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Review: Health Promotion and Aging: Practical Application for Health Professionals (David Haber)

Haber, David. Health Promotion and Aging:  Practical Application for Health Professionals. New York, NY: Springer Publishing Company. 2013. ISBN978-0-8261-9917-1, 536 pp. Price $90 (Paper)

Dr. Haber’s text delivers exactly what the title says and more.  Like most books on aging, this book begins with a demographic perspective of aging in the Unites States.  It then moves onto a clinical perspective of the current state of health (or disease based on your perception) in older adults.  The book continues with a frank discussion of how we as helping professionals should focus on wellness vs. health care (or disease management, again based on your interpretation of the health care system).  The text provides examples of evidenced based practical applications of wellness that can be utilized by gerontologists, public health professionals and everyone in between who works with older adults.  The book ends with a look at the ever changing public policies and programs for older adults such as Medicare, Social Security, and the Affordable Health Care Act.  The final chapter provides words of wisdom, ideas, and hope for the future to continue to serve and care for the growing older adult population.  One can only hope that policy makers have a copy of this book on their shelves and take Dr. Haber’s words to heart.
Health Promotion and Aging is now one of my favorite books and I look forward to using it in class.  It takes many of my interests in the professions of gerontology and public health and combines them all in one book.  This is perfect for the jack of trades professional.  Every health educator, health care administrator, and community planner could benefit from the research and application examples described in this text.  This is the perfect “crossover” text for the public health professional who says they don’t work with older adults and the gerontologist who says they don’t focus on health care.  This book provides a “big picture” look at our society and how we plan (or have not planned) to meet the needs of the fastest growing segment of our population.  This would be an excellent text for an applied gerontology course.  It provides valuable examples for future professionals in the world of recreation, wellness, and administration for older adults.
As a former senior center director, I particularly liked chapter 13, where Dr. Haber provides five unique career paths for students.  The first one, being to redesign existing senior centers as wellness centers.  This book would have been a great asset to assist me in new program development.  As an instructor, this book provides examples for future service-learning projects.  Dr. Haber provides ideas for new programs using evidenced based practices and a good amount of detail to write the policies and procedures (if not the actual procedure) to get a new project off the ground without having to reinvent the wheel.  As a bonus, Dr. Haber provides suggestions on agencies for community collaborations.
I found the author’s writing style particularly engaging.  While reading the text, I felt as if Dr. Haber were speaking to me as if we were old friends or colleagues.  I enjoyed reading his personal insights and thoughts even in areas of the text I would have been tempted to skim just to read what his impression was of a particular topic or situation.
There is a wealth of history along with current events described in the text.  For those of us who have been around, I really liked how Dr. Haber provided “then and now” examples.  For example in chapter five, Dr. Haber describes the USDA’s new program MyPlate vs. MyPyramid in teaching about balanced meal planning.  In chapter four he provides examples of the Surgeon Generals recommendation for activity that used to focus on targeted heart rates and now focuses on the accumulation of activity most days of the week and explains why we changed from one method to another.  If there is a weakness in the book, I have not found it, unless you are not a fan of Dr. Haber’s style of humor and blunt honesty.

Jennifer A. Wagner, MPH, LNHA
Bowling Green State University
Gerontology Program


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AAQ Volume 34 Issue 4 (April 2014) – Aging, Sex, and Well-Being in Brazil, edited by Annette Leibing

AAQ34(4)cover1DOWNLOAD full version PDF for free here:AAQ34(4)full

Anthropology & Aging Quarterly, Volume 34, Issue 4

Note from the Editor-in-Chief


Group Submission: Aging, Sex, and Well-Being in Brazil, edited by Annette Leibing

Heterotopia and Illness: Older women and Hypertension in a Brazilian Favela
Annette Leibing, Université de Montreal

Aging, Gender and Sexuality in Brazilian Society
Guita Grin Debret, Universidade Estadual de Campinas

Surgery-for-Life: Aging, Sexual Fitness and Self-Management in Brazil
Alexander Edmonds, University of Edinburgh


Argentine Tango: Social dance health ‘to’ you
Jonathan Skinner, University of Roehampton


Lynch, Caitrin & Danely, Jason, Eds. Transitions & Transformation: Cultural Perspectives on Aging and the Life CourseRenee Rose Shield

Chang,  Heewon, Faith Wambura Ngunjiri, and Kathy-Ann C. Hernandez. Collaborative AutoethnographyRichard Zimmer

Ulsperger, Jason S. and Knottnerus, J. David. Elder Care Catastrophe: Rituals of Abuse in Nursing Homes & What You Can Do About ItDiane L. Brown

Sanjek, Roger.  Gray PanthersLindsay DuBois

Haber, David. Health Promotion and Aging:  Practical Application for Health Professionals. Jennifer Wagner

Review: Gray Panthers (Roger Sanjek)

Sanjek, Roger.  Gray Panthers. University of Pennsylvania Press.  320 pp.Cloth 2009  ISBN 978-0-8122-4137-2 , $65.00; Paper 2011, ISBN 978-0-8122-2191-6  $26.50; Ebook 2011, ISBN 978-0-8122-0351-6,$26.50

Studies of elder activism are rare indeed.  Much more so the kind of rich and detailed account which veteran anthropologist and activist Roger Sanjek offers us here.  Gray Panthers has much to give those interested in older people, not just because of the quality of the study itself, but also because the Panthers to whom we are introduced are themselves experts on aging from whom we need to learn.
Some professor once taught me that  the test of a good ethnography was the degree to which the data it presented could enable another scholar to re-anaylze it to answer different questions.  I was reminded of this criteria as I read Gray Panthers.  The careful study of the emblematic activist organization is rich enough in data to speak to a dozen different research agendas: relating to the history of left politics in the United States, the activism of older people, social movement organizing, leadership and gender, ideas about older people, intergenerational politics, and insider anthropology, among others. The life history of a social movement, Gray Panthers traces the story of the eponymous organization from the moment of the group’s inception in 1971 in a fight against mandatory retirement and the ageism it represented.  The group grew to represent the interests of older Americans in a variety of ways: denouncing living conditions in nursing homes, unethical practices in the hearing aid industry (in collaboration with Ralph Nader), media portrayals of older people, for example.   Yet, it has been much more than that.  It’s slogan, “Age and Youth in Action,” signals the group’s intergenerational philosophy.  It took up pressing social justice issues of the moment, including the war in Viet Nam, public health care, sexism and racism.  It is to this larger critique that the group owes its name, an intentional reference to the Black Panthers. The story spans several decades and many states, including specific chapters focusing on the Panthers in Berkeley, New York, and Washington.  (Sanjek originally encountered the Panthers in Berkeley in 1977.  He and his wife both became personally involved with the Panthers.  The author only later took up the group as an object of study.)  The account continues through the organizations various ups and downs, including internal conflict, and the death of its found Maggie Kuhn in 1995, to the time of writing.
For scholars interested in aging, the book is doubly fruitful.  There is much to learn about how older people organize and do politics.  Most striking perhaps is the symbolic politics which the Panthers were so good at: intentionally interrupting mainstream views of older people and aging by doing “outrageous” things.  Another important question for older activists is time.  In Gray Panthers, we see this particular relation to time in at least three ways.  First, older people are often retired, thus have more time available to dedicate to their causes.  Second, older people also benefit from long experience and extensive networks.  Once and again in Gray Panthers we see how members make use of expertise and contacts acquired in earlier stages of their lives.  One of the most personally compelling aspects for this reader was the way the Panthers connect us to earlier activist movements and political struggles that have been all but forgotten in US political memory — in particular the pre-cold war left traditions.  Third, the activists and their organization have to contend with the fact they are nearer the end of their lives, than the beginning.  This can create a sense of urgency, that time is limited. It also creates practical challenges for political organizing.  Experienced and knowledgeable members are more likely than their younger counterparts to be sidelined by illness, or even to die.  The particular strengths of and challenges faced by the elder activists here can thus inform our understanding of the third age more generally.
In sum, Gray Panthers is a book that needed to be written.  Evidently Sanjek was the man for the job.  The Panthers have played an important role in redefining what it means to be old.   This book both describes and continues that project.

Lindsay DuBois
Department of Sociology and Social Anthropology
Dalhousie University


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Review: Elder Care Catastrophe: Rituals of Abuse in Nursing Homes & What You Can Do About It (Jason S. Ulsperger and J. David Knottnerus)

Ulsperger, Jason S. and Knottnerus, J. David. Elder Care Catastrophe: Rituals of Abuse in Nursing Homes & What You Can Do About It. Boulder, CO: Paradigm Press. 2011. ISBN 9781594519079, 222 pp.
Price $ 28.95 (Paper).

As the population rapidly ages and people are living longer, today’s Boomers are faced with the complex decision of determining who is going to provide proper care for their elderly parents.  Dependent upon medical, financial, physical, mental and other specific needs, some individuals may decide to care for their parents on their own while others seek out long-term care facilities such as assisted living, adult day care, respite care or nursing homes that provide optimum care. While finding a facility takes time and much thought, the complexity of the issue lies in finding long-term care where elders are treated with kindness, respect, and cared for as human beings; not abused, neglected, ignored or treated as “impersonal, material items” (84).
Authors Jason Ulsperger and J. David Knottnerus investigate the root causes of abuse in nursing homes and other long-term care facilities based on systematic research and sociological theory to help one understand the different types of nursing home maltreatment.  The book is divided into nine chapters. Beginning with identifying the bureaucracy that encompasses today’s nursing homes and other long-term facilities, the text transitions into the history of nursing home care. Final chapters focus on the organizational dynamics and everyday rituals that can unintentionally lead to elder abuse and neglect.
Although present in the 1960s, nursing home care and maltreatment drastically emerged as a social problem and came to the forefront in the 1970s. This resulted in the establishment of the nursing home reform movement and efforts by organizations such as the National Citizen’s Coalition for Nursing Home Reform (NCCNHR) to continue to assume important roles in the history of nursing homes.  Interestingly as the authors point out, even with the development of the Omnibus Budget Reconciliation Act of 1987 (OBRA) also known as the “Nursing Home Reform Act” (59) elder abuse and maltreatment continued to plaque our nation and impact the care of aging adults.  But why?
Bureaucracy and rules impact the overall care for our elderly.  Rules replace compassion.  Government regulations impact how assigned, everyday duties or “rituals” go unnoticed or undone due to daily tasks assigned to specific employees based on skill/knowledge levels.  Simple things such as removing dirty dishes from the table in a resident’s room or seeing a resident stranded in a hallway waiting for someone to roll them back to their room may not get done if top-level employees are the only ones available.  I totally agree that in our complex world rules are a necessity. However environments where people are dependent on compassion and quality care at a time in their life when they are alone, afraid, and/or ill, rules can contribute to unethical and inhumane care.
This book addresses the core issues of elder abuse and maltreatment and provides case vignettes of everyday situations that long-term/nursing facility residents tolerate due to bureaucratic policies. I was angered when I read many of these short stories which depict bureaucratic induced dehumanization of care. The authors stress the need for culture change; shifting away from the traditional nursing home model (130) to a positive, “resident-centered care” model, thus transforming a facility into a home. The authors remind the reader to acknowledge the elderly for the human beings they are and not “unemotional work products” (83). Engage them, don’t isolate and be responsive to individual needs. Hire employees who have the compassion and desire to care for the elderly and not just fill bureaucratic positions based on policies/demographics.
I would recommend this book to any lay person, healthcare provider, nursing facility employee; or anyone from the Boomer generation who may be faced with the decision of one day finding the proper home for a parent.  This book should be required reading for anyone working in a nursing home or long-term care facility as a reminder how not to treat those they are caring for. Although a quick read, this book provides a wealth of advice and strategies for lessening elder abuse and maltreatment. In one of the chapters the authors compare today’s nursing homes to zoos; stressing the point that residents who are unruly and labeled “troublemakers” are often tranquilized and restrained to protect themselves and those around them much like a zoo keeper would do to a wild gorilla. Both have staff ready to contain unruly creatures that cause disruptions throughout the workday, even if the physical welfare suffers.
Two other types of maltreatment the authors identify is “spoken aggression” and “infantilization” (122). Spoken aggression involves speaking to residents in an intimidating, cold tone or calling names (e.g., calling an older female resident a “mean old woman” or yelling at someone to “shut up and eat your dinner”) (123).  Infantilization is speaking in a condescending way that reduces the status of the resident to a young child (117). Healthcare providers need to be attuned to the subtle nuances that can degrade the status of those they are caring for by treating them like children instead of the adults they are.
The world around us is aging and providing compassionate care is the model all facilities should strive toward. The authors summarize the book nicely by concluding that in order to provide such care, nursing homes must undergo culture changes that downplay bureaucracy, revise staff policies, counter loneliness and isolation from the inside, empower residents and respond to their individual needs.

Diane L. Brown, MS
Program Manager II
Medical College of Wisconsin


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Portfolio: Argentine Tango: Social dance health ‘to’ you, text and photos Jonathan Skinner

Anthropology & Aging Quarterly Volume 34, issue 4 (April 2014) pp.260-263

Argentine Tango: social dance health ‘to’ you

Download as PDF: AAQ34(4)portfolio_p1AAQ34(4)portfolio

These three photos evoke the plaint of life. They are a static portrait of Argentine tango dancers mid-movement. This is life and action frozen and memorialized from a long-awaited Christmas party in Belfast, Northern Ireland. Unlike Julie Taylor’s (2001) succession of mini-tango moves in her ethnography of tango and Argentina, a choreography by flipping, there is only the hint or trace of movement in these photos: the legs in open position with torque on the body, a shoelace working its way free; couples in closed embrace, the leader with motility, the partner with either open or closed eyes, primed to follow their initiations. There is longevity in the pictures from the detail of the marriage rings to the wrinkles on faces solemn with the dance, concentrating but also flowing with solace – ‘relaxed responsiveness’ as Richard Powers (2013) puts it.
Dance – described by Spencer (1) as that ‘nonutilitarian patterned movement’ – can be cathartic, controlling, competitive, communitarian as well as sustaining, maintaining and self-generating. There is solidarity amongst dancers, regularity in the order of attending, learning and performing a dance, and mutual self-affirming of an ontology of being-in-the-world each night when one dons one’s dance clothes and horns a pair of dance shoes. Leslie Gotfrit (1988) speaks to the nostalgia and longing of a bygone body in women reclaiming theirselves on the boogie floor. The same can be said of the tango couple, rejuvenating under the Christmas decorations. There is familiarity and comfort in the sociality of the Other in one’s arms, often a life partner of decades moving with you, reassuring walking as one. “I dance to you”: the ‘to’ a linking narrative and a metaphor for corporeal intimacy in the eyes of Judith Hamera’s (2001) appropriation of Irigaray-ian philosophy.
‘Indistinction’ is how Jonathan Bollen (2001) phrases it as the dancers lean in, support each other, and begin to move in an improvised script to a music from a far-away land and a far-away time. In this case, social dance transports us to Argentina in the 1940s. In the beating of the hearts, and the fleetness of the feet, and the alert anti-clockwise lead around the room, there is wellbeing. Solace seeps up through the motile feet and calm descends from a labile imagination.  Argentine tango, a self-selecting social dance, affects the dancers – variously, an anti-psychotic (Anon. 2013), a stabilizer for Parkinson’s (Hackney et al 2007), an omni-therapy (Woodley and Sotelano 2011). These are just some of the benefits of this genre of social dancing. Other social social dancing such as ballroom dancing also has its strengths as a form of ‘serious leisure’ (Stebbins 2006) – a personal vehicle for successful ageing (Skinner 2013) – and can retain muscle density and stave off social isolation amongst other benefits. But Argentine Tango has the ‘Healing Embrace’ (Berve 2008): it is a resting place for the active. Those interested in more tango visuals and in following up on the worth of tango in the medical setting can follow this link to the annual ‘All of Us Are Crazy for Tango’ programe put on by Hospital Borda in Buenos Aires.
Wherever danced – from Buenos Aires to Belfast, and carrying whatever condition – from physical to mental health issues, this dance addiction can become a boon and adjunct to other fracturing and faltering rhythms in life.
Dr Jonathan Skinner
University of Roehampton
2013 The “tango therapy,” very special treatment hospitals in Argentina., accessed 29 December.
Berve, Anette
2008 Tango Therapy: The Healing Embrace. The Argentina Independent, 1 August,, accessed 6 February 2014.
Bollen, Jonathan
2001 Queer Kinesthesia: Performativity on the Dance Floor. In Dancing Desires: Choreographing Sexualities On and Off the Stage. J. Desmond ed. Pp. 285-314. Madison, Wisconsin: University of Wisconsin Press.
Gotfrit, Leslie
1988 Women Dancing Back: Disruption and the Politics of Pleasure. Journal of Education 170(3): 122-141.
Hackney, M. E., Kantorovich, S., Levin, R., and Gammon, M.
2007 Effects of tango on functional mobility in Parkinson’s disease: A preliminary study. Journal of Neurologic Physical Therapy 31(4): 173-179. See more at:
Hamera, Judith
2001 I Dance To you: Reflections on Irigaray’s I Love To You in Pilates and Virtuosity. Cultural Studies 15(2): 229-240.
Powers, Richard
2013 Great Partnering., accessed 29 December.
Skinner, Jonathan
2013 Social Dance for Successful Aging: The Practice of Health, Happiness, and Social Inclusion Amongst Senior Citizens. Anthropology & Aging Quarterly 34(1): 18-29.
Stebbins, Robert A.
2006 Serious Leisure: A Perspective For Our Time. Piscataway, NJ: Transaction Publishers.
Taylor, Julie
2001 Paper Tangos. Durham: Duke University.
Woodley, Karen and Sotelano, Martin
2011 Tango Therapy 2, Research and Practice. Cardiff: Creations.

Note from the Editor-in-Chief

Download this note as a pdf here AAQ34(4)Danely_notefromeditor

As Editor-in-Chief of Anthropology & Aging Quarterly, I am proud to announce that our journal has finally completed preparation to take the bold step into the world of open-access digital publishing. Beginning with Volume 35 (the next issue), Anthropology & Aging Quarterly will be published by University Library Systems (a non-profit corporation) through the University of Pittsburgh. It will join other ejournals that our readership may be already familiar with in the D-Scribe Digital Publishing Program such as Ethnology and Health Culture and Society. We will work with the ULS and Pitt to partner with abstracting, indexing, and discovery service providers to increase our visibility.

Our contributors, peer reviewers, and staff all put a great deal of effort into the content of AAQ, and I am impressed with the quality of the results with every issue. One need only look at this current issue, featuring new contributions from three prominent anthropologists on three continents to find and example of the kind of rigor and dedication we value. This is work that can inspire anthropologists, social gerontologists, and others in related fields to engage as a community to expand our base of empirical knowledge on global aging, and explore new theoretical frames and concepts. We do this work because we believe it is important, and our new digital format will make this work freely available and readily accessible to the world. For more on open-access in social science research, I highly suggest the Society for Cultural Anthropology’s free podcast “Can Scholarship Be Free to Read.”

As we make our transition to this new format, many things will remain the same: our mission to create a global forum for the exchange of knowledge, our rigorous double-blind peer-review process, our commitment to publishing work that is original, diverse and engaging. Contributions will be protected under the Creative Commons Copyright attribution 3.0, and neither AAGE nor the University of Pittsburgh will have publication or reprint rights without author agreement. There will be no hefty publication fee as there are with many other open-access journals, but we will require all contributors to be members of AAGE.

Other things will change, beginning with the number of issues published per annum, and consequently the journal’s name. Beginning with Volume 35, the journal will be published twice per annum, and will drop “Quarterly” from its title. In an informal poll of members, “Anthropology & Aging” was the most preferred new title. Other changes will include a streamlined review system, search functions, ability to include new forms of media, and greater interactivity. We have also expanded our editorial advisory board by seven members, including scholars based in Japan, Demark, Canada, and the US.
Finally, AAQ would like to encourage student readers to submit essays for the revived Margaret Clark Award. Anthropology & Aging will have the right of first refusal for the winners of this award, which, together with workshops and conference events, is a key way that the journal remains intertwined with the ongoing activities of AAGE.

To be sure, this new step means new challenges and a lot of work to be sustainable. AAGE members will remain key, but keeping the journal vibrant will depend on growing our network and building relationships. We hope that the journal will present new opportunities to meet our challenges and build our strengths.

Thank you to all who have helped AAQ reach this point. Looking forward to your submissions.

Jason Danely, Editor-in-Chief Anthropology & Aging Quarterly

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Surgery-for-Life: Aging, Sexual Fitness and Self-Management in Brazil – Alexander Edmonds

Surgery-for-Life: Aging, Sexual Fitness and Self-Management in Brazil

Alexander Edmonds
Professor of Social and Medical Anthropology
University of Edinburgh

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This article draws on ethnographic fieldwork on plastic surgery to explore tensions in aging norms and ideals for women in Brazil.  I situate my analysis in relation to debates about a “de-chronologized life course.”  Some scholars argue that the life course in late capitalism has become less standardized.  In this account, chronological age diminishes in importance as consumers are defined by life style choices available to all ages and the period of youth extends into middle age and beyond.  In Brazil consumers embrace plastic surgery as a means to “manage” aging, mental well-being, and reproductive and sexual health.  This promise of a flexible and optimized aging trajectory seems to echo the notion of a de-chronologized life course.  I argue, however, that medical discourse and patients’ accounts show ambivalence about aging and conflicts in the ideal of medically-managed sexual fitness for women.  Drawing on analysis of changes in family structure and women’s health regimes, I argue that passage through the life course, rather than becoming more flexible, is in some ways becoming more rigidly defined by biological processes.

Keywords: Aging, plastic surgery, de-chronologized life course, sexual fitness, self-management

Cite as:

Edmonds, Alexander. 2014. Surgery-for-Life: Aging, Sexual Fitness and Self-Management in Brazil. Anthropology & Aging Quarterly 34 (4): 246-259.

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Aging, Gender and Sexuality in Brazilian Society- Guita Grin Debert

Aging, Gender and Sexuality in Brazilian Society

Guita Grin Debert, PhD
Full Professor, Department of Anthropology Institute of Philosophy and Human Sciences
Universidade Estadual de Campinas

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Drawing on the interplay between gender, aging, and sexuality, the aim of this article is twofold: (1) to show how Brazilian gerontologists treat gender differences and sexual activity in old age; (2) to analyze the  ways  discourses regarding the aging body and sexuality are perceived and evaluated by older women and men . I argue that  attempts of gerontologists’ to eroticize old age have to contend with the widespread notion that the desire for sex is inevitably lost with age. Thus, in the retiree associations that were studied, men had a tendency to assume they are not ‘old’ because their erectile function was still in good condition, and divorced or widowed women, in senior citizen associations, tend to regard themselves as happy due to having freed themselves from the sexual obligations imposed by marriage. In both cases, the dominant belief that there is a loss of sexual desire in old age was reproduced.

Keywords: sexuality, gender, aging, Brazilian gerontology, sexology

Cite as:

Debert, Guita Grin. 2014. Aging, Gender and Sexuality in Brazilian Society. Anthropology & Aging Quarterly 34(4): 238-245.

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Aging in an Age of Climate Change: Part 3, by Janelle Christensen


Janelle Christensen, data program analyst, Lake Worth campus  Janelle Christensen, PhD, MPH (AAGE member since 2006). Janelle’s research interests lie at the intersection of disaster management and aging studies, exploring how community dwelling families respond to emergency preparedness and disaster planning while simultaneously providing care for family members with Alzheimer’s disease.  She completed both PhD in Applied Biocultural Medical Anthropology and a Masters in Public Health (MPH) at the University of South Florida and has done Socio-legal research in intentional communities (Camphill Communities) based on the care of individuals with developmental disabilities in both Germany and the United States while completing her MA in Sociology of Law. Janelle is currently working as a Program Data Analyst for the Health Information program at Palm Beach State College.


When Hurricane Katrina struck New Orleans1 in 2005, the death tolls were overwhelmingly among those over 65 years of age.2 Many were frail elders who were not prioritized during hospital evacuations.3 Others died in their homes, alone. Many were separated from families and stranded as the area struggled to rebuild.4

I am an anthropologists who has worked with aging populations in hurricane prone areas, specifically individuals with Alzheimer’s disease and related dementias and their caregivers in South Florida.5,6 For many anthropologists, climate change is not an abstract concept that may or may not affect humanity in the far off future. When models show that a warming climate and warmer oceans fuel more powerful hurricanes 7,8 and one lives in a coastal area, as I do, climate change is not far away. As Crate and Nuttall (2009) poignantly explain,9 climate change has an immediate impact on many groups around the globe, from the Sahara to the Arctic. As people living at the margins of society, or at the margins of habitable land, struggle to adapt to the symptoms of a disrupted climate, their stories are documented in the field notes and writings of anthropologists who work with these groups. To the people contending with the results of a changing climate, it is not a hypothetical: climate change is real, immediate, and personal. Likewise, when one works with and cares about the very people who are likely to be considered among the most expendable 3,10 should an inevitable hurricane hit one’s area, there is cause for concern.

In 2012, Hurricane Sandy struck New York and New Jersey. While the death toll was much lower than in Louisiana and Mississippi during Hurricane Katrina, of those who died as a direct or indirect result of Hurricane Sandy, most were over the age of 60.11 Decisions made by governors, hospital and nursing home administrators, and private citizens all played a role in the disproportionate death tolls during both Hurricane Katrina and Hurricane Sandy.1

To many, this is not surprising. As Fjord (2007) points out, the sick, disabled, and elderly are “the expected dead”.12 While elders might be cared for well enough under normal circumstances, all too often during a disaster, many of the most vulnerable are deprioritized. During Hurricane Katrina, buses that had been contracted for nursing home evacuations were commandeered by Federal agencies for other purposes.1314 Nursing homes were not often regarded as essential facilities and therefore, are not prioritized for power restoration after a storm.15At least two hospitals in New Orleans (Memorial Hospital and Lindy Boggs) did not evacuate many of the patients who needed the most intensive care. 10,16 Though neonates were evacuated after the storm and the ambulatory could be evacuated by boat when the hospital flooded, those who were elderly were left to die in the oppressive heat to which the elderly are particularly vulnerable. At both of these hospitals, morphine was administered in potentially lethal doses to many of the elderly patients (though charges of homicide were later dropped).3

Sheri Fink describes the challenging ethics that accompanied the allocation of scarce medical resources before Hurricane Sandy hit New York in her book 5 Days at Memorial. She notes that many of the lessons supposedly learned during Hurricane Katrina had failed to translate to prepared hospitals in New York as the storm approached.10 Generators were still located in flood-prone basements. Administrators and staff met to decide who should be kept on the limited number of electrically powered respirators should there be a prolonged loss of power. The protocol for deciding who is the most worthy of life-saving equipment and procedures is rarely established and clear. The allocation goals are supposedly to serve the “greatest good” but, as Fink asks, “what does the “greatest good” mean when it comes to medicine? Is it the number of lives saved? Years of life saved? Best ‘quality’ years of life saved? Or something else?”3 These questions hint at another: Should the younger populations be prioritized before the elderly? In answer to this, Fink cites a response from a woman participating in a focus group.

If a significant generation, if the senior citizens were cut in half that would alter our society. That means that, you know, just like you definitely don’t want your child to die, people don’t want to be grandmother-less, people don’t want to be grandfather-less… So, I am just a little concerned about the aftermath of just giving it to the youngest person.”3

Anthropologists such as Anthony Oliver-Smith and Susanne Hoffman have long argued that disasters act as spotlights that shine on societies’ collective values.17,18 Recent hurricanes have forced us to ask, “To what extent do our elders matter to us in the United States?” Certainly, not all people over the age of 65 are frail and ill. Many are strong and healthy. Others are wealthy and can purchase assistance if needed. However, for those that are unable to simply get in a car and evacuate, who rely on others to assist them with their wellbeing, and have few resources, how do we ensure that they are not left behind? How do we resist the mechanisms in place that seem to deprioritize those with the most lived experience because they are the most inconvenient to serve during a disaster?

(In the next post of this series Janelle will look at how these questions can help us understand the lives of older people in the Lake Okeechobee region of Florida, where she conducted ethnographic research)

1. A Failure of Initiative: Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. Washington, D.C.; 2006:1–379.

2. Brunkard J, Namulanda G, Ratard R. Research Hurricane Katrina Deaths, Louisiana, 2005. Disaster Med Public Health Prep. 2008:1–9.

3. Fink S. Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. New York, New York: Crown; 2013:576.

4. Adams V, Kaufman SR, Hattum T Van, Moody S. Aging Disaster: Mortality, Vulnerability, and Long-Term Recovery Among Katrina Survivors. Med Anthropol Q. 2011;30(3):247–270. doi:10.1080/01459740.2011.560777.Aging.

5. Christensen JJ. Hurricane Preparedness of Community-Dwelling Dementia Caregivers in South Florida by. 2012:1–354.

6. Christensen JJ, Richey ED, Heide Castañeda. Predictors of Hurricane Evacuation of Community-Dwelling Families Affected by Alzheimer’s. Am J Alzheimers Dis Other Demen. 2013.

7. Trenberth K. Warmer Oceans, Stronger Hurricanes: Evidence is mounting that global warming enhances a cyclone’s damaging winds and flooding rains. Sci Am Mag. 2007;297(1):44–51.

8. Emanuel K. Increasing destructiveness of tropical cyclones over the past 30 years. Nature. 2005;436(7051):686–8. doi:10.1038/nature03906.

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Aging in an Age of Climate Change: Part 2

On March 11, 2011, an unusually strong earthquake off the coast of northeastern Japan produced a tsunami that in some places reached as high as 40 meters. The massive wave crashed across the coastal towns, carrying massive boats and buildings before sweeping back out to sea, in an instance transforming the landscape into a wasteland. 15,884 people were confirmed dead as a direct result, and over 3000 more died in the aftermath. 2633 people are still considered missing, and over 260,000 were evacuated to temporary housing. A majority of those who died and almost half of those who were moved to temporary housing were adults over 60, often suffering from a combination of inadequate medical and caregiving assistance, emotional trauma and grief, and loneliness as a result of the displacement and the slow pace of recovery efforts. Suicides have been particularly high among older adults, and survivors’ risk of dementia is 1.3 times higher than the general population. Over 110,000 older adults in the areas most affected by the tsunami (including those evacuated from the area around the damaged Fukushima No. 1 Nuclear Power Plant) are certified as needing care. Fukushima, which has seen a 50% rise in seniors needing care since the disaster, just announced that it will be offering cash incentives of up to 450,000yen towards training and certification expenses to attract caregivers to the badly understaffed area. The last three years since the earthquake and tsunami have highlighted the larger issue of older adults’ vulnerability in the wake of natural disasters, many of which are now increasing in severity and impact as a result of climate change.

This past year in Japan has seen its share of climate related extremes, which, when combined with the changing demographic and residential trends, . Record snowfalls in northern Japan, for instance, resulted in hundreds of isolated villages, many of which, as a result of gradual depopulation over the last half century are mostly comprised of older adults. In early February, I joined a group of volunteers in Kyoto to shovel snow in one such community, located on the outer edge of the “city” limits, about an hour drive from downtown. According to the local community welfare director, of the 90 residents in this community, deep in the mountains, about 50 were over the age of 70, and while the plows had cleared many of the main roads, many could not leave their homes due to accumulated snowfall. Drifts blocked doorways, and ice covered the steps. “The snow is so frightening!” one long-time resident told me, “There are no young people to help us anymore. This place is going to disappear.”

After spending the morning shoveling we gathered in the senior community center, once the local elementary school to eat lunch and speak with some of the local residents. One of the organizers of the volunteer group spoke first: “Residents here pay into the same mandatory long-term health insurance plan as everyone else in the city, but don’t receive the services one has in the rest of the city! It is only one of many more communities where the insurance fees are just wasted. Volunteer groups like this one let them know that they are not abandoned, that there is still someone watching over them.”

At the bottom of the mountains, in the urbanized part of the city, the older adults are also the most keenly aware of global climate change, however, their main concern has been the increasing temperatures. “We used to get plenty of snow here in Kyoto,” my neighbor told me as the last remnants of the previous night’s snowfall melted off his gray shingled roof, “But these days we get one or two snowfalls and it melts right away.” Older Kyotoites notice these changes everywhere, from the water levels in the rivers to the timing of the peak of fall colors. The seasons that they grew up with are different than they remember them.

In 2013, Kyoto had its hottest summer on record (since 1946), with average temperatures 1.2 degrees (C) higher than average. By mid-August, a record 21,000 people had been hospitalized with heat stroke, about half of them over 65. The warming trend, beginning in 1930, is easily attributable to atmospheric Co2 and other greenhouse gases. The seas around Japan, which in the past had moderated these severe fluctuations in weather, are also warming, leading to more severe typhoons and even tornadoes, which were virtually unknown in Japan until about five years ago. At disaster prevention drills organized by local self-governing associations, those gathered are mostly older adults. “Things were a little different after 3.11,” one organizer told me at a recent drill, “But now the feeling has weakened; young people just think that they are going to live forever!” We were interrupted by a drill leader with a microphone who reminds us to remember things like medication and dentures when evacuating older people, and to clearly record how many adults will need diapers on our evacuation record paperwork.

The point I want to make here is not about the meteorological connections between snowstorms, typhoons, tornadoes, and climate change, but rather about the way that people interpret these uncertain weather changes to call attention to social, political, and demographic changes. How do people prepare for or prevent the uncertain? How do they assess their personal risk and the social effects climate change has on their future? As I informally polled snow shoveling volunteers and the those in attendance at disaster drills, it was clear that the consciousness of risk was not evenly distributed among generations. One result of this generational gap, in part structured by political systems of welfare, insurance, and community organizing, is an increased feeling among older adults that they are alone in their concern, that one cannot rely on the community or on formal assistance to fully prepare for the next disaster. Understanding aging in the age of climate change requires attention not only to the vulnerabilities in the wake of severe weather events, but also to the social and cultural environments in which relations of assistance and safety are created and the need for a global response that recognizes the complex dynamics of politics and population change.

 Jason Danely

Editor-in-Chief, Anthropology & Aging

Assistant Professor of Anthropology, Rhode Island College

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