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(Robert Lipsyte) Coming up on "Life (Part 2)," if you're old, is it better to be white, black, Asian or Hispanic? A provocative question, but we'll take it on. And later, if you want to be vital and strong until the very end, we'll meet a woman who knows what you and our government should be doing about that right now. Plus, best-selling author Linda Fairstein on how her two careers came together to create a storybook ending. All coming up on "Life (Part 2)."   

(woman) Major funding for "Life (Part 2)" was provided by The Atlantic Philanthropies-engaging many to improve the lives of and achieve health and economic security for older adults. And by MetLife Foundation--celebrating the wisdom, talent, and experience of older adults. MetLife Foundation proudly supports "Life (Part 2)."

[bass, & plucked strings play in playful rhythm; bright in tone]
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(Robert Lipsyte) Welcome to "Life (Part 2)," I'm Robert Lipsyte. How do different communities treat their older populations? Does an African American Baby Boomer coping with aging parents face different challenges than say an Hispanic or Korean American in the same situation? And what can each of our communities learn from the other's experience? These are some of the questions we'll tackle today. But first, let's see how one Korean immigrant is caring for her 92-year-old mother.
[vibraphone plays softly]
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(woman with Korean accent) I cannot imagine my life without my mother. I lived with her throughout my life, and without her devotion, we would not been here today actually, that's how I feel. She's losing her memory and she does not have a notion of what she's doing, you know. The other day she asked me how many children I have. You know, when you get a question like that, oh my God, what's happening with Mom? The doctor advised me to send her to nursing home, but if I send her to nursing home, she would not get Korean meal, which is really crucial for health and sustain her life actually. And if I send her to nursing home, she would not be able to communicate at all. So sending her to nursing home was not my option. So I try to find a home health aide who could speak Korean and cook Korean meal, but there wasn't anybody available in the Philadelphia area.

[speaking Korean]

It was really difficult; it was burden to everyone in the family, and luckily about 3 or 4 months after, I heard somebody, is coming from Connecticut who has a license. So I immediately hired her.

(nurse aid) 1... 2... [speaks Korean]

(woman) In Korea, parents are usually children's responsibility, but here, the system takes care of elderly. But still, we have a guilt feeling if we don't take care of our parents.

[singing "Amazing Grace" in Korean]
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(woman) It's not just my mother. Any people out there, Korean or non-Korean, doesn't matter, really, they have very similar need.
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(woman) [speaks Korean] But my mother has added needs because of a language barrier and food need, cultural barrier.
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(Robert Lipsyte) A very contemporary American story we've just seen, which brings us to our panelists. Dr. Giang Nguyen is Assistant Professor of Family Medicine and Community Health at the Hospital of the University of Pennsylvania. Melvin Delgado is a Professor of Social Work at Boston University. He's the author and editor of many textbooks, including... Dr. Jerry Johnson, is Chief of the Division of Geriatric Medicine at the University of Pennsylvania, and is Senior Fellow at Penn's Institute on Aging. He's is a former President of the American Geriatric Society. Welcome all to "Life (Part 2)." Melvin, the movie we've just seen, could that have been shot in the Latino community?

(Melvin Delgado) I think there were many similarities there. As I watched it, you can easily close your eyes and get a sense that you were talking about a Latino family. Concerns around cultural values not being respected, language barriers, a sense of moral duty to take care of your family rather than put somebody in a nursing home.  All those are themes that we can find in the Latino community across the country. So no, very easily, it could easily be a family with a Latino background.

(Robert Lipsyte) When an Asian family, and I hate to say that because there's Korean, there's Chinese, there's so many different forms of Asian families, comes smack up against ensconced American institutions, there's always a rub, isn't there?

(Dr. Giang Nguyen) There is; the woman in that clip spoke about the fact that in America, the system takes care of older people, but the problem is that the system really isn't set up for people who are like the woman in the story, and particularly for Asian Americans, where you're dealing with such a broad range of cultures and languages. It is a challenge for any system to be able to do it well.

(Robert Lipsyte) Jerry, if they finally do find their way into the medical-industrial complex, they're very likely to come up against doctors who are not culturally prepared for them.

(Dr. Jerry Johnson) Absolutely, that's one of the big challenges for all of us. First of all, there's a culture of medicine, a culture of Western medicine that often is at odds with views that ethnic groups have about the cause of disease, about the nature of help that should be provided. One of the challenges though, that this film brought to mind, and I think it relates to what Melvin was saying, that would be a big challenge for an African American family, would be whether or not to put the person, allow the person to go into a nursing home. There's a strong sense of concern, if not guilt, that to allow one's parent to go into a nursing home, is a manifestation of neglect. And if there are not enough resources in the home, then the person doesn't get good care.

(Robert Lipsyte) This guilt and shame that might be felt, is also coming up against the mainstream white Boomer entitlement.

(Dr. Giang Nguyen) The issue of this guilt and shame is a very large issue for Asian American communities, because in many, particularly the Eastern Asian communities, the concept of filial duty is predominant, and that is families are obligated to provide total and comprehensive care to their elders as they get older. And if these families are unable to do it on their own, then they are somehow not fulfilling their duties. And so people are reluctant to ask for help. They are reluctant to admit that they are unable to do what they are meant to do.

(Robert Lipsyte) Do you think that's true in the Latino community too?

(Melvin Delgado) I do, as a Boomer I find that I'm really caught between two worlds here. The cultural values of my family, being born and raised in Puerto Rico, and the cultural values of this country where I was born and raised, on one level I'm told that my parents, when they get old enough, they should go into a nursing home. That it's not my responsibility, it's society's responsibility. However, being born and raised in a culture that says, no, your parents stay with you and we'll work out a system where different family members will provide. And as a Boomer, you're kind of caught between these two worlds, that say, no, you should be able to move on on your own, and not worry about your parents, but on the other hand, you do experience a great deal of guilt.

(Robert Lipsyte) One of the things is, I've been hospitalized a few times and several times with Latino roommates who brought 100 family members.

(Melvin Delgado) Right, very true.

(Robert Lipsyte) My first reaction was being irritated. But then I began to see what they were doing. That he was beginning to get the kind of care--and some of them came over to my side of the room--he was getting the kind of the care that nurses were not giving anymore. And I also sensed that he would get an aftercare from this extended family.

(Melvin Delgado) See, it's interesting, because your example is classic, because it's not unusual for an older Latino to go to a medical appointment and have 4 or 5 people with him. And it's interesting, I sat in on one interview once, where the doctor asked the patient a question and then the patient's daughter answered it. And the doctor asked the patient a question, and the uncle answered it. Then after a while you didn't know who was the patient. So it's almost like a clash of values of individualism versus interdependence. In many of the cultures we're talking about interdependence, it's, I'm not sick, we're all sick. If I'm not well, we're not all well. Ultimately, either the system is going to have to accommodate, or we're going to have to change, and right now, I think we're at loggerheads on that.

(Dr. Jerry Johnson) Well, one thing that I hear from you and that I believe, is that we in the health professions have to recognize that families have variable definitions. And a family today may not be the same traditional model as family 30 or 40 years ago. The important members of a family may not live in the same house, they certainly may be either gender, there may be cousins, sometimes the important caregivers, who act like family, are not biologically related at all, but have a very instrumental role in caring for an older adult. So who is accorded respect? With whom is information communicated? And I think the answers to those questions have to be more expansive than they've been in the past.

(Robert Lipsyte) We've talked so much about the dynamic of the family, the interdependence, and it seems like there's a yin and yang here, good and bad, yes?

(Melvin Delgado) I think there is. The good part is that you're never alone, and you always have people around you who can help you. So at least from the Latino community, I see a lot of positives, I see tension, to be quite honest, but if I had to take it or leave it, I like it, and I would take it.

(Dr. Giang Nguyen) I would agree with the Asian American community as well, that this idea of collectivism is a great strength. It holds families together; it draws upon resources from various different aspects of the family, and I agree that there's also tension because sometimes people are quite conflicted between the obligations to the family and obligations to the self. And one of the things certainly with immigrant families, that we deal with, is the impact of acculturation stress on mental health. As people who have lived most of their lives from somewhere else, move into this country, they have certain expectations of what life is going to be like as they grow older. And then their children, who are now adults in this country, may have very different ideas of what that relationship between them as adult children and their parents will be, and the culture clash can lead to pretty important mental health problems.

(Melvin Delgado) But you raise another point about acculturation, which is, in the Latino community, there's a lot of research going on on acculturation, and what they find, that those of us who were born and raised in this country, when we compare ourselves with someone who was a newcomer to this country, those of us who were born and raised in this country, tend to be much more unhealthy. Our life expectancy is lower, which is counter logical to what a lot of people say. You've got access to this great healthcare, why are you dying earlier on? And the research takes a look and says look at the diet of somebody who's high acculturated in this country would be fast foods, and lack of exercise, because of the kind of jobs you may wind up going into. Compared to somebody who is a newcomer who's going to be looking at food very differently prepared, so that there's a lot more research taking a look at the acculturation factor and basically saying acculturation may get you more money, may get you more status, but it also gets you a shorter life.

(Dr. Jerry Johnson) Let me make a comment about what Melvin said. The acculturation has resulted in, in some ways, African Americans being more like mainstream in their thoughts than some of the other ethnic groups. One of the places where that does not hold true, is a general sense of belief or trust in the healthcare system. And that presents challenges for health professionals and a need for a respectful and cautious approach to negotiation.

(Robert Lipsyte) Well, I think the bottom line is I'm going to enter an ethnic family and have the kids take care of me. Thank you all so much for joining us on "Life (Part 2)."

(Robert Lipsyte) Of course, any conversation about caring for aging family members, raises huge public policy issues that we should be confronting right now. Which is why I sat down recently with Dr. Linda Fried. She is Dean and Professor of Epidemiology at the Columbia University Mailman School of Public Health as well as a Professor of Medicine at Columbia's College of Physicians and Surgeons. When we met, I listened very carefully to her advice.

(Robert Lipsyte) Dr. Linda P. Fried, welcome to "Life (Part 2)."

(Dr. Linda Fried) Thank you, it's a pleasure to be here.

(Robert Lipsyte) In an editorial you wrote in a national journal, a very scary phrase that you quoted from the National Institute of Aging,"...a silver tsunami approaching for which we are unprepared. This is kind of all the old people, us included,who are sweeping in-- it scared me, should it have?

(Dr. Linda Fried) Perhaps, it depends upon whether we prepare for that tsunami or not or whether we're caught by the wave.

(Robert Lipsyte) What's happening?  Are we preparing?

(Dr. Linda Fried) In brief, no, for sure, not adequately and the tsunami is a tsunami of numbers, which is that we're going through an unprecedented revolution in human history, which is that we're an aging society. In 1900, 4% of the U.S. population was over 65 and a little over 100 years later, it's going to be 20%. It really requires a whole lot of thinking ahead of time about how to do this well, because it could be great.

(Robert Lipsyte) What's so great about it? I mean, everybody's fighting age, the Boomer Generation is denying age, why should be we thrilled to be part of this silver wave?

(Dr. Linda Fried) One of the things that's perplexing is that the aging of society is the success of all of our investments in public health and in medical care over the last century. And those investments have been phenomenally successful and underlie people being able to live longer, and people being able to live longer in general, much healthier than previous generations would have seen. So we have a success, which we, societally now are often looking at with grim eyes, and the way we look at it might be the obstacle to experiencing those benefits.

(Robert Lipsyte) Well, one of the statistics was that the highest tide will be in 2030, when I will be 92 and will really be in need of what you call "complexivists," doctors who really understand all the complicated issues of aging. And there are not going to be enough of them. Why is that?

(Dr. Linda Fried) Maybe because geriatrics is one of the youngest specialties in medicine. It's only 21 years of age. But some of it may be that the way our health system is constructed, is not one that really facilitates caring for people with long-term chronic complex health problems. And physicians who are invested in caring for highly complex, often frail, older patients, do so at their own risk in terms of going into deficit, into debt, when they see patients who require a lot of time.

(Robert Lipsyte) On the harsh side of all of this is also that so much of medicine is really on a heroic standard, keeping people alive whose quality of life doesn't seem worth it, and then the dark side of that, of thinking that as we start prioritizing in a supposed time of need, that we will not be taking care of older people properly because we'll have triaged them out of the system.

(Dr. Linda Fried) We have a healthcare system which is intolerably expensive, with poor outcomes, poor health outcomes compared to most of the countries in the developed world and even some of the countries in the developing world. That would suggest that we're bringing the one health system to different problems, and they don't match well. And heroic measures are needed in many situations, but we are bringing them to situations where I think we create unnecessary expense because we have the wrong system.

(Robert Lipsyte) Given the power invested in me by "Life (Part 2)," I've just made you the National Health Czar, and I want to know, this is the vetting procedure, I want to know, what are the 2 or 3 things that you're going to do right away?

(Dr. Linda Fried) I think I would do 3 things. One is, we need to transform our health system to a caring system that is invested in the prevention of chronic diseases and conditions associated with aging and to expert care of people with chronic conditions to avert, to prevent those acute episodes that are costly to the individual as well as to society. I would create a public health system that really knew how to do prevention of chronic diseases and was designed to interface with the health system, which we have not really done effectively. And the 3rd thing I would do is design new kinds of ways to keep people happy, active and engaged, in ways we never envisioned before. Because we don't have roles for people after retirement in the main in the society. We are losing out on all that they have to contribute. But people have to stay active in doing things they love and that bring meaning and where they feel like they're making a difference to stay healthy along with the other things we know. And so we need all 3 approaches.

(Robert Lipsyte) And I guess one other thing that I was thinking about is in the message that you would send out is that we all start aging seriously probably at 40 and 50, and we should start really seriously thinking about it then. You make me wish I really had more power than I do.

(Dr. Linda Fried) We can work on this together.

(Robert Lipsyte) We will, Dr. Fried, thank you so much for joining us on "Life (Part 2)."

(Dr. Linda Fried) Thank you.

(Robert Lipsyte) Being fortunate enough to use your experiences in a new way, has to be one of the great pleasures of getting older. And that's certainly the case for best-selling author, Linda Fairstein, who's latest novel is "Lethal Legacy."

(Linda Fairstein) One of the good things about getting older is that your hard-won experience of the world ends up serving you well, sometimes in ways you never expected. This is especially true for a writer like me, but it's really true for anybody. My childhood ambition had been to write fiction. My father, whom I adored, worried constantly about the unemployable literature major as he sent me off to college. He told me over and over again that I had nothing to write about. "Get a job," he urged me. So I settled for my second choice, public service in the form of prosecution. And that's how I earned my lines and wrinkles the hard way. For 30 years, starting right after my graduation from law school, I served as a prosecutor in the great office of the New York County District Attorney, where my specialty became a new legal field, crimes of violence against women and children. I was a 25-year-old kid when I started the job, but years of chasing bad guys and the challenges of the criminal courtroom, taught me more than I wanted to know often about the dark side of life. But I never gave up my dream, and came to realize with great delight, that my career in the law had provided endless material to fuel the stories I wanted to tell. And how better to grow older than enjoying the writer's life. It assured me of two things; first, in creating a protagonist  who is my alter ego, Alexandra Cooper, a prosecutor on the front lines, waging war to make the streets safe for women, she could be younger, thinner, and blonder than I had become over time and I could keep her that way. Alex only ages a couple of months between capers, so a dozen books later, she's only 2 years older than when readers first encountered her. And then, there's the air-brushed author photo, which keeps me on librarian bookstore shelves looking forever young. All of which proves that sometimes the choices that you thought of as settling turn out to be the best choices you ever made.

(Robert Lipsyte) Linda listened to her dad. Let that be a lesson to you kids. For now, that's it for "Life (Part 2)," thanks for joining us. I'm Robert Lipsyte, see you next time, older and better.

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(woman) Major funding for "Life (Part 2)" was provided by The Atlantic Philanthropies--engaging many to improve the lives of and achieve health and economic security for older adults. And by MetLife Foundation--celebrating the wisdom, talent, and experience of older adults. MetLife Foundation proudly supports "Life (Part 2)."

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