Suicide among the Elderly

In terms of cost savings, suicide among the elderly would be quite effective. Perhaps “suicide panels” would be as successful as the imaginary ”death panels” that caused so much consternation as healthcare reform was being processed. A ready-made theme song for “suicide panels” could be “Suicide is Painless“, the theme song from the hit TV show, Mash.

As ghoulish as this sounds, this is not a one-time Halloween trick. Indeed, something like this was even predicted by the outstanding pioneer in studying suicide, the psychiatrist Herbert Hendin, M.D. In his classic book, Suicide in America, Hendin discussed the unique challenges of suicide in the elderly. He pointed out that the history of large birth cohorts, like we have had with the “baby boomers”, usually manifests with increased stress through life and correspondingly higher suicide rates at every age level. When the stressors of aging are added on, the suicide rate will predictably be even higher. Continue reading…

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Fixing the Technological Fix

Perhaps like many of my age, I am not captivated by a number of much-touted technological innovations, increasing choices I don’t desire, and fulfilling needs I didn’t realize I had. I am not sure that having a cell phone at the ready every minute of the day and night to bring messages, pictures, and apps to busy and not-so-busy people (who will become busy because of that phone), is a great human benefit. I watched a father recently in a restaurant who had brought his three young children to lunch, spending at least 45 of his 60 minutes looking at his smartphone screen and not exchanging a single word with them. Continue reading…

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The Medicare Social Club

Days from her 80th birthday, “Nancy” (not her real name) is doing well.  She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator.  Her busy schedule of weekly activities includes several appointments with physicians.  Nancy’s medical needs are covered by Medicare.

Nancy’s been in psychotherapy for a half-century.  She’s seen me, her psychotherapist, for the past three years.  Nancy reports difficulty developing meaningful relationships over the course of her adult life.  On a fixed income funded by Social Security, like many older adults, Nancy’s mental health care is also secured by Medicare.

To be eligible for insurance coverage, Nancy needs a presenting problem—a reason to be seen for care.  In psychiatry, a patient receives a five-axial diagnosis, largely for reasons of insurance.  The presenting problem, or complaint, is categorized as Axis I– the focus of treatment.  Insurance companies only pay for these diagnoses.  Continual psychotherapy through a span of decades is a strong indicator there’s something else going on with Nancy. Continue reading…

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Don’t Hide Behind HIPAA to Avoid Communicating with Caregivers!

 In May, Carol Levine posted about how HIPAA (the Health Insurance Portability and Accountability Act) interferes with caregiving for the elderly by leading many health professionals to refuse to communicate with families and others involved in care of the elderly. Carol subsequently interviewed Leon Rodriguez, director of the Office of Civil Rights at the Department of Health and Human Services, who is responsible for enforcing the HIPAA rules about privacy and information security. With Carol’s permission, Jim Sabin derived this post from that interview.

Here is Rodriguez’s key guidance for clinicians dealing with elderly patients and their families: Continue reading…

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Coming Out about Age

When I was growing up, every 12 months I got one year older. But my mother, who turned 39 three months after my 7th birthday, remained 39. That puzzled me. My mother explained that for women, by magic, their age never clicked past 40! The French have long dealt with my mother’s reluctance to come out about advancing age with the decorous phrase – “d’un certain âge.”

Some years ago, a distinguished physician-colleague a few years younger than I am now, told me he’d experienced three phases in his medical career. Early on, potential patients would say “Who is Dr. X and what does he know?”  At mid-career they would say “I want to see Dr. X – he’s the best!” Then, in when he got to the over-65 phase, they asked “Oh – is Dr. X still alive?”

Teen agers worry about looking too young to get in to R rated films or the popular clubs. For over 65ers like Dr. X, the worry is about looking too old to be seen as relevant to ongoing life.

I recently conducted a small, unplanned experiment with “coming out” about age. Continue reading…

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How Not to Become King Lear

“You see me here, you gods, a poor old man,
As full of grief as age; wretched in both.”
-King Lear, 3.2

The story is one for the ages. Our ages. Shakespeare’s tragedy, King Lear. But it is a story that my wife and I can no longer easily watch or read, for it is a story of much that can go so wrong for the aged. Nevertheless, if there is any play that those of us over 65 should see, or see again, when thinking of our legacies, it is this one.

Since we’ve seen the play several times already, I can summarize the plot. Note that there is no back story for King Lear and how his daughters were raised, nor how he came to power. The role of his wife, the mother of those daughters, is also absent. Continue reading…

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Grandma and Her Robot

As early as 1985, in A Robot in Every Home, futurist Mike Higgins predicted that “pet robots” would ultimately provide companionship for the elderly. He was right.

“Service robots,” like the vacuum cleaner Roomba (on sale at Costco for $299), perform instrumental tasks. By contrast, “social/emotional robots” target the experiential aspects of our lives. Earlier this year the journal GeroPsych devoted an entire issue to the use of social/emotional robots in the aging global population.

The most widely used social/emotional robot is Paro, developed in Japan over a 12 year period by Dr. Takanori Shibata at the Japanese National Institute of Advanced Industrial Science and Technology.  Paro, modeled on a baby harp seal, is cute and cuddly. It has internal sensors, responds to its name, and apparently can adapt to the preferences of the person interacting with it. The company website features videos of nursing home residents holding and petting Paro. A man, who is said to have been non-communicative, is shown singing to Paro. Continue reading…

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Avoiding Futile Care and Reducing Medicare Costs

If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications. 

Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A Trust Fund is projected to have insufficient funds to cover all hospital bills starting in 2024, polling guru Robert Blendon reported that 47% of the public do not see Medicare as a large budget item, and only 31% see it as a major contributor to the federal deficit!

Here are some of the key findings from Blendon’s study: Continue reading…

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