Category: General interest

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.

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.)

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.

General interest/Health/Money
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Affordable Health Reform

by Fran Johns

It was actually spoken out loud on NewsHour Friday night: we could have a workable, affordable healthcare system if we would address the excessive costs that go into the last six months of life, particularly the last few days. The remark was immediately followed by the standard caveat: of course, no one is going to suggest doing this.

Good grief, why not? Everybody knows it, a few others have even said it out loud. Sure, it’s political suicide, but if someone were ever brave enough to fall on that particular sword there would be a lot of people around to pull out the sword, cleanse the wound and stand him or her back upright.

It could be done. If individual choice were encouraged and enabled. If physicians had to be honest about the quality of life (if any, usually for a few days or weeks) being bought with aggressive treatment at life’s end. If futile treatment were avoided. If protections were put in place for physicians and hospitals complying with the above, since fear of lawsuit is behind most of the mess. If all of us began to look at — and make clear — what extreme measures we would or would not want.

Big ifs. But the reward would be a workable, affordable system.

General interest
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More on the Housing Choices Dilemma

by Fran Johns

This week’s earlier post about the multiplicity of housing choices for the post-Boomers (and often Boomers ready to downsize or make other shifts) touched on just a few of the possibilities out there. The staying put option is one that many, including my friend Berta whose current consideration of home changes was cited, would choose. The question is addressed at some good length in today’s New York Times:

Stay put or sell?

That’s the question many older people ponder as they move into their 70s and beyond.

Most older people settle on staying put, according to a recent survey by the Home Safety Council, a nonprofit organization dedicated to preventing home-related injuries. (From the source of the survey, you can see where this column is heading, right?)

Staying put makes economic sense. It is not only more comfortable to live out your life in your own home, it’s much more affordable.

Those posh retirement condos and assisted-living facilities might seem easy-living and attractive, but crunching their numbers can take the shine off their attraction fast.

The average annual fee at an assisted-living facility — a place where older people live independently but also receive a host of services like medication monitoring and meals — is $34,000. And in the nation’s most expensive metropolitan areas, including New York, the costs may be closer to $70,000.

The Times article goes on to cite the case of octogenarian Catherine Fisher, who chose to adapt her New Jersey home to her own needs rather than take those needs elsewhere. Sooner or later, countless Americans will face similar choices.  Guidelines to what is becoming “an entire service industry… taking shape around the goal of letting people age in place” are worth a quick study now, for whenever “later” comes.

via Patient Money – Cost-Effective Ways to Make Homes Safer for Older People – NYTimes.com.

General interest
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Grassroots Healthcare Reform

by Fran Johns

If we get a health reform bill, it may be thanks in part to a push from the ground up. That belief is leading to a variety of grassroots support endeavors.

At a hospital-sponsored town hall meeting on the issue this week in San Francisco attendees were invited to take the microphone to tell their stories. Probably a bad idea at any meeting, since such an invitation guarantees off-point rambles and rages and this one certainly proved the point — but there were enough horror stories to assure everyone that our current non-system is a train wreck.

A cardboard cut-out of President Obama stood at the back of the room (there was a lot of photo-op going on before things got started) and the promise was that videos of the stories would go straight to Washington to help speed passage of the hoped-for health reform bill.

Participants told of needed care that couldn’t be found, needed drugs that couldn’t be bought and the widespread suffering of the un- or under-insured. A panel of local experts presented aspects of the hoped-for national plan and spoke of San Francisco’s own moderately successful effort to provide health coverage for all.

Speakers were asked to keep their remarks to under three minutes, another dictum doomed to failure, and a few did. My own plea (one minute, forty seconds) was for inclusion of some guarantee/protection of individual choice at the end of life. It stemmed from working for many years (as I still do) with terminally ill adults who seek options including hastening their dying. It was tempered in deference to the hosts, since St. Francis is a member of Catholic Healthcare West and the opposition of the Catholic Church was largely responsible for defeat of a widely popular physician aid-in-dying bill that narrowly failed in California two years ago. And the likelihood of such a controversial issue getting into the massively complex bill we may or may not get is somewhere between slim and none, but what the heck. With Mr. Obama standing there, I couldn’t resist.

At similar gatherings around the country, I suspect the message and the messengers are much the same. Health reform is a national need that translates in millions of heartbreaking individual stories.

My personal favorite message came from panel member Catherine Dodd, PhD, RN, District Chief of Staff for Nancy Pelosi in her pre-Speaker days. Dodd explained the current three-fold status (two in the Senate and one in the House) of the healthcare bill and defended its  probable cost. Then she threw out one new number: 19.7. After everyone had let 19.7 sink in, she told us that is the number of years it has taken this country, every time a health reform bill has been floated, to bring it up again. “We can’t afford another 19.7 years,” she said. I think she’s right.

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