The complex world of caring for your ill parent means practicing love, acceptance, and sometimes even yelling at God.
By Virginia Stem Owens
I had never seen the logic in asking "Why me?" when some calamity befell me. Couldn't one just as reasonably ask "Why not me?" But when my mother began to show signs of dementia from Alzheimer's disease, I found myself asking on her behalf, "Why her?" If ever a person did not deserve such a fate, it was my mother. She was a good, generous, funny, loving person who had already suffered a number of tribulations in her life.
But deserving has little to do with disease. Like the rain, it falls on the just and the unjust. And, as suddenly as a summer thunderstorm, my mother's care fell to me as she declined into dementia and finally to death over a seven-year period. In this country, millions of people are living through similar experiences. Knowing my own desperation while I tried to help both my parents during those years, I've gathered some expectations, suggestions, and nuggets of wisdom that might help others.
July 20, 2008
Geezers Doing Good
By NICHOLAS D. KRISTOF
This month Bill Gates starts his new full-time career as a humanitarian, leaving behind the software bugs to swat the kind that cause malaria.
We often think of those trying to save the world as bright-eyed young people, but Mr. Gates is part of a booming trend: the “encore career” as a substitute for retirement. Definitions are still in flux, but an encore career typically aims to provide a dose of personal satisfaction by “giving back.”
Some 78 million American baby boomers are now beginning to retire, and one survey this year by a research institute found that half of boomers are interested in starting such new careers with a positive social impact. If we boomers decide to use our retirement to change the world, rather than our golf game, our dodderdom will have consequences for society every bit as profound as our youth did.
One example of this trend is Peter Agre, a medical doctor who won the Nobel Prize for Chemistry in 2003 for research on ... on ... well, on something to do with cell membranes that I still don’t understand. Dr. Agre could have run his lab indefinitely but was restless to assume a challenge that would more directly affect society.
He thought about politics, but ended up taking on a fancy administrative position at Duke University, thinking he could help shape students and education. Then he became restless again, and this year he took a substantial pay cut to head the Malaria Research Institute at Johns Hopkins University.
“It wasn’t a matter of being a Mother Teresa,” Dr. Agre said. “It was a matter of, ‘Boy, that sounds like fun!’ ”
Yet he concedes — a little bashfully — that there is also a thrill at the possibility of helping overcome malaria, one of the great scourges of humanity. These days, Dr. Agre presides over a team of 20 scientists working on everything from designing malaria vaccines to engineering a malaria-resistant mosquito that in theory could outcompete others if released in the wild.
Marc Freedman, author of a book called “Encore: Finding Work that Matters in the Second Half of Life,” notes that adolescence is a relatively modern concept; until the 19th century teenagers normally were treated as adults. In the same way, he says, a new life stage is emerging — the period of 10, 20 or even 30 years after one’s main career is completed but before infirmity sets in.
The best things that graying do-gooders bring to philanthropy is their management experience and Rolodexes. Bill and Melinda Gates are most noted for showering billions of dollars on public health, but perhaps just as important has been the hard-nosed business sensibility they invoke, demanding metrics to demonstrate that particular approaches are cost-effective.
Aside from Mr. Gates and Dr. Agre, another general in the war on malaria is Rob Mather, a British management consultant who — thank heaven! — isn’t very handy with a TV remote. Mr. Mather was trying to turn off his set in June 2003 when he accidentally flipped to another channel and was riveted by the image of a 5-year-old girl who was struggling to overcome severe burns all over her body.
Mr. Mather suggested to several friends that they swim as a fund-raiser for the girl. Because Mr. Mather is relentless, the swim ended up involving 10,000 people in 73 countries and raised hundreds of thousands of dollars.
Bowled over by the possibilities of mobilizing people for good causes, Mr. Mather set up a swim the next year to raise money against malaria — and this time 250,000 participated. He left the business world and founded a group called Against Malaria, now one of the world’s leading organizations battling the disease.
Mr. Mather browbeats businesses into donating services and covering overhead — “we have 17 legal firms working for us, and we’ve never paid a legal bill” — so every dollar donated to the organization ends up actually used to buy bed nets for families that can’t afford them.
He said he had just received e-mail about an African village that had 387 cases of malaria per month before the bed nets were distributed and seven cases per month afterward. Mr. Mather’s work has resulted in hundreds of thousands of bed nets being shipped abroad to save lives so far — all of which he finds rather more fulfilling than his previous, more lucrative career.
If more people take on encore careers like that, the boomers who arrived on the scene by igniting a sexual revolution could leave by staging a give-back revolution. Boomers just may be remembered more for what they did in their 60s than for what they did in the Sixties.
As any amateur futurologist can tell you, the rich world is rapidly getting older. By 2050, more than a quarter of the developed world's population will be over 65.
At the moment, that group makes up about a sixth of the rich-world population, and only about 25 per cent of them are over 80. In 2050, the octogenarians and their elders will comprise 40 per cent of the 65-plus cohort in wealthy countries.
This greying of the prosperous parts of the world has long been foreseen, if not very well prepared for. Much less well known is the fact that well-off countries are far from alone in facing the prospect of an aging population.
Babies born today in poorish countries such as Thailand or Jamaica can reasonably expect to live into their 70s. And as more and more Indians and Chinese escape from poverty, they too will have much longer spans.
By 2050, the percentage of the Indian population over 80 will have risen fivefold, and the same segment in China will have gone up six times.
Such changes happen for two reasons: people's general health is better, meaning they wear out later, and preventable deaths of the relatively young are, in fact, prevented. As anti-retroviral treatment for HIV-AIDS becomes more common, childbirth safer and malaria more treatable, people will die at a more advanced age.
By 2050, close to 80 per cent of all deaths in the world are expected to occur in people who are older than 60.
While people 59 or under die in any number of dramatic ways, people on the other side of 60 face three possibilities which between them carry off most of the elderly, whatever their economic circumstances. Each peaks in a different decade, and each produces a different sort of end of life.
The first is cancer: most victims function reasonably well before entering a steep decline. Cancer deaths peak at 65-plus, and more and more sufferers recover. If they do, two other clouds appear on the horizon. One of these is chronic organ failure and the other is frailty, dementia and decline.
Chronic problems with an organ -- usually heart disease or emphysema -- bring a gradual decline punctuated by severe episodes, such as a heart attack or lung failure.
Dementia or frailty can mean a long, poor-quality end of life. As more cures are found for cancer, and sensible types give up smoking and bacon, more people will find that a slow decline is the meagre reward for their virtuous behaviour. That applies to developing countries as well as rich ones.
There has never been a bigger need for cheap, effective treatment for diseases of the old, such as Alzheimer's, or for easier access to pain relief and reliable care.
The influenza vaccine, which has been strongly recommended for people over 65 for more than four decades, is losing its reputation as an effective way to ward off the virus in the elderly.
A growing number of immunologists and epidemiologists say the vaccine probably does not work very well for people over 70, the group that accounts for three-fourths of all flu deaths.
The latest blow was a study in The Lancet last month that called into question much of the statistical evidence for the vaccine’s effectiveness.
The authors said previous studies had measured the wrong thing: not any actual protection against the flu virus but a fundamental difference between the kinds of people who get vaccines and those who do not.
This contention is far from universally accepted. And even skeptics say that until more effective measures are found, older people should continue to be vaccinated, because some protection against the flu is better than none.
Still, the Lancet article has reignited a longstanding debate over claims that the vaccine prevents thousands of hospitalizations and deaths in older people. “The whole notion of who needs the vaccine and why is changing before our eyes,” said Peter Doshi, a doctoral candidate at M.I.T. who published a paper on the historical impact of influenza in May in The American Journal of Public Health.
The Lancet paper, by Michael L. Jackson and colleagues at the Group Health Center for Health Studies in Seattle, was based on an analysis of medical charts of thousands of elderly members of an H.M.O.
The study found that people who were healthy and conscientious about staying well were the most likely to get an annual flu shot. Those who are frail may have trouble bathing or dressing on their own and are less likely to get to their doctor’s office or a clinic to receive the vaccine. They are also more likely to be closer to death.
Dr. David K. Shay of the Centers for Disease Control and Prevention, a co-author of a commentary that accompanied Dr. Jackson’s study, agreed that these measures of health and frailty “were not incorporated into early estimations of the vaccine’s effectiveness” and could well have skewed the findings.
Not everyone is sold on the significance of the Lancet study. “I think this is another study that provides interesting findings and raises questions,” said Dr. Kristin Nichol, chief of medicine at the Veterans Affairs hospital in Minneapolis. “I don’t think we know yet what the final word is on influenza vaccinations in the elderly.
“I really feel, and I feel very strongly about this, that the public health message should be that vaccines are effective,” she continued. “I don’t think that science is necessarily best hashed out in the media.”
Dozens of studies since 1960 have supported the view that the vaccine is a powerful protector of the elderly, cutting their risk of dying in winter from any cause by almost 50 percent and reducing the risk of hospitalization by nearly 30 percent.
Those findings came from observational studies, in which scientists make inferences about the effect of a treatment on a population by comparing what happens to a group that has the treatment with what happens to an apparently similar group that does not.
There has been only one large study that compared the flu vaccine with a placebo for two random groups of older people in which neither the patients nor the scientists knew which group was receiving which injection. It came to a different conclusion from the observational studies.
Conducted by Dutch researchers and published in 1994 in The Journal of the American Medical Association, it found that in those 60 to 69, the vaccine prevented influenza about 57 percent of the time. In those over 70, the vaccine prevented the flu just 23 percent of the time, though the estimate is imprecise because the study was not designed to look at this age group.
But the influenza vaccine was never put through more placebo-controlled trials, which are considered the gold standard in medical evidence. “I think the evidence base we have leaned on is not valid,” said Lone Simonsen, an epidemiologist and visiting professor at the George Washington University School of Public Health and Health Services in Washington who was not connected with the Lancet study.
In 2005, Dr. Simonsen, who was then at the National Institute of Allergy and Infectious Diseases in Bethesda, Md., published a paper in The Archives of Internal Medicine that found something odd: even though the percentage of older people who got an annual flu shot more than tripled from 1980 to 2001, there was no corresponding drop in the death rate.
That paper included one of the first estimates of how many deaths are actually caused by the flu — a number hard to pin down because doctors seldom confirm flu in their patients with lab tests. Using a statistical model and the best available data, Dr. Simonsen found that influenza probably causes just 5 to 10 percent of all winter deaths in the elderly. But earlier studies had found that the flu vaccine cut an elderly person’s risk of dying by 50 percent.
“You don’t have to do a whole lot of math to realize that doesn’t add up,” said Dr. Lisa A. Jackson of the Group Health Center for Health Studies in Seattle, who has also studied the effectiveness of the flu vaccine in the elderly.
Dr. Jackson at first tried to tease out underlying differences between vaccinated and unvaccinated elderly people by using medical codes — a numerical shorthand that doctors use to classify and record what is wrong with their patients. She and other researchers reasoned that patients with codes for cancer or heart disease, for example, might be very sick, thus skewing the results. When they adjusted for those codes, however, the differences between the vaccinated and unvaccinated groups became even more pronounced. The vaccine looked even more protective.
It was Michael L. Jackson’s thesis project, at the University of Washington, that revealed the flaw in using the codes to differentiate patients.
For the project, Mr. Jackson (no relation to Lisa Jackson) and three other researchers spent almost three years reading medical charts and examining X-rays. They discovered that health-conscious people were more likely to get medical codes for things like heart disease and cancer simply because they went to the doctor more often. But when Mr. Jackson adjusted for measures of frailty — things like lung function, whether people needed help bathing or dressing, and what kinds of medications they took — he found that vaccination had little effect on older people’s risk for pneumonia, the most dangerous complication of the flu.
That finding has a biological basis. Vaccines work by priming the immune system to recognize and respond to incoming threats. Because the immune system slows down with age, older adults do not respond as well to vaccines as younger adults.
A recent study by Dr. Wilbur H. Chen and colleagues at the Center for Vaccine Development at the University of Maryland School of Medicine found that elderly participants needed four times the amount of antigens given in a standard dose of the flu vaccine to have the same kind of immune response as healthy adults under 40. They presented their findings in May at the Annual Conference on Vaccine Research in Baltimore.
Despite these findings, Dr. Shay said the C.D.C. had no plans to change its vaccine recommendations, though he added that the agency had financed studies to look for more effective influenza vaccines for the elderly.
Dr. Simonsen, the epidemiologist at George Washington, said the new research made common-sense infection-control measures — like avoiding other sick people and frequent hand washing — more important than ever. Still, she added, “The vaccine is still important. Thirty percent protection is better than zero percent.”
September 30, 2008
Violations Reported at 94% of Nursing Homes
By ROBERT PEAR
WASHINGTON — More than 90 percent of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued on Monday.
About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.
Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.
Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.
About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.
The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.
“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”
On Monday, Mr. Levinson issued a compliance guide for nursing homes that says some homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.”
Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.
The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”
Bruce A. Yarwood, president of the American Health Care Association, a trade group, said: “We know we have to do a better job. We have been doing a better job, in treating pressure sores, managing pain and reducing the use of physical restraints.”
Mr. Yarwood said that the inspection system was broken. “It does not reliably measure quality,” he said. “It does not create any positive incentives.”
More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are typically inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.
Deficiency rates varied widely among states. The proportion of nursing homes cited for deficiencies ranged from 76 percent in Rhode Island to 100 percent in Alaska, Idaho, Wyoming and the District of Columbia.
The average number of deficiencies also varied, from 2.5 deficiencies per nursing home in Rhode Island to 13.3 per home in Delaware.
Mr. Yarwood said: “Inspectors are subjective and inconsistent. They interpret federal standards in different ways.”
In December, the Bush administration plans to begin using a five-star system to describe the overall quality of care. The best homes will get five stars. The rankings will be published on a federal Web site.
Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill. Mr. Levinson said some nursing homes had improperly classified patients or overstated the severity of their illnesses so the homes could claim larger Medicare payments.
November 22, 2008
In Housing Slump, Elderly Forgo Assisted Living
By JACK HEALY
The housing crisis has kept thousands of older Americans who need support and care from moving into retirement communities or assisted-living centers, effectively stranding them in their own homes.
Without selling their houses or condominiums, many cannot buy into retirement homes that require a payment of $100,000 to $500,000 just to move in. So they are scratching themselves off waiting lists, canceling plans with packing services and staying put, in houses that fit well 30 years ago, but over the years have become lonely, too large or too treacherous to navigate.
“It is part of the hidden problem of the recession,” said Larry Minnix, president of the American Association of Homes and Services for the Aging. “Every neighborhood, every family’s got them.”
Facilities that have watched their waiting lists wither and their occupancy rates fall in the last year are now scrambling to bring people through their doors. Some assisted-living centers have called in real estate agents to teach prospective residents about online advertising and how to clean and preen their homes for showings. Others have set up programs with banks to provide bridge loans to homeowners, or are discounting apartments and offering low-interest loans.
The Cedar Community, which provides a range of housing for the elderly in West Bend, Wis., has seen independent-living occupancy rates drop by 4 percent this year. There were so many people waiting for their homes to sell that the facility decided, in some cases, to let new residents pay month-to-month until they could unload their houses and use the proceeds on the facility’s entry deposit.
“We’ve never done that before,” said Tracey MacGregor, a spokeswoman at Cedar Community.
But for people like Ruth Scher, 85, selling their home is a critical first step before moving on, or moving anywhere. Ms. Scher put her two-bedroom condominium in Delray Beach, Fla., on the market last year, but no one has made an offer.
In the 34 years since she moved to South Florida, Ms. Scher’s husband has died, the siblings who moved south from New York to join her have died, and her friends have moved away. She is recovering from a fall that broke her clavicle and suffers from arthritis in one shoulder, and she says it is time to move back.
“It’s lonesome,” Ms. Scher said. “So many other people have passed away or moved away. It’s very lonely. The children would love me to come up and I would love to, but I just can’t sell.”
Ms. Scher hoped to move to a retirement community in Cornwall, N.Y., where she has friends. But in the year her home sat on the market, she could not even find a broker willing to sell the property, she said. She finally de-listed her condominium.
“They tell you, ‘We’re sorry, we can’t get any people to come and look,’ ” Ms. Scher said. “If I can’t sell here, I can’t go nowhere.”
There is no way to say how many older Americans are in similar straits, as no statistics track how many of America’s 4.27 million unsold homes are owned by people 65 or older. But industry groups and administrators at retirement homes call the problem a growing one, which worsened as the financial crisis spread from real estate to lending markets. It has been felt worst in regions hit hardest by the housing bust.
“It remains to be seen whether we have a short-term stress, or whether we’re facing a crisis,” said Mr. Minnix, of the Association of Homes and Services for the Aging. “We’re into brand new territory here. It is deeper and potentially broader.”
Across the country, occupancy rates for independent and assisted-living facilities have fallen slightly in the last year, by about 2 percent through the middle of 2008, according to the National Investment Center for the Seniors Housing and Care Industry.
But the problem is playing out acutely in hard-hit areas like Florida, where the vacancy rate at some facilities is up 20 percent to 30 percent over last year, said Paul Williams, director of government relations for the Assisted Living Federation of America. At Luther Manor, a retiree community in Milwaukee, the number of residents moving into independent living has dropped 20 percent this year. In southern Ohio, 65 percent of the people who visited the Bristol Village retirement community this year said they could not buy a unit because their homes were still hanging around their necks.
For these businesses, each occupied room generates thousands of dollars each year. Retirement condos charge monthly fees ranging from a few hundred dollars to $5,000, while the average price for private-pay care in assisted living is $3,013 per month, or $36,156 per year, according to a MetLife study.
At the Crosby Commons assisted-living center in Shelton, Conn., where waiting lists that once ran two years or more have shrunk to six months, some residents who moved before selling their homes are spending through their savings as they wait, said Lois Poultney, the center’s director. One resident had to move from Crosby’s free-market homes to its subsidized rent-controlled apartments, Ms. Poultney said.
“I’m hearing it over and over again: ‘Mom needs to sell her house before she can afford to move in,’ ” she said.
There are signs some families and retirees are turning to adult day care services as a stopgap. Providers say their business has spiked as people look for an alternative to continuing care or home aides to provide food, companionship and therapeutic services. But Mr. Williams of the Assisted Living Federation said that people who need more day-to-day care, those who have trouble getting up stairs or who need someone to check on them, were taking a risk by staying at home.
“When they’re coming in at 85, they’re coming in very frail and needing services,” he said. “They can’t wait this out. They need the care when they need the care. That’s the scary part. You have people putting it off when they need care right now.”
For Katherine Styberg, 84, that moment of realization came when she slipped on a patch of ice in February and fractured a vertebra. She has to use a cane when she walks now, and she says she has been thinking about how she lives alone, and if she fell in her two-bedroom condominium in Milwaukee, no one could catch her or help her up.
The real estate broker calls Ms. Styberg a day before bringing potential buyers to see her apartment, and a few have come to look around, but no one has made an offer yet.
As parents linger in their homes, they say their children start to worry. Some adult children are even facing financial hardships if they cannot sell their parents’ homes.
In April, Ruth Swessel, 84, of Milwaukee, had a stroke that aggravated the effects of her aging, leaving her unable to follow “Meet the Press” or read the political magazines she once loved. Her daughter, Laura Westling, had to put her into skilled care, and the family began the process of selling Ms. Swessel’s house to pay for the facility’s $60,000 annual cost.
The house has been sitting on the market since the summer, and Ms. Swessel’s family has lowered the price twice, to $174,500 from $189,900, but they have not been able to close a deal. Her children are spending her investments to pay for her care, but Ms. Westling said they did not know what they would do once that money ran out.
“It’s not easy,” she said.
As stock markets have slid in the last year, homes have become a more critical source of wealth for retirees who have watched their mutual funds and 401(k) accounts hollow out. Next to accrued Social Security benefits, housing is the single greatest asset for people 60 to 70 years old, making up 22 percent of their total wealth and outweighing investments and pensions, according to the Center for Retirement Research. For retirees like Herman McHan, who watched the value of his mutual funds fall to $35,000, from $70,000, or Sylvia Merlin, whose portfolio has lost nearly $200,000 of value, owning an interminably on-the-market home compounds the worries of their dwindling investments.
For Ms. Merlin, it is a disconcerting place to be at age 93. She said she and her late husband, Al, had lived modestly to raise their four children, taking one vacation a year, to the Jersey Shore. She is on oxygen now, and finds it harder to get around her fifth-floor apartment outside of Philadelphia. The doorman’s wife takes her to the hairdresser on Fridays, but Ms. Merlin said she wanted more consistent care.
“I’m going to be 94, and I need help,” she said. “Making the bed is difficult. I need a little help taking a shower. Those things are difficult. I was a great cook, but I really don’t cook anymore. I bought the TV dinners, and they’re pretty lousy.”
No one has made an offer on her condominium, and Ms. Merlin said the retirement home had refunded the $1,000 deposit on the $130,000 unit she hoped to buy. Now, instead of moving, she said she had decided to stay.
“I just couldn’t go anywhere until I sold my apartment,” she said. “I and a lot of other oldsters are stuck.”
Drug improves learning, memory in middle-aged rats
By Sharon Kirkey, Canwest News ServiceFebruary 16, 2009
A drug used for stroke patients may help sharpen middle-aged brains, researchers are reporting.
In the latest development in the quest for cognitive enhancers, researchers found the drug Fasudil significantly improves learning and memory in middle-aged rats.
If proven in humans, the drug may one day help blunt the impact of normal aging "or even enhance learning and memory throughout the life span," the American Psychological Association said in an announcing the findings, published in the February issue of the journal Behavioral Neuroscience.
"I do think that we are going to move into that area,"says lead author Matthew Huentelman, an investigator at the non-profit Translational Genomics Research Institute in Phoenix, Arizona.
"Really, we stumbled on this drug, and what do we do with it? Our drug is only supposed to be used for sick people. Can it be used for healthy individuals as well? It's a tough question."
University students are already using Ritalin and other prescription amphetamines to boost their grades. A survey by Nature, a top science magazine, last year revealed one-fifth of its global readership admitted to using "cognition-enhancing" drugs to help them concentrate. And seven prominent neuroscientists and ethicists recently argued in the same journal that not only is the trend likely to grow, but that "mentally competent adults" should be free to use safe cognitive enhancements with-out being made out to be felons.
But is using brain enhancers to boost productivity and give people a competitive edge cheating, like doping in sports?Would workers need protection from pressure from employers to "enhance?"
Several drugs now being tested in humans may help stave off normal, age-related memory decline in healthy people, and many drugs used to treat psychiatric and neurological problems can also increase how quickly and accurately people think.
The Arizona study began several years ago, when researchers identified a gene that plays a role in memory in humans. Next they looked for drugs that affect the gene's function. They tested Fasudil, a drug that improves blood flow to the brain, in rats.
The dosed rats performed significantly better on water maze testing learning and memory than rats given a saline solution. The doped rodents performed more like four-month old rats, or the equivalent of a teenager in human years.
"It was a pretty significant improvement in their memory performance," Huentelman says. There were no side-effects, and the drug has been shown to be safe and well tolerated when used in humans. The findings, and the relative safety of the drug, support its potential as a "cognitive enhancer in humans," the researchers report.
Huentelman worries about cognitive-enhancers creeping into high schools and colleges, but if the drugs can push out the onset of Alzheimer's disease or other dementias by even five years, "that's a massive impact.
"To me, aging is the worst disease, because it happens to all of us.
"Improving our ability to age, aging more gracefully as they famously say, is a benefit for all."
Four of the researchers hold stock in the drug company that owns the rights to develop this drug.
When an old lady died in the geriatric ward of a small hospital near Dundee , Scotland , it was believed that she had nothing left of any value.
Later, when the nurses were going through her meager possessions, they
found this poem. Its quality and content so impressed the staff that
copies were made and distributed to every nurse in the hospital.
One nurse took her copy to Ireland. The old lady's sole bequest to
posterity has since appeared in the Christmas edition of the News
Magazine of the North Ireland Assn. for Mental Health. A slide presentation has also been made based on her simple, but eloquent
poem. And this little old Scottish lady, with nothing left to give to the world, is now the author of this 'anonymous' poem winging across the Internet:
Crabby Old Woman
What do you see, nurses?
What do you see?
What are you thinking,
When you're looking at me?
A crabby old woman,
Not very wise,
Uncertain of habit,
With faraway eyes..
Who dribbles her food,
And makes no reply,
When you say in a loud voice,
'I do wish you'd try!'
Who seems not to notice,
The things that you do,
And forever is losing,
A stocking or shoe
Who, resisting or not
Lets you do as you will,
With bathing and feeding,
The long day to fill?
Is that what you're thinking?
Is that what you see?
Then open your eyes, nurse,
You're not looking at me.
I'll tell you who I am,
As I sit here so still,
As I do at your bidding,
As I eat at your will.
I'm a small child of ten,
With a father and mother,
Brothers and sisters,
Who love one another.
A young girl of sixteen,
With wings on her feet,
Dreaming that soon now,
A lover she'll meet.
A bride soon at twenty,
My heart gives a leap,
As I make the vows
That I promised to keep.
At twenty-five now,
I have young of my own,
Who need me to guide,
And a secure happy home.
A woman of thirty,
My young now grown fast,
Bound to each other,
With ties that should last.
At forty, my young sons,
Have grown and are gone,
But my man's beside me,
To see I don't mourn.
At fifty once more,
Babies play round my knee,
Again we know children,
My loved one and me.
Dark days are upon me,
My husband is dead,
I look at the future,
I shudder with dread.
For my young are all rearing
Young of their own,
And I think of the years,
And the love that I've known.
I'm now an old woman,
And nature is cruel,
'Tis jest to make old age,
Look like a fool.
The body, it crumbles,
Grace and vigour depart,
There is now a stone
Where I once had a heart...
But inside this old carcass,
A young girl still dwells,
And now and again,
My battered heart swells.
I remember the joys,
I remember the pain,
And I'm loving and living
Life over again.
I think of the years,
All too few, gone too fast,
And accept the stark fact
That nothing can last.
So open your eyes, people,
Open and see,
Not a crabby old woman;
Look closer - see ME!!
Remember this poem when you next meet an old person who you might brush aside without looking at the young soul within.
Everyday life just fine for keeping sharp, says study
ReutersFebruary 19, 2009
Healthy older people spending money on computer games and websites to ward off mental decline are giving their wallets more of a workout than their brain, according to a U.S. study.
Dr. Peter J. Snyder of Lifespan Affiliated Hospitals in Providence, R. I., reviewed the scientific evidence for the benefits of these "brain exercise"programs says but found they did not live up to expectations.
"These marketed products don't confer any additional benefit over and above being socially and intellectually active in one's normal daily life," Snyder told Reuters Health.
"There are some things that we could be doing that have much more rigorous data to support their application."
However, Snyder and his team note in the journal Alzheimer's&Dementia that types of "brain training" are known to help people with memory problems function better, but their benefits for those who don't have measurable cognitive impairment isn't clear.
Meanwhile, Snyder said in an interview, the market for these products has swelled from$2 million US in 2005 to an estimated $225 million this year.
To review evidence on the benefits of cognitive training for healthy older people, Snyder and his colleagues analyzed 10 randomized controlled trials of a variety of approaches, ranging from a popular computer-based program to individualized piano lessons.
While there was some evidence that brain training helped people's immediate performance on tasks related to the training, there was no evidence that the effects could be generalized to other areas of mental function, Snyder and his colleagues found. Further, just half of the studies included extended followup, so evidence for long-term benefits was slim.
The findings don't mean that brain training isn't helpful for people who have memory problems, Snyder told Reuters Health, nor are they definitive proof that brain exercise can't help keep healthy people's wits sharp.
But social and intellectual engagement in day-to-day life, from reading to grandchildren to doing crossword puzzles, is "probably just as effective or more effective" than any formal brain exercise program, he added.
Further, he pointed out, these activities are free.
Snyder said there is strong scientific evidence that being physically active every day preserves cognitive function. Because cardiovascular disease and Type 2 diabetes are both known to contribute to mental decline, he added, exercising and taking other steps to maintain heart health and a healthy weight will help keep the brain healthy, too.
March 31, 2009
Treating an Illness Is One Thing. What About a Patient With Many?
By SIRI CARPENTER
Mazie Piccolo has so many health problems it’s hard to keep track. Congestive heart failure makes her short of breath and causes her legs to swell. An abnormal heart rhythm raises her risk for stroke. Arthritis in her knees makes it hard for her to get around, and she can no longer drive.
Mrs. Piccolo, 84, of Rosedale, Md., also has osteoporosis, and she has fallen several times in the past few years, once breaking her pelvis. On top of all these medical ailments and others — high cholesterol, high blood pressure, gastric reflux — she has a history of depression, and it is sometimes hard for her to care for her husband, who is even frailer than she is.
Strictly by the book, Mrs. Piccolo should be taking 13 different medications — an expensive, confusing cocktail that has proved too much for her to manage. Other medications that might be advisable cause intolerable side effects, and the more drugs she takes, the greater the risk of dangerous drug interactions.
What is striking about her predicament is not how rare it is, but how common. Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions, and 68 percent of Medicare spending goes to people who have five or more chronic diseases.
As a group, patients like Mrs. Piccolo fare poorly by any measure. They linger in hospitals longer, experience more serious preventable health complications and die younger than patients with less complex medical profiles.
Yet people with multiple health problems — a condition known as multimorbidity — are largely overlooked both in medical research and in the nation’s clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.
“Very often, there is nobody looking at the big picture or recognizing that what is best for the disease may not be best for the patient,” said Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine.
And treating one disease in isolation, she added, can make another disease worse. In controlling diabetes, for example, doctors often seek to reduce levels of a blood-sugar marker called hemoglobin A1C. “But we know that for some people with complicated diseases, that’s not always the best move,” Dr. Tinetti said.
Mrs. Piccolo is being treated by Dr. Cynthia M. Boyd, a Johns Hopkins University geriatrician whose research focuses on patients with multiple chronic conditions.
“Doing right by patients like this is tremendously challenging,” Dr. Boyd said. “Would she get the most benefit from lowering her blood pressure or cholesterol level, or from being treated for her osteoporosis, or from taking warfarin for stroke prevention? Or is it more important to treat her depression so she can manage her overall health better, or to try to improve her ability to physically get around?”
The medical file for Fred Powledge, 74, is four inches thick, with more than a dozen current diagnoses, including diabetes, gout, chronic obstructive pulmonary disease, compressed vertebrae, three replacement joints, two replacement eye lenses and arthritis.
Mr. Powledge, a Maryland writer, takes almost a dozen pills a day, as ordered by six physicians.
“Good luck and a lot of sleuthing on my part have given me doctors whom I trust and who are mostly aware of interactions among the drugs they prescribe,” he said in an e-mail message. “But what’s missing is someone who can look at the big picture and see my health as a whole.
“That falls to me alone, with the help of my very wise wife and frequent visits to reliable Web sites,” he continued. “As our population ages, we need some kind of overseer to juggle all the diagnoses and prescriptions and look for conflicts and duplications. This would also help to counteract the notion in many people’s minds that the doctor knows best — because often the doctor doesn’t.”
In a medical system geared toward individual organs and diseases, there is no champion for patients with multiple illnesses — no National Institute on Multimorbidity, no charity Race for the Multimorbidity Cure, no celebrity pressuring Capitol Hill for more research.
And because studies involving uncomplicated populations are cheapest and easiest to interpret, patients with multiple diseases are routinely shut out of drug trials. A 2007 study found that 81 percent of the randomized trials published in the most prestigious medical journals excluded patients because of coexisting medical problems.
“We often don’t know what the real safety or efficacy is for patients with multiple illnesses,” said Dr. W. Douglas Weaver, president of the American College of Cardiology.
Pharmaceutical companies are required to study how well particular drugs and medical devices work in the real world, after they’ve gotten government approval. In theory, such post-marketing studies should shed light on how best to treat patients who have complex medical problems. But the studies tend to include only a small fraction of patients receiving treatment, Dr. Weaver said.
Comprehensive data registries that track all patients at a given hospital or clinic are more promising, he said. But he added that unless the federal government stepped in to support such registries and pay doctors for participating, they might not be sustainable.
Because so little research includes complicated patients, physicians have little scientific evidence on which to base their care. In a 2005 study, Dr. Boyd and colleagues analyzed influential, evidence-based clinical practice guidelines used to treat nine of the most common chronic diseases, among them osteoporosis, arthritis, Type 2 diabetes and high cholesterol.
Fewer than half the guidelines specifically addressed patients with multiple illnesses, and most were limited to patients with only one coexisting disease or a small number of closely related diseases. “We’re so far away from having perfect evidence about how to help patients with complex health problems,” Dr. Boyd said.
Lacking solid guidance, doctors make their best guesses about whether a particular guideline is applicable to the patient, said Gerard F. Anderson, a professor of health policy and management at the Bloomberg School of Public Health at Johns Hopkins. And “their best guesses,” he went on, “vary all over the map.”
Time pressures intensify the doctors’ predicament. A typical 15-minute appointment leaves too little time to weigh the risks and benefits of a complex treatment plan, much less to fully consider the patient’s preferences and priorities.
“We don’t actually know how to weigh evidence across diseases,” said Dr. Boyd, of Johns Hopkins, “and we also don’t know the best ways of communicating to patients what we do and don’t know.”
Quality-improvement measures, which tie doctors’ compensation to how closely they follow evidence-based practice guidelines, further complicate matters, and some worry that they provide a financial incentive for physicians to sacrifice individualized decision-making.
“Doctors know that it’s not right for someone to be on 15, 18, 20 medications,” said Dr. Tinetti, the Yale geriatrician. “But they’re being told that that’s what’s necessary in order to treat each of the diseases that the patients in front of them have.”
Changing that will require a major investment in research, guidelines and quality measures that include the kinds of complicated cases doctors see every day.
“I think everyone realizes that we need to figure out how to integrate care for our elderly patients with multiple chronic conditions,” said Dr. Ardis D. Hoven, an internist in Lexington, Ky., who is a trustee of the American Medical Association. “But we’ve got a long way to go. We’re just now beginning to verbalize this.”
Skills to Learn, to Restart Earnings
By JOHN LELAND
Tyrone Turner for The New York Times
ANOTHER DAY Faye Milbourne, a former Verizon worker who went back to school to become a teacher, waits for students to arrive at an elementary school in Virginia Beach.
Finding their retirement nest eggs short, many are doing whatever it takes to start a second career.
Slide Show: Back in School Again
A Quest for a Home, Put on Hold
By JODI RUDOREN
Her next move was supposed to be her last, but her well-laid plans to enter a retirement community have been frustrated by the sagging market.
Experienced, Eager to Serve, Will Travel
By ELIZABETH POPE
Within two days of President Obama’s Inaugural Address, online applications to the Peace Corps spiked, and many older Americans have responded to the call to serve.
A Move to Expand Volunteer Ranks | How to Enlist
Calling for Financial Advice . . . and Reassurance
By CHARLES DELAFUENTE
Hotlines provided by employers or groups they belong to have experienced a spike in activity from callers seeking mostly long-term advice.
More Are Spending Less to Get Away From It All
By STEFANI JACKENTHAL
While this may seem like a peculiar time to take a dream vacation, the prices are right if you have the cash.
Slide Show: Travel Deals for Tough Times
Doctors Are Opting Out of Medicare
By JULIE CONNELLY
Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them.
Times Topics: Medicare
Protecting Retirement Accounts From Creditors
By DEBORAH L. JACOBS
Even at today’s depressed values, it’s important to protect your retirement accounts from creditors.
Over-55s urged to join Say Go! fitness scheme
2:33pm Thursday 2nd April 2009
RESIDENTS aged over 55 are being urged to take up fitness activities aimed at promoting healthy lifestyles for older people.
The Say Go! scheme covers a range of activities at different venues across the borough, including sports, dance and yoga lessons.
It is organised by Age Concern Barnet, with funding from Barnet Council and Sport England.
The classes are run in partnership with a number of faith and community groups, including the Barnet African Caribbean Association, Barnet Asian Old People's Association and the Anand Day Centre, but anyone aged over 55 is welcome to attend.
A new ten-week course of tai chi was launched on Tuesday, aimed specifically at members of the borough's Ismaili Muslim community, to be held at the North London Jamatkhana, in East End Road, Finchley.
The classes will take place during the day and also offer a chance for members to socialise after the session.
Councillor Lynne Hillan, cabinet member for community services, said: "The Say Go! scheme provides a very important service for older people living in Barnet and helps to work towards the council's corporate priority of a strong and healthy borough.
"I hope that many of our residents aged over 55 take the opportunity to take part in one or more of the Say Go! classes as they continue to be rolled out and enhanced throughout the coming year."
For more information visit the council website at barnet.gov.uk/activities-for-older-people or call the council on 020 8359 2000.
Canada faces serious crisis in elderly care: study
Seniors likely to double in 25 years
By Teresa Smith, Canwest News ServiceMay 31, 2009 7:25 AM
Canada will soon face a serious crisis in caring for the elderly unless policymakers act now to head it off, says a Carleton University researcher.
Gabrielle Mason, a PhD student in political science, says lifestyle changes combined with an aging population are about to create a serious elder-care crunch in Canada.
Mason said that policymakers should keep "Canada's aging society in mind so that the (government) can adjust and design infrastructure, policies, plans and resources which celebrate increased longevity and reduce dependencies on family."
By 2015 there will be more people in Canada over the age of 65 than under the age of 15, according to Statistics Canada's most recent population projections. And the number of seniors is expected to double over the next 25 years. "Canadian citizens deserve and should expect good quality of life in their elder years," said Mason. "A minimum level of care shouldn't be considered a luxury."
Mason argued that investing in services now to help the elderly find care will dramatically cut costs to taxpayers later on.
She suggested several reasons a crisis is looming. Most elderly people in Canada are currently cared for by their family, but the traditional caregivers-- younger, female family members--now have full-time jobs and are less able to look after their relatives. Also, baby boomers who married and had children later in life or had fewer children and moved frequently may live far away from their kids and have no one nearby to care for them.
Reasonably healthy elderly people may simply need help with shopping or heavy housework, as well as emotional support. But those with more serious physical and mental impairments may require 24-hour care.
In her research, Mason found that 90 per cent of Canadians would prefer to spend their final years at home, favouring help from formal services over family care.
"Relying on family members' help for care often evokes feelings of indebtedness and clashes with closely held ideas about independence and self-reliance," she wrote.
The Senate committee on aging, which submitted its final report in April, found that caring for clients who are permitted to stay at home costs less per year than caring for those who must enter a care facility --even when the informal caregiving work of family members is allocated a financial cost.
They found that a patient in community care will cost about $37,000 per year, compared to $87,000 in a facility.
Artificial cats and other man-made companions could be keeping Britain's elderly company within three years if society can be persuaded to start experimenting with robots.
A report by the Royal Academy of Engineering published on Thursday shows robot soldiers and surgery devices are rapidly being developed, but the legal and ethical debate is lagging.
"This is not constrained by the technological possibility of it so much as by the desire to do it--and that is bound up with all sorts of social factors," said Prof. Will Stewart of Southampton University, who contributed to the report.
As well as robotic pets, autonomous systems could be morphed into robot babysitters, artificial therapists and social or even sexual companions.
With Britain's elderly population set to grow about 50 per cent by 2020, robotic companions could also help monitor the health of Britain's increasingly grey population.
"It is not a complete replacement for your kid calling you once a week. What you want is continuous attention and that is very difficult," said Stewart.
A robotic pet could help raise the alarm in the case of an accident, monitor fridge contents, and voice prompts could remind them to switch off the heating.
The ethical challenges facing a robotic revolution include concerns that artificial pets or helpers could lead to social isolation for the elderly.
September 19, 2009
Helping the Aged Leave Nursing Homes for a Home
By JOHN LELAND
PHILADELPHIA — Walter Brown never wanted to live in a nursing home, but when he had a stroke two years ago, he saw little choice. Mr. Brown, 72, could not walk, use his left arm or transfer himself into his wheelchair.
“It was like being in jail,” Mr. Brown said on a recent afternoon. “In the nursing home you’ve got to do what they say when they say it, go to bed when they tell you, eat what they want you to eat. The food was terrible.”
But recently state workers helped Mr. Brown find a two-bedroom apartment in public housing here, which he shares with his daughter. “It just makes me more relaxed, more confident in myself,” he said, speaking with some difficulty, but with a broad smile. “More confident in the future.”
A growing number of states are reaching out to people like Mr. Brown, who have been in nursing homes for more than six months, aiming to disprove the notion that once people have settled into a nursing home, they will be there forever. Since 2007, Medicaid has teamed up with 29 states to finance such programs, enabling the low-income elderly and people with disabilities to receive many services in their own homes.
The program in Pennsylvania provides up to $4,000 in moving expenses, including a furniture allowance and modifications to the apartment, and Mr. Brown has a home health aide every morning and a care manager to arrange for services like physical therapy. The new programs, financed largely by $1.75 billion from Medicaid, are a sharp departure from past practices, where Medicaid practically steered people into nursing homes.
“Medicaid has had an institutional bias in favor of nursing homes,” even for people who do not need them, said Gene Coffey, a staff lawyer at the nonprofit National Senior Citizens Law Center. “Federal law requires states to provide nursing home services. They don’t have to provide home or community-based services.”
For Mr. Brown, the transition to his own home has changed his life, he said. Now, with his motorized wheelchair, he travels the city on public buses, visiting friends in other neighborhoods.
“It’s a great feeling,” he said. “In the nursing home I got up at 5 o’clock in the morning, then the rest of the day was just watching the TV or my VCR. I wanted to be able to get out and see people, see the world. I didn’t want to be confined. Now I go where I want to go.”
States and the federal government hope to save money, though research about cost savings has so far been inconclusive. A recent study by researchers at the University of California, San Francisco, found that home care costs taxpayers $44,000 a year less than a nursing home stay — though this number cannot be used to estimate total savings, because often home-based services replace family care, not nursing home care.
About 1.5 million Americans are living in nursing homes.
“It’s amazing how quickly people can end up in a nursing home,” said Jean Janik, the director of community living options at the nonprofit Philadelphia Corporation for Aging. “Say you’re a single man and have a stroke, and need to go into a nursing home to rehab. You’re elderly so you don’t quite bounce back quickly. After 60 days, Medicare doesn’t pay any longer, so you need a Medicaid grant to stay in the nursing home. Then your Social Security will go to the nursing home.”
Many lose their apartments and regular support from family members, Ms. Janik said.
“We meet people who say, ‘I went to the hospital and next thing I know, here I am. I don’t know what happened to my apartment.’ ” Ms. Janik added, “We go and check, and it’s not in their name. Especially if they don’t have a strong family support system in place. A lot of people just think, Uncle Joe fell and broke his hip and now he’s in a nursing home, so be it, that’s where he’ll be. People don’t realize they can get services in their home.”
Each participating state has designed its own program, called Money Follows the Person. The federal government, which shares Medicaid costs, provides extra financing for the first year.
Some experts worry that the programs will end up transferring some of the expenses of caring for the elderly or the disabled to their family members.
Carol Irvin, a senior researcher at Mathematica Policy Research has been contracted by Medicare and Medicaid Services to study the costs of the program in its first five years.
“It could be shifting costs onto a person’s relatives,” Ms. Irvin said. “But even if it’s not saving money, a lot of people believe living in the community is the right thing for individuals.”
Elizabeth Kamara, 72, spent 18 months in a nursing home after having her left foot amputated because of diabetes. Mrs. Kamara can get around using a walker, but in the nursing home she spent whole days in a wheelchair.
“I just let people do things for me,” she said. “They say, ‘If you fall, we’ll get in trouble. Please sit down.’ ”
Mrs. Kamara has moved into a independent living facility, where she cooks dishes from her native Sierra Leone and navigates the hallways on her own. She gives herself insulin injections and gets a friend to drive her to doctors’ appointments. An aide comes twice a week to help clean. “This is my home; I’m free,” she said. “In the nursing home it was two persons in one room. Here I have my privacy. I can get my hair done, my nails done.”
Susan C. Reinhard, a senior vice president of the AARP Public Policy Institute, said of Money Follows the Person: “It’s gotten Congress’s attention, and shown that people can leave a nursing home. That is a wake-up.”
For Esther Pinckney, 88, who ended up in a nursing home after a stroke, moving out has been literally a breath of fresh air. Ms. Pinckney now lives in a bright subsidized apartment where home aides visit twice a day.
“What didn’t I like about the nursing home?” she asked recently. “What would you like about smell, smell, smell, morning, noon and night?”
Because Ms. Pinckney lost her apartment and furniture while she was in the nursing home, the Philadelphia Corporation for Aging bought her new furniture and a microwave oven. Before, she said, her Social Security check went to the nursing home; now she pays 30 percent of her check for her rent. “I couldn’t even buy a soda,” Ms. Pinckney said. “You want to be independent, don’t you? That’s what I wanted.”
Life on her own has not been perfect, she admitted. Aides often fail to show up or spend their time talking on the telephone.
But her pastor takes her to church four times a week, and she can go to stores near her building. If her health should fail again, she said, she did not like to think about going back into a nursing home.
“Don’t mention it,” she said, her face tightening. “I don’t want to do that.”
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