PART 1: Older Adult Mental Health Awareness Day 2020

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PART 1: Older Adult Mental Health Awareness Day 2020

Dr. Everett We have a distinguished group of presenters this afternoon who will discuss how to connect people to treatment and social support in ways that foster collaboration across agencies that served older adults at the federal state and a local level. Before we hear from our presenters, it is my pleasure to present SAMHSA�s Assistant Secretary for Mental Health and Substance Use, Dr. Elinore McCance-Katz. Our Assistant Secretary is an Addiction Psychiatrist. She is a distinguished fellow of the American Academy of Addiction Psychiatry and served as a Professor of Faculty for Psychiatry at several esteemed institutions in the Department of Psychiatry. I will now turn it over to Dr. McCance-Katz Dr. McCance-Katz Thank you, Dr. Everett and good afternoon. It is a pleasure to be here to mark the third National Older Adult Mental Health Awareness Day event. Today, more than ever, we know the importance of focusing on our nation’s older adults. I would like to thank our federal partners, the Administration for Community Living and the Veterans Health Administration for their assistance. I also want to thank the National Coalition on Mental Health and Aging for their ongoing work. It is an honor and a privilege to be hosting today’s event with you. When SAMHSA began to plan for this event in December, no one could have foreseen all that would transpire in our nation. In the early days of 2020 up to this point, our nation�s seniors have been particularly affected by both the physical health and mental health consequences of combating this pandemic. As a nation, we have all spent the last month combating the coronavirus. It has taken a tremendous toll on our nation’s health system, but the medical community is strong and resilient and will persevere. In the area of substance abuse and mental health treatment, we have had to adapt to like never before. SAMHSA has developed a number of resources along with the compilation of guidance from the number of trusted sources that are on the COVID-19 page, which is at www.samhsa.gov/coronavirus. Today’s event will highlight the latest information on social isolation and loneliness. As always SAMHSA�s goal for this event is to raise public awareness around the mental health of older Americans and address the needs of promoting evidence-based population approaches, mental and substance abuse prevention treatment, and recovery and to foster collaboration between the mental health and aging network. All of us who work with the older adults know well that by 2030, Census Bureau indicates that there will be nearly 75 million Americans over age 65 or nearly double the current population. As our nation’s collective focus is on addressing the public health crisis of COVID-19, we must not forget about the other crisis that also continues to plague our nation – that is a crisis of both mental illness and substance use disorders. Unfortunately, these crises do not go away simply because of physical health has emerged. Rather these crises are exacerbated for individuals, families, and communities across the country and our nation’s older adults are not immune to these conditions. Data from the National Survey on Drug Use and Health show that nearly 16 million, or 14% of people age 50 and older, have mental illness and over 2.8 million, or 2.5%, have a serious mental illness. Over 4.4 million, or nearly 4% of people over age 50, have a substance use disorder. Quite troubling in this era of aloneness is that over 20 million people or 18% Americans over age 50 reported binge drinking in the past month. To assist older adults, their families, and aging and mental substance use disorder treatment service providers, SAMHSA has developed the Get Connected Toolkit – linking older adults with resources on medication, alcohol, and mental health. This toolkit divides the design for organizations that would provide services for older adults, offers information, and material to help understand the issues associated with substance misuse and mental illness in older adults. The toolkit also contains material to educate older adults Tragically, suicide continues to be a particularly urgent problem among older adults. In 2017, those 85 and older had the second highest suicide rate of any age group, 20.1 people per 100,000, second only to the 45 to 54-year-old age group which is just a little higher at 20.2 suicides per 100,000 people. These are troubling and high numbers. SAMHSA has developed resources for senior centers and senior living communities on ways to prevent suicide in older adults and how aging and mental health service providers can collaborate and support families if someone dies of suicide The country�s opioid crisis continues to play a major role in the lives of all Americans and older Americans are no different. To serve older adults, SAMHSA created guidance and factsheets that are available at the SAMHSA store. Such as RX Pain Medications: Know the Options and Get the Facts. All of the resources I am mentioning can be found by searching the title of the document online and are available for download at no cost Another issue that confronts us at this time is the proliferation of marijuana use. Two facts about marijuana use – 49.5 million people over 50 reported lifetime use of marijuana with 5.5 million reporting use in the last month, including nearly 1.3 million people 65 and older reporting current marijuana use. It is important to note that many older adults are using marijuana or cannabis derivatives as medicine with little or no evidence of effectiveness with little or no control as to the potency or content of the drug sold to them, and with little or no information on the health risk of marijuana use, mental health issues, pulmonary issues for smoke or vaped products, impairments and potential injuries On the intervention side SAMHSA is working to build a mental health system that enables Americans to find effective treatments and services in their communities. While effective treatment exists, far too few people with mental illness receive the help they need. SAMHSA funds services and supports for Americans in need for behavioral health services. However, another major responsibility is to ensure Americans are aware of available treatment resources. Treatment can be found at treatment.gov or [email protected] SAMHSA and our federal partners know that the growing number of seniors means we need skilled providers to meet the treatment challenge. SAMHSA has placed a greater focus on educating and training the workforce at no cost to programs and providers through our Technology Transfer Center network. This national network of regional TA centers provides training and education on substance abuse prevention, treatment, and mental health. SAMHSA is committed to ensuring the availability of training, education, resources, and services to address the needs of older Americans. Our country�s seniors have paved the way for us, have proven strong and resilient, and now it is our time to provide for them, not just in words but in our actions to make sure that services exist, treatment is available, and care is taken to provide the very best and most evidence-based approaches to addressing their needs I would like to end my remarks to ask all of you, as you go through our nation’s unprecedented crisis, that your voice is needed on behalf of our seniors. While containing the physical health effects of the virus is critically important, it is not sufficient to solely consider physical effects when developing and implementing strategies. We must also examine how our strategies to contain the virus may inadvertently cause issues just as deadly as the virus itself. Before we simply have a knee-jerk reaction to continuing these policies at any cost, we must examine whether no visitation or stay at home policies which disproportionately affects seniors are causing other major avoidable harms to them Thank you all for taking the time out of your busy day and scheduled to be part of this event. That action alone demonstrates your commitment to this population. I urge you to use that commitment as a much-needed voice during this time on behalf of older Americans everywhere and to help put in place rational policies that protect our most vulnerable – their physical health and mental health and emotional needs. Thank you very much for your time and commitment. I’m pleased to share with you an excellent program of talented professionals that have dedicated themselves to this very important cause. Thanks very much Dr. Everett Thank you, Dr. McCance-Katz. Now I have the pleasure of introducing the Assistant Secretary for Aging and Administrator for the Administration for Community Living, Mr. Lance Robertson. His vision for ACL focuses on five pillars. One, supporting families and caregivers. Two, protecting the rights and preventing abuse. Three, connecting people to resources. Four, expanding employment opportunities. And five, strengthening the aging and disability networks. His leadership in the field of aging and disability began in Oklahoma where he served for 10 years as a director of aging services within the state�s Department of Human Services. Prior to that he spent 12 years at Oklahoma State University where he cofounded the gerontology Institute and served as the executive director of the nation’s largest regional gerontology association. Mr. Robertson is also a U.S. Army veteran. I will now turn the program over to Mr. Lance Robertson. Lance Mr. Robertson Thank you Dr. Everett and happy Thursday everyone and thank you Dr. McCance-Katz. It’s really an honor and a privilege to join you today and I’m so grateful for the dedicated work that our federal partners at SAMHSA bring to bear every day. And for the great work also at the VA to help veterans, being one. And I’m extremely appreciative of the work being done by our non-federal partners at the National Council on Aging and the National Coalition on Mental Health and Aging so, thanks to them and to each and every one of you who are joining us today as we all attempt to Make Our Mark on Older Americans Mental Health Awareness Day. I know that this webinar has three goals, goals ACL is certainly committed to realizing. The first is to raise public awareness about the importance of mental health in later life. Second, we want to promote the use of evidence-based and innovative approaches for addressing the mental health needs of older adults. And then finally to foster the collaboration between the mental health and aging networks to address behavioral health needs in later life. And I love that one. As most of you know May is both Mental Health Month as well as Older Americans Month. And we started planning for this month, as Ellie said, sometime back, and would have never imagined the challenges our nation would currently be facing with his pandemic. But it is during a time of physical distancing that we are certainly encountering roadblocks that we are addressing and that does include maintaining those important social connections. I think we all understand that for many older adults, health and well-being is negatively impacted by social isolation. Frankly, the same is true for most Americans. Humans are a social species and the current public health emergency has caused many programs that promote social well-being, such as our congregate meals, to temporarily cease. With that said, every day I wake up to hear a new story about how an organization has found an innovative way to help older Americans stay engaged and connected. Even an idea that sounds a little funny, can hit the mark. Let’s use the virtual pets example in New York State. One of many examples. I think all of you who are listening who I know also have had good ideas that have turned into new practices. Even some on a trial basis. Another example that with from idea to implementation comes to us, one of many states � but out of the state of Florida, which has started a new program to get tablets into long-term care facilities so that residents can stay connected to their families via video chat So, on this day I think it is important for all of us to recognize that the mental health issues some of our elders face certainly impact the lives of millions of individuals, not just the older adults, we�re talking about families and caregivers as well. Because of the research that�s been done, we know that approximately one in five adults in the U.S. experiences mental illness in a given year. And that among these adults, there were 14 million older adults who experience mental illness Substance abuse, and misuse, the opioid public health emergency in particular, has also touched the lives of millions of older adults. Many older adults battle addiction daily. Others may be caring for grandchildren because of addiction-related issues that may be occurring in their family And it is a sad reality that too many older adults experience abuse and exploitation at the hands of a relative or friend. Suicide, as Dr. McCance-Katz mentioned, continues to be a particularly urgent problem among older adults who have some of the highest rates of suicide in our nation And returning to the difficult issue of social isolation we know this problem is particularly prevalent and problematic in later life. As many as 17% of older Americans are negatively impacted by social isolation; I think that is an underreported statistic. The economic and human cause of social isolation we know are staggering and according to that recent report many of us have seen from AARP and Stanford University, social isolation accounts for an additional 6.7 billion dollars in Medicare spending annually. But it isn’t just the money that we, of course, worry about. There is also another study that many of have seen from Brigham Young University, BYU, indicates that prolonged social isolation is as harmful to our health as smoking 15 cigarettes a day. So, again, it is a very, very serious public health issue that we’re talking about here. The uncertainty of the COVID-19 crisis and the need for social distancing has undoubtedly affected the mental health and well-being of many older Americans. During this crisis and beyond we must collectively step up our efforts to ensure that older adults have meaningful and plentiful opportunities to stay engaged and connected with one another, their families, friends, and communities At ACL we were really created, just so everyone is aware, on the fundamental principle that all people regardless of age or disability should be able to live independently and fully participate in their communities. We help mostly by supporting many of the people on the call today by funding programs and certainly offering guidance. In this time of national crisis America�s vast aging network, many of whom again are on the call, play a critical role in addressing the most fundamental needs of older adults and their families For those of you who are on the call working on the front lines, listen, I salute you. You�re providing meals and personal care. You’re connecting people to critical services. And you�re reducing social isolation amongst many, many other things So, in the past few months, the president, as most of you know, signed into law the Families First Coronavirus Relief Act and the CARES act. These two acts brought more than $1.2 billion to the Administration for Community Living, which we then, of course, sent out to states. And those funds are continuing to filter to the State Units on Aging and the AAAs, the Area Agencies on Aging. And they are arriving to help community-based organizations. And those funds were and will be put to good use by many of you So working together, the aging and disability networks can provide a model of integration for clinical and community-based organization, provide older adults with the services they need, and deserve in order to stay engaged. Recognizing the importance of addressing social isolation and increasing engagement among older adults, ACL recently announced our intention to fund a national technical center to expand the role of the aging network in helping older adults remain engaged and active. Applications for this grant opportunity are due May 29th and you can find more information on our website at ACL.gov. This will be an important investment in developing and disseminating strategies for reducing social isolation and loneliness at a time of great need As Dr. McCance-Katz said, we have a wonderful program for you today and I hope you�ll certainly plug back into your states and communities and programs with some concrete strategies for preventing social isolation and loneliness in later life, as well as solid approaches to building aging and mental health partnerships to increase access to mental health supports, that�s so important, and then also, tangible resources and action steps for increasing engagement in later life. So, again, thank you so much for your efforts and your commitment for being on the webinar today and for supporting older adults, their caregivers, and their families. Thank you very much. Dr. Everett back to you Dr. Everett Thank you Assistant Secretary Robertson. It is certainly a pleasure to have heard your remarks and also to have both of our Assistant Secretaries here, that is a mark of how important this issue is to you and the recognition of the significant to the American public. Thank you. Now I have the delight of introducing to you Ms. Janice Trinette Chase, who is Ms. Senior DC for 2019 and she�s the president of an organization called SOUL. SOUL stands for Seniors Offering Unconditional Love. It is a senior platform of the love more movement. Ms. Chase truly believes that Seniors are our soul and need to lead our most vulnerable committees by becoming human treasure hunters and bridge builders that are resilient enough to cross oceans of trauma to destinations of healing, joy, hope, purpose, and transformation. Ms. Chase Ms. Chase Thank you for having the compassionate understanding to create a sacred space to hear a voice that is normally not heard. With these few moments I want to give you a snapshot of what many seniors think, feel, and believe about healing, purpose, aging and driving. I had the opportunity to see many levels of what looked like, what it looks like to navigate past trauma, while living with an aging mind, body and soul. The most important concept that I have ever shared with you regarding mental health and substance abuse is that we all have to heal before we build. I have been blessed to know the difference by participating with SOUL, Seniors Offering Unconditional Love, whose mission is to help seniors heal, repurpose, and form a new bucket list for life. My journey has included an abrasive childhood, being a single parent trying to escape the war on drugs, crack era, and protect my children from all the things that went along with the violence and abuse of the area. Through this journey I also have become a survivor of cancer, a brain tumor, homelessness, and many of the other things that are associated with poverty. I have been through therapy, the therapeutic process, through the entire process, but have never been connected to an authentic process of healing, with divine purpose and joy. So let me say right now that even though we were taught that misery loves company but I know that joy loves company and even as I grow old and gray that we are valuable enough to be loved. Heal and our souls and we can heal the world. I thank SAMHSA and Rosalind for introducing me to SAMHSA for given me the opportunity to be heard and let me be the banner for healing and transformation for our most valuable community. So, seniors are our foundation and when we heal, we will heal the world Dr. Everett Thank you Ms. Chase! Those were wonderful remarks. Appreciate that tremendously. It is very nice and we are honored to have among our panel as an individual who has what we call the lived experience, so to speak, of being an elderly person whose had many adversities and have overcome them really well. So thank you so much for sharing that with us Ms. Chase It is definitely with guidance of Dr. Bruce Purnell with the SOUL organization. And our seniors, we were burned out in September of 2018 and that was part of our healing. We have lost about 20 seniors since that time. It was 160 units and the whole building burned down. I mean the whole building; we lost everything. So, on the top of that we are now going through this virus and it is very crucial that seniors see themselves as valuable and can contribute something to society. This is what we really want to stand on Dr. Everett Very important. Yes, you certainly are a good working living example of that and we want to thank you very much for your time with that. I would like to turn now to our formal presenter Dr. Dillip Jeste (M.D.). Dr. Jeste is a senior associate Dean for Healthy Aging and Senior Care. He is a distinguished professor of psychiatry and neurosciences. The Estelle and Edgar Levi Memorial Chair on Aging at University of California San Diego. He is the director of the Sam and Rose Stein Institute for Research on Aging and he co-directs the UC San Diego IBM Center on Artificial Intelligence for Healthy Living. As you can tell just from those pieces of his long and extremely productive career, he�s quite a scholar. He has dozens of peer review published journals as you see a number of different awards rather than these names, professorships and he also is quite a gentleman. I think you will enjoy hearing about the delightful work of Dr. Jeste Dr. Everett Will have a little bit of transition as we go to the slides and presentation thank you Dr. Jeste I want to thank the organizers of this wonderful conference for inviting me here to speak to all of you. I am going to talk about loneliness, wisdom, and aging in the COVID-19 era. I will spend the first part of my talk discussing loneliness and then I will talk about wisdom during the second half of my talk. What is loneliness? According to Dr. Fay Alberti, a British historian, the word loneliness did not exist in the English language until 1800. The word that existed was oneliness. And it just meant being alone, by yourself but it didn�t have a negative connotation of loneliness. Most cases there was one just being alone how you have felt. This is have connotations of loneliness. So you could be by yourself still feel contented and happy. The L got added around 1800 with the beginning of the industrial revolution. So what has changed since 1800? According to Alberti, with industrialization families became smaller and more mobile. Evolutionary biology, Darwin�s theory of survival of the fittest became popular, as a result the traditional paternalistic vison of a society, in which everyone had a place, were replaced with individualism, where everyone was responsible for themselves. And I feel that the changes have accelerated during the last three decades and the stress levels have gone up because of increasing globalization and breakneck speed of advances in technology. What is loneliness? And what is social isolation? Although these terms are used synonymously they are not the same � they are related but somewhat distinct. Loneliness refers to subjective distress caused by a feeling of being alone. So it is perceived isolation. Social isolation on the other hand is objective � you can measure it by counting the number of social relationships. Oneliness, or what is sometimes called positive solitude, can have serval benefits. You can self-reflect. You can enjoy this time alone. You can decide to reach out to others or you can open up your creative side. So there are number of pleasant, enjoyable things you can do while alone. That is why one may be happy while alone. On the other hand, one may be lonely in a crowd. For example, college students who live in dorms, who are surrounded by hundreds of other students but here some of them may feel very lonely. What does it feel like to be lonely? Recently we published a qualitative study of older adults, some of whom felt lonely and others didn�t. One person who felt lonely said it is kind of grey and incarcerating. Just look at the word incarcerating, so powerful. He said I would like to cry out for somebody. Another person said, �I don�t know what to do. It is a feeling of being lost and out of control and it just gets worse.� Another woman who was feeling lonely said, �Lonely is feeling sort of empty or not really belonging to someone.� There are some people who do not feel lonely. We asked them what they thought lonely people feel like. They said lonely people probably feel insignificant. They have no place on larger society. They�re like an outsider trying to get in and don�t know how to get in. So you can see how loneliness can be very distressing. Importantly, this loneliness, as well as objective isolation, are presenting a grand challenge for society. Julianne Holt-Lunstad published a wonderful meta-analysis of studies associating mortality with loneliness and social isolation. Loneliness, she said, is a silent killer. It increases the odds of mortality by 30%. Loneliness is as dangerous to health as smoking 15 cigarettes a day and is as dangerous, if not more dangerous, than obesity. In the U.S., according to the Agency of Healthcare Research and Quality, 162,000 deaths per year are attributable to loneliness � that number exceeds the number of deaths due to lung cancer or stroke. In the U.K., Prime Minister Theresa May appointed a new Minister of Loneliness two years ago. The reason was that business in the U.K. found out they were losing billions of pounds because of loneliness among the workers which was contributing to their lack of productivity. In the U.S. the average lifespan has been increasing continuously since 1950. That is until recently. For the first time in decades, the average lifespan in the U.S. went down two years in a row. And this decline was not because of some new cancers, strokes, or heart disease. It was caused by behavioral impetus Suicides. The rate of suicides in the U.S. increase by 33% in just two decades. You will see that men have higher rates of suicide than women, and this has always been the case The mortality increased even more so with opioid abuse. In 1999, 8,000 American died from opioid related deaths. Today that number exceeds 50,000. Both in suicides and opioid abuse, one of the major risk factors for both of them is loneliness. There are other factors involved in suicides and opioid abuse but loneliness is one of the major, common, underlying factors Currently we are experiencing and undergoing the COVID-19 pandemic. This is particularly serious for older adults. Older adults are more likely to develop complications, more likely to be hospitalized, more likely to require I.C.U., and more likely to require ventilators, and also more likely to die. The social distancing, which is necessary for flattening the curve, is unfortunately increasing the risk of loneliness and social isolation in older people. That is because they are less likely to have access to and familiarity with smart devices, like smart phones. So they don�t use Facetime like the younger ones do. Similarly, they are less likely to use social media, like Facebook, than the youth Loneliness is both a trait and a state but it is more of a trait. It is partly genetically determined. There was a very nice large scale study done in the U. K. this is a GWAS study, a Genome Word Association Study, which included nearly half-a-million people in the U.K. So this genomic study, as well as twin studies, and family based studies support that loneliness is a moderately heritable trait (37-55 percent) with a highly polygenic architecture. They found it was up t0 50% heritable, meaning it was affected mainly by the environment and behavior. The genes that predisposed for loneliness are predisposed to cause cardiovascular diseases, metabolic diseases like diabetes, and psychotic disorder such as depression and dementia. They are also associated with high level of triglycerides and low levels of HDL, which contributes to obesity Loneliness has serious health consequences. It is associated with physical diseases, like cardiovascular, metabolic, and others. And also neuropsychiatric disease like depression, anxiety, and dementia. Part of the association is because of the genes, that I talked to you about and part of that is because lonely people are likely to be inactive and inactivity, plus sedentary behavior, plus unhealthy diet would increase the risk of metabolic and other diseases Like other personality traits, loneliness has a neurobiology. Some functional MRI studies have shown that lonely people have less enjoyment from social interaction and during the time there is less activity in the ventral striatum. Also the genes associated with loneliness are expressed in brain regions that control emotional expression and behavior. I�ll talk briefly later about the neurobiology of wisdom and how both of them seen to share the same region of the brain There aren�t many studies of risk factors for loneliness. One of these studies included a population-based sample of 225 adults aged 50-68 from the Chicago Health, Aging, and Social Relations Study. The research found that the socioeconomic status was negatively associated with loneliness. In other words the more affluent people were less lonely than other. The research also found that racial minorities had more loneliness. But when you control for socio-economic status the differences disappeared. In other words the higher rate of loneliness in minorities is not attributable but biological differences but are attributable to differences in socio-economic status. Being married and having positive marital relationships seemed to offer the greatest protection against loneliness and trashis finding has been reported in several other studies, too. Other risk factors for loneliness included: physical symptoms or physical illnesses, chronic work stress/chronic social stress, small social network, and poor quality social relationships There is a very interesting study of loneliness and ethnic diversity in middle schools. This study included 11 public middle schools with more than 70 classrooms of sixth-graders and the schools and classes varied in ethnic diversity. The research found that higher classroom diversity was associated with less loneliness and greater feeling of satisfaction. In ethnically more diverse classrooms, African American and Latino students felt less lonely, they felt safer in school, were less harassed, and had higher self-worth and the finding stood even after controlling for classroom differences in academic engagement. So clearly the message is that diversity helps reduce loneliness in minorities There have not been many studies among older LGBG adults but one report found that older LGBT individuals were more vulnerable to loneliness as they were more likely to be single, live alone, and have lower levels of contact with relatives. The study also reported that older LGBT individuals were less likely to engage with local health services and 80 percent (four out of five), individuals did not trust that their professionals understood their culture or lifestyle Loneliness is common in people with serious mental illnesses. We published a study of loneliness in schizophrenia in San Diego. We studied 116 adults with schizophrenia and 106 non-psychiatric comparison subjects, similar in age, sex, and ethnicity. We used a scale called the UCLA Loneliness Scale (ULS) developed by Russell and colleagues, this is the most validated and widely used scale for loneliness. We found the mean levels of loneliness was nearly a standard deviation higher in the schizophrenia group than in the comparison group. In both groups, loneliness was associated with worse depression, anxiety, and perceived stress and negatively associated with mental well-being, happiness, and resilience Several prospective longitudinal studies have shown that loneliness is a risk factor for cognitive decline as well as some psychiatric disorders. This is a four year follow-up study of non-demented older participants, the researchers found that loneliness at baseline predicted declines in multiple cognitive domains and double the risk of Alzheimer�s Disease. Another study done by Nancy Donovan at Harvard included 79 cognitively normal people, some of them had high-amyloid levels in their brain while others did not and this was found using Magnetic Resonance Imaging or MRI. The high-amyloid group was 7.5-times more likely to be classified as lonely than the low amyloid group. And this association was even stronger in people who were APOE4 carriers. APOE4, as most of you know, is a major risk factor for Alzheimer�s Disease There are two large-scale studies in Ireland and England showing how loneliness is associated with the increased risk of dementia and mood disorders. The first was an English Longitudinal Study of Ageing, which included almost 7,000 people who were followed for six years � they did not have dementia at baseline but about 220 people had developed dementia by the end of the study. The risk of developing dementia was significantly higher in people who had loneliness at baseline. The risk correlated closely with the number of close relationships and being married. The Irish Longitudinal Study of Ageing (TILDA) included more than 5,000 people over the age of 50. The researchers reported greater subjective and objective social isolation at baseline predicted significantly higher risk of developing major depression or generalized anxiety disorder two years later. Thus, loneliness is associated with higher risk of several neuropsychiatric disorders We conducted a study of loneliness of people in San Diego a couple of years ago. My younger colleague Erin Lee was the first author for this paper published in International Psychogeriatrics. It included 340 randomly selected adults from age 27 to 98. We found that in San Diego, which we all call America�s Finest City, even here a majority of the people meet the criteria for loneliness. And although loneliness was common across all age groups, it was particularly common in three periods: late 20s, mid-50s, and late 80s. There is some good news, though. The good news is that in our study we found there was a significant inverse correlation between wisdom and loneliness. People who scored high on the scale for wisdom were less likely to be lonely and vice versa And this brings us to the second topic: Wisdom. What is wisdom? Wisdom is an ancient religious and philosophical construct. Wisdom had been mentioned in all religions and all philosophies since time immemorial. But empirical research on wisdom is a more recent phenomenon. It started in the 1970s at the Max Plank Institute in Berlin and at the University of Southern California in Los Angeles. Since then, the number of papers published in peer reviewed journals and are available on MedLine or PubMed has been increasing by leaps and bounds. But between 2010 and 2019, 2000 papers were published with wisdom in their title or as one of the key words. What is wisdom? We did a thorough literature review to find out what is the common understanding of wisdom. First, I would say wisdom is much more than intelligence. We all know some very intelligent people who are not wise. Wisdom is a trait, it�s a complex trait with multiple, specific components. I will show you in the next slide what those components are. To sum up it is important to note these components may increase with age. IQ does not increase with age but wisdom may increase with age. Wisdom enhances a person�s well-being and also helps the society�s welfare So what are the components that constitute wisdom? I am going to talk with you about five of them. The first is self-reflection � it is the ability to look inwards, trying to understand our own behavior, having insight. The second is compassion or kindness � kindness toward others but also kindness toward ourselves. The third is emotional regulation � think about the teenager whose emotions fluctuate from hour to hour and minute to minute, then think about an older and wiser person who has control over her emotions. Fourth is decisiveness amid uncertainty � accepting diversity and uncertainty of perspectives and yet being decisive when it is needed. Fifth is spirituality � this is different from religiosity, spirituality refers to accepting the fact there is something beyond what we see, hear, or know How do you measure wisdom? Like other personality traits there are scales for measuring wisdom � there are about a dozen scales. We developed a scale a couple of years ago � we called it the San Diego Wisdom Scale or SD-WISE. Like all personality scales, these are self-report scales so they are biased by self-report. Nonetheless that have been shown to be strongly reliable and validated. So this scale has 24 items, each rated on a 1 to 5 scale from strongly disagree to strongly agree. It has excellent psychometric properties � this scale has already been translated into several languages and used in several studies. Let me just give you examples of examples of the items. One is, �it is important that I understand the reasons for my actions.� So this looks at self-reflections. Another is, �I have trouble thinking clearly when I am upset.� So this is the opposite of emotional regulation. As I mentioned earlier, wisdom, like loneliness is partly neurobiologically based and we have published several papers on the protective neurocircuitry of wisdom. This includes mainly two regions of the brain � the prefrontal cortex, which is the newest part of the brain in evolution, and the limbic striatum or amygdala, which is the oldest part of the brain in evolution. It is really interesting to think that the neurocircuitry of wisdom involves the oldest and the newest parts of the brain from an evolutionary perspective. There is something called the grandmother hypothesis of wisdom. What is the grandmother hypothesis of wisdom? It says based on studies in bottle-nosed dolphins, killer whales, Seychelles warblers � this is a species of bird, and humans � both in ancient and modern humans � that when Grandma (GM) helps her adult daughter (D) in raising her children, D lives longer, is happier, and produces more children than GM did plus has greater happiness, health, and longevity in all three generations. And this is not feel good tv science � these are papers published in the highest journals in our field, such as Nature and Science. Recently there was a paper published by my colleagues at UC-San Diego in the proceedings of the National Academy of Sciences � it talked about grandparent genes � variants of APO-E and CD-33, two genes that are involved in the immune function, people with this variance live longer and have better functioning hearts and brains. The suggestion is these people are able to transmit their wisdom through the younger generation through grandparenting So it should be clear that intergenerational activities would promote wisdom. There are a number of studies of this kind but let me talk about just one � Experience Corps. This was funded by the MacArthur Foundation and the results have been published in multiple journals, primarily done by researchers at Johns Hopkins. In this study, researchers invited some older volunteers who had retired from their jobs, trained them to serve as mentors and tutors in public elementary schools and they had to agree to spend at least 15 hours per week. These are children who did not have grandparents and many of them did not have functioning parents. The older adults job was to help them with their literacy development but also their behavioral management skills. After one year, by the way this was a randomized controlled trial, after one year the children�s grades went through the roof and they were very happy, not surprising, but interestingly the older adults who participated in this intervention, they had better physical and mental health and better bio-markers of stress and aging, in blood and urine, and they had larger hippocampus on brain MRI than similarly aged people who did not participate in this intervention. It speaks to the importance of wise parenting and grandparenting and the importance of intergenerational activities The American Academy of Social Work and Social Welfare in 2015 called loneliness one of the grand challenges for the society and began a campaign to end loneliness. It includes public education about loneliness. The WHO and AARP have been promoting age-friendly communities. Age-friendly not merely structurally but also functionally, these are communities where older people have opportunities for learning new things and also for leading the communities. The CDC has long focused on social determinants of health such as social isolation and loneliness. There is now an emerging consensus that there should be a routine assessment of loneliness in healthcare evaluation, using a brief but validated measure. And in a review of interventions AHRQ reported that healthy lifestyles seemed to be associated with less loneliness Different pandemics need different solutions. We are right now living in two pandemics at the same time. The first is a more acute one � COVID-19 � caused by a virus which is infectious. So, what do we need to conquer it � anti-viralizations and then vaccines. That is how we have conquered viruses over the centuries, form plague and cholera to small-pox. The other pandemic is harder � that is the epidemic of loneliness, along with suicides and opioid abuse. It is chronic, it is not acute like COVID-19, and it is behavioral, not caused by a microorganism. So the vaccines we need for this are not some drugs but they are behavioral vaccines and this is where wisdom comes into play. So individual level wisdom and societal level wisdom. Is it possible to increase wisdom competence? The fact is we have plenty of literature. We have a paper in press in JAMA Psychiatry which is a meta-analysis of 57 randomized controlled trials that sought to enhance one of the three components of wisdom, in particular compassion, emotional regulation, and spirituality. These studies included people with mental illnesses, people with physical illnesses, and just people from the general public. Nearly half of these studies reported significant increase in the levels of the specific components of wisdom, with moderate to large effect size. Obviously, not everybody would improve, not every intervention would work but is suggests there is a good chance that with the right kind of therapy we can increase the specific components of wisdom, in at least some people We just published a Pragmatic Randomized Control Trial of Group Intervention. This intervention had a one month control group and group intervention and three months of follow-up at the end of the intervention. This study done in five different retirement communities in three different states � California, Arizona, and Illinois. We used a behavioral intervention that was manualized and this is important. This intervention was administered by unlicensed staff in those retirement communities. We trained them but the staff often did not have a related degree but they had worked with older people. The intervention included savoring, engagement in value-based activities that people considered meaningful, like working and volunteering in the community, keeping a gratitude diary in which you write a couple of things that make you feel grateful and happy, and had homework � this is important, that you don�t do this think only during the intervention hour but you do it every single day. We found that the level of wisdom improved significantly, the level of perceived stress went down significantly during the intervention period, whereas the level of resilience improved significantly from the pre-intervention to the follow-up period. So, in a pragmatic trial we could show an improvement in resilience and wisdom and a reduction in stress in the community So that covers the individual label, what about the societal label? Increasing globalization and incredibly rapid advances in technology are upending long-held social mores and causing social anomie that is causing modern social behavioral pandemics of loneliness, opioid use, and suicide. So a solution is needed not just at an individual level but at a societal level. We need to bring in compassion, self-reflection, emotional regulation, acceptance of diversity, and spirituality into our everyday lives and in society as a whole. And we need to start with schools and workplaces. Currently our education focuses on hard skills. For example, in elementary and secondary schools we focus on the three Rs � reading, writing, and arithmetic. In professional schools, we focus on hard skills related to that profession. For example in medical schools, we teach the medical students how to be the best at diagnosing disorder and teaching them, which is absolutely fantastic, this is what physicians need to do. Is that enough, though? People need something more to lead a meaningful life. So we need to bring them compassion, empathy, emotional regulation, self-reflection into our training, whether it is at the elementary school level or school of medicine, school of law, school of engineering, and also in the businesses and workplaces I wanted to end this presentation on a positive note � not talk about the downsides of aging, how older adults are susceptible to so many things. And yet, there are inspiring examples of older people. So is a list of the oldest survivors of COVID-19. Believe it or not, 11 centenarians from China, Italy, Iran, the UK, and the US developed COVID-19, they were hospitalized, they got treatment, and they left the hospital and are doing fine. I wanted to give you two specific examples. One is Bill Lapschies, a World War Two U.S. Army veteran from Lebanon, He beat corona virus to celebrate his 104th birthday.� And then, Connie Titchen, a 106-year-old former sales assistant, from Birmingham, England. Her daughter said that Connie still cooks but still enjoys an occasional trip to McDonald�s. So we have great inspirational examples This is my last slide, so I believe the aging of society is not a silver tsunami, as it is frequently dubbed. But it will be a golden wave � happy, health, active, bright, and inspiring seniors, if the society will help the seniors. Thank you for your attendtion Dr. Everett Thank you Dr. Jeste. At this point we don’t have time with the structure that we have can enable questions and things like that. I wanted to make sure that you are aware that we will certainly have our presentation available on the website, at some point, in the not too far in the future. And we certainly do want to convey ongoing conversation and communication regarding Dr. Jesse very provocative and useful information. Certainly a great example of taking deep science questions that have sociologic background and translating that into things we can think about – application in regards to the way our systems are structured in the clinical space but also in the social support space that we have set up for all of us but particularly our aging. So, thank you very much Dr. Jeste for those very enlightening words Our next speaker is Kathleen Zuke. She is a senior program manager at the National Council of Aging. Kathleen was privileged to grow up with eight loving grandparents. As a result of that she developed a passion for supportive services for older adults as a caregiver for her grandfather. She has been a senior program manager with the Center for Healthy Aging since 2015. In this role she works collaboratively with community-based partners across the country to identify, implement, and sustain evidence-based programs that support older adults in staying well and aging in the community. This includes chronic disease self-management, education, falls prevention, behavioral health, and other factors. Please welcome Kathleen Zuke Dr. Everett Our next presenter is Michelle Smith. She is a certified peer specialist with the VA Health Administration, and she is in New Jersey. Michelle is a Marine Corps veteran who served at the White House among other duties during her eight-year career. She currently works on the Women’s Treatment Unit for PTSD and the Core Residential Unit which is geared for veterans that have SMI diagnoses. She has served veterans all the way ranging from World War I to the current OEF, OIF, OND veterans. Michelle is the co-chair of the national webinar planning committee for peers. Please welcome Michelle Smith Ms. Smith Hi, thank you so much I’m so excited to be here. In the sake of time I’m not actually going to use my slides I’m going to talk about some of the high points if that�s okay. Yes and I’m very excited to be here to tell you about what peer specialist in the VA do. We are all veterans of the military. We all have experienced at least one year of sustained recovery. But most importantly we have the ability desire and skill to help others. I am only one of over 1100 peers in the VA system and we work in many different settings from acute, to residential, to outpatient, to substance abuse. Our newest development is primary care – we have peers there and hopefully we will be getting more services to join us down the line. As indicated, I work in residential programs So, what do peer specialist do? We serve as examples that recovery is possible. We help veterans with goal setting and problem solving. Keeping in mind that it is the veteran’s goals and the veteran�s wishes that we go by, not out own, even though sometimes we do think we know what is better but we don’t get to do that. We also help them develop their strengths, if they wish, and also identify what the feel are their weaknesses and help them develop them into strengths. Older veterans, you know, we work with a lot. And they want the same things out of life that we do. It is identification of what people want. They want the same thing that everybody else does, a valued role in life, a place in the community, and a nice place to live. I want to give you examples of how we work with them. As people are getting older, they are facing many different challenges. People may be going from a fully structured time schedule to a looser, unstructured time schedule. Or their employment status may be changing? Or their physical and mental health can be impacting their lives. Sometimes they have too much time to think and that could be a good thing or could be a difficult thing. I want to tell you about a veteran I worked with he was a navigator on an aircraft carrier. And he had gone through the Suez Canal and one of his regrets in life that he never got to see the pyramids. So, he eventually did his research, identified it as a goal I worked on it and went. Had the time of his life. (an aside) I am not really following the slides, so you can move them as you want. I just want to make sure that Kathleen has time to talk We can go to slide eight though because this is my very favorite slide and I wish I could take credit for the great ideas on it. Several of my colleagues started coffee socials in town as a way of community integration especially with the older veterans. They set up in a local veteran service organization. The veterans would meet, have coffee, you know talk, chat, get along, have socialization. Sometimes the peers would do groups or bring in a speaker, depending on what the veterans wanted. Of course, now during COVID, they are not meeting but they are certainly keeping in touch among themselves. The other great idea which I really wish I appropriated, was the Peer to Pier. Veterans identified in a goal group one of the things they wanted to do was go fishing. So the Peer specialist work with them. They researched how to get a license at a military discount and they, for the first couple weeks, drove them to the pier and the fishing group but then they start exploring bike routes, and bus schedules, and they would go meet the peers there themselves, which is what community integration is about. They are not necessarily meet during COVID, but I heard a lot of them are going to different areas and compare notes on where they went and how the fishing was and which one caught the biggest fish. So, we are encouraged to use creativity. One of the things I like is we give them chalk. We send them chalk to color their sidewalks with whatever message they want to give. Even though our worlds have drastically changed in the past two months, we are doing a little bit of really outside the box different things. One of them would be, is that for some groups we talk about the challenges that they have and then we make up a list, actually, of different virtual tours. So sometimes they could like if they are afraid of crowds, they might do a virtual tour of New York City – to get acclimated. There are so many things that we can do and I’ve included in my slides some handouts The other thing I wanted to talk about real fast is we encourage journaling. Journaling is one of my recovery tools, for my own recovery, and if people don’t know how to start a journaling, I ask them to think about what is your weather condition today? If you were a weather condition, what would it be? So, journal about that either art or talking or writing. I’m sorry I am rushing but I did want to make sure that everybody gets a chance to speak. My contact information is there, and I want to give a shout out to all the people who helped me with this presentation. Because it does take a village. Not one person in the VA can survive without other people. And we have also included a list of VA links to see what we’re doing and to also probably offer you some suggestions. Anyway, my contact information, the links, the journaling, and a bunch of things that I do to stay halfway normal during COVID, are attached to the slides. Thank you so very, very, much. It has been an honor and a pleasure to be here Dr. Everett Thank you for those words Ms. Smith and also thank you for your wisdom and distilling the most important components of your talk and clearing a little bit of space for Ms. Zuke. Kathleen are you with us? Thank you very much. We have already announced you so and your role as senior program manager of the National Council on Aging. If you can go ahead and proceed that would be great Ms. Zuke Thank you so much Dr. Everett and it was a pleasure to hear Dr. Jeste and Michelle speak. I’m here on behalf of the National Council on Aging. Go to the next slide. We have a vision of creating a just and caring society where we all have the opportunity to live with dignity, purpose, and security. Next slide. We are specifically with the Center for Healthy Aging and we operate two national resource centers funded by the Administration for Community Living. One focuses on chronic disease self-management education and the other on falls prevention. Next slide. We provide a variety of technical assistance activities to state and community-based organizations across the country on better implementing, expanding, and sustaining community-based programs. Next slide. The main point of this slide here is to point out that among healthcare settings there is a challenge for accessing mental health care, specifically for older adults. You will see that older adults were less likely to receive any type of treatment for mental health or substance use conditions. That was even more clear in specialty settings and were also less likely to be discussing emotional problems with primary care providers. So, there�s a role, perhaps to connect older adults to mental health services through community-based organizations that they might already be in contact with. Next slide. Of course, there is some challenge there as well. There is a lot of variety in whether there are community-based organizations that have mental health services available onsite. There�s limited comfort and training and knowledge on using mental health screenings. If they do use these screenings, where do they refer older adults seeking services. There is a lack of geriatric mental health care providers to address the unique needs of older adults. And community-based organizations are working to overcome the stigma related mental health treatment, especially in community-based settings. And ultimately everybody will benefit from addressing these issues as mental health conditions may prevent older adults from participating in other beneficial activities, like meal programs, chronic disease self-management, education, falls prevention, and physical activity. Next slide. The community-based organizations are particularly skilled at addressing older adults in their home. They have already built the trust and they have been particularly critical as a lifeline to older adults during the pandemic. Area Agencies on Aging, senior centers, state and local units on aging, and public health have been ramping up their ability to provide meals, social engagement, healthcare access, and transportation. And they�re really experts at addressing the social determinants of health. Next slide. I’m going to skip through these slides, these have provided some results of a survey that we recently did on community-based organizations and how their services have been impacted by the pandemic. You can skip to the next. Next. Next. And one more. So ultimately, we know that community-based organizations that responded to the survey, over 1000 organizations are pivoting to offer their normal services by phone or videoconference on a variety of different topics. And they’re doing that with fewer resources, lost revenue, with lower access to volunteers than they would normally have during the pandemic, in trying to fill this need. Next slide. There are a lot of strategies that community-based organizations are using across the country. One of those main strategies is implementing a community-based, evidence-based program. Next slide. So, a few programs that I will highlight quickly, all adhere to the definition of evidence-based that has been proposed by the Administration for Community Living. This might differ a little bit from different federal agencies but ultimately, they have been shown to improve health for older adults, they�ve been tested in a published article, and they are available to be implemented across the country. It is important to note that most of these evidence-based programs are implemented in person. So, we’re tracking right now alternative ways to offer these programs during the pandemic to keep connections and a lot of them are available by phone, virtually, or by mail. Next slide. Here is a list of a few programs that address mental health. Community-based organizations have the infrastructure already in place to offer these in many areas. So, these include Healthy Ideas and PEARLS to address mild to moderate depression. These are typically implemented in-person but are now available by phone. There�s also Chronic Disease Self-Management Education, which was originally developed at Stanford University and there are a variety of ways to offer that right now. Enhanced Wellness is a one-on-one program that can be offered by phone and really focuses on action planning and skill-building to address chronic conditions. Wellness Recovery Action Plan is a great tool, and they actually have a free app to develop an action plan that will identify helpful activities and identify triggers for crisis and what to do in case that happens. And then two programs, one to manage medications and the other to indicate whether additional treatment is necessary for substance use So we can skip through the next few slides. Here are a few additional ways to stay connected to older adults during COVID-19. NCOA is continually updating our resources on our website, including information on mental health during the pandemic. Our National Institute for Senior Centers has published a Senior Center Connects Guide and there are several other resources that you might check out to remain connected to older adults in your community during this time. I also encourage you, if you’re not familiar with any agency nearby that focuses on serving older adults, to go to the Elder Care Locator to identify your Area Agency on Aging to call and ask for providing any virtual programs right now. Next slide. Here are a few resources that you can explore to learn a little bit more about evidence-based programs, as well as behavioral health resources we have. Feel free to reach out with any questions, peruse the additional information that we were not able to cover, and reach out with any information that you would like to connect about. Thank you so much Dr. Everett Thank you and I want to thank you for the time and talent presented to us in the range of resources that you presented which is very useful for us to hear and see. I want to remind everybody that we will, as soon as it is feasible for us to do so, will be posting this event on our website. Because of the situation we are not exactly how sure the how long it would take but within the next several days is what I’m expecting. I also want to thank everybody for bearing with us during this time. This is our third event. The first year we had 30 or so participants; the second year maybe 100 or so; this year, over 4,000 individuals signed up which exceeded the capacity of the original capacity we planned for. I think that speaks to the great interest in the area. Some interest sparked in part because of the pandemic that we are currently in also to the hunger for information that is of the type that our speakers, including our assistant secretaries, provided to us. I want to thank everybody for attending a special shout out to all of our presenters and we hope you will join us next year, sometime in May, when we have the Fourth Annual Older Adult Mental Health Awareness Day. Thank you very much. This concludes the meeting