479 posts categorized "Health"

The Long, Slow Winding Down of Old Age

Lately, I have made a few choices to do something or not do something because – well, it seems to be connected to my time dwindling down. Or, at least, that's the reason I “think” I am doing and (mostly) no longer doing some things.

That idea has some background in my life. Let me tell you about my great Aunt Edith who was born in 1895.

She left her home in Chicago at age 15 to join a traveling dance troupe.


A few years later, the troupe left her behind in Portland, Oregon, when she was laid up with pneumonia so she found a job in an office, eventually becoming the manager.

Those of you who live in the Portland area might like to know that in 1923, my great aunt Edith was queen of the Rose Festival. In those days, they were not chosen from high schools but more or less appointed from suggestions made to the Rosarian organization.

Here she is with her “court” from a book, Portland Rose Festival, written by George R. Miller.


Until she retired at age 70 in 1965, Aunt Edith worked all her life in various corporate executive positions at a time in history when hardly any women worked out of the home. Here she is at age 68:


In addition, she cared for her ageing and sick parents when they could no longer rely on themselves and she raised her sister's son, my father, from age 10, among other family obligations she took on as need presented itself – and there was plenty. It was always something in my family and Aunt Edith handled it all.

She was my favorite relative.

By the time she retired, I was long gone from Portland, in New York City then, and every week we spent an hour or so on the telephone together discussing cooking, books, the news, politics, telling each other funny stories and we also regularly wrote letters – remember those?

She included her recipes (she called them receipts) in those missives along with New Yorker cartoons and sometimes entire articles clipped from newspapers and magazines.

She knew everything that was going on in the world and had an opinion on all of it in addition to being funny, especially, in her later years, about the minor physical irritations of growing old. She was just great.

By the mid- to late-1970s, the letters still arrived mostly on schedule but they were shorter and there were fewer enclosures. In our phone calls, she didn't have as much to say about world affairs and increasingly repeated the same stories from her childhood in Chicago that I had heard many times.

(Thank god for telephones without video in those days: you could make faces to help yourself get through the one hundredth telling of the story about Fluffy the cat without the speaker knowing how impatient you were being.)

I don't mean to suggest that these changes were sudden. Aunt Edith's disengagement was noticeable in the beginning and it increased only gradually over a decade or more. At one point she said that she had given up reading books because her eyes tired so easily now and she lamented the fact that most of her friends were dead, even many who were younger than she.

When she made a joke about not being able to stand up after scrubbing the kitchen floor on her hands and knees (“Hello, Aunt Edith,” I said. “There is the newfangled thing called a mop with a long handle.”), my brother, who lived in Portland, arranged for a regular house cleaner.

Over time it felt to me as if, perhaps, interest in her own world and in the world at large was diminishing because they were becoming fuzzier, less clear - metaphorically, not physically - and she paid less and less attention.

Her time to leave was coming nearer and she did that in 1984, at age 89 after what was to my eyes, decade long period of preparation, an unwinding if you will, and a letting go of her attachment to the world.

Ever since then, I have believed that if Aunt Edith's “preparation” is not how it happens for everyone who doesn't die suddenly or unexpectedly, it happens to some, maybe quite a lot and without making a big deal of it, I've watched for those signs in myself.

In just the past year or so, there have a few small but, I think, telling changes. Examples:

The 2016 presidential campaign notwithstanding, I watch much less cable news which is to say political news since that is about 90 percent of what those channels cover. I'm slightly embarrassed to admit that it has taken me this long to become tired of the repetition (which was around long before Trump) and know that if anything important happens, it will be hard to miss.

Similarly, I have unsubscribed from a large number of news and commentary email newsletters. Again, it is the repetition that has made them irrelevant. Aside from a handful of commentators and columnists I respect and look forward to reading, I don't feel I need to keep up in as much detail as I did during the 40 years that it was my job to know what was going on in every area of news, politics and culture and have continued in the decade since retiring.

This applies too to a lot of reporting and commentary about ageing – I've eliminated about half of what I was reading or, lately, not reading and feeling guilty about it. (There's no more guilt if they don't show up in the inbox.) Ageing news tends to be even more repetitous than political news - if that's possible.

And I'm not proud to say that I've let the frequency of email correspondence with friends decline. It just seems that there is not as much to say as there once was. I get up, I work on the blog, I attend a couple of meetings or lunches each week, I shop, cook, read and sleep. Maybe in my old age my thinking has slowed and I use up all that kind of energy writing TGB. Or not. I don't know. But something has slowed me down.

As much as I find certain technology advances captivating, I have been hesitating for a long time before making new purchases. Most recently (for a year or more) it's the Amazon Echo Dot. I just love it. I read every new report about it and it costs only $49 - that's not a stretch for me. But I still haven't bought one.

There are some other purchases I've put off and may never make because at my age, how much will ever use them seems to be my reason although I can't be certain and it could be, unrelated to usage, that I'm simply in the earliest stages of what we might call, today, great Aunt Edith syndrome.

Not even collectively can a case be made that this list of minor changes represents the early stages of preparing to shuffle off this mortal coil, as they say. But then, maybe they are.

Maybe I am at the very earliest stages of following in Aunt Edith's steps toward the end. I wouldn't mind if that's what I'm doing now because I am going to be big-time pissed off if I die while I'm still interested and curious. I want to feel done with this life when it's time to leave and Aunt Edith's gradual letting go seems to be a good way to make that happen.

I'll update you when/if there's more to say about this.

Watching Myself Grow Old

A couple of weeks ago, we had a long discussion about cosmetic surgery in old age. The comments score pro and con, if you don't count a few who confused cosmetic and reconstructive surgery, was about 50/50.

It baffles me how anyone, particularly those no longer competing in the workforce, would spent a moment of precious time thinking about how old he or she looks, let alone spend retirement funds to achieve a facsimile of youth that fools no one.

On one level, I get it. We live in an ageist world that devalues people over the age of – oh, it starts around 40 - and the constant drumbeat in every communications media that old people are, by definition, deficient is shameful.


Like so many, I was forced out of the workplace due to my age long before I was ready to retire. In addition, I've been made invisible in dozens of different ways. My thoughts and opinions have been dismissed merely because I'm old and wrinkled.

Actually, I complained about that last item until I was 30 or so when I finally began to look like a grownup. Until then, I had looked like a teenager and was so happy to finally be taken seriously. No one warned me then that there would be an expiration date.

Perhaps that dismissal of me in my youth accounts for never having spent a single serious moment wishing I were younger than I am (currently 75).

Mostly I got on with life and career and never thought about growing old until that day in 1995 or 1996 when I noticed that I was older by decades than the 20-somethings I worked with.

It was a turning point for me that day, the idea that I am not the one immortal on earth and that I will get old, I will die and I've spent a large portion of my days since then studying, researching and thinking about ageing - the results of which, beginning in 2004, have become this blog.

Any of you who have been hanging around here for awhile know that I often use myself as the guinea pig; if it – whatever “it” is - happens to me, it happens to thousands of you too.

So when I have a problem with urinary incontinence, so do some of you. Or with going bald, something more surprising to women, I think, than men, I'm not the only one. Or dropping things more frequently as I've gotten older, I know it's not just my problem.

I'm pretty sure – well, actually, I know I would never have been capable of confronting those (and many other) ageing issues, writing about them here and particularly, admitting to them if I were concerned about looking or even being old.

There's an old wive's tale that no matter how healthy you have been, after 75 it's all down hill. That's been on my mind this past year along with the idea – more often male than female – that you might be likely to die at the same age your father (for men) or mother (for women) did.

Both of these ideas are really stupid. What kind of idiot would believe them? Ahem, try me.

My mother died at age 75 and nine months. I have been acutely aware since my last birthday in April that this month, January 2017, I am the same age as my mother at her death. I know it's absurd but what can I say. It's there. It pops to mind regularly.

It's not growing old or looking old that bothers me anywhere near as much as losing the good health I've enjoyed all my life. I understand perfectly that I have no control over the former and I'm working on understanding the same for the latter.

Meanwhile, with great curiosity and interest, I keep watch on the signs of my ageing. They accumulate.

It was seven or eight years ago I noticed that a smile line on one side of my mouth didn't disappear anymore when I wasn't smiling. Since then I've carefully watched it grow deeper and be joined by its partner, etched on the other side of my mouth. I don't mind.

Then there is the crepe-y skin in all manner of places on my body. It increased abundantly after I lost 40 pounds four years ago - on my belly, my arms, my hands, my thighs and lately, even my knees. If I live long enough, I suppose I'll just be a saggy bag of wrinkles.

What now seems more remarkable to me is how many decades my skin remained relatively smooth. It apparently takes a long time for skin to wear out. wrinnkled hands

These days, I tire more easily compared to most of my life before now. A weariness comes over me sometimes in the afternoon that is similar to what I felt in bygone days in the late evening at bedtime.

Also, all my life I have been eager to hop out of bed as soon as I wake, to get going with the day, to see what it will bring. For the past couple of months, for the first time ever, I'm just as happy to pull the quilt over my head and snooze for another hour or two.

There is more, but you get the point and I'm not alarmed or worried about these physical changes. I'm almost four years short of 80. It's okay.

What does concern me are the changes I've noticed in my brain function, even though I know they are normal for my age.

It is harder now to organize my to-do list each day, to work out what should come first, second, etc. Sustained focus, such as finishing an article I'm reading or getting at least a rough draft of a blog post done before moving on is a goal now, not a fact.

Even I am not sure how many partly finished books, magazine stories and blog posts are floating around.

Making some types of choices has become a joke. For all my adult life, I made a distinction between a review being all I want to know about about a book's subject and others I was eager to read in full.

Now, if I read the review, the book goes on my to-read list. There are either a whole lot more better books in the world than 20, 25 years ago or I can't make make the distinction anymore. You know which of those two choices is correct.

I'm pretty sure all that I've described is how it happens, this getting old stuff. Even if like me, you jave been lucky enough so far to have no chronic illnesses or conditions (she said knocking wood), one's capabilities for ordinary things get chipped away at as the years pile up.

So far I'm having a fine ol' time watching the changes come over my life and I'm grateful I'm not burdened with a yearning for youth. I don't claim any superior level of understanding about that - I didn't earn it; it's just how I am.

My hope is that as I inevitably grow less capable in body and mind in coming years, I can accept those changes with some composure, self-possession and particularly curiosity as I have until now.

older than the internet

Coming Soon: Over-the-Counter Hearing Aids

There was a lot of movement in Washington, D.C. last week about making certain hearing aids more available and more affordable. First, some facts. According to statistics published recently by the White House:

30 million Americans suffer from hearing loss

The average cost of a hearing aid is $2,300 – twice that for two ears

Only 20 percent of Americans who would benefit from hearing aids have them, mostly due to the price

The reason for the White House interest in hearing aids was this announcement last week from the Food and Drug Administration (FDA) which on 7 December

”...issued a guidance document explaining that it does not intend to enforce the requirement that individuals 18 and up receive a medical evaluation or sign a waiver prior to purchasing most hearing aids [and]

“...also announcing its commitment to consider creating a category of over-the-counter (OTC) hearing aids that could deliver new, innovative and lower-cost products to millions of consumers.”

In addition, last week Senator Elizabeth Warren (D-Massachusetts) and Senator Chuck Grassley (R-Iowa) introduced the Over-the-Counter Hearing Aid Act of 2016 [pdf] in Congress. The bipartisan legislation would make certain types of hearing aids available over the counter.

A press release posted on Senator Warren's website notes that the Act would

”...allow hearing aids that are intended to be used by adults to compensate for mild to moderate hearing impairment to be sold over the counter, and would eliminate the requirement that people get a medical evaluation or sign a waiver in order to acquire these hearing aids...

“The bill is supported by the Hearing Loss Association of America (HLAA), the American Association of Retired Persons (AARP), the Consumer Technology Association, Bose, and the Gerontological Society of America.”

There are additional consumer-friendly provisions in the Warren/Grassley bill not included in the FDA changes.

All this is, essentially, a done deal. Before too long, under the conditions laid out above, we will be able to buy hearing aids at a reasonable price.

As I explained a couple of months ago in a post on hearing loss and Medicare – which does not cover hearing aids - this news is important to me personally. It has been decades since I could easily hear a conversation in a noisy restaurant and beginning earlier this year, the audio on certain television shows sounds like gobbledegook to me.

Well, listen to this: about three weeks ago, during a visit to the doctor, the assistant who recorded my vitals said that the wax (also known as cerumen) in my ears was impacted but they could fix that.

And wow. At the risk of indulging in too much information, I would not have believed before that the amount of wax removed could even fit into an ear. But more, I could instantly hear better.

It's not that it was hard to hear in most circumstances before but that everything was instantly more crisp. And all that gobbledegook from the teevee? Except for one show I watch fairly regularly, Elementary, I can hear the audio clearly now.

(This revelation is specific to me. It is not necessarily an answer for anyone else with mild hearing loss.)

What I have noticed since then is that although I can hear clearly, I need to work harder, pay closer attention than I remember doing for most of my life when hearing was automatic and that is why I am so happy to have the news about over-the-counter hearing aids before too long because there is no way I could afford an average price of $6400.

Of course, there are types of hearing loss that require treatment by an otolaryngologist or an audiologist and sometimes involve surgical treatment and/or aids that are more complex that what will be available over the counter.

But for many of the 80 percent who have untreated hearing loss because they can't afford the aids, this new over-the-counter remedy will be a boon. And it is more than just improved hearing: untreated hearing loss leads to depression, loneliness and isolation which can lead to further health problems.

Over-the-counter reading glasses have been available without a prescription for decades and are so inexpensive that most people can afford to have several pair. There is no reason that a remedy for simple, mild hearing loss should not be available in the same manner.

In the coming months and years, we are going to need to work our fingers to the bone to protect Social Security, Medicare and Medicaid. This change is one simple but important thing will improve the lives of millions who cannot now afford hearing aids and millions more in the future too.

Dilemma: Finding a Primary Care Physician

About a month ago, I woke one morning with a mystery malady: randomly placed aches on the front, sides and back of my torso in about half a dozen specific locations which change from day to day.

These are entirely different from muscle pains I get when I occasionally overdo my fitness workout.

Because I hardly ever get sick and when I do, it is easily identifiable and not terribly important; and because I spend as little time with doctors as I can get away with, I followed my usual procedure when something goes wrong: wait and see.

By mid-afternoon that first day, I still hurt. I tried a pain pill, went bed and waited an endless 90 minutes for the medication to kick in.

This routine continued for next couple of weeks. The aches would be there for a day or two and then I would wake the next day feeling, unless you count general lethargy, almost my normal self again and got on with life believing that whatever had caused the aches was resolving itself.

But nooo. After one pain-free day – or two sometimes – the aches returned. Finally I broke down and went to the doctor. And this is where the story I came to tell you today begins.

Over a period of 15 or 20 minutes, the pleasant and clearly competent physician's assistant took my vital signs that, she said, were all within normal range and asked about any changes from what she read out on my chart. The doctor then arrived, sat down at the computer and started typing.

I had a written list of my mystery malady symptoms so I could be concise, along with a couple of unrelated, minor symptoms I wanted to check on while I was there.

Reading off my list, I explained my mystery symptoms and noted that for the previous day and that day, I was pain free but I'd been there before and didn't think the malady had corrected itself.

The only time the doctor looked at me directly and touched me was when he felt the glands under my chin pronouncing them, after a few seconds, to be normal. He returned to the computer and, I assume, entered that information.

The following conversation ensued (paraphrased):

DOCTOR: I can't see that there is anything going on we need to be concerned about and you said that the pain has subsided so you're apparently getting better. Give the MT a urine sample so we can check for a virus.

The doctor then walked toward the door.

RONNI: Wait. I have two other small things I want to ask about.

DOCTOR: Sorry. We're out of time.

And he left after being with me for 10 minutes - probably more like seven or eight minutes.

I peed in the cup and drove home in growing fury – and a little bit of fear. (Two days later, I was informed that the urine test indicated no infection or virus.)

For a couple of days I thought the pains had finally gone away but they returned and have continued that haphazard schedule of a day or two on, a day or two off.

Clearly it was time to find a new primary care physician. I'm 75. There is an old folk tale I'm unwilling to dismiss entirely that no matter how healthy you are, after 75 it's one damned thing after another.

A year or so after moving here, I used online listings of both primary care physicians and geriatricians to find a new doctor. My preference was for the latter but there are fewer of them every year so there's not much chance of finding one with room in his or her schedule.

These days, the web pages of most physicians list what kinds of insurance coverage they accept and I quickly learned that if Medicare is not listed, it is not a oversight. It means they won't consider you.

It took me several days to call all the physicians who listed Medicare and in every case the phone conversation went like this:

RONNI: I'm looking for a primary care physician and would like to make an appointment.

PHONE PERSON: What kind of insurance do you have?

RONNI: Medicare.

PHONE PERSON: I'm sorry, we are not accepting new patients at this time.

I kid you not. Every single one said this.

(I did not find a doctor until I needed cataract surgery a couple of years ago that could not be performed without a full physical exam first. When I explained I did not have a primary care physician, the eye doctor made an appointment with the one I now see.)

A week or ten days ago, I asked a friend who has lived here for decades about finding a physician and she said, “Good luck with that. In this town, they all have waiting lists.” A neighbor I spoke with agreed.

Before long, I will need to repeat the exercise – it's been several years since last time – of calling the list of primary care physicians (and maybe take a stab again at the geriatricians) within a somewhat reasonable distance from my home to see if any will accept Medicare AND a new patient.

(One list is the Physician Compare Directory at the Medicare website where all the doctors do take Medicare. There are other online lists from various sources, often local, usually searchable by Zip Code in addition to specialty.)

Before that, however, another friend has offered to make an inquiry for me and we'll see how that goes.

But the point remains that if Medicare is your health coverage and you need a new physician for whatever reason, you may be out of luck. Of course, when/if I find one, there is no reason to believe he/she will spend any more time with me than my most recent encounter and we don't get to do job interviews before choosing a doctor. It's more like, if one will take you and he or she is still breathing, don't say no.

A fairly short trip around the web turned up multiple stories of elders with Medicare unable to find a physician willing to accept them.

A 2013 NPR story about this dilemma noted that between the year 2000 and 2012, the number of Texas doctors accepting Medicare dropped from 78 percent to 58 percent. There is no reason to believe it is any different in the other 49 states and god knows how low the percentage is now, four years later. Further:

”Seventy-eight-year-old Nancy Martin is one of the seniors who had a tough time finding a physician.

“'I felt frustration, disappointment and I would say, despair. A lot of days I would get to the point where I would think, I'm never going to find a doctor in Austin,' she told the NewsHour. It took a full two years for Martin to find one.

Ten thousand people a day turn age 65 so this problem isn't going away any time soon.

PRE-EMPTIVE NOTE: We are not here for any long-distance diagnoses of my mystery malady so please don't. The issue at hand is important – our experience, discussion and advice (if any) on finding a physician.

Saving Medicare and Contacting Congress


EDITORIAL NOTE: This is a nuts-and-bolts post pulling together some information we are going to need before long. I know some readers don't want any more politics, but emboldened Republicans are hard bent on killing Medicare and they want to do it right after the New Year.

Discussion of Medicare privatization may come up sooner than we expect; Congress reconvenes today, none of the Republicans are shy about pressing their political advantage.

I spent some time over the long weekend, locking down details of one way we can make our voices heard. There will be others, but contacting your representatives is basic to the effort, and there is a right way to do it. Maybe you will want to bookmark some of these links for future use.

* * *

As I wrote here last week, House Speaker Paul Ryan (R-Wisconsin) has been pushing a plan to privatize Medicare for at least half a dozen years and is willing to lie to the American public to accomplish it:

”What people don't realize,” Ryan told [Fox News host Brent] Baier, “is because of Obamacare, Medicare is going broke, medicare is going to have price controls because of Obamacare, Medicaid is in fiscal straits.

“You have to deal with those issues if you are going to repeal and replace Obamacare. Medicare has serious problems [because of] Obamacare.”

This is exactly opposite of what is true which you can read about on my most recent Medicare post here.

As it looks now, Ryan's new, private Medicare coverage would compete against traditional Medicare. New York Times reporter, Robert Pear, who has closely followed Medicare and Social Security for many years, wrote about Ryan's plan last week and noted this about how it would work:

“'Beneficiaries would have to pay much more to stay in traditional fee-for-service Medicare,' said John K. Gorman, a former Medicare official who is now a consultant to many insurers. 'Regular Medicare would become the province of affluent beneficiaries who can buy their way out of' private plans.”

According to many reports (but who knows what applies in a * administration), Ryan intends to push Medicare privatization (also called voucher plan) legislation as soon as the 115th Congress convenes in January.

Last Friday, in response to the Republican Medicare threat, Senate Minority Leader-elect, Chuck Schumer (D-New York) issued a defiant statement reminiscent of actor Clint Eastwood in a certain movie [emphasis is mine]:

“Medicare is one of the most successful government programs ever created – it’s been a success story for decades. The Republicans’ ideological and visceral hatred of government could deny millions of senior citizens across the country the care they need and deserve.

“To our Republican colleagues considering this path, Democrats say: make our day. Your effort will fail, and this attack on our seniors will not stand.”

I hope Senator Schumer is right but with a Republican-controlled Senate, he will need a lot of backup from the people of the United States and it is we, elders, who best understand the consequences of Medicare privatization.

For when that time comes – and it may be as soon as early January – I have collected some information about how to take our message to Congress and make it as effective as possible. Having this information now will keep future posts on the issue much shorter.

I found instructions from a former six-year Congressional staffer, Emily Ellsworth, with an excellent list of what does and does not make the biggest impact.

Twitter and Facebook do not work. Staffers hardly ever check them.

Emailing your representatives is better, but the staffers get so many emails and are so busy, they just use an algorithm to “batch them” and send out form letters in response. (Snailmail is, apparently, dead.)

At Lifehacker where I found this information, the reporter notes that Ms. Ellsworth specifically recommends phone calls:

”...phone calls have to be dealt with when they occur and they can’t be ignored. A large volume of phone calls can be overwhelming for office staffers, but that means that their bosses hear about it.

“Which office you target also matters. Members of Congress have offices in DC, but they also have offices in their home district that they represent. Target your letters and phone calls to your local office and you’ll have an easier time getting their attention.”

Also, says Ms. Ellsworth, “If you want to talk to your rep, show up at [local] town hall meetings. Get a huge group that they can't ignore. Pack that place and ask questions.”

These and other instructions are included in Ellsworth's (irony alert) Twitter chain that is reproduced in full at Lifehacker.

U.S. Senate contacts including D.C. and home district offices: You might have to search around to find the state office contacts but with a few exceptions, they are somewhere on the main page.

U.S. House of Representatives contacts including D.C. and home district offices – the latter sometimes called satellite offices: Although I have not looked at the web pages of all 435 Congress people, listings for district offices were on the pages I spot checked.

Over the years here, I've recommended other websites that list Congressional phone numbers but after my latest scrutiny, these appear to be the most thorough and best organized. New members of both the House and the Senate are sworn in on 3 January 2017. Obviously, newly-elected representatives may not have web pages yet on day one.

Congressional staffers – at home and in Washington – are busy people. Another excellent suggestion is to prepare a short, to-the-point script you can read when you telephone your representatives.

A Google Doc by Kara Waite is messy but is packed with great information – especially this page of scripts (click on "Calling Scripts" at the top of the page). And in the future, I will create some sample scripts as a starting point you can personalize.

Medicare Part B Premium Increase and Normalizing *

There is a spiral-bound notebook on my desk where I keep a running list of ideas for future TimeGoesBy posts. Some of them are terrible ideas I never use (well, mostly). Others are mainstays – such things as updates or threats to Medicare and Social Security that our age group needs to know.

Mostly, the book is a reminder so I won't lose thoughts I had in passing while doing something else, and I add maybe three or four a week. Since election day, however, there are four new, tightly-hand-written pages now that there are deeply worrying potential dangers afoot in Washington, D.C. that will affect Americans of all ages.

I am telling you this in explanation for what is a new kind of post here now and then that will cover two or three unrelated items that seem to me to be important right now as opposed to having a decent shelf life or, sometimes, even being evergreen.

So here goes with the first one.

As you know, there was no increase in the Social Security cost-of-living adjustment (COLA) for the past two years. That means that for most Medicare beneficiaries there was, also, no increase in the premium for Part B which covers expenses for doctors, other outpatient care and durable medical equipment.

Now, due to the measly .3 percent COLA to Social Security for 2017 (which does not begin to cover inflation that most elders experience) an increase in the Part B Medicare premium is allowed.

The increase in the average 2017 Social Security payment is about $5. It will be wiped out for 70 percent of recipients because the Part B premium, which is deducted from the Social Security benefit each month, rises by 3.9 percent from $104.90 to about $109.

High earners will have an even larger increase in the Part B premium as will certain other categories of beneficiaries. You can see more detail at this PBS page.

It's not that I will go hungry or anything drastic, but so many other fixed expenses are increasing in the new year, by up to 10 percent in at least one case, that I will be cutting back and I expect many of you will be doing so too. This has happened every year for the decade I've received a Social Security benefit and I keep wondering in what year it will become a serious hardship.

In addition, the Part B deductible for 2017 will increase from $166 to $183. The Social Security Administration will soon be sending their annual benefit update letter so you will see your new numbers then.

As I mentioned last week, it took less that 24 hours after the election results were in for pundits and most of the media to call for giving the president-elect “a chance” - as if we didn't already know what kind of man he is.

As Rohit Chandan, writing at FAIR (Fairness and Accuracy in Reporting) on Friday about normalization:

”The danger is that by normalizing Trump—a candidate distinguished by an embrace of political violence and open appeals to ethnic nationalism who boasted of getting away with sexual assaults — these commentators will make racist and sexist bullying an acceptable way to run for public office.”

No kidding. His way of speaking has already brutalized public discourse in general. Here is FAIR's accompanying cartoon laying out the media's excuses for normalization:


Over the past year, Seth Meyers, host of Late Night on NBC-TV, has become my favorite of the late night hosts – I can't stay awake that late but I record his show every night to watch the opening 10 minutes the next day. Meyers is smart, funny and fearless.

Last week, in his “A Closer Look” segment that airs at the top of each show, he pilloried the media and * associates trying to insist * is a normal person. Enjoy.

It is easy, when outrage after outrage is repeated hundreds of times a day in the media, to fall victim to accepting it as normal. Please be vigilant of yourselves and don't let it happen to you.

Medicare Open Enrollment for 2017

It's amazing how much the presidential election has changed our lives this year. In the case of an important annual event for elders that I report on here every year, it got postponed due to the third Clinton/Trump debate.

So here we are today, 10 days late with the information you need.

October 15 marked the start of the Medicare Open Enrollment period which lasts until 7 December. During this time, people 65 and older may, if they choose, make changes to their Advantage programs and their Part D prescription drug plans.

Oh joy. It shouldn't be this hard to keep up one's health care coverage year to year and it wouldn't be with a single-payer system like most western democracies have. But for now we're stuck with Medicare - and I'm awfully glad to we have it - so here is what you need to know.

(This is a long post. I am hoping I have created enough bold headers that you can skip to the information you care about and ignore the rest.)

If you currently have traditional Medicare, you are allowed to change to a private Advantage plan – or vice versa. Traditional Medicare does not provide drug coverage so you need a separate plan (Part D) for that.

Some Advantage plans cover drugs and others do not, so if you choose a plan without drug coverage you will need a stand-alone drug program as traditional Medicare enrollees do.

• Part A covers inpatient hospital care, skilled nursing, hospice and home health care. It is free.

• Part B covers preventive care, outpatient services and doctor visits. The monthly premium is deducted from your Social Security benefit.

Optional • Medigap (or Supplemental) coverage pays for the “gap” between what Parts A and B cover and your out-of-pocket costs. You MAY NOT CHANGE this coverage during this 15 October-7 December open enrollment period.

• Part C is another name for Advantage plans. These take the place of original Medicare (Parts A, B and Medigap). Premiums are usually lower, they often cover drugs but physician choice is limited to the company's network and physicians are allowed to drop out of the program mid-year.

• 2017 Medicare Costs
As we discussed last week, there will be a .3 percent increase in Social Security benefits in 2017 but we do not yet know if or how much that will effect the Medicare Part B premium that is deducted from the monthly Social Security payment.

For the past two years, without a Social Security cost-of-living adjustment, the Part B premium has remained at $104.90. The new premium will be announced in November.

Certain people pay higher Part B premiums. Medicare costs in general for 2017 are not yet available. You can see last year's costs at this webpage where next year's costs will be available when they are released.

Medicare is a gigantic, complicated program with many permutations depending on individual circumstances. I cannot possibly pretend I understand it all and if I did, I could not account for them all here. What I can do, is provide some good links to help you through this year's ordeal to making changes (or not) you might want.

Remember, even if you think you are happy with your current coverage, prices change, deductibles are added, subtracted, increased, etc., and drugs are added and deleted from companies' formularies. So it is just good sense to review your plans each year at this time.

The Medicare.gov website is not perfect but it gets better and easier to use each year. You can check your current enrollment, premiums, drugs list and find all sorts of general health information.

When you get there, click on the line: “Medicare Open Enrollment starts October 15 and ends December 7 Review your health and prescription drug coverage options” near the top of the home page to get into the open enrollment area with both your current coverage and options for 2017.

One of the best things about the Medicare.gov selection tool for drug coverage is that if you take the time to enter all your prescriptions and their dosages, you will get a list of plans that cover what you need and you can then compare other criteria to select the plan that works best for you.

In my case, I use no prescription drugs and since there is no way to guess what might happen to me and what kind of drugs I would need, I punt.

I choose the least expensive plan and hope (how's that for an intelligent healthcare program?) that whatever happens to me, I will be able to afford the drugs I require until next enrollment period when I can select a different plan based on my drugs.

This year, there are 27 prescription drug plans available to me. I'm lucky that my current plan has reduced the premium by 7.6 percent (whoever heard of this?). The deductible goes up by just over 11 percent but there is no increase in the in-network co-pays.

It's a no brainer for me this year; I stay with the plan I have.

The annual open enrollment period is open season for scammers. You will likely receive many snailmail advertisements for Advantage and drug plans, and phone calls too. Be smart.

Never give out personal information such as Medicare and Social Security numbers, account numbers, etc. to anyone who has telephoned you. Ever. Medicare representatives never call to ask this kind of information.

If you are due a refund for any reason from a private insurer, it will be sent to you via postal mail. If anyone calls asking for personal information to receive your refund, it is probably a scam. Hang up.

Many legitimate companies are offering a variety of health coverage plans during this period. But some are not who they say they are or will employ high pressure tactics to try to sell you coverage you don't need. Be aware.

Many offers of “free” medical supplies or checkups via postal mail are excuses to extract personal information from you. Check them out carefully before agreeing to them.

Medicare website.
Medicare telephone: 1-800-Medicare

Medicare and You
By now, Medicare enrollees will have received your annual Medicare and You booklet. If you have not received it, or misplaced it, there is an electronic version [pdf]. Note that only the print version has a list in the back of plans available in your state.

Medicare Find a Plan

Here is a direct link to the Medicare Find a Plan main page.

My Medicare Matters
The National Council on Aging (NCOA) maintains a good educational website with lots of trustworthy information about Medicare and how it works.

The State Health Insurance Assistance Program (SHIP) is a national program that offers free, one-on-one counseling and assistance to people with Medicare, their families and caregivers. Find your state's SHIP here.

65 and Signing Up For the First Time
If you are new to Medicare, Kaiser Health News has a succinct one-pager to get you started with a lot of links to additional online information.

Don't Forget
Open enrollment ends on 7 December 2016.

Exercise, Even In Small Doses, Offers Tremendous Benefits For Elders By Judith Graham

RONNI HERE: Remember last month when I told you that my friend Judith Graham, a trustworthy and respected reporter on the “age beat,” had begun a new column at one of the most trustworthy and respected health websites we have, Kaiser Health News?

Yesterday, as I was pulling together links to include in blog post today to harangue you yet again with the latest information about how important even small amounts of exercise are for elder health, Judith's newest column materialized.

She had already written a great deal of what I intended that I don't see any reason to repeat all her good work.

So below is Judith's column in full as Kaiser encourages republishing. Also, Judith is always looking for older adults with aging and health stories to tell. If you’ve got one, send it to her at judithegraham@gmail.com.

One more thing. I realize that I probably write post stories about exercise way too often - that you've got the point by now - and asked myself why it keeps coming up for me. Here's what I think:

I am so astonished that repeated, independent studies from respected researchers all around world keep reaching the same conclusion, that it doesn't take much exercise at all to make an enormous difference in our health.

Most of my life I was told and believed that to have any benefit, exercise needed to be long and hard and lots of it. And that just wasn't in me. But the new studies - the number and continuing flow of them - must be believed and even I can do as much (and even more) than they recommend.

But it's one of those things that amaze me - real, measurable, observable health benefits without having to be a gym rat or marathon runner. I haven't gotten over my astonishment yet. In future, I'll try to keep my enthusiasm under more control

* * *

(Republished with permission from Kaiser Health News.)

Retaining the ability to get up and about easily — to walk across a parking lot, climb a set of stairs, rise from a chair and maintain balance — is an under-appreciated component of good health in later life.

When mobility is compromised, older adults are more likely to lose their independence, become isolated, feel depressed, live in nursing homes and die earlier than people who don’t have difficulty moving around.

Problems with mobility are distressingly common: About 17 percent of seniors age 65 or older can’t walk even one-quarter of a mile, and another 28 percent have difficulty doing so.

But trouble getting around after a fall or a hip replacement isn’t a sign that your life is headed irreversibly downhill. If you start getting physical activity on a regular basis, you’ll be more likely to recover strength and flexibility and less likely to develop long-term disability, new research published in the Annals of Internal Medicine shows.

This encouraging finding comes from a study of people at high risk of mobility problems: men and women between the ages of 70 and 89 who were sedentary and had some difficulties with daily activities but were still able to walk a quarter mile without assistance.

Half of the group attended 26 weekly health education classes followed by monthly seminars. The other half spent about an hour getting physical activity — primarily walking — at a clinic twice a week, followed by at-home exercises.

The goal was to have participants meet the government’s recommended standard of 150 minutes of weekly moderate physical activity and sustain that level over time.

Results confirmed the extraordinary benefits of physical activity, which has been shown in previous research to lower an individual’s risk of heart disease, cognitive impairment, diabetes, depression and some cancers.

The group that focused on walking and strength and balance exercises was 25 percent less likely to experience significant problems with mobility than the group that focused on education over a period of almost three years. Specifically, they recovered faster from episodes of being unable to walk and were less likely to have problems getting around after that recovery period.

The program “was a godsend,” said John Carp, 87, who didn’t make it a point to walk regularly before he joined the study. “There was an improvement in physical feeling and also my mental attitude.”

“If there was a pill that offered comparable benefits, it would be a billion-dollar product and people would be all over it,” said Dr. Thomas Gill, lead author of the new paper and a professor of geriatrics at the Yale School of Medicine, as well as director of Yale Program on Aging.

Gill hopes to convince Medicare and other insurers to adopt the intervention he helped create. But older adults don’t need to wait for that to happen. There are plenty of places — YMCAs and senior centers, for instance — where seniors can take classes. Experts’ practical advice:

It’s never too late. “Older adults may think ‘it’s too late for me — I’m too old or too sick for this,’” said Patricia Katz, a professor of medicine and health policy at the University of California, San Francisco. “The message from this study is it’s never too late.”

“Prescribing exercise may be just as important as prescribing medications,” Katz wrote in an editorial accompanying Gill’s report.

Focus on activity, not exercise. “Older adults, if you talk to them about exercise, will say that’s not for me, that’s for my grandchildren,” Gill said. “But if you talk to them about become more physically active, they’ll say ‘okay, I can do that.’”

“Basically, I walk in the park or around the neighborhood and move my arms and legs around at night in different positions, and try to flex my muscles,” Carp said, describing his daily routine. “It’s not hard, and it makes a big difference.”

Start slow. Some participants could barely make it around a track at the beginning of the study so “we started low and increased slowly,” offering remedial help along the way, Gill said.

“I recommend focusing on smaller and achievable goals, initially, and not trying to do everything at once because we know that tends to make people give up,” said Dr. Anne Newman, chair of the department of epidemiology at the University of Pittsburgh and co-author of a new study showing that people who eat healthily, maintain a normal weight and are physically active live longer and spend less time being disabled at the end of their lives.

Even small amounts make a difference. Newman’s study tracked more than 5,000 older adults over the course of 25 years. One conclusion: “There’s no threshold for benefit from physical activity,” she said. “Every little bit helps.”

“You don’t need to get on a treadmill, go to the gym, or wear Spandex,” Newman said. All you need to do is start walking for a few minutes every day and gradually build up your strength and endurance.”

Beware of becoming sedentary. The worst thing seniors can do is “sit down and take it easy,” said Susan Hughes, co-director of the Center for Research on Health and Aging at the University of Illinois at Chicago.

Make a plan. Hughes helped develop Fit & Strong, an evidence-based physical activity program for seniors with osteoarthritis that incorporates health education.

Before participants go off on their own, coaches craft an individualized plan that covers three questions: What are you going to do and how often, where are you going to do it and who are you going to do it with? You can make a plan yourself, but make sure it’s enjoyable, Hughes said. Otherwise, it’s very unlikely you’ll follow it for any length of time.

* * *

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Elder Orphans – Part 1: Definition

About 18 months ago, I started a conversation here about elder orphans. It is a distinct characteristic of old age for tens of millions of old people but recognized as such only recently.

Somehow I dropped the ball on this and am only now getting back to it. The intention this time (and you are allowed to call me out if I don't follow through) is to cover the issues in installments that will appear here on a regular basis – about once a month or so.

Let's start today with the definition – who/what is an elder orphan? This is more important and more complicated than I anticipated because as I began catching up on the newest information, I was shocked at the universally negative description of life in old age itself and worse for elder orphans. Some samples.

Even Dr. Maria Torroella Carney, chief of geriatric and palliative medicine at the North Shore-LIJ Health System in New York City (who may or may not have coined the phrase, elder orphans, paints a terrible picture.

”According to Carney,” writes Carol Marak in Huffington Post, “older adults have a higher risk of having trouble with daily tasks, experience cognitive decline, develop coronary heart disease and even die.

“The risks increase for people living alone and socially isolated. They have higher incidences of medical complications, mental illness, mobility issues and health care access problems. This is not good news for us, the single without children.”

Well, geez, just shoot me now.

Ms. Marak, who keeps a Facebook page called Elder Orphans, also writes, at Next Avenue in a piece titled, Elder Orphans Have a Harder Time Aging in Place:

”...once 65 hits, the changes bring reminders that we’re no longer the same. We don’t move as quickly, we don’t multitask as well, nor do we easily adapt.

“Those are the simple cues. As we age, the physical and mental challenges delivered through loss, immobility and dependence are the ones that put us at higher risks.

“However, the effects of aging land harder on an 'elder orphan,' because the worry and concern of 'what will become of me if I can’t care for myself?' triples when no one is around.”

There is no way to know where that “triples” reference comes from nor do I buy it. Not for a minute do I think elder orphans worry three times as much as non-orphans about the effects of aging.

However, even without that hysterical tone, some academics sound as dire in their definitions of elder orphans: “both childless and friendless;” “people over 65 who are single or widowed, have no children at least in the area, and no support system;” “have low social capital.”

Some of you who have been here at TGB for a number of years perhaps recall what I discovered about the literature of growing old after I had been studying aging for half a dozen years. As I wrote in the About page for this blog:

”...I spent the greater part of my time away from the workplace researching what it is like to grow old. I wanted to know what I was in for and it wasn't a pretty picture.

“Whether popular books, magazines and newspapers, scholarly and academic research, psychology and medical texts, movies, TV shows, advertising and comedy too, the conclusions were universal: old age was all about the three Ds – disease, decline and decay leading to a fourth D, death.”

And that was the best anyone had to say about growing old which is why I adopted the subtitle for this blog, "what it's really like to get old." It's nowhere near that bad.

In the decade since then, as the boomers have reached the beginning of their elder years, old age has become “cool” to write about as both popular and academic reporting has taken a more realistic and positive attitude toward it.

Except, apparently, among the people who have at least acknowledged the existence of elder orphans. I'm going to assume that these people mean well but I reject their descriptions of old age just as I did a dozen years ago.

Yes, some old people will become sick, lonely and dependent on family or others but nowhere near a majority of old people and I'll back that up with research and statistics in a future post.

Today, let's get to a definition of an elder orphan. At the risk of stringing out what would have been a one-page blog post until I started reading, here is a definition in list form from Ms. Marak's Huffington Post story linked above:

”Who are elder orphans?” she writes.
We are the socially and physically isolated aged living in local communities

We live without a family member or a designated surrogate

We have a higher vulnerability to losing the decision-making capacity

We use only a few community resources and are lonely

We have a high risk of losing independence and safety

We aren’t acknowledged (as a group) that will need more attention and care”

No. NO. NO. There is no evidence for a word of that.

Lack of family or close friend, in itself, does not make anyone more vulnerable, lonelier, less safe or liable to loss of cognitive abilities than old people with children or close friends.

I suspect Ms. Marak has confused research on loneliness in old age with being an elder orphan. Some elder orphans are lonely. Some old people with families are lonely. The two characteristics are not synonymous and alone is not the definition of lonely.

Here is a better definition of an elder orphan from 18 months ago:

An elder orphan is an old person who is single, lives alone, has no children or family member or friend who can act on his or her behalf in handling health, legal and financial issues.

An elder orphan has no one, or is uncertain of who, to list on that “next of kin” line in forms, no one designated to carry out end-of-life wishes, and see to the funeral and burial.”

That was a decent definition a year and a half ago but it needs expanding at least this much: Some old people who have children or other family members are elder orphans because they are estranged from their family or children and/or don't want them involved in decision making.

It's amazing how many people I've run into who feel this way. Having relatives doesn't mean you trust them – or even like them.

As my friend Wendl Kornfeld – who knows a whole lot about elder orphans and who you will be hearing more from during this series of blog posts – says:

”We urge people without family to be their own strongest advocate and to support that by creating a community as their family.”

And that is what we will do in this series: break down the issue into easily doable chunks. And we will do it without making anyone feel that being an elder orphan is a calamity that makes our lives worse than that of other old people. It is not.

Welcome to Fall - And to Falls Prevention

Besides being the official first day of fall, yesterday, 22 September, was National Falls Prevention Awareness Day – as it has been for the past nine years.

Wait. Let me back up a bit first.

For readers who have been coming around here for a year and more, this will look familiar. I publish a falls prevention story every year at this time and maybe, like me, you feel that you have read it recently.

That's the age-old problem for old people of time passing so quickly as the birthdays pile up. In my case, I have no idea anymore how long ago any given thing happened. I've taken to telling people, when I use the word “recently,” that it could mean anything from six months ago to ten years ago.

However, in the case of falls prevention, familiarity and repetition are a good thing. If you don't think so, take a look at just a few of the statistics about falls in regard to people who are 65 and older. From the National Council on Aging (NCOA):

One third of all people 65 and older fall each year

Every 11 minutes, an old person is admitted to an emergency room for treatment for a fall

Every 19 minutes, an old person dies as the result of a fall

Falls are the leading cause of fatal injury and the most common cause of non-fatal, trauma-related hospital admissions among people 65 and older

Every year, the NCOA holds a competition for short videos from amateurs about falls prevention. Here is the first place winner of the 2015 Falls Free® video contest:

There are more Falls Free® contest videos here.

The National Institute on Aging (NIA) has an excellent page about what you can do personally to keep yourself from falling, along with a list of items for fall-proofing your home. It's a good reminder to check your home for falling and tripping hazards at least once a year.

This infographic (below and online here) is from the NCOA about falls prevention programs you may be able to find in your community:


There are so many medical and physical problems over which we have little or no control – unexpected diseases and conditions that seem to choose victims randomly. Falling is one thing in life we can go a long way toward preventing.

So don't forget, be careful out there.

Hearing Loss Treatment and Medicare


Hearing loss is one of the least attended health problems in the United States. That's just my opinion but take a look at the statistics. According to The New York Times:

Hearing loss affects 45 percent of people age 70-74

Hearing loss affects 80 percent of people who are 85 and older

Fewer than 20 percent of people with hearing loss use hearing aids

Some of the 80 percent who do not use hearing devices are concerned about the stigma that still attaches. There are other, more serious reasons people do not seek help for their hearing difficulty:

  1. Medicare, by deliberate legislation when it was created in 1965, does not cover hearing loss examination, treatment or devices

  2. The hearing aid business has an anecdotal reputation problem most of us are familiar with. That organizations such as AARP warn [pdf] people to carefully check the credentials of hearing specialists doesn't create a great deal of confidence

  3. Average hearing aid cost is about $2500 per aid, many people need two of them and that is for the devices only, not examinations and other specialist fees

Here is one person's – mine - hearing story.

Although I've had trouble since I was 30-something hearing nearby voices in noisy rooms such as restaurants, I just avoid them. For 10 years or so, I have lived with tinnitus but except that I long for some silence in my life, it doesn't affect hearing in general which is a good thing since there is no treatment for it.

More recently a different hearing problem has developed; it has become hard to hear dialogue on television.

The difficulty is not volume. In fact, I no longer go to movies in theaters because the audio is jacked up so high it hurts my ears. Instead this new-ish issue is that voices at certain timbres or pitches turn into gibberish. I can hear them perfectly well; it is just that the actors could be speaking Martian as far as I can tell.

But not all television audio is unintelligible. I hear news programs, documentaries, talk shows and other kinds of live broadcasts perfectly well (radio too) along with replays of these shows.

My hearing problem is specific to a large percentage of scripted programs, original TV and theatrical movies broadcast on television. I have become an adept lip reader but drama – and comedy – is such that half the time the person speaking has his/her back to the camera.

Two months ago, Consumer Reports published a “Hearing Aid Buying Guide” which is as useful and thorough as we have come to expect from this organization.

There is an overview of the causes of hearing loss, an excellent explanation of types of hearing aids with their various, individual features along with a list of considerations in choosing a hearing aid provider - from a medical doctor to hearing specialists:

”The professionals you might encounter at independent hearing-aid providers could fall into two categories: Audiologists or hearing-aid specialists (also called hearing-instrument specialists). Both types of professionals can evaluate your hearing and fit your hearing aids. But their training varies significantly.

“Audiologists must have a doctoral degree (Au.D.), and more than 1,000 hours of clinical training. Hearing-aid specialists generally have six months to two years of supervised training or a two-year college degree.”

Even if you have no hearing difficulty now this Consumer Reports guide is worth saving for possible future use.

Earlier this week, writing in The New York Times, reporter Paula Span looked at the Personal Sound Amplifiers (PSAPs).

”...many of us with mild to moderate hearing loss may consider a relatively inexpensive alternative: personal sound amplification products, or P.S.A.P.s. They offer some promise — and some perils, too,” she writes.

“Unlike for a hearing aid, you don’t need an audiologist to obtain a P.S.A.P. You see these gizmos advertised on the back pages of magazines or on sale at drugstore chains. You can buy them online.”

As Span notes, PSAPs are unregulated and, in fact, manufacturers are not allowed to label or market them as usable for hearing loss. And, many of them are terrible ripoffs. But some, she says, are not:

”Dr. Reed has tested just 29 participants so far, he cautioned, and real-world results will vary. Still, he and his colleagues were impressed with three P.S.A.P.s.

“The Soundhawk, which operates with a smartphone, performed almost as well as the hearing aid, with a list price of $399. The CS50+, made by Soundworld Solutions, and the Bean T-Coil, from Etymotic, worked nearly as well and list for about $350.”

If that sounds like something you want to look into, be sure to read the entire Times piece and the Consumer Reports guide that, like Span, warns of the shortcomings:

”These over-the-counter products generally have fewer features and less functionality than hearing aids...These are designed for people who want to amplify certain sounds—and they aren't subject to the same safety and effectiveness standards that hearing aids are.”

Probably not coincidentally, this same week Lori Orlov, the marketing expert who publishes the Aging in Place Technology Watch blog, has a short, informative list of five of the latest hearing technology gadgets. No reviews, just information about what is new on the immediate horizon.

As to my hearing? It is a big concern that my problem is gobbledegook, not volume because I suspect that makes it a brain, not ear, issue. So I'll start with my physician. If the outcome is interesting or useful, I'll let you know.

Meanwhile, it is unconscionable that Medicare does not cover hearing loss. Actually, you can think of this failure as cutting off the heads of elders; Medicare also does not cover routine vision and dental care.

Flu Shots and Exercise for Elders


When I was young, in my twenties, I came down with a flu every winter, stuck in bed for a week, achy, miserable and barely lucid. By age 30, I got smarter and I was taking the vaccine every year. For me, it has always worked – except for that one year sometime in my forties, the year I forgot to get the flu shot.

For two weeks I was barely conscious, too sick to care if I lived or died. What went on during those 12 or 14 days – phone calls maybe? did I watch TV? maybe a friend dropped by? I have no idea.

When finally the fever lifted, my head cleared and I got out of bed ready to return to the world, I found on the kitchen counter two, empty, one-gallon jugs that had once held water. I had never bought bottled water in my life, not in gallon containers or any other size. But there they were.

In all the years since then, every now and then, I wonder if, in the fog of flu that year, I walked to the corner bodega and bought that water. And, since I sleep naked, if perhaps I did that without putting on clothes, in the fog of flu, and the guys at the bodega colluded with my neighbors to not embarrass me by mentioning it.

Who knows. But I've never skipped the vaccine again.

Last week, I stopped by the pharmacy for that annual innoculation. The pharmacy has my records from years past so it took only about five minutes and cost me nothing.

In general, Medicare Part B covers the price if your physician accepts assignment. There are a couple of nuances to that you will find here.

This is serious business for elders.The U.S. Centers for Disease Control (CDC) recommends the flu shot for everyone six months of age and older. But it is especially important for

”...anyone who is 65 years of age or older; nursing home residents; and people with serious health conditions such as heart disease, diabetes, asthma, lung disease or HIV. Caregivers for older adults should also get vaccinated to avoid spreading the flu,” explains healthinaging.org [pdf].

People who are allergic to eggs, have had allergic reactions to flu shots in the past, or have been diagnosed with Guillian-Barre Syndrome should not take the flu shot.

Mark you calendar today to get the flu shot. Soon. In my area, pharmacies give it without the need for an appointment. If that's not so where you live or you would rather see your physician, do arrange for it. Influenza can be deadly for old people.

There have now been so many studies proving, confirming and reconfirming that exercise is the best medicine known to mankind, it cannot be questioned. Every one of us should be up and moving around as much as our physical condition allows.


The effectiveness of exercise on physical and cognitive wellbeing is so conclusive that the experts have been left for the past several years arguing not if we should, but what type, duration and intensity of exercise does the most good.

Most experts suggest that four kinds are necessary: endurance, strength, balance and flexibility. But newer studies are suggesting that for people who cannot and for elders, something as simple as brisk walking can be enough to help.

For the past few years, most experts recommended that all people, including elders, need at least 150 minutes of the four kinds of exercise per week.

For people who have been sedentary for a long while or have conditions that might prevent that much work, that is a lot. But early this summer, WebMD reported on a new study that suggests that less is almost as good:

”'The biggest jump in benefit was achieved at the low level of exercise, with the medium and high levels bringing smaller increments of benefit,' said Dr. David Hupin, of the University Hospital of Saint-Etienne, France.

“The low level of exercise is equivalent to a 15-minute brisk walk each day, according to Hupin.”

You could do that even at home on rainy, cold days. Jack up the volume on some music you like and keep moving for 15 minutes. Time magazine reported further on the same study.

”...there’s growing consensus among some exercise researchers that perhaps people, especially the elderly, can still achieve improved health with less.

“'Fifteen minutes per day of moderate and vigorous physical activity could be a reasonable target dose in older adults,' the study authors conclude. Small increases in physical activity may enable some older adults to incorporate more moderate activity and thus get closer to the current recommendations. If more may be better, ‘Even a little is already good’.”

Note the last sentence of that quotation. I am seeing that again and again in my readings about exercise and old people. Even a little helps and is better than nothing.

Also, if you aim for more than that do only as much as you can. That is, don't be lazy, push yourself as far as is reasonable, but don't rush toward the goals you set.

When I first began my daily home workout routine several years ago, I could not do more than two pushups – only two - before collapsing and we're talking those girly type of pushups on my knees, not toes. I now do 50 without too much effort but it took a year to get there. Do as much as you can but not to much as to injure yourself.

Here are some online sources to help you think through an exercise program.

CDC Basics of Exercise for Older Adults: Not quite up to date as the study I've quoted above but a good explanation of levels of exercise.
Today's Geriatric Medicine is similar to the CDC page but more detailed.
Physical Activity Guidelines for active older adults from health.gov.

How To Fight For Yourself At The Hospital and Avoid Readmission by Judith Graham

[RONNI HERE: My friend Judith Graham recently became a regular columnist for Kaiser Health News which is one of the most useful and trustworthy websites on health in general and on elder health issues that you can find online.

Judith's experience makes her uniquely qualified. She was a national correspondent and senior health reporter at the
Chicago Tribune for many years and later blogged for The New York Times’ New Old Age blog.

Her new Kaiser Health column, which appears twice a month, concentrates on aging and health with a consumer focus.

Lucky for you and me, Kaiser Health News allows organizations to republish their stories free of charge and Judith's columns are an excellent fit for TGB.

Judith is always looking for older adults with aging and health stories to tell. If you’ve got one, send it to her at judithegraham@gmail.com.

* * *

(Republished with permission from Kaiser Health News).

Everything initially went well with Barbara Charnes’ surgery to fix a troublesome ankle. But after leaving the hospital, the 83-year-old soon found herself in a bad way.

Dazed by a bad response to anesthesia, the Denver resident stopped eating and drinking. Within days, she was dangerously weak, almost entirely immobile and alarmingly apathetic.

“I didn’t see a way forward; I thought I was going to die, and I was OK with that,” Charnes remembered, thinking back to that awful time in the spring of 2015.

Her distraught husband didn’t know what to do until a long-time friend — a neurologist — insisted that Charnes return to the hospital.

That’s the kind of situation medical centers are trying hard to prevent. When hospitals readmit aging patients more often than average, they can face stiff government penalties.

But too often institutions don’t take the reality of seniors’ lives adequately into account, making it imperative that patients figure out how to advocate for themselves.

“People tell us over and over ‘I wasn’t at all prepared for what happened’ and ‘My needs weren’t anticipated,’” said Mary Naylor, director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania.

It’s a mistake to rely on hospital staff to ensure that things go smoothly; medical centers’ interests (efficiency, opening up needed beds, maximizing payments, avoiding penalties) are not necessarily your interests (recovering as well as possible, remaining independent and easing the burden on caregivers).

Instead, you and a family member, friend or caregiver need to be prepared to ask plenty of questions and push for answers.

Here’s what doctors, health policy experts, geriatric care managers, older adults and caregivers recommend:

Planning for a transition home should begin as soon as you’re admitted to the hospital, advised Connie McKenzie, who runs Firstat RN Care Management Services in Fort Lauderdale, Fla. You may be too ill to do this, so have someone you trust ask your physician how long you’re likely to be hospitalized and whether you’ll be sent home or to rehabilitation afterward.

Ask if a physical therapist can evaluate you or your loved one at the hospital. Can you get out of bed by yourself? Walk across the room? Then discuss what difficulties might arise back home. Will you be able to handle your own bathroom needs? Get dressed? Climb stairs? What kind of assistance will you require?

Request a consultation with a nutritionist. What kinds of foods will and won’t you be able to eat? Does your diet need to change over the short term, or longer term?

Consider where you’ll go next. If you or your loved one is going to need rehabilitation, now is the time to start researching facilities. Ask a hospital social worker for advice or, if you can afford it, hire a geriatric care manager (now called aging life care professionals) to walk you through your options.

Don’t wait to learn about the kind of care that will be required at home. Will a wound need to be dressed? A catheter need tending to? What’s the best way to do this? Have a nurse show you, step by step, and then let you practice in front of her — several times, if that’s what it takes.

Ann Williams watched a nurse give her 77-year-old mother a shot of Warfarin two years ago after being hospitalized for a dangerous blood clot. But when it was Williams’ turn to give the injection on her own, she panicked.

“I’m not a medical professional: I’ve only given allergy shots to my cats,” she said. Fortunately, Williams found a good instructional video on the internet and watched it over and over.

Make sure you ask your doctor to sit down and walk you through what will happen next. How soon might you or your loved one recover? What should you expect if things are going well? What should you do if things are going poorly? How will you know if a trip back to the hospital is necessary?

If the doctor or a nurse rushes you, don’t be afraid to say, “Please slow down and repeat that” or “Can you be more specific?” or “Can you explain that using simple language?” said Dr. Suzanne Mitchell, an assistant professor of family medicine at Boston University’s School of Medicine.

Being discharged from a hospital can be overwhelming. Make sure you have someone with you to ask questions, take good notes and stand up for your interests — especially if you feel unprepared to leave the hospital in your current state, said Jullie Gray, a care manager with Aging Wisdom in Seattle.

This is the time to go over all the medications you’ll be taking at home, if you haven’t done so already. Bring in a complete list of all the prescriptions and over-the-counter medications you’ve been taking. You’ll want to have your physician or a pharmacist go over the entire list to make sure there aren’t duplicates or possibly dangerous interactions. Some hospitals are filling new prescriptions before patients go home; take advantage of this service if you can. Or get a list of nearby pharmacies that can fill medication orders.

Find out if equipment that’s been promised has been delivered. Will there be a hospital bed, a commode or a shower chair at home when you get there? How will you obtain other supplies that might be needed such as disposable gloves or adult diapers? A useful checklist can be found at Next Step in Care, a program of the United Hospital Fund.

Will home health care nurses be coming to offer a helping hand? If so, has that been scheduled — and when? How often will the nurses come, and for what period of time? What, exactly, will home health caregivers do and what other kinds of assistance will you need to arrange on your own? What will your insurance pay for?

Be sure to get contact information (phone numbers, cell phone numbers, email addresses) for the doctor who took care of you at the hospital, the person who arranged your discharge, a hospital social worker, the medical supply company and the home health agency. If something goes wrong, you’ll want to know who to contact.

Don’t leave without securing a copy of your medical records and asking the hospital to send those records to your primary care doctor.

Seeing your primary care doctor within two weeks should be a priority. “Even if a patient seems to be doing really well, having their doctor lay eyes on them is really important,” said Dr. Kerry Hildreth, an assistant professor of geriatrics at the University of Colorado School of Medicine.

When you call for an appointment, make sure you explain that you’ve just been in the hospital.

Adjust your expectations. Up to one-third of people over 70 and half of those over 80 leave the hospital with more disabilities than when they arrived. Sometimes, seniors suffer from anxiety and depression after a traumatic illness; sometimes, they’ll experience problems with memory and attention. Returning to normal may take time or a new normal may need to be established. A physical or occupational therapist can help, but you may have to ask the hospital or a home health agency to help arrange these visits. Often, they won’t offer.

It took a year for Barbara Charnes to stand up and begin walking after her ankle operation, which was followed by two unexpected hospitalizations and stints in rehabilitation. For all the physical difficulties, the anguish of feeling like she’d never recover her sense of herself as an independent person was most difficult.

“I felt that my life, as I had known it, had ended,” she said, “but gradually I found my way forward.”

* * *

Kaiser Health News is eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation.

Consider the Quarterstaff

My mini-vacation continues for a while this week, but there is new stuff here for you that I prepared in advance. Last Friday, in the comments on Ann Burack-Weiss's story, Consider the Cane, Jean Gogolin commented that she uses a "hiking stick" instead of a cane. That reminded of this post from 2008.

It was written by renowned geriatrician Bill Thomas who was then a columnist on this blog. He has since gone on to bigger things - his website is Changing Aging and he hosts his ongoing Age of Disruption Tour that you can find out about here.

Here is Bill's quarterstaff column from 2008.

* * *

In 1992, The New York Times took a look at the research AARP was doing on walking canes:

”Many people who use canes injure themselves because they don't do the necessary research before buying one. That is an early conclusion of a continuing study on canes sponsored by the American Association of Retired Persons.

“According to Dr. Margaret Wylde, vice president of the Institute for Technology Development in Oxford, Miss., which is conducting the study, the conclusion is based on a review of recent medical and rehabilitation literature and on more than 1,000 letters solicited from A.A.R.P. members who are regular cane users.

“Some of the most serious damage, Dr. Wylde said, can result from the cane's grip. Carpal tunnel syndrome, a painful ailment, can result from any repetitive motion like typing or using a cane.”

There are two reasons people use walking canes.

  1. To improve balance by providing a third contact point with the ground

  2. To redistribute weight away from an injured or arthritic lower limb

As a physician, I have never really liked walking canes. Here is one patient's experience:

”I noticed several problems within the first five minutes. My triceps were quickly fatigued as they worked to hold my weight up.

“As a result, my scapula elevated to relieve the triceps, putting strain on my rotator cuff. This "shrugging" effect could be somewhat offset by lowering the height of the handle below my waist, which served to extend the arm and reduce the amount of elevation in the shoulder.

“The handle of the cane was designed in such a way that the grip increased in broadness from the neck of the handle to the end, providing a wider, flatter surface where the palm would rest.

“Unfortunately, the result was not a more comfortable feel, but rather a terrible dorsiflexion combined with ulnar deviation in the wrist and a bruised hamate bone where the weight was concentrated. I felt tweaks of pain all day long in my wrist and shoulder which continued into the night, long after I had ended my experiment.

“Aside from design problems, there were several functional problems as well. For instance, each step was accompanied by a jarring vibration which was transferred up the entire length of the arm every time the rubber cane tip struck the concrete. The swing of the cane often had to be initiated by a flick of the wrist, resulting in a constant repetitive oscillation between ulnar and radial deviations.

“Furthermore, adjusting the cane to the correct height was difficult due to a simultaneous push of a button and pull of the shaft requiring relatively dexterous fingers; arthritic hands would be pitifully ineffective.”

PREDICTION! Elders of today and tomorrow are going to give up on the cane, abandoning it in favor of the quarterstaff.


"Gandalf the Grey carried about with him a spike brown staff which served partly as an agency of his power, as can be seen when he faced the Balrog in Moria. Besides functioning as a useful walking stick, it was also thought to symbolize what he was and his position in the Istari."

There are three reasons I think elders can and will retire the old-time walking cane and embrace the quarterstaff:

  1. The cane places the greatest strain on the smallest muscles and joints (the wrist and forearm). Repetitive use can easily lead to wrist and forearm injury.

  2. The quarterstaff transfers the weight into the shoulder girdle itself. The shoulder joint and its surrounding muscles are much better prepared to handle the load than are the wrist and forearm.

  3. Imagine a scene: an older woman using a bent-top walking cane crosses a building lobby, trying to reach the elevator before the doors roll closed. Now imagine the same scene with the older woman striding across the lobby with the aid of a seven-foot, oak quarterstaff. People hold the door open not because of chivalry, not out of a desire to help little old ladies, but rather because she just looks so damned cool.

Elders are obligated to give younger people clues about how deep and mysterious elderhood can be.

I'll close my appeal with a quote from one of America's greatest walkers...

"Although the vast majority of walkers never even think of using a walking staff, I unhesitatingly include it among the foundations of the house that travels on my back. I still take my staff along almost as automatically as I take my pack. It is a third leg to me - and much more besides.

“On smooth surfaces, the staff helps maintain an easy rhythm to my walking and gives me something to lean on when I stop to stand and stare. Over rough going of any kind, from tussocky grass to pockety rock, and also in a high wind, it converts me when I am heavily laded from an insecure biped to a confident triped…

“It may well be, too, that the staff also gives me a false but subconsciously comforting feeling that I am not after all completely defenseless against attack by such enemies as snakes, bears and men."

- Colin Fletcher, The Complete Walker III, 1984 (page 78)

[AFTERWORD from Ronni: For about the last six or seven years of her life, until she died in 1978, Margaret Mead and I lived across the street from one another in Greenwich Village. I didn't get to know her well but we sometimes walked several blocks together on our errands around the neighborhood.

She always used a quarterstaff, although I didn't know it was called that. She looked magnificent and powerful striding down the block, especially in the colder months when she wore a full-length cape.

I've known since then that when the time came, I would use a staff and not a cane if at all possible. Now, with Dr. Thomas's permission for us to do so even if we don't require one yet and the Colin Fletcher quote, I may start sooner.]

UPDATE: In the comments below, Wendl asked how to choose the correct size of quarterstaff or walking stick. Here is a short video that makes it easy to know:

And if you'd rather not hunt for my answer below to Wendl's question about how to search online for quarterstaffs - here's what I wrote:

"Quarterstaff is a kind of medieval word that Bill Thomas likes and I do too but most people don't know what it means. So search "walking sticks" instead. There are many different kinds sometimes called a hiking stick, walking pole, walking staff and various combinations of those words.

"Search those and you'll find a large variety of choices."

Good and Bad “Entitlement” News From Congress and Trump World

Good News on Medicare Observation Status

Many readers have emailed about this issue - one that is boring to read about but crucial to understand. First, a short background:

Medicare Observation Status has been a frightful bugaboo for beneficiaries for years. Patients can be treated in hospitals under “observation status” - often for days – without being formally “admitted.”

Hospitals do this, explains Robert Pear in The New York Times, “for fear of being penalized by Medicare for inappropriate admissions.”

What it means for patients is that they become liable for substantial hospital bills and nursing home care. Medicare payment requires three consecutive days of admission as an inpatient. As Pear tells us:

“Time spent under observation does not count toward the three days, even though the patient may spend five or six nights in a hospital bed and receive extensive hospital services, including tests, treatment and medications ordered by a doctor.”

The good news is that on Saturday, 6 August 2016, a new Medicare law went into effect. Named the NOTICE Act, it

”...requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted...

"Under the new law, the notice must be provided to 'each individual who receives observation services as an outpatient at a hospital for more than 24 hours.' Medicare officials estimate that hospitals will have to issue 1.4 million notices a year.” [emphasis is mine]

Notification will begin in January and as positive as that is, it still falls far short of protecting elders from life-crushing costs because hospitals can still keep patients under observation status as long as they notify them.

Like me, you may wonder how notification is possible if, for example, a patient arrives at a hospital in pain, bleeding or even unconscious. If I were in dire physical condition, I'm fairly certain I'd nod agreement to pretty much anything to get some relief and treatment.

Judith A. Stein, the executive director of the non-profit Center for Medicare Advocacy, agrees. She says this new law is a good first step but does not go nearly far enough.

To that end, another bipartisan bill is under consideration in Congress. Pear of The Times again explains for us:

”Twenty-four senators and more than 120 House members are supporting bipartisan legislation to address that concern. Under that bill, time in a hospital under observation would count toward the three-day inpatient stay required for Medicare coverage of nursing home care.”

When Congress returns, we will keep an eye on how that legislation is moving forward although it would not be a surprise if it stagnates until the new Congress is sworn in next January.


Republican nominee Donald Trump has several times said he would, as president, leave Social Security and Medicare as they are.

That is not really good enough but it is a step forward from the opponents he defeated in the primaries who all wanted to cut “entitlements,” as Republicans always do.

One morning last week, 16 August to be precise, MSNBC was droning in the background as I caught up with email.

Host Stephanie Ruhle was speaking with a former Navy Seal and current Trump surrogate, Carlie Higbie, about Trump's call for “extreme vetting” of immigrants, what the phrase means and how it would be carried out.

As Higbie explained it, our current law enforcement agencies are incapable of vetting immigrants and the country needs a commission of experts to find the kind of people who can do extreme vetting.

Here is the transcript from that point [emphasis is mine].

STEPHANIE RUHLE: Who are these people that aren't currently doing it for us?

CARL HIGBIE: What we will have to do is you have to look outside of the law enforcement agencies that we have that our hands are tied so tightly they're worried about being profiled, you know, being called a radical or any type of profile, that we need to bring people in here, intelligent people from the private sector that understand this threat and that can actually operate without the fear of bureaucracy.

SR: But, Carl, what are you gonna pay them with? Donald Trump at the same time has made it very clear he's going to reduce our debt. If you're looking to get experts from the private sector, these boys and girls get paid a lot of money.

CH: They do. But you know what? There's plenty other places to cut. If we're expanding our vetting process here, we probably can get border security somewhere else. We can probably cut a number of federal programs. I mean, heck, we give trillions of dollars away in entitlements every year. We can cut some of those.

Well, heck, why not get rid of those pesky “entitlements” - you know, Social Security and Medicare that recipients paid into all their working lives? Just dump them.

Do we think Mr. Higbie is speaking for Donald Trump? I haven't paid close attention to this idea, but do surrogates lay out policy positions that candidates' don't want to say out loud themselves?

As long as Mr. Higbie is being described publicly as a Trump surrogate, I'm going to assume he speaks for Donald Trump. What about you?

(You can watch the exchange between Ruhle and Higbie here.)

Getting Elder Sex Out of the Closet

One of the pleasures of writing this blog for so many years - more than a dozen so far - is watching how issues affecting elders sometimes get better.

When I began doing this, the general attitude toward old people having sex was “ick” and in fact, nursing, assisted living and other care homes had rules against sex between residents - even, sometimes, married couples.

Those rules have been widely relaxed in recent years, but I recently ran across this report about how such personal rights of residents in some assisted living residences are restricted:

”...these facilities share a mission of providing a homelike environment that emphasizes consumer choice, autonomy, privacy and control” reports Medical News Today of the research done in several care homes in Georgia...

“The study found that staff and administrators affirmed that residents had rights to sexual and intimate behavior, but they provided justifications for exceptions and engaged in strategies that created an environment of surveillance, which discouraged and prevented sexual and intimate behavior.”

Contrast that to a well-known care home in New York City, that has had a rational, life-giving, respectful attitude toward the sexual desires of its residents for more than 20 years. As Bloomberg News reported it in 2013:

”'The nurse was frantic,” as Gruley relates the story. “She’d just seen two elderly people having sex in a room at the Hebrew Home at Riverdale, New York. She asked Daniel A. Reingold, then the home’s executive vice president, what she should do.

“'Tiptoe out and close the door so you don’t disturb them,' he told her.

“In 1995, the home adopted a four-page policy - considered the first of its kind - stating that residents 'have the right to seek out and engage in sexual expression,' including 'words, gestures, movements or activities which appear motivated by the desire for sexual gratification.'”

Notwithstanding complications in such a policy that must be addressed for people with varying degrees of cognitive difficulty, having anything less than a policy closely resembling the one at the Hebrew Home not only breaches elders' human rights, it infantilizes them.

It takes a long time for long-held beliefs to change (see civil rights, women's rights, religious bigotry, etc. etc.) and although I can't be sure, reports of repression of sexual activity in assisted living seems to be declining fairly quickly now.

A recent story in The New York Times reveals that the Hebrew Home has further expanded its liberal attitude toward sex among residents:

”The Hebrew Home has stepped up efforts to help residents looking for relationships. Staff members have organized a happy hour and a senior prom, and started a dating service, called G-Date, for Grandparent Date. Currently, about 40 of the 870 residents are involved in a relationship.”

You can read the Hebrew Home's now six-page Residents Sexual Rights policies and procedures here [pdf].

The Hebrew Home has been ahead of many others on the issue of residents' sexual rights but stories like this one about a recently released research study of 6,800 people age 50 to 89, from Coventry University in the U.K., can help change even more minds:

”In our analysis, we took into account many factors that might influence either sexual activity or cognition – age, education, wealth, levels of physical activity, cohabiting status, general health, depression, loneliness and quality of life.

“Even after adjusting for all of these factors statistically, we established that there is indeed an association between sexual activity and higher scores on tests of cognitive function in people over the age of 50 years.”

Obviously, the next question is whether sex improves brain power or vice versa. Either way, it couldn't be a bad thing.

Sometimes it appears that the business and creative communities are ahead of science. There is a growing number of movies about love between old people, including sex scenes. I wrote about some of them last year that you can find it here.

The website Stitch has been helping elders find love - or just companionship and new friends - for two years now, and there is a movie from 2015, The Age of Love, about an evening of speed dating that was held in Rochester, New York, exclusively for people age 70 to 90. As the producers explain:

”Faced with feelings 'even our own kids never ask about,' each dater’s intimate confessions blend with revealing vérité to shed light on the intense and complex feelings that still lurk behind wrinkled skin and thinning hair.”

Here is the trailer:

The Age of Love is not playing in theaters but there is a list of about two dozen screenings in cities throughout the U.S. at the film's website along with a page where you can find out how to host a screening in your area.

Undoubtedly, there are young people who still don't want to know anything at all about old people having sex (ewww!) and that's fine. They will be glad when they're our age that our generation helped make it okay for them to be sexy.

End-of-Life Doulas

Dr. Susan Cohen is director of the palliative care program at Bellevue Hospital in Manhattan. In this video, she talks about the volunteers of the Doula Program to Accompany and Comfort who work with her medical group's patients. Note the age range of the volunteers in the training program:

A doula (pronounced DOO-la) is an ancient Greek word meaning a woman who serves other women. Most often through the centuries, doulas have helped care for women just before, during and after childbirth.

Doulas still exist for that purpose but in recent years another kind of helper has adopted the name: doulas who provide emotional, spiritual and practical comfort for people who are dying.

End-of-life doulas are not all women. Here is a description of one of the earliest doula programs from The New York Times in 2004:

”He was a retired corporate lawyer in his mid-60's, recruited into a new program that paired volunteers somewhat enlightened in the particulars of death (they were called 'doulas') with terminally ill people alone with their mortality.

“After all, there's no rental agency for friends, for when you're sick and staring death in the face. Bill Keating belonged to the program's first full crop of volunteers, nine strong...”

In 2011, Baylor University reported on their doula program that they had developed after reading The New York Times story:

”Out of a firm belief that no patients at Baylor University Medical Center in Dallas should have to...die alone, Baylor's Supportive and Palliative Care Service developed and implemented the Doula to Accompany and Comfort Program...

“For the last 5 years, members of the palliative care team have screened and selected volunteers for the doula program. Volunteers are asked about their views on death and their motivation for taking on the role of doula.

“Once selected, volunteers are trained by professionals in the stages of death and dying, grief and grieving, advocating for patient needs, comfort touch, compassionate presence, active listening, communication strategies, and spiritual and cultural beliefs at the end of life.

“The doulas provide comfort and companionship to those patients who do not have family support, who feel lonely or abandoned, or whose caregivers are exhausted and desire respite.

Baylor's carefully developed volunteer doula program notwithstanding, anyone can call her- or himself a doula and hang out a shingle. Some have had careers as registered nurses before becoming doulas and some of those have worked in hospice. Most have not.

There are at least two doula certification programs in the United States that are unaffiliated with hospitals and other medical groups. One of these for-profit businesses charges $75 for 22 hours of training for certification. Another charges from $970 to $1650 for various levels of certification, although there is no organization outside hospitals' end-of-life doula programs that sets professional standards.

One highly respected non-profit, Doula Program to Accompany and Comfort, in New York City (which may be the origin of the Baylor program) trains end-of-life doula volunteers who then provide end-of-life to individuals at home, in hospitals, other care facilities and through such organizations as the Visiting Nurses.

As their website states:

”The Doula Program to Accompany and Comfort's mission is to minimize the isolation and loneliness experienced by individuals with life threatening illness who are facing the end of their lives alone. Individuals are known beyond their diagnosis, through special relationships with a doula volunteer.”

This is one of the earliest doula organizations, dating from 2001. Volunteers range in age from 20 to more than 80. The Doula Program provides their volunteers for free, supported by foundation and individual donations.

Here is another video – this one of Gus explaining how being a Doula Program volunteer is important to him:

You can find out about the history and mission of the Doula Program to Accompany and Comfort here. And this print interview with a freelance end-of-life doula in the United Kingdom is a nurse's point of view.

Almost all old people, when asked, say they want to die at home but a lot of us have no have family or close friend, or no one whose circumstances allow them to accompany an elder on this final journey.

End-of-life doula programs are not the same thing as hospice but are there for people in addition to it - perhaps we could say side-by-side with hospice - another, newer choice for people who would otherwise have no one at the end of their lives.

It is a life-affirming, selfless mission in which everyone benefits.

Addicted to Trump

A couple of days ago, I caught myself having a craving. It was a surprise because I haven't seriously experienced a yearning that strong since I quit smoking cigarettes years ago. Here's what happened:

It was early afternoon. I was at the computer working on an upcoming blog post when irresistibly I was pulled to the TV remote and clicked on one of the cable news channels.

Understand that I was both busy and on a roll. I had been at it for a couple of hours. There were a bunch of open documents on the screen and spread around on the desk as I was pulling together information to explain to you, dear readers, what I was writing about and it was going well.

But my brain, on its own with no conscious coercion from "me" switched to another thought stream: to Donald Trump. Interrupting everything else, it suddenly felt overwhelmingly urgent, at that moment and not later, to find out what the latest outrageous statement from the person Charlie Pierce at Esquire calls “the vulgar talking yam” might be.

It took only momentary reflection to realize that I have been functioning this way for many months – I get antsy if more than a couple of hours go by without checking the latest Trump news.

I have always been a news junkie. In the olden days, The New York Times was delivered to my door and I read a lot of it in the subway on my way to work where a stack of five or six other newspapers awaited my attention when I arrived.

Back then, my routine was to stay home on Monday evenings to read all the weekly news magazines. I also tracked the television news programs, both evenings and the Sunday pundit shows.

I adapted my news routine as cable news channels were launched and as news and political websites proliferated on the internet, I largely switched from paper to electronic reading.

Obviously I consume a lot of news and although politics and ageing are my two biggest interests, I keep track of a lot more. These days, the first two-to-three hours of my day involve reading news online while taking in the caffeine required to fuel my day.

Before this election campaign, I usually checked the news again during lunch, when I was home, and sometime in the late afternoon or early evening. But my addiction has changed that.

The obsessive need to check cable news and online headlines and updates goes on all day, interrupting whatever I'm doing. Before I lost 40 pounds a few years ago, I stopped halfway through vacuuming the house to rest and catch my breath for a few minutes. Nowadays, I stop to check the news.

Since this election campaign began, I've been known to shut a book I'm reading in bed or click away from a movie I'm watching in the late evening to check for Trump updates.

None of this is rational any more than drug addiction is rational.

Beyond the personal idiocy, several things bother me about what I'm doing. The most important general truth about life I have learned all on my own over these 75 years is that if “it” - whatever that may be – is happening to me or if I think it or do it, I am not alone. Millions of other people do too.

So it follows that some percentage of you are as addicted to Donald Trump – as a phenomenon, as a terrifying potential president - as I am.

On one level, the addiction is understandable. There has never, in my lifetime, been a presidential candidate who is as much a train wreck as the vulgar talking yam. And like a train wreck, it is impossible to look away.

Through all this, Secretary Hillary Clinton doggedly continues discussing policy from state to state but she gets about one-tenth the television and other media attention as Trump.

So I wonder, whatever the result of the election in November, if this bizarre, crude, loutish and dangerous campaign style of the Republican candidate will have become the new normal, and people like me who cannot take their eyes off it are partly to blame.

Excuse me now while I go check on what Donald Trump has said today.

Medical Marijuana Lowers Medicare Prescription Drug Costs

Here's a surprise – look at this headline from NPR:

After Medical Marijuana Legalized, Medicare Prescriptions Drop For Many Drugs

The story is based on a study published in July at Health Affairs. As the abstract of that research notes:

”Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented.”

The NPR story, which was originally published at Kaiser Health News, goes on to explain why cannabis can be a better option than some other prescription painkillers:

”Marijuana is unlike other drugs, such as opioids, overdoses of which can be fatal, said Deepak D'Souza, a professor of psychiatry at Yale School of Medicine, who has researched marijuana.

"'That doesn't happen with marijuana, he added. 'But there are whole other side effects and safety issues we need to be aware of.'”

As a lifelong pot smoker, I am not concerned much with side effects which are so much milder and less dangerous than, for example, alcohol.

Meanwhile, recreational marijuana use is legal in four states (Alaska, Colorado, Oregon, Washington) and the District of Columbia. Just last Friday, the governor of Illinois signed legislation decriminalizing minor cannabis offenses. And in November, at least nine states will vote on some form of legalization.

Of course whatever is decided in individual states, marijuana is still illegal on the federal level because, the government maintains, it has a high potential for abuse, no medical use, and severe safety concerns – all of which, I believe, are woefully out of date, unsubstantiated opinions.

The research published in Health Affairs notes that the

”...national overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013.”

That's not much money and nobody should take the savings in Part D payments seriously because patients are paying for the marijuana out of pocket instead of billing Medicare.

Should the day come that Medicare pays for cannabis treatment, the savings would be reduced or eliminated depending on the price compared to the drugs for which it is substituted.

Nevertheless, cannabis is already big business in the states that have legalized it and I believe that before long, the federal government will remove it from the list of Schedule I drugs for just that reason – money: there are billions of dollars to be made and big corporations want in on that profit.

Here is a video about exactly that from CNN Money:

Now it's your turn. What do you think about legalizing marijuana and having it covered by Medicare Part D?

Recovery Time in Old Age

So far in my old age – I am 75 – I have been lucky in my health (I say that with multiple knockings on wood). I have no intrusive afflictions, no conditions, no diseases, nothing that requires medication.

I owe a lot of my good health, I tell myself, to a strong, peasant gene pool and without being zealous, try to eat well, exercise regularly and get enough sleep.

That doesn't mean I haven't slowed down. I don't have the energy reserve now that during most of my earlier life was so easily available that I didn't notice or appreciate it. I wear out more quickly these days and it takes longer to recover when I have overdone.

I mention this today because time was, one good night's sleep refreshed me from any extra strain on my body. No longer.

On Tuesday, I underwent more dental surgery. You've heard this story before but that was my upper jaw, now in excellent working order. This year it is the lower jaw.

The surgery was no small undertaking. It lasted about an hour-and-half involving cutting out an old bridge, inserting a temporary one, mostly cosmetic so there is not a gap in my smile while the two implants that were also inserted on Tuesday take the next four months to fuse with bone after which the new overdenture can be crafted.

I napped most of the rest of the day and slept more soundly than usual that night - for all the good it did me: I didn't feel much different on Wednesday so I took another day off from life. And, except for this post, another one on Thursday so I would be rested enough to enjoy a two-hour Friday morning group meeting I was looking forward to.

The recovery seems lengthy – two-and-a-half days – but too often we (read: I) forget that dental surgery is, after all, surgery and just because I don't have a big bandage or cast to show off, doesn't mean it's not a bodily invasion by foreign objects involving blood and, when the anesthetic wears off, pain.

It took every bit of that recovery time for me to feel right again this week and it's not that I didn't know I would need it. It had take several days during similar surgeries for my upper jaw - I just forgot and therefore was blindsided with the time needed this week to feel restored.

(NOTE: I'm not looking for sympathy with this post. After nearly two years of continuing dental work, it has become more of an annoyance than anything else. I've learned how to manage residual pain and to prepare ahead to have soft foods ready during the healing period. But that doesn't shorten the recovery time.)

A week or two ago, a friend said to me, “No one tells you these things about growing old when you're young.” She was specifically referring to how much longer it takes to do all kinds of things after 50 or 60 or 70, and that it would have been nice to be warned.

I've often said that myself. I've probably written it in these pages too. But I've had plenty of time to think about that this week and I've changed my mind.

Why clutter up other people's younger years with news that would only be taken as a bummer?

The changes of ageing come to us gradually over decades and even as we might resent them, we accommodate them as needed, as (ahem) time goes by.

And anyway, who would believe us when we say that the day will come when you cannot play tennis all afternoon, prepare a dinner for 10 guests and then go dancing until 2AM without a second thought?

I would not have believed it – or, at least, not taken it seriously - even in my forties. So unless they ask, let them find out in their own time, I think now. Most of us manage the surprises of age without too much fuss, forgetful as I was about them this week.