General


The Benefits of Phased Retirement

Until relatively recently, employees in the U.S. typically transitioned directly from full time work to full time retirement. That practice had at least four major drawbacks: Some employees wanted to stop working full time but for financial reasons felt a need to continue earning. Some employees found their work meaningful apart from the income it […]

Regulation of Long-Term Care Insurance in Massachusetts

The time may come when any one of us will need outside help with certain basic activities, referred to collectively as the activities of daily living or ADLs.   Long-term care insurance (LTCI) is a resource for covering some or all of the costs of providing the care needed in that unfortunate situation.  It is not […]

Setting Generational Priorities

In the mid-1980s, just as I was becoming interested in health care for the elderly and the future of Medicare, Samuel Preston, a distinguished social scientist at the University of Pennsylvania, give a 1984 presidential address to the Population Association of America. His topic was the growing disparity between health and other resources for children […]

Why the Elderly Should Support Health Care Rationing

On the face of it, it would seem preposterous to argue that the over 65 population should support health care rationing. After all, both Democrats and Republicans regularly pledge to protect Medicare from any changes and attack the other party for threatening the program. And in a 2012 Pew Foundation poll, over 65ers by a […]

Memory Loss

Talking to my friends and looking at my own reactions, I believe that memory loss is one of the most feared disabilities of aging.  Since, as we age, most of us experience some degree of memory loss, it is easy to wonder if what we are experiencing are the first steps to dementia.  Witnessing someone […]

“Still Alice” and the Ethics of Dementia

Several friends had urged me to read “Still Alice,” a novel by Lisa Genova about a 50 year old Harvard professor and mother of three who develops early onset Alzheimer’s disease. I’ve finally read it. My friends were right. I’d urge you to read it as they had urged me.

Response to Unreasonable Health Choices: Smoking cigarettes over age 65

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 […]

How HIPAA Interferes with Caregiving for the Elderly

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 […]

Acceptance

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 […]

Treating Older People in the Emergency Department

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 […]