American Society on Aging 575 Market Street, Suite 2100 San Francisco, CA 94105-2869


2019 Graduate Student Research Award p. 13 | End-of-life planning in immi­ grant communities.

In praise of elderhood p. 16 | A conversation with UCSF

gerontologist Dr. Louise Aronson.


Covering advances in research, practice and policy nationwide

MAY–JUNE 2019 volume xl number 3

the bimonthly newspaper of the American Society on Aging

Sacred singing at the threshold between life and death

In this issue

FORUM Putting an end to polypharmacy and housing

By Alison Biggar

“This is not a performance,” says choir member Kat Stenstedt, “but an offering creating a sacred space around someone.” An Inspiration of Song The idea for the Threshold Choir came into being in 1990, an inspiration of Kate Munger, a songwriter who had sung for a friend as he lay in a coma, dying of HIV/ AIDS (on the Choir’s website Munger ex­ plains that singing was what she would do when she was terrified). Munger sang to her friend for two and a half hours, and re­ alized this not only comforted her, but also her friend. A decade passed before Munger es­ tablished the choir in 2000 in El Cerrito, Calif., with 15 women, most of whom are still active participants. As of last count in 2017, the Choir had 174 chapters across the United States, in the U.K., and in Australia, New Zealand, Canada and Thailand. Here at home, chapters are more concentrated in California, the Northwest, the Mid-Atlantic and the

discrimination pages 3–4

W omen trickled into the United Methodist Church meeting room in Oakland, Calif., on a cold Thursday evening in February, bun­ dled up, smiling, ready to practice singing in the Threshold Choir. Although a crowd diverse in age and style, when the singers began harmonizing, their voices blended in a way that felt sacred: it was a rare priv­ ilege to be listening to them. But they say they feel privileged to be doing what they do, which is to sing at the bedsides of people who are dying, and, upon occasion, at a baby’s birth or in a Neonatal Intensive Care Unit where in­ fants are struggling to live. They quietly sing so as to calm caregivers, families, even nurses, and to pave a more peaceful journey for persons approaching death. Zeroing in on isolation and loneliness—boosting social capital By Ashwin Kotwal and Carla Perissinotto T he healthcare community and general public increasingly ac­ knowledge that “successful aging” involves not only a focus on physical and mental health, but also on social well-be­ ing and connectedness. In particular, the concepts of social isolation and loneliness have emerged as critical to the health and quality of life of older adults, and to public health overall. While the terms often are used interchangeably, they have different meanings; accordingly, how we address each may differ. Social isolation relates to a quantifiable deficit in the number of relationships or volume of contact with family, friends and community. Risks for being socially iso­ lated include living alone, being unmar­ ried or unpartnered, having no children or having minimal contact with others. Loneliness, in contrast, is a subjective and distressing feeling of isolation, lack of ‘It’s a vivid, rich, charged time.’

AGINGWITH OPTIONS Family caregivers— still home alone? page 5

Consulting— the next career transition strategy? By Joanne Handy and William Benson A s ASA members contemplate transitioning from full-time employment or moving toward retirement, consulting offers opportuni­ ties to use one’s expertise and talents in more flexible ways. Some members look forward to the “hard stop,” a date when one ceases all professional involvement in the field of aging and moves on. But for those still wanting to be involved in the field, consulting may be a sound transi­ tion strategy. We offer the following “Seven Habits of Highly Effective Consultants”: The right stuff—personality charac- teristics of consultants: There is no one successful consultant personality type, but effective consultants usually possess certain characteristics. They need to be self-starters who are comfortable net­ working, selling and developing a pipeline of future projects while juggling current ones. They often work alone, and infre­ quently socialize with or work in teams. They find intrinsic satisfaction in the Rocky Mountain regions, though they ex­ ist in all areas of the United States and are continually forming. Songs are usually written by Choir members, and typically consist of a simple repetition of a few lines in which singers can harmonize. The idea is similar to Gre­ gorian chant, but these songs are much more relatable and the words and phrases vary from upbeat to more peaceful, de­ pending upon the occasion and recipient. A song written by Agnieszka Wolska from theCalgaryThresholdChoir and sung dur­ ing the recent rehearsal in Oakland repeat­ ed these lines: “Let lovewash over you /Let lovewash over you/Let lovewash over you, › continued on page 15

IN FOCUS Probing the shadows: social isolation and loneliness in older adults page 7 Up with tech: older adults apt to use health technologies for self-care page 12 2019 ASA Hall of Fame Award winner: an advocate

for dignity page 13

companionship or a perceived discre­ pancy between ideal and existing social connections. Loneliness and social isola­ tion can co-occur, but recent research suggests they often occur separately. ‘Nearly two-thirds of individuals reporting significant loneliness were married.’ A 2017 national study found that nearly two-thirds of individuals reporting signif­ icant loneliness weremarried. On the oth­ er hand, people can live relatively solitary lives with no complaints of loneliness.

work and do not depend upon extrinsic acknowledgement; their work may be in­ visible to anyone beyond their clients. It Consultants find intrinsic satisfaction in the work and do not depend on extrinsic acknowledgement. helps to enjoy travel, to be able to manage inconsistent income and to thrive in un­ structured situations. Identify a niche: To launch a consul­ tancy, first identify areas of expertise that lend themselves to consulting. These

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