail McCulloch, Development & Alumni Relations, at 734.764.8093, or visit sph.umich.edu/giving, where you’ll find more scholarship stories.

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Peter Smith

University of Michigan School of Public Health Office of Marketing and Communications 1415 Washington Heights, Ann Arbor, MI 48109-2029