Author: Fran Johns

General interest
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Brain Fitness: The New Best Thing

by Fran Johns

At a program on Assistive Technology for Seniors sponsored by the Commonwealth Club of California yesterday, four panelists at least one generation away from 50 themselves discussed the technological wonders being perfected by their contemporaries for the likes of boomers and beyonders. (Devices that tell your children across the country how many times you open the refrigerator; nifty machines to compute and address your every need…) But for some of us, the handsome twenty-something geek talking about brain fitness made the most newly-revealed sense. OK, maybe he’s 30-something, but not very something if so.

“Exercising your brain in very specific ways,” said Eric Mann, Vice President of Marketing for Posit Science, ” will be recognized within the years ahead as just as important as cardiovascular exercise.” The brain is not an organ condemned to progressive deterioration, he explained, but something evolving every day. Pointing out that mind and body are the two assets with which everyone comes equipped, Mann urged his largely gray-haired audience to understand that both need to be maximized through ongoing exercise.

To that end, his company has thus far created programs titled Brain Fitness, DriveSharp (brain/foot/hand fitness?) and InSight.

The program went back and forth between those sorts of brain-governed assists for our rapidly aging population — the percentage of Americans over 65 increases every day — to the computer-assisted living which is coming, ready-or-not, onto the scene. In what would surely have been proclaimed la-la land a decade or two ago, assistive technologies at one’s fingertips already include personal emergency response systems (esthetically improved over the “Help! I’ve fallen and I can’t get up!” necklace, cell phones with a button that alerts your five first choices), medication management systems (electronic pillboxes that do everything but pop the right dosage into your mouth) and senior-friendly e-mail options for the internet-averse.

The thought of all that technological wonder was enough to induce brain-weariness in some audience members who occasionally wish they had the “Number, please” telephone lady back. But because such an attitude might fall into a category Mr. Mann referenced in passing as  “maladaptive compensatory behavior,” most went home willing to hear it all as good news. And to ramp up the exercising of their brains.

More on those technological wonders in a following blog.

General interest/Health/Politics & Causes
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Looking at one's own end-of-life issues

by Fran Johns

A tough story eloquently told by California physician Martin Welsh adds poignancy to the fight for legalized physician aid in dying, and emphasis to the need for patient choice as a consideration in health reform. Dr. Welsh speaks in clear language of his current dilemma:

I am a 55-year-old retired family doctor with a large, loving family and innumerable friends and former patients whom I see often. I am an extraordinarily lucky man.

For the last five years, I have also been a patient. I have ALS (or Lou Gehrig’s disease), a cruel neurological illness in which a normally functioning intellect becomes trapped in an increasingly weak and eventually paralyzed body. Soon, I will die from it.

Through my career, I tried to honor my patients’ end-of-life wishes. But after a quarter-century as a firsthand witness to death, I’ve developed my own perspective.

It’s not that I’m a quitter. I have struggled against adversity of one sort or another all my life, and those challenges have helped prepare me for what I face now. I still delight in accomplishing difficult things, and I always wear a bright red ALS wristband that says “Never Give Up.”

That said, there will come a limit. I have made it very clear to my wife, my family and my doctors that I want no therapy that will prolong my suffering and lengthen the burden on others. I do not want a feeding tube nor a tracheotomy when the time comes that I can no longer eat, drink or breathe for myself.

Dr. Welsh suggests, for himself and others, making a list of 100 things that make life worth living, ordinary things one does every day.

Some are routine, some are “chores,” some are pleasurable. Get out of bed and walk to the bathroom. Kiss your wife. Answer the phone.

Drive your car to work. Go play golf with your friends. Brush your teeth. Write a letter, lick and seal the envelope closed and put a stamp on it. Hug your child.

Of course we do many more than 100 things each day, but for now, just imagine 100 that are essential to the life you live. Now if you take away one, you can still do 99. Is life worth living without being able to smell the rose in the garden? Of course it is! How about losing two or seven, or 23 — is life still worth living? Of course.

But suppose you get to where you’ve lost, say, 90 things, and now with each thing taken away, a bad thing is added…

At some point, no matter who you are or how strong, you can lose enough things that matter — and acquire enough negatives — that the burdens will outweigh the joys of being alive…

Recognizing he’ll reach that point one day, Dr. Welsh looks his destiny squarely in the eye:

…as I face my diminishing list of the 100 things that make life worth living, the choice of quality over quantity has to be mine to make.

Healthcare/seniors
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Celebrations, changes and challenges

by Fran Johns

The quietude of this space of late is in direct proportion to the activity, at long last!, over at my new blog on True/Slant.com. Boomers and Beyond (you’re invited to visit) looks at issues of concern to seniors and, increasingly also to their boomer children. Health and healthcare, housing, fitness, economic survival, liesure & recreation. We’re open to suggestion. True/Slant is a still-developing all-journalists news aggregate site I think will continue to grow stronger and more useful. With the necessary little www preceding it, trueslant.com/franjohns will take you to my page.

In the meantime, I hope to keep an occasional post over here at the Celebration site. It’s a joy to have a spot in cyberspace on which to ponder anything that might seem worth pondering; it’s even more joyful to get paid (!) for it.

Hope you’ll surf over to True/Slant whenever you can. Hope I’ll still find time to post, here, things that seem too far-out or too quirky to toss up on a serious news site. Over here on Celebrations, I still need to get to the meringue cookie issue.

General interest
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Co-housing: Not Your Grandmother's Commune

by Fran Johns

Somewhat like 60 being the new 40, co-housing is the new yesterday’s small town. Think pioneer groups sharing meals around a campfire… then think post-2000 college grads seeking affordable housing and wanting community; or think 60s communes with wifi and central air conditioning. You’ll get an idea of today’s growing U.S. co-housing movement. (The term is written with or without a hyphen.)

At a recent OWL-sponsored panel discussion, two representatives of different (in some ways vastly different) California cohousing projects outlined some of the reasons this option is attractive to Boomers (downsize into simpler lifestyle, find community) and seniors (anticipate future needs, find community) in particular, but multi-generational others as well. The big key word: community. Cohousing villages are designed and self-managed with intention. They range from west coast to east and in between, from simple to posh, urban to rural. Swan’s Market in downtown Oakland, CA is on the National Register of Historic Places in an area fast morphing from down-and-out to up-and- coming. Mosaic Commons in Berlin, MA west of Boston boasts of green space, green planning, green building. Blue Ridge Commons near Charlottesville, VA touts organic gardens and a renovated 1890s farmhouse, while recently completed Great Oak Cohousing, Ann Arbor MI’s second such venture, lists 30-some households which include “about 65 adults” and “about 37 kids.” Cohousing populations are moving targets.

The common thread is the desire for economically and ecologically viable close-community living. Most cohousing villages have at least two or three shared meals per week with everyone taking turns in the communal kitchen, while the rest of the time residents dine at home. Most share other things like laundry space, recreational space and assorted activities. The same occasional conflicts that probably afflicted cave dwellers arise among today’s cohousing residents, but enthusiasm runs rampant.

And increasing numbers of Americans are considering, or at the very least familiar with, the concept. This reporter appeared to be the only person in an overflow audience who had to ask who the oft-mentioned Chuck and Katie were. (Kathryn McCamant and Charles Durrett; they wrote the book.)

Health/Money
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Waterfront Condos: More on the housing dilemma

by Fran Johns

Waterfront esplanade, expansive views from a sunny terrace, walk to the ballpark — what’s not to love about this housing choice?

Downsizing from a large, Victorian house filled to overflowing with the accumulations of two very active lives, the Langleys of San Francisco decamped, a few months ago, to a new, easy-care, sun-filled two-bedroom condo in the city’s happening-place Mission Bay neighborhood. They love the convenience, the mix of ages and cultures, the freedom from old-house maintenance worries and some unexpected bonuses like new friends living on houseboats from another era who are within conversation range of their 4th floor deck. “We (the new condo development) block the view they used to have all those years,” Judy Langley says, “but there are a lot of  trade-offs like getting the creek (which leads into San Francisco Bay) cleaned up, and the park over there…” For the newcomers, the young dog-walkers on the esplanade below, the middle-aged Chinese couple doing tai chi on the common lawn, it is an urban idyll.

Urban condos, even those without kayaks at the door and aged houseboats for neighbors, are an increasingly popular answer to the downsizing dilemma. But the dilemma remains huge and answers are seldom easy.

On the day the Langleys were hosting an Open House in their new digs, my sister was packing the last boxes from the high-ceilinged Boston condo that’s been her family’s home for decades. She and her husband are headed for a New York retirement community to which a physician daughter will also relocate from the west coast. Elsewhere this weekend a childhood friend was finalizing plans for a move from Northern Virginia to a coastal community where her husband will be able to live in a Memory Unit while she lives independently nearby.

These choices typify the variety of factors that go into contemporary downsizing decision-making: Is it affordable? Will I (or my parents) have the care that’s needed? Can life still be good (or even get better?)

And any of these families might also have considered co-housing. Yet another option for Boomers and Beyonders as well as for younger families and individuals, co-housing in some ways harkens back to a simpler, long-ago lifestyle and in other ways could only work in the 21st century. It was the topic of an OWL-sponsored panel discussion on Saturday, and will be tomorrow’s Boomers and Beyond topic.

General interest/Health/Money/Politics & Causes
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Palliative Care: Rush Limbaugh vs the Grannies

by Fran Johns

The patient was in four-point restraint, which means his hands and feet were tied to the bed. He was shouting over and over, in Spanish, “Help me!” but no help came. Until Diane Meier happened upon the scene.

The back story, she learned, was that the man had end-stage cancer for which he had declined treatment. After he fell at home, his adult children had found him on the floor and called 911, landing him back in the hospital. There, among other interventions that were put into play, a feeding tube had been inserted through his nose. When he repeatedly pulled it out, his hands were tied. After he then pulled it out three times with his knees, his feet were tied. You could say these treatments were being performed over the patient’s not-quite-dead-body.

“Why,” Dr. Meier asked, “is it important to have the feeding tube?” The attending physicians answered, “Because if we don’t, he’ll die.”

It was at this point that Diane Meier, M.D., F.A.C.P., already honored for her work in geriatrics and for her personal and medical skills, became a crusader for palliative care. “A light bulb went off,” she told a group of physicians and other professionals in the field today in San Francisco. “I realized it was an educational problem, and thus a solvable problem.” She saw that the doctors and nurses were only doing as they had been taught, and the results were distressing also to many of them. “All I did was say ‘It’s all right to care about your patient.'”

Meier’s pioneering efforts to shift care of critically ill patients from aggressive, often futile treatment to comfort care focusing on the patient instead led to formation of the Center to Advance Palliative Care, which she currently serves as Director. They also resulted in a MacArthur Fellowship she was awarded in September, 2008.

“The MacArthur,” says the self-effacing physician, “was in recognition of the tens of thousands of people working in palliative care.” But those tens of thousands are not enough to have eliminated the tragedies of patients such as the unfortunate man cited above. Walk the halls of almost any hospital, nursing home or similar institution in the U.S. and you will hear the incessant “Help me!” cries of people being treated over their almost-dead bodies.

Helping them with comfort care rather than aggressive treatment, though, is referred to by the Rush Limbaughs of the world as “Killing off the grannies.” It is a handy sound bite, and it is tilting the balance against sanity in our lurch toward health reform. Unless Mr. Limbaugh can convince me I’d rather be 4-point-restrained with a tube inserted in my nose than gently treated with comfort care when I encounter my next critical illness, this particular grannie would appreciate his butting out of my rights. Palliative care should be a right.

It is, unfortunately, a campaign of the political right to keep palliative care out of health reform. They will prevail, Dr. Meier said, unless voices of sanity are raised, whether Democrat or Republican. She urged her audience, representative of a wide variety of compassionate groups, to help get the message out and get the calls, e-mails and letters in. Legislators behind the three bills working their way through Congress, she said, need to hear from the citizenry.

The citizenry is unquestionably in favor of comfort, and where palliative care can be understood it is welcomed. Hosting Dr. Meier’s informal talk were the California HealthCare Foundation, the California Coalition for Compassionate Care, Archstone Foundation and the University of California, San Francisco, four of many organizations committed to making palliative care understood, available and effective.

The question of whether they or Rush Limbaugh will prevail is as yet unanswered. Having Mr. Limbaugh forming our health policy, though, is almost as scary to this granny as 4-point restraint.

General interest/Health/Money/Politics & Causes
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Health Reform 101 for Seniors

by Fran Johns

At an annual reunion gathering of California Senior Leaders today at the University of California, Berkeley, AARP California Executive Council member Bob Prath (himself a CA Senior Leader) made a valiant effort at outlining key segments of the proposed Health Reform bill which are of primary concern to over-50 generations.

Those segments include, in no specific order of significance or degree of complexity: guaranteed access to affordable coverage for Americans 50 to 64; closing the Medicare Part D coverage gap (known to insiders and more than a few others by now as the “doughnut hole”); approving generic versions of biologic drugs; preventing costly hospital readmissions by creating a follow-up care benefit in Medicare to help people transition to home; increasing funding for home-and-community-based services through Medicaid to help people stay in their homes and out of institutions; and improving programs that help low income Americans in Medicare afford needed drugs.

If that list of details seems daunting, it was not so to the Senior Leaders. Word had already circulated that Prath had read the entire 3,000+ pages of the bill, and no eye was going to glaze over. Covering it all, though, despite a carefully prepared power point presentation, was somewhat of a challenge in the after-lunch time whittled down to less than 30 minutes by the irrepressible tale-sharings of the reunion attendees.

Prath was asked, afterwards, for suggestions of where and how anyone over 50 might find concise and useful information, short of undertaking his own feat of studying 3000+ pages. Much, he says, can be learned through Health Action Now, and those worried about exorbitant drug bills can get some good, practical help from a nifty AARP brochure, “Don’t Dump Dollars into the Doughnut Hole.”

More enlightenment from the time-squeezed power point will appear in this space over the next few days.

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