The Elderly not Resting on their Laurels

On the morning of Wednesday, November 20th, 2013, I was beginning to peruse the article by Dan Gorenstein in the New York Times, “How Doctors Die: In Coming to Grips With Their Own Mortality, They Are Showing the Way for Others”. CNN was on the TV in the background. On came the presentation of the 2013 Presidential Medals of Freedom to 16 people, a few of them posthumously. This is the highest civilian honor one can receive. This was the 50th       anniversary of the award, established by President Kennedy not long before the 50th anniversary of his assassination. It has become one of his clear-cut legacies.

Quickly my attention was refocused on this presentation, which I soon found to be absorbing and inspiring. President Obama said the “The Presidential Medal of Freedom goes to men and women who have dedicated their own lives to enriching ours”. Given that broad definition, it was not surprising that the awards recognized those in fields ranging from sports to sexuality, from jazz to journalism, and from religion to human rights. The ethnic backgrounds and countries of origin of the recipients were similarly diverse.

The ones that were the most impressive to me were the ones who not only did such important things earlier in their lives, but who are continuing to do so as they age. It would have been easy and understandable if they just had retired and rested on their laurels. But, no, they did not and, as such, they are models for what all of the elderly potentially can do, in our own ways and with our own skills.
 
Here are those elderly recipients who, as far as I can tell, are still living and in good health, and clearly not resting on their laurels: Continue reading…

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Dogs and the Elderly

As an only child growing up in New York City, I hounded my parents for a dog.  They held fast. Then, in the eighth grade, playing stickball with friends after school, I came upon a mutt tied to a barbershop pole. The barber told me the dog had been wandering around on its own. Did I want it?

I called my parents, and to my amazement they said I could bring the dog home. He still had a rope around his neck, leading me to name him “Dilly,” after the famous bank robber John Dillinger who I mistakenly thought had been hanged. (He was actually killed in a shootout with police.) Continue reading…

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Exercise for the Elderly

The past year has seen mounting evidence of the strong cumulative benefits from physical activity at every age, not least for persons over 65. Yet as the time for New Year’s resolutions rolls around once again, we see the same bleak media predictions of how few people, among all those who resolve to begin a new exercise regimen, will actually keep it up for more than a month, if that.   

I have recently learned of a Swedish website for an excellent manual used by health professionals to advise about physical exercise for prevention and treatment of a variety of disease conditions, such as obesity, multiple sclerosis, Parkinson’s Disease, dementia, and asthma. It also has more general chapters, including ones concerning the effects of physical activity, the role of motivation, health considerations for strength training, children and young people, and the elderly.

I, for one, have learned a lot from looking at a number of the chapters, even though I have always taken an interest in exercise, beginning with vain attempts, at eleven, to emulate with friends the 1945 Swedish world record holder of our hero Gunder Hägg by running along the roads of a Stockholm suburb. I am convinced that perusing selected chapters in the manual could help individuals seeking the extra motivation to strengthen their resolve to exercise more, and more wisely. Continue reading…

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Going South

I was 68 and long since retired when I had the pleasure of being an “accompanying spouse” on a junket to a Caribbean island where my wife was attending a business conference. During her meetings I whiled away the time on the beach and simply fell in love with the climate. It was reliably sunny and warm every day – a big improvement on the vagaries of Florida weather and a marvelous respite from the brutal New England cold wave we had left behind. The combination of sun and salt water was soothing to my psoriasis, and a daily rum punch helped stir up memories of long summers at the beach where my parents had a house when I was a boy.

I’m 74 now, and starting my seventh winter in the Caribbean. The first year I stayed a month; the second I bumped it to two; and the third I maxed out at three. I found my first apartment via the Internet while I was still back home; since then I shop for next December’s place before going home in March. My wife takes two or three breaks from her work every winter, ranging from long weekends to a couple of weeks.  Continue reading…

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On Aging and Writing a Hard Book

I recently finished a biography of Bertrand Russell, a major 20th century British philosopher who, as his career moved along, shifted heavily toward personal involvement in international political and cultural affairs, most notably arms control and nuclear weapon reduction—but meanwhile, as a kind of relaxation, continuing to turn out a stream of philosophy books. He died at 98, working to the very end in a flurry of international trips, lectures and conferences at a pace exhausting to read about, picking up along the way a Nobel Prize for literature.

Not bad, I thought, a fine role model for those of us who want to finish our lives in the same way, even if not aspiring to win a Nobel Prize. I was particularly interested in how he coped with his aging body and brain in those final years. He was subject to a number of physical ills, some serious, some not, but always present. He spent his very last years in a wheel chair but carried on. His critics often derided him as an old man whose time had come and gone, as one who should leave serious politics to the young. There was some evidence of senility. Continue reading…

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Update on LTCI in Massachusetts: Law Passed, Implementation Stalled

The Affordable Care Act has been front-page news from well before its passage in 2010 up through its present turbulent phase of getting up and running.  Questions, concerns, and controversies have abounded and continue to do so.  What impact will it have on benefits?  On premiums?  On cost to the taxpayer? 

Similar questions are commonplace for all health-related insurance, and long-term care insurance (LTCI) is no exception.  For LTCI one of the most pressing questions is how rapidly state insurance departments will permit premiums to rise on existing policies.  When the premium reaches some distressingly high level, policyholders inevitably allow their policy to lapse, and the welcome shield this form of private insurance provided for the taxpayer is eliminated.  Continue reading…

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Aging Well

My mother will turn 88 in a few weeks. According to the definition of successful aging put forward by Rowe and Kahn nearly 16 years ago, she is aging quite well. Her kidneys, lungs, and heart work fine. She is still very active—she teaches a French class once a week at the local senior center, she tutors English to foreigners, she plays scrabble with friends, and she drives daily to visit my father at the nursing home where he lives. My mother does have her share of medical problems: she has painful arthritis affecting her knees and her back and she is very weak, finding it difficult to turn a door knob or to lift a container of milk. Until about a year ago, she walked at least a mile every day, but now she can only take short walks and has to sit down frequently. Her memory isn’t what it once was, though it’s still pretty good. My mother will say that “old age is no picnic” and that “people live too long” today. When her physician told her she was aging gracefully, she told him he was full of it. Her doctor has one perspective on successful aging; she has another one. How are we to put the two views together? Are we using the right definition of “successful aging?” Continue reading…

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Surrender at the End of Life

First, the problem

“Do not go gentle into that good night…

Rage, rage against the dying of the light.”

So wrote the Welsh poet, Dylan Thomas.

Working intensively over the past seven years in end-of-life care, I have often seen this attitude as a response by good people to the bad things that are happening to them.  Our patients are faced with conditions that are terrible and despite our best efforts clinically are only going to get worse.  Faced with such, it is common for them to become angry and spend much energy fighting against their situation and much emotion in railing against their fate.  They spend their last days exhausting themselves in a futile struggle, burning up energy that might be better spent otherwise.

But, I have observed that some patients with mortal illness choose another way:  surrender.

What is surrender? Continue reading…

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Aging in Place in a Bleak Landscape

Somewhere near the middle of Alexander Payne’s new movie Nebraska, a young boy rides up on a bicycle to take a photo of Woody Grant for the local newspaper.  Woody has, or so he believes, won a million dollars in a merchandising sweepstakes. He has become a celebrity in Hawthorne, the small fictional Nebraska town he left years ago to move to Billings, Montana, to open an auto repair shop.  Driven by his younger son, David, he is on his way to Lincoln to pick up his winnings, and they have stopped for a few days for a family reunion of sorts. 

When this youngster appeared on screen with his camera, I wanted to step into the frame and call out, “Grow up fast, young man, and get out of this town!”  But his moment in the movie was too fleeting.  Assignment completed, he was on his way, perhaps already heeding my unspoken advice.  Continue reading…

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Proust on Treating Chronic Illness

The need to control health care cost is a central challenge for health and economic policy. Other than the high prices we pay in the U.S., chronic illness is a main driver of cost escalation, especially for Medicare.  Seventy-six percent of Medicare spending is on patients with five or more chronic diseases, including heart disease, metabolic syndrome, end-stage renal disease, and cancer. Treatment usually doesn’t lead to a cure, but it does tend to extend patients’ lives.

 Prolonging life is one of the triumphs of medicine when the result is reasonably good health. But often costly treatments for chronic illnesses simply prolong the dying process, inevitably raising difficult questions about setting limits. “It is a great miracle that medicine can almost equal nature in forcing a man to remain in bed, to continue on pain of death the use of some drug.” That statement would not be out of place in current health policy debate, but it was written by Marcel Proust in 1923 in Remembrances of Things Past: Volume III – The Captive, The Fugitive, Time Regained. The rest of the passage, which follows, resonates today. Continue reading…

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