Submitted by: Carolyn S. Wilken, Ph.D., M.P.H., Associate Professor, Extension Gerontology
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Haas, W. H., Bradley, D. E., Longino, C. F., Stoller, E. P., & Serow, W. J. (2006). In retirement migration, who counts? A methodological question with economic policy implications. The Gerontologist, 46(6), 815-820.

In this study Hass and colleagues examined how the implications of various definitions of retirement migration influence programming and policy. Although one may think that Shakespeare’s admonition that ‘a rose by any other name smells as sweet’ would apply to describing older adults who we commonly call ‘snowbirds’, these researchers found that relying on a traditional age-based definition of retirement migration (people ages 60 and over who move across important political boundaries i.e. county, state, or nation) significantly miscounts the migrant population. Accurate population estimates have important policy and program planning implications, not to mention the structuring/restructuring of political districts.

The researchers identified 3 definitions of older adult migration:

1) Traditional Age-based Definition: Retired migrants age 60 and over.

2) Retirement-Based Definition 1: Retired migrants aged 50 or older who report working no more than 26 weeks a year and report receiving at least $1 in Social Security or disability income.

3) Retirement-based Definition 2: Retired migrants who are 50 or older who are not in the labor force and report receiving at least $1 in Social Security or disability income.

Using data from the long-form of the 2000 U.S. Census the authors found that using the traditional definition of retirement migration excludes those who retire earlier, at ages 50-59. Using retirement rather than age as a qualifier, the actual number of retired migrants was 21% less.

Florida, Arizona, California, Texas and North Carolina are the five top retirement migration hosts, or receiving states. A comparison of the rates of migration between each definition (for Florida) revealed important differences between definitions suggesting that specifying actual working/retirement status reduces the real number of older (50 years and older) migrants coming into Florida.

“So what?” you may ask.

Understanding the employment status of older migrants to a community leads to a better understanding of the economic impact of migration. Retirees bring with them transfer payments such as Social Security, private pensions, and equity income, as well as Medicare and generate what is known as a mailbox economy. Those who are fully retired bring those assets into a community and do not compete with the indigenous workforce for jobs. Those who are still working, even part-time have a different impact on the economy. Using all three definitions of migration, the researchers found that fewer partially retired people migrate to Florida than Texas and California, therefore having less impact on the workforce.

Implications for County FCS Faculty

County faculty are frequently involved in county-level community development and are responsible for the development of their own programs. Recognizing the differences in how migration is calculated provides faculty with important information to contribute to those planning processes. This study which utilized data from the U.S. Census reminds us of the wealth of information available from the census data. To find data related to many aspects of your county or community (i.e. age distribution, education levels, income, housing costs, etc.) follow this link to the American Community Survey and enter your city or county. In the past the census data was unusable to most professionals, but now census data is presented in a very user-friendly format and is therefore not only accessible it is also usable! Data presented in the American Community Survey reflects the issues of concern to FCS agents and can be very helpful in developing needs assessments, preparing situation statements for Plans of Work, and for prioritizing programs.

Prevention of falls and consequent injuries in elderly people

Submitted by: Carolyn S. Wilken, Ph.D., M.P.H.

Prevention of Falls and Consequent Injuries in Elderly People. Kannus, P., Sievanen, H, Palvanen, M., Jarvinen, T. & Parkkan, J. Lancet 2005; 366: 1885–93 Retrieved September 17, 2006.

Introduction

Injuries from falls is a serious concern for older adults, their family members and the professionals who provide care for them. An elderly person who falls may suffer long-term pain, disability, and even death. As the number of older adults continues to rise, the number of falls is expected to increase correspondingly. Researchers have found that fall prevention includes several components, including regular exercise including both strength and flexibility training, attention to nutrition particularly vitamin D and calcium supplements, reducing or withdrawing certain medications, vision assessments such as cataract surgery, and an environmental evaluation to remove tripping hazards and lighting deficiencies. These prevention methods apply both to elders living at home and those living in institutions.

Methodology

This article is a review of current research (up to May 31, 2005) related to falls among the elderly population world-wide. Articles included in this review were published in two premier medical databases Medline and PubMed, relevant journals and congress abstracts.

Main Ideas

Falls are a significant cause of injury and death among older adults, particularly elderly women. Risk of falling is important among both community dwelling elders and those residing in institutions as 30% of people over 65 years of age living in the community fall each year, and nearly half of older adults living in an institution fall. A key concern regarding falls is that more than half of those who fall will likely suffer additionally falls over time. Furthermore, injuries are the fifth leading cause of death among the elderly, and 80% of these injuries are the result of falling. Among those over 65 who fall, 20% need medical attention (5% for fractures, including head injuries). Statistics regarding falls generally double for women over the age of 75 because of the high incidence of osteoporosis.

After reviewing the literature on falls, the authors recommend a multi-pronged approach, including exercise, diet, medication evaluation, and environmental adaptations. Exercise recommendations involve both strength building through weight bearing exercises (i.e. standing, walking, and stair climbing) and flexibility training such as Tai Chi. Strength and flexibility promote balance, reaction time and gait. What we don’t understand is the frequency and level of exercise needed at various ages.

The literature appears to be consistent in the recommendation of Calcium and vitamin D supplementation as a positive approach to reducing injury resulting from falls by increasing bone density. Because calcium and vitamin D are both reasonably inexpensive the combination serves as an effective population-based injury prevention strategy.

Although only one study was found to include in this review, the reduction of psychotropic drugs used primarily as treatment for mental illness, reduction of the drugs resulted in a 66% reduction in the number of falls.

Researchers have found that professional analysis of the home environment and related adaptations can lead to a significant reduction in the number of falls for those at high risk of falling.

Although past research has focused on single factors associated with falling, such as exercise, diet, nutritional supplements and the environment, the authors recommend additional research on the effectiveness of multi-factorial approaches to reducing the risks of falling. Also needed is research based on diverse populations (e.g. age, ethnicity), and including elders suffering myriad illnesses, utilizing a variety of drugs, and focusing on numerous causes of falling in addition to osteoporosis.

Implications for Extension Programs

Because falls are a constant worry to older adults, their families and their caregivers, the topic provides an important opportunity for Extension educators to combine programming in nutrition, housing, health (exercise), and aging. Such programs can be directed at older adults as well as their caregivers and can be presented at senior centers, nutrition/feeding sites, and many other program locations.

For programming materials directly related to falls, see Aging in the 21^stCentury for the program developed by Kristen Smith titled Florida Injury Prevention Programs for Seniors (FLIPS). The EDIS publication is found at http://edis.ifas.ufl.edu/FY629 and the related PowerPoint presentation can also be found at the IFAS Presentations website at http://presentations.ifas.ufl.edu/ The complete FLIPS program can be found at the Florida Department of Elder Affairs website at http://elderaffairs.state.fl.us/english/flips.html A complete series on fall prevention is also on EDIS and can be found at EDIS Topic Series: Fall Prevention

Carolyn Wilken, Ph.D., Extension Gerontologist.

Young, B. H., Ford, J. L.C.S.W., Ford, J. D., & Watson, Survivors of natural disasters and mass violence. U.S. Department of Veteran Affairs National Center for Post Traumatic Stress Disorders. Retrieved March 14, 2006 from http://www.ncptsd.va.gov/facts/disasters/fs_survivors_disaster.html

Each year millions of people around the world are impacted by natural and technological disasters. While the immediate impact of hurricanes, tsunamis, tornados, and terrorist attacks are easily recognized by the physical and environmental destruction the psychological impacts on the victims is often overlooked or is not manifest until months following the disaster.

Posttraumatic Stress Disorder (PTSD) is defined as a psychiatric disorder that can occur after experiencing or witnessing a life-threatening event such as war, hurricanes, terrorist incidents, serious accidents or personal attacks. Although most survivors return to normal in time, some have stress reactions that are not easily resolved resulting in Posttraumatic Stress Disorder. Symptoms of PTSD include, reliving the traumatic event through nightmares and flashbacks, sleeping problems and feeling of detachment. Sometimes these symptoms can be severe enough and last long enough to impair the person's daily life in a significant way. Physical and mental health problems associated with PTSD include depression, substance abuse, memory problems, and other physical and mental health problems. PTSD also affects its victim’s social and family life, ability to function in the work place, marital problems and divorce, family difficulties and problems with parenting.

The authors identify four types of reactions to PTSD:

• Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love and intimacy or difficulty taking interest and pleasure in day-to-day activities)



• Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame.



• Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive.



• Interpersonal reactions, in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling.

Predictors of increased risk for PTSD and lasting readjustment problems are greatest if the victim either directly experienced or witnessed any of the following during or after the disaster:

• Loss of loved ones or friends


• Life threatening danger or physical harm (especially to children)


• Exposure to gruesome death, bodily injury, or dead or maimed bodies


• Extreme environmental or human violence or destruction


• Loss of home, valued possessions, neighborhood, or community


• Loss of communication with or support from close relations


• Intense emotional demands (e.g., rescue personnel and caregivers searching for possibly dying survivors or interacting with bereaved family members)


• Extreme fatigue, weather exposure, hunger, or sleep deprivation


• Extended exposure to danger, loss, emotional/physical strain


• Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)

Most people can ‘handle’ a single stressful event, but when the stress begins to ‘pile up’, the individual’s, or the family’s ability to cope may become proportionally compromised. How individuals, families, and communities respond to stressful event such as natural (or man-made) disasters depends upon the resources that are available prior to and following the disaster.

Role of Extension Faculty in Protecting Others & Themselves

Extension professionals often find themselves in the midst of disaster situations, such as hurricanes-and personally at risk for PTSD. While there are often limitations on what can and must happen ‘on the scene’, the authors recommend these tips as strategies to help prevent PTSD:

1. Protect: Find a safe haven that provides shelter; food and liquids; sanitation; privacy; and chances to sit quietly, relax, and sleep at least briefly.



2. Direct: Begin setting and working on immediate personal and family priorities to enable you and your significant others to preserve or regain a sense of hope, purpose, and self-esteem.



3. Connect: Maintain or reestablish communication with family, peers, and counselors in order to talk about your experiences. Take advantage of opportunities to "tell your story" and to be a listener to others as they tell theirs, so that you and they can release the stress a little bit at a time.



4. Select: Identify key resources, such as FEMA (Federal Emergency Management Agency), the Red Cross, the Salvation Army, or the local and state health departments, for clean up, health, housing, and basic emergency assistance.

Resources for Extension Faculty

EDEN Extension Disaster Education Network

http://www.eden.lsu.edu/

National Center for Posttraumatic Distress: US Department of Veteran Affairs http://www.ncptsd.va.gov

National Institute of Mental Health http://www.nimh.nih.gov/healthinformation/ptsdmenu.cfm

National Rural Behavioral Health Center at the University of Florida http://www.nrbhc.org/