Response to Unreasonable Health Choices: Smoking cigarettes over age 65

By Steven A. Schroeder

In her May 6 post about “Unreasonable Health Choices,” Sissela Bok poses the question of why people make unreasonable choices, using cigarette smoking as one example, since everyone knows that smoking is bad for your health.  In fact, during our lifetimes we have witnessed a revolution regarding attitudes and practices of smoking.  When I was growing up the detritus of cigarettes was an accepted part of our household. Both my parents smoked, as did many of their peers.  They were able to quit at age 55 (dad) and 71 (mom), and most of their friends did the same.  By contrast, I suspect that it is rare for the followers of Over 65 to even know a friend who smokes, let alone to have visitors smoke in their homes.

What caused this dramatic shift? Continue reading…

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How HIPAA Interferes with Caregiving for the Elderly

By Carol Levine

Although it was not the intent of the law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has been interpreted and misapplied as a barrier to communication with the very people who have a deep and often lifelong relationship with elderly  patients  and who will be responsible for managing or providing care in the community. When a family member asks almost any question relating to a family member’s care and treatment, this is what they too often are likely to hear: “I can’t tell you because of HIPAA.”  End of conversation.  Continue reading…

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Acceptance

By Al Martin

Aging requires the acceptance of some inevitable truths about oneself and about life. We are no longer able to imagine an infinite future. Our mortality is assured. Progressively, we will lose our energy, our friends, our cherished activities and the identity we once knew.  If you are like me, you don’t suddenly arrive at this point, it comes upon you in small fragments of experience which often you would just as soon deny.

We want to think of ourselves as we always were, and, in fact, for most of our lives, aging occurs so gradually that we can maintain that illusion, until some physical or emotional event teaches us otherwise. Over the age of 60 or so, aging progressively accelerates so that this year no longer looks like two years ago. Interestingly, in some surveys of elderly people, most of them said that they still thought of themselves as they once were and couldn’t figure out who the person in the mirror was. Continue reading…

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Treating Older People in the Emergency Department

By Jay Banerjee

In my 16 years in Emergency Medicine in England it has become increasingly common to see people over 85 years of age. This is an experience shared with ED colleagues from several other countries. Even the proud near-centurion awaiting a “letter from the Queen” is a not infrequent visitor to my department.

EDs are increasingly thronged with older people. Our ED has seen a 40% increase in the over-85’s in one year! They are increasingly coming by ambulances and are taking up more and more of our time and hospital beds. Is this a problem or is it a symptom? Continue reading…

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Unreasonable Health Choices

By Sissela Bok

Long before reaching 65, most people know all too well the costs of decades of going against their own best interests by engaging in practices they knew carried risks for their health – as with smoking or overeating. In at least some respects, they resonate to Oscar Wilde’s “I can resist everything except temptation.” Even if they have finally succeeded in bringing about change, as many seniors have with respect to smoking, they may ask, looking back, “Why did I not decide to try to stop much sooner?” Continue reading…

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Balancing adequacy and sustainability: lessons from the Global Aging Preparedness Index

By Richard Jackson

The world stands on the threshold of a stunning demographic transformation brought about by falling fertility and rising life expectancy. It is called global aging, and it will challenge the ability of many countries to provide a decent standard of living for the old without imposing too big a burden on the young.

The GAP Index

Which countries are most prepared and which are least prepared to meet the challenge? The Global Aging Preparedness (GAP) Index, developed by the Center for Strategic and International Studies (CSIS), provides a unique new analytical tool for assessing the progress countries are making in preparing for global aging—especially in balancing the twin goals of income adequacy and fiscal sustainability (see sidebar on page 10 for GAP Index Country Rankings in these areas). Continue reading…

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Japan – and then there was one

By Richard Jackson

Population: 127.4m

65 years and over: 23.9%

Life expectancy at birth: 83.9 years

Population in 2050: 99.7m

Everybody knows that Japan is ground zero for global ageing. The youngest of the developed countries as recently as the mid-1970s, it is now the oldest – and its age wave will continue to roll in for decades to come. 

By 2050, the proportion of Japanese who are 65 or older is on track to reach 39 per cent, up from 23 per cent in 2010 and only 9 per cent in 1980, when Japan Inc seemed poised to conquer the global economy. Japan’s total population, which is already contracting, will enter a precipitous decline, shrinking by over a half by the end of the century. Extending this dismal forecast even further into the future, the Japanese Government projects, half seriously, the date when there will be only one Japanese citizen left living.   Continue reading…

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Reimagining Geriatrics

By Leslie Kernisan

A little over a year ago, I found myself burning out and realized that my work life was unsustainable.

 I’d been working at a Federally Qualified Health Center, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our house calls and geriatrics programs. 

 All of this was supposed to be a 50% position — plus 5% paid time for follow-up. Needless to say, this job was taking far more than 55% of my time, and seemed to be consuming 110% of my psyche. I very much liked my boss and colleagues, was learning a lot, and felt I was improving care for older adults.

 But I was also irritable, stressed out, and had developed chronic insomnia. And clinic sessions were leaving me drained and feeling miserable: try as I might, I couldn’t find a way to provide care to my (and my patients’) satisfaction with the time and resources I had available. Continue reading…

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Preparing for the Final Exam of Life

By H. Steve Moffic

Recently, I was taken aback by being asked to deliver the memorial eulogy for our departed classmates at our upcoming 50th year High School Reunion. Why me, I asked? Isn’t there a Priest or Rabbi in our class who is used to doing something like this? That question not only did not seem to matter to the classmate planning the event, but she replied that my professional background would be the most appropriate of all. No stigma about psychiatry here. At least I had done a couple of memorial eulogies for staff who had died, one even from suicide. And I had learned much about eulogies from my Rabbi son. So, with a feeling of both personal and professional honor, I agreed.

Here is what I prepared to say: Continue reading…

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Public pensions need to evolve

By Alicia Munnell

The Ontario Teachers Pension Plan recently released a new documentary on the sustainability of pension plans titled “Pension Plan (ev e looSHen).”  It presents interviews with practitioners and experts from Canada, the United States, and The Netherlands.  The tone and conclusions of the film really resonated with me.

The theme of the documentary is that the world changes and public pension plans, like other institutions, need to adapt and evolve – hence, the subtitle “ev e looSHen.” Continue reading…

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