472 posts categorized "Health"

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

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(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.

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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.

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(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.

Not Enough Geriatricians

When I moved to Oregon in 2010, and needed a new physician, I used the internet to track down the geriatricians in my area. About half the listings included a note that the doctor was not taking new patients.

When I telephoned the remaining names on my list, each one told me they were not taking new patients.

So much for finding healthcare that actually relates to my stage of life and needs.

FACT: In 2014, there were 46.2 million people 65 and older in the U.S.

FACT: In 2030, there will be about 71.4 million people in the U.S. 65 and older

FACT: Currently, there are about 7,000 geriatricians in the U.S. - about one for every 6600 people.

As The New York Times reported in January,

”The American Geriatrics Society estimates that to meet the demand, medical schools would have to train at least 6,250 additional geriatricians between now and 2030, or about 450 more a year than the current rate.”

In case you are misinformed – many people are - the Times article also includes a good, short explanation of what a geriatrician is:

”...a physician already certified in internal or family medicine who has completed additional training in the care of older adults. In addition to providing clinical care, geriatricians are skilled in navigating the labyrinth of psychological and social problems that often arise in the aging population.”

Some people, even some physicians, believe that primary care doctors can delivery the same-quality care to elders as geriatricians. Elizabeth Eckstrom, a geriatrician who happens to practice right near me in Portland, Oregon, refutes that:

”If primary care doctors were providing optimal care to older adults, polypharmacy would not be one of the leading killers in that population. Fifty percent of dementia would not be missed in primary care practices. Many patients with delirium would not be missed by physicians in our hospitals.

“Recent evidence about care provided by geriatrics teams shows that hospital length of stay is about one day shorter, costs less, and has fewer complications, including falls, pressure ulcers, and catheter-associated urinary tract infections.”

Dr. Eckstrom also says not every elder needs a geriatrician but has called for additional training of all types of health care providers (except pediatricians).

Many residencies in geriatrics go empty. The biggest reason is that geriatricians are paid much less than other specialists. They can expect an annual income of about half that of other specialties - $200,000 versus $400,000. Their insurance reimbursement is usually less that other physicians because elder care just takes more time than other specialists require.

”Unlike other physicians who might specialize in one organ system or disease, geriatricians must be adept at treating patients who sometimes are managing five to eight chronic conditions, reports U.S. News and World Report.

“...Geriatricians also 'pay special attention' to a person’s cognitive and functional abilities, including walking, eating, dressing and other activities of daily living, McCormick says. 'Geriatricians take a holistic approach. We look at how we can help patients to be as functional as possible and exist in the community in the best way possible,' he says.

American surgeon, Atul Gawande, wrote the best, most eloquent explanation of the complexities of geriatric care I've ever read. It is a long story in the 30 April 2007 issue of The New Yorker magazine titled “The Way We Age Now.”

For the story, Dr. Gawande shadowed a geriatrician through his day seeing patients and recounts in detail the entire examination and the many questions the geriatrician asks one 85-year-old woman who lives on her own. Then -

”In the story of Jean Gavrilles and her geriatrician, there’s a lesson about frailty. Decline remains our fate; death will come. But, until that last backup system inside each of us fails, decline can occur in two ways.

“One is early and precipitately, with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals. The other way is more gradual, preserving, for as long as possible, your ability to control your own life.

“Good medical care can influence which direction a person’s old age will take.

“Most of us in medicine, however, don’t know how to think about decline. We’re good at addressing specific, individual problems: colon cancer, high blood pressure, arthritic knees. Give us a disease, and we can do something about it.

“But give us an elderly woman with colon cancer, high blood pressure, arthritic knees, and various other ailments besides—an elderly woman at risk of losing the life she enjoys—and we are not sure what to do.”

This is what geriatricians are for – to “think about decline” and to preserve, “for as long as possible, your ability to control your own life.”

And bless every one of them for doing so.

Unfortunately, most of us will not have that kind of care and will need to educate ourselves in our own care to work with the kind of physicians we have.

From an article last week in Kaiser Health News:

”[Dr. Todd] Goldberg also teaches at the Charleston division of West Virginia University and runs one of the state’s four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field.

“For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years.

“'This is not just our local program, or in West Virginia,' said Goldberg. 'This is a national problem.'

“The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled.”

One more problem in our world for which there seems to be no solution.

What to Expect From the Free Medicare Wellness Visit

The Affordable Care Act (ACA), or Obamacare, includes several benefits for Medicare beneficiaries including a Welcome to Medicare Wellness Visit.

This is not a substitute for a more extensive physicial exam but a way for your physician to ask some questions about your health and work with you to develop or update a plan to prevent disease.

I was reminded of this recently when my internet friend, Chuck Nyren, published a report at his Huffington Post blog (where he describes himself as “Writer, Gadfly, Troublemaker”) about his first wellness visit.

It was a good reminder to me to tell you about it but on second thought, why reinvent the wheel, I thought. Besides, Chuck is a funnier guy than I am and he gave me permission to reprint his story titled Welcome to Your Welcome to Medicare Visit. Here's Chuck.

* * *

I didn’t ask if it was mandatory when this lady called, I just said, “Yeah, yeah, I’ll do it.” A free exam of some sort because you’re now sixty-five was what she wanted me to schedule. I did.

She said it wouldn’t be with my doctor but with a health care professional. I was only half listening. “And the best part is you can spend a whole hour with her! Not like with your Provider where you’re only allowed fifteen minutes.”

My egoism got the better of me. A whole hour talking about me, and if I’m not talking about me the other person is talking about me. That sounded great.

On my way to the appointment I tried to think of things to talk about. My arthritic knees had been overly achy lately but for the last few days had been fine. Other than that, I felt pretty good. It was weird going to the doctor when there was nothing wrong with you.

A nurse called my name. I was weighed, had pounded up a bit over the winter. I’ll lose it. Blood pressure was high a tad, lungs and heart sounded good. She shook out an octopus array of wires and I had a quick EKG. Heart = Fine. The nurse left and I spent a few minutes yanking off the stickies from crannies on my torso I never knew existed.

Marlene knocked and entered. “Welcome to your Welcome To Medicare Wellness Exam!”

“Thanks!” I said. I was chipper. She was chipper. We were chipper.

“Over the weekend I spent some time looking over your medical history,” she said.

“So that’s why my ears were burning!”

She readied herself to type. “Is there something wrong with your ears?”

“Ummm, no. A little wax, maybe.”

She typed something.

After documenting the faux affliction, we got to the real ones. I’d had some issues over the last few years, mostly one-offs like an episode of gout, shingles, a fainting spell (documented here on Huffington Post), some panic attacks years ago that still ambush me every so often.

The rest were namby-pamby boring stuff — none worthy of even a mention in a TV medical drama. A kidney stone fifteen years ago, psoriasis on and off. With every affliction mentioned, she typed and typed.

“It says you have cancer in your family.”

“Yes. Here and there.”

“Any family history of heart problems?”



“A brother and a grandmother. You probably see there that I took a bunch of blood tests a few months ago and everything was normal except my triglycerides were a bit high.”

We went through my medications. “Do you still take Cialis?”

“...Sure, when needed. Although I don’t really need it. If I take it it’s only a nick off the pill to counteract the very small, daily dose of Zoloft. If a hotsy-totsy night is planned, it just makes things a lot easier for, you know...everyone involved.”

She typed something.

There was talk about my thyroid. This was the first I’d heard of it. (A blood test was ordered, the next day it came back in the normal range.)

We said our goodbyes and I was out the door with a few pages of hard-copy in my hand. I imagined it read, You’re fine, go home.

I don’t remember exactly where I was when I actually looked at the first page — either outside the car and about to open the door or already in the driver’s seat. It’s all a blur now. Manually highlighted in blinding yellow was this list:

You Were Seen Today For
History of Adenomatous Polyp of Colon
Spondylosis Lumbosacral Region, unspecified spinal osteoarthritis complication
BMI 32.0-32.9, adult
Thyroid Mass of Unclear Etiology
Anxiety Disorder
ED (erectile dysfunction)
Essential Hypertension
Cerumen Impaction
Risk for falls
History of Nephrolithiasis

I have no memory of driving home. I’m surprised I made it home at all because I’m obviously dying.

That was a week ago, and I’m still miraculously hanging on. I’m afraid to move, to breathe. If I do either, it’s done cautiously. Any wrong move might kick in one of my conditions, and I’ll kick.

I walk into the doctor’s office with bad knees. I walk out with a Death Sentence.

My new take on medical visits: Fifteen minutes is much too long. Who knows what could happen during such an excruciating amount of time. From now on I want my appointments to be no more than thirty seconds, maybe less. They’d go something like this:

Doctor walks in. “What’s wrong?”

“Sore throat.”

“Open and say “Aahhh.”


“I’ll write up a prescription and you can pick it up at the front desk. ‘Bye.”


The less I know, the healthier I’ll feel.

* * *

Ronni here again. I'm pretty well in sync with Chuck about how to deal with doctor's visits but there is a serious point to this too – that you should take advantage of these free wellness visits.

Anyone with Medicare Part B is eligible. It is free to almost everyone as long as your physician accepts assignment, and the Part B deductible does not apply although if the doctor orders tests not approved for the visit, you may owe a co-pay.

The Welcome to Medicare Visit can be done anytime during the first 12 months after you've joined the program. You do not need to have done the Welcome Visit to take advantage of the annual wellness visit.

There is more information about both visits – which are not the same thing as more extensive physical examinations – at medicare.gov.

UPDATE: A reminder for all medical/health posts. In the comments you may not recommend any specific kind healthcare, treatment, physician, medication, etc. or link to any website related to those areas or to any commercial product.

What is Old People's Voice and Why Does It Happen?

A few days ago, TGB reader and my good friend Wendl left a comment wondering about her recent vocal changes:

”...weaker, cracky, hoarse, reedy, phlegmy, etc. I think my vocal cords actually started changing when I retired and stopped talking all day. Use 'em or lose 'em?”

We all know what Wendl is talking about – I call it old people's voice - and she has done a good job of describing it in almost the same words as the medical professionals do. They call it presbyphonia which just means “changes associated with the ageing voice.”

I spent way too much time online looking for an audio example for us and found mostly actors doing impressions of old people's voices so that will have to do.

Here is a pretty good one titled: Older Woman: Voice Acting. There are three variations. The closest to what we're discussing today is the first and it ends at :45 seconds. You can skip the rest of the video.

Geriatric otolaryngology is the study of the ear, nose, mouth, throat, larynx and pretty much anything else from the neck and above as it relates, in this case, to old people.

Otolaryngologists used to be called “ear, nose and throat doctors: or ENT for short.

The Australian website entwellbeing is remarkably consistent with Wendl's description of this condition of the voice,

”...the inability to produce adequate sound using the vocal mechanism. People with presbyphonia may experience:

Occasional or frequent breaks in their voice
A breathy vocal quality
Laryngeal tension
Sudden interruptions in the normal flow of speech – stoppages in phonation
Reduced pitch and loudness

NBC News explains the underlying causes:

”When we age, our vocal chords weaken and become drier...Weakened and dry vocal chords become stringy, which prevent normal vibration, causing higher pitched voices that sound thin.

“And the transformations in the respiratory system and chest mean we have less power behind our voices. Even the joints in our vocal chords can become arthritic, contributing to problems.”

There are good descriptions of the five ways our voices change at the verywell website. Here's their take on how pitch changes:

”According to Clark Rosen, professor of otolaryngology at the University of Pittsburgh and director of the University's Voice Center, a woman's pitch typically drops over time, whereas a man's pitch actually rises slightly with age.

"'We don't know exactly why this occurs,' says Rosen. 'Like other vocal shifts, changes in pitch may also be due to atrophy of the muscles in the vocal folds, and in women it may be thanks in part to hormonal changes leading up to and past menopause. We do know there's quite a consistent pitch change by gender.'"

You will find equally clear explanations for the other four changes at verywell.com.

Although benign vocal changes are common as we age, Rosen says they can occasionally be a warning:

”If you're hoarse for more than two weeks - especially without a trigger like a cold or flu or if you are a long-time smoker - seek out the advice of your doctor since you may be at risk of a more serious problem like vocal cord nodules or even laryngeal cancer.”

Disease aside, there are treatments for “old people's voice.” Otolaryngologist and Director of the Johns Hopkins Voice Center Lee Akst says that “Good vocal hygiene, such as staying well-hydrated and not yelling or screaming is a must,” and speech therapy can be effective:

”Akst notes that most patients improve with voice therapy alone. While they may not sound like they did when they were 40, voice therapy helps promote a stronger voice.

“For those still struggling to be heard, a procedure called vocal cord augmentation involves injecting a synthetic filler into the deepest muscle layer of the vocal folds. This more invasive therapy can last from just a few months, to a permanent change in the case of a surgical implant.

"'It's an uncomfortable procedure, with a risk of side effects like bleeding,' says Akst. 'It works best in conjunction with voice therapy, and if you were to choose only one course of treatment, you'd do better with just voice therapy.'”

Or, unless people really cannot hear you, you could just live with it. I know quite a few people with presbyphonia and have no trouble understanding them.

Annual Extreme Heat Advisory for Elders Plus an Extra Treat

A lot of important, even crucial things in life are really dry and boring to read. This is one of them. So I've arranged a treat for you at the end, but only if you read all the way through. Don't skip anything. Don't peak. Don't cheat. Read it all and THEN you get to laugh your ass off.

* * *


About half the United States has been burning up over the past couple of weeks and summer's been here only a week or two. Secretary of State John Kerry is all over television saying 2016 is already the hottest year on record, although climate change deniers are – well, denying it is true.

I'm betting those people also believe the moon landing was faked and President Barack Obama is a Muslim. Moving right along...

As you certainly know, excessive heat is more problematic for old people than most younger ones because our body temperature regulators don't work as well as they once did.

According to the Centers for Disease Control (CDC), there are about 650 heat-related deaths each summer in the U.S. and the number has been rising.

In 2012, one half of those deaths affected people 65 and older and that's not unusual. Among the groups most vulnerable to heat-related illness or death are the very old, children four and younger, and those with chronic medical conditions such as diabetes and heart disease.

So this is my annual summer heat warning post. Boring maybe, but crucial to understand the difference between heat exhaustion and heat stroke and how you can prevent them.

HEAT EXHAUSTION occurs when the body gets too hot. Symptoms are thirst, weakness, dizziness, profuse sweating, cold and clammy skin, normal or slightly elevated body temperature.

Move yourself or someone experiencing these symptoms to a cool place, drink cool liquids, take a cool bath or shower and rest.

HEAT STROKE is a medical emergency. It can cause brain damage so get thee or the affected person to a hospital. It occurs when body temperature reaches 104 or 105 in a matter of minutes.

Other symptoms include confusion; faintness; strong, rapid pulse; lack of sweating, flushed skin, bizarre behavior and coma. Don't fool around with this. Call 911 immediately.

The first rule is drink lots of fluids during hot weather. Old people don't always feel thirst when their bodies need hydrating so keep a glass of water nearby.

Here is a list for keeping cool in summer heat.

Wear light-colored, loose clothing.

Heat waves are not the time to skimp on the electric bill. Turn up the air conditioning when you need it.

If you do not have air conditioning, now is the time – before a heat emergency – to find out the locations of your city's cooling centers. Hundreds of cities use school gyms and other large gathering places to help people cool down during the worst of the day's heat.

You could also go the movies, the mall or visit a friend who has air conditioning during the afternoon.

If you have air conditioning, invite a friend who does not have it to visit you during the hottest hours of the day.

If you must be out and about during a heat wave, do your errands in the early morning. Schedule appointments before the highest temperatures of the day.

Eat light meals that do not need cooking. High-water-content foods like cantaloupe, watermelon, apples and other fruits are good.

Keep window shades lowered and curtains drawn during the strongest heat of the day.

Some medications for diabetes, high blood pressure and other conditions can inhibit the body's ability to cool itself. If your area is experiencing a prolonged heat wave, perhaps ask your physician if you can forgo or reduce the amount of those medications for the duration.

Have I left out anything? Do you have more suggestions?


I know you didn't cheat, right? You read every word of this important extreme heat information. Good for you. Now here's your treat for being so diligent.

On last Sunday's HBO show, Last Week Tonight, host John Oliver opened with one of the mightiest, most righteous rants he has ever given us. It is about the previous Thursday's Brexit vote. It is - never mind. Just watch and enjoy.

Easing End-of-Life Pain

Ask pretty much any old person and he or she will tell you that dying quietly in their sleep is the way they want to go. It's sure true for me.

Unfortunately, dying isn't always that easy. Sometimes it is painful and some of those times it is excruciatingly so or, equally terrible, it involves constant breathlessness. In fact, Joseph Andrews, a physician at a Connecticut hospice, says that breathlessness is the worst thing.

But there is a drug, a strong, often misused drug we have all heard of that can alleviate much of this kind of suffering at the end of life. It's called morphine:

Morphine is seen by many physicians and laypeople as a sort of single-purpose, liquified grim reaper, and understandably so: It is dangerous and addictive,” reports STAT.

“Older physicians in particular were typically not trained to use it, Andrews said, and can resist recommendations to use morphine even for cancer patients with severe bone pain, for fear of killing them.”

End-of-life patients can also be denied this drug because, according to Dr. Andrews, there is a myth that hospice care uses the drug to send the terminally ill on their way a bit faster than nature intended.

That doesn't happen in hospice, Andrews says, but the myth keeps physicians from prescribing morphine or family members from allowing it.

Fortunately, that was not true of my mother's physician when I was caring for her during her final months of life in 1992. We had a good-sized bottle of liquid morphine he had prescribed and I don't recall any warnings from him about how lethal it can be. For a long time she only chose the other pain pills that, although I couldn't be sure, did not seem to alleviate the pain as much as the morphine might.

When I finally had the wit to ask her why she refused to use it, she said she might become addicted and do something illegal.

This, from a woman who perfectly well knew she was dying and who was no longer ambulatory. “Ma, I said, I really don't see you running down the road to rob the candy store; you can't even get out of bed. And who cares if you become addicted.”

No dummy, my mother, she thought this over for a moment and switched to liquid morphine.

Dr. Andrews says he has seen a small amount of morphine completely change the last days or weeks of life for his patients when they or their family agree to it use.

In the case of one of his hospice patients, a man who could barely breathe and had been told his heart would fail within three days, decided to try the drug. Soon after he began using a small dose,

”...the man’s breathing eased, he started a new routine. Twice a day he’d ask his children or grandchildren or nurses to bring his cap and his overcoat and they’d wheel him to the waterfront with his oxygen tank.

“He’d stay as long as the gathering cold and darkness allowed. He saw the tides flow and the leaves fall and gulls and boats pass. In early December he began sleeping more, and then he slept entire days away, and then he died.

“But that November reprieve, 'It was one of the best morphine stories I can remember,' Andrews said. 'He had a great run.'”

You can tell your physician, family members, medical proxy or, better, all of them what your wishes are about such drugs for pain at the end of life. I'm doing that and if circumstances make morphine usable in my case and if it works as Dr. Andrews describes, I have a better chance of dying in my sleep.

It's worth your time to read the short report on this at STAT.

Expectations Versus Reality About Old Age

Not too long ago, my Canadian blog friend, doctafil, emailed a story from the Montreal Gazette that contained a lot of statistics and information about how people are growing old in Canada.

The serendipity is that it arrived when I had wondering for awhile if we – you and I, other old people, younger people and the media that report on ageing (who are rarely old themselves) – spend too much time worrying about all the terrible things that can happen to us in our late years.

The thing that worries us all, of course, is an awful diagnosis or the accident – a broken hip, for one example - that can turn us instantly from living in competent independence to helplessness from which we may or may not recover. There are plenty of other things that can wreck our old age plans too.

We are reminded of this from a lot of angles. Discussions of nursing homes – often horror stories. Reports on ageing in place and its alternatives - sometimes, recently, with warnings about the dangers of living alone. Articles reminding us to see our physician at least once a year even if there is no immediate reason. Warnings about drugs interactions and so on.

Pretty much the only good news about growing old are reports of the outliers who climb Mt. Everest at 85 and run marathons at 90 which infer that the rest of us, the 99 percent, aren't keeping up and are, therefore deficient.

(That Montreal Gazette story anchors its report with an interview with an active elder who refuses to give her age but is described by the reporter as having “passed the biblical allotment of three score years and 10 a couple of decades ago.”)

The overview of elders health in the Montreal Gazette story repeats the typically negative way statistics on our group are reported.

”In the 85-and-over age group, 35 per cent of women and 23 per cent of men lived in nursing homes or other care facilities.”

Really?! I think the more honest news is that 65 percent of women and 77 percent of men in that age group do not live in nursing homes or other care facilities.

Here's another example:

”Among Canadians 80 and older, 37 per cent had four or more chronic conditions in 2009, from a list that includes arthritis, osteoporosis, high blood pressure, diabetes, heart disease, cancer, effects of a stroke and Alzheimer’s...”

That means, if you look at it differently, a large majority, 63 percent of Canadians 80 and older do not have four or more chronic conditions.

Geriatrician Bill Thomas has been saying for years that old people have standing in the United States (undoubtedly Canada too) only as far as they behave like young people – and the widely-believed stereotype is that old age is a terrible time of life filled with disease, debility and decline, a belief that automatically marginalizes elders from participating in society.

It's certainly not untrue that our bodies slow down in all kinds of way as the years pile up but it's not all of us by any means and not even a majority. Take a look at what a wide-ranging, 2009 Pew survey discovered about how elders really live versus younger people's expectations for their own old age:

”About one-in-four adults ages 65 and older report experience memory loss. About one-in-five say they have a serious illness, are not sexually active, or often feel sad or depressed.

“About one-in-six report they are lonely or have trouble paying bills. One-in-seven cannot drive. One-in-ten say they feel they aren’t needed or are a burden to others.

“But when it comes to these and other potential problems related to old age, the share of younger and middle-aged adults who report expecting to encounter them is much higher than the share of older adults who report actually experiencing them.”

Here's the Pew Research chart comparing young expectations to elder reality:

Real v expectations chart

While working on this post, I've been trying to remember what I believed, in my childhood and young adulthood, what old age was like. It's not so easy to do, in my case. There are hardly any elder relatives.

My great Aunt Edith retired from full-time work at age 70 and lived on her own until she got sick at age 89 and died within a few weeks. Until then, she did quite well with some help during the last few years with house cleaning and shopping. She had a wonderful sense of humor about the physical surprises that snuck up on her in old age.

Both my parents died relatively young - my father died in his mid-60s from cancer that had been diagnosed while he was still working so he didn't get to grow old. My mother, even with two hip replacements, lived well on her own until she died at age 75 of cancer.

A couple who were sort of adopted grandparents I knew throughout my childhood were active, healthy and lived on their own until they died. For awhile we thought Ray had become deaf but then realized he only pretended so when he wanted to ignore his wife who always had one more household chore for him, then one more and so on. It became a family joke that he was so selectively deaf.

Friends' parents I knew were healthy and living on their own until into their late 70s and 80s and beyond in a couple of cases so discounting disease, which seems to me to be happenstance over which no one has much control, my personal experience with advanced age is it works out pretty well for most people.

And two of my best online friends that I've known for a decade, Millie Garfield and Darlene Costner, will both be 91 years old this year. They are wonderful role models for any of us who are lucky enough to grow as old as they are.

There is, of course, no way to know with certainty if our expectations affect how our old age turns out to be. But mine are all positive and without being too stupid about it, I think I will just continue to believe that I'll get old similarly.

What about you?

SPEAKING OF LIVING WELL INTO OLD, OLD AGE: On Sunday, our own Darlene Costner will celebrate her 91st birthday. Happy Birthday, Darlene!


Crabby Old Lady and Loud Movies

Last week we discussed hearing loss. Today, it is the opposite – painfully loud noise. Specifically, the audio volume in movie theaters.

A couple of months ago, a friend suggested seeing Spotlight at a local theater.

Crabby Old Lady hardly ever does that anymore. One reason is that it's not nearly as easy as it was in New York City with dozens of theaters within easy distance. Here, she must drive several miles for all but one tiny theater near her so she doesn't often do that.

Even so, Spotlight was on the “don't miss” list and it would be nice to see her friend so they met at the theater. As soon as the lights dimmed and the screen lit up, the bigger reason Crabby mostly avoids movie theaters came back to her.

Crabby's real problem is that the piercingly high volume of movie sound nowadays causes actual pain, a deep ache in her ears.

Crabby's not talking about action movies that don't interest her anyway. She is talking about even the few films still produced that consist of dialogue – like Spotlight.

It had been so long since Crabby watched a movie in a theater that she didn't think to bring ear plugs (not that they help much) so she stuffed her ears with Kleenex. Only in the most minimal way did that reduce the pain.

As Crabby and her friend walked out of the theater afterward, her ears were ringing even louder than from the perpetual tinnitus she has lived with for the past eight or ten years, and ambient street noise along with her friend's voice sounded muffled. That can't possibly be good for anyone.

As Crabby has mentioned here in the past, she firmly believes that if it (“it” being pretty much anything) is happening to her, it is happening to hundreds, maybe thousands or even millions of others.

News stories or commentary about excessive movie volume had never crossed her path so Crabby didn't expect much from a Google search. Wrong, at least to a small degree.

”The National Institute on Deafness and Other Communication Disorders reports that prolonged or repeated exposure to sounds 85 decibels and higher can cause hearing loss,” reports the healthyhearing website.

“And the louder the sound, the less time it takes for damage to occur.”

Hearing loss at above 85 decibals. For old people who, by age alone, are more susceptible to hearing loss, loud movie audio could be devastating. KRCA-TV in Sacramento, California, tested the levels of several movies in and around that city.

Insurgent and Cinderella - at five different local movie theaters. Both films frequently hit peaks above 85 dBA (decibels), with Cinderella reaching a peak of 120.4 dBA and Insurgent reaching 118 dBA.”

Here's a 2014 report from KXAN-TV in Austin, Texas about excessive movie audio volume:

In 2014, legislation was introduced in the Connecticut legislature aimed at regulating the decibel level of movie audio in theaters but apparently nothing came of it. One reason cited is that people objected to more government intrusion in their lives. As opposed, one wonders, to deafness?

Others say that due to the digital nature of film projection these days, “limiting the noise level could make it difficult to calibrate motion pictures for easy listening when it comes to dialogue and other low-volume scenes.” (healthyhearing.com again)

Yeah, right. Crabby Old Lady has quite a few years of past experience with audio editing and although digital has come along since then, she would need to see some proof before she believes that audio between a scene with explosions and a quiet conversation next, for example, cannot be balanced.

It could be done in the past; why would digital make it impossible?

Meanwhile, Crabby watches movies at home but there are always some she would rather see on a ginormous screen in a theater and to do so without horrible pain in her ears, not to mention potential physical damage. It is unacceptable for a technology known to cause hearing loss to be ignored.

Does any of this (dare Crabby say it?) ring a bell with you?