Life: does longevity trump quality?

“We have to get out of the way,” she said; “make room for other, new people on the planet.” Accomplished author/editor Cyra McFadden, at a recent dinner party, was talking about a group of women scientist friends’ excitement over discoveries they have made which show promise of extending life a fraction longer. Cyra was in fierce, though silent, disagreement.

It may be time for those of us who disagree with the rampant prolong-life-at-all-costs theories  to stop being silent.

Americans are, in fact (as reported in Epoch Times below, and elsewhere) living longer all the time. Sometimes that’s just fine, especially if we’re in reasonable health. But what if we’re not? What if we’d just as soon be getting on with whatever follows this temporary time on earth? Millions and millions of people are living for hours, days or extended months and years in circumstances they would not choose simply because we have created a culture that says we must be kept alive no matter what.

Average life expectancy continues to increase, and today’s older Americans enjoy better health and financial security than any previous generation. Key trends are reported in “Older Americans 2008: Key Indicators of Well-Being,” a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics.

“This report comes at a critical time,” according to Edward Sondik, Ph.D., director of the National Center for Health Statistics. “As the baby boomers age and America’s older population grows larger and more diverse, community leaders, policymakers, and researchers have an even greater need for reliable data to understand where older Americans stand today and what they may face tomorrow.”

Where do we stand right now? Well, the same source that says we’re living longer and enjoying better health and financial security (hmmmm on the financial security business) reveals that Americans are “engaging in regular leisure time physical activity” on these levels: ages 45-64: 30%; ages 75-84: 20%; geezers 85 and over: 10%. Hello? Better health and financial security, just no leisure time physical activity? Could it bear some relationship to obesity factors in the same data: 30+% for men, 40+% for women?

Does living well need to be assessed in the compulsion to live long? Why not? Everyone should have the right to live at whatever weight and whatever level of inaction he or she chooses. But the system is weighted toward keeping us alive under all conditions, and bucking the system is not easy. A poignant, wrenching tale of her father’s slow decline and death — and her mother’s refusal to go down that same path — was recently told by California writer/teacher Katy Butler in the New York Times Sunday Magazine.

Almost without their consent, Butler’s gifted, educated parents had their late years altered to match the system’s preferences:

They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Given the limitless sources of victimization floating around, we should not have to add just-try-to-keep-them-alive-forever health care to the list.

My husband and I, having long ago signed advance directives with additional specific issues sheets (“If this happens, do that; if that happens, don’t do this,” etc) recently got them out and talked things over again, a very good thing to do for EVERYbody over 18. We will add dementia provisions to the existing documents while we can remember to do that (the closest you can come to avoid being warehoused in a memory-loss facility for umpteen years.) We are clear, and our friends and family understand, about having no interest in hanging onto life in a greatly diminished state if such an opportunity presents itself; for increasing thousands, it presents itself every day.

All this being said, there’s still a reasonable chance that I’ll be out of town one day when I’m in my 80s (which aren’t that far off), get wiped out by a speeding cyclist and picked up in a seriously mangled state by the paramedics, taken to a hospital that’s not Kaiser (which has all my directives on file,) miraculously brought into some heavily-sedated state of being because the hospital doesn’t consult Kaiser or the living will registry (which also has my directives) and kept alive by assorted mechanisms. By the time my husband or children get there to insist everything be unplugged — which of course will involve long hours and possibly court action — hundreds of thousands of dollars will have been needlessly spent.

I consider myself a highly valuable member of society, and my life a gift from God. But would those dollars not be better spent on a few kids needing specialized care?

Epoch Times – Americans Are Living Longer, According to Federal Report.

Robo-seals invade U.S. nursing homes — perhaps a gadget too far?

Stuffed seal
Image by matsuyuki via Flickr

What with human affection so hard to come by these days, wouldn’t Granny be happy with a fuzzy mechanical toy? That, presumably, was the reasoning behind Japanese inventor Takanori Shabata’s idea for the nursing home’s new best friend, Paro the robo-seal. $15 million dollars later, Paro had hummed and buzzed his (her?) way into the hearts and homes of some 1300 Japanese adults who don’t want the hassle of real, live pets. Now cleared as a Class 2 medical device — a category enjoyed by his brethren the motorized wheelchair and similar less-cuddly items — Paro’s newest destination is U.S. nursing homes.

“Some of our residents need more than we as human beings can provide,” says Marleen Dean, activities manager at Vincentian Home, one of four facilities run by Pittsburgh-based Vincentian Collaborative System. Vincentian Collaborative recently used a $55,000 grant to purchase eight Paros and finds them especially comforting to patients with dementia. “We’ve tried soft teddy bears that talk and move. But they don’t have the same effect.”

Bill Thomas thinks it’s inhumane to entrust the task of emotional support to a gadget.

“If you give me a robot that helps perform mundane tasks associated with caregiving, such as vacuuming or doing the dishes, I’m all for that,” says Dr. Thomas, founder of the Green House Project, a campaign to make nursing homes smaller and more like regular houses. But “if we wind up with nursing homes full of baby-seal robots, the robots will be trying to fulfill the relationship piece of caregiving, while the humans are running around changing the beds and cooking the food.”

This space sides with Bill Thomas. At $6,000 per robo-seal, it just seems that some less anti-bacterial real creature could be found to serve the same purpose. But Paro has made believers in several U.S. nursing homes such as one in which a dementia unit resident is quoted as whispering to it, “I know you’re not real, but somehow, I don’t know, I love you.”   The question of whether offering Paro for love and affection (and often just for calming down the agitated folks who tend to populate nursing homes) is ethical and proper is stirring debate both here and in Denmark, where more than 100 Paros have found homes.

Sherry Turkle, a professor in the Science, Technology and Society program at the Massachusetts Institute of Technology, acknowledges Paro’s potential as a communication aid, but warns against regarding it as a companion. “Why are we so willing to provide our parents, then ourselves, with faux relationships?” she asks.

Danish filmmaker Phie Ambo, who spotlighted Paro in her 2007 documentary on interactive robots, “Mechanical Love,” dismisses such concerns. “When I came into nursing homes and found people sitting in rocking chairs with dolls, no one lifted an eyebrow.”

DTI (European distributor Danish Technological Institute) requires caregivers to attend Paro seminars, where they discuss such issues as whether it’s OK to leave an elderly person alone with a Paro, and whether patients must be told it’s a robot. Don’t allow someone to “escape into a strange seal robot’s universe,” cautions Lone Gaedt, senior consultant at DTI.

Admittedly, we carry on with perfect strangers in the parallel worlds of cyberspacial social networks. But somewhere, somehow, a few lines of human interaction might be better off left un-blurred.

What do you think?

Paro the Robo-Seal Aims to Comfort Elderly, but Is It Ethical? – WSJ.com.

So many pills… so little memory

If you’ve ever had a serious or chronic illness you know the routine: a line-up of all the little pills beside the breakfast plate, or maybe one of those little-old-lady boxes with a cubicle for each day, or perhaps a high-end color-coded wheel of medical fortune.

Now, it turns out, for a mere $100+ or so you can have a machine that does it all for you. Counts out the pills, spits them into a little cup, rings a bell when it’s time to pop another, calls your family if you skip something. When technology can address an issue, count on someone to perfect it. Even if its complexity boggles the mind.

Actually, for aging adults who must rely on a whole bunch of pills, these devices turn out to be a real boon. We learned this in a news release just out from the Center for Technology and Aging, through its Medication Optimization Position Paper, which is far more useful than its tongue-twisting name would have you believe.

The Center for Technology and Aging, a non-profit organization that was founded in 2009 with a grant from The SCAN Foundation (www.thescanfoundation.org,) is affiliated with the Public Health Institute (www.phi.org). It aims to find and advance technologies that help older adults stay independent and lead healthier lives — including technology for monitoring patients, for helping with tasks, social networking… and keeping track of pills.

It turns out, there are pill-counting wonders of every sort and price range. So if you can’t remember which vitamin comes before which super-drug, or you think Mom and Dad won’t remember, there’s a tech-app for that.

When Mom & Dad stay home — and need care

Years ago when my grandmother was dying — a process that seemed to consume her for a very long time — her children took turns having their semi-invalid mother live with them for a period of months. Grandmother was not an easy patient. She spent most of her days talking about how everyone she loved was dead — which used to make me wonder where my sisters, my long-suffering mother and I stood with her. But Grandmother’s decline was before technology complicated such events, and pretty much all that was needed was to put a borrowed bed somewhere, try to keep her comfortable and entertained and call the doctor if she needed anything. Most of her six children had at least one at-home family member who could handle Grandmother’s care for a few months without straining the family budget or everyone’s patience and good humor.

Caring for aging family members today is not so simple. Few families have a stay-at-home member able to juggle regular routine with patient care, such  care now often calls for high-tech equipment and/or high-cost drugs and interventions, and doctors don’t make house calls every other night.

In an informative and enlightening ‘Encore’ feature, Wall Street Journal writer Anne Tergesen follows the adventures of several families wherein siblings have become caregivers to aging parents.

Family cohesiveness is a tall order at any time of life. But as parents grow frail, brothers and sisters often encounter new obstacles to togetherness—at precisely the time they most need to rely on one another. Sibling rivalry can emerge or intensify as adult children vie, one last time, for a parent’s love or financial support. And even as parents grow dependent on children, the desire to cling to old, familiar roles can create a dysfunctional mess.

Today, with the economy and household finances in disrepair, such strains are more pronounced. According to a recent report by the National Alliance for Caregiving and AARP, about 43.5 million Americans look after someone 50 or older, 28% more than in 2004. In comparison with 2004, a smaller percentage—41% versus 46%—are hiring help. And more—70% versus 59%—are reaching out to unpaid help, such as family and friends.

Experts say it’s crucial that families figure out ways to work together, to work through their differences, for the common goal of caring for a parent. If they don’t, their parents will suffer—and so will they.

“Family caregivers are the backbone of the long-term-care system in this country,” says Francine Russo, author of a new book about how siblings can cope with aging parents, “They’re Your Parents, Too!” Siblings who work together, she adds, can help preserve not just one another’s health and sanity but also a “last link to their first family.”

There is, fortunately, a lot of support for family caregivers, through sources listed above, the Family Caregiver Alliance and other local or national groups. There are also helpful tips, many of which are outlined in Tergesen’s article: use new technologies, seek help, be flexible, keep lists, and laugh a lot.

The latter was what saved my family from collapse during Grandmother’s stays in our home. Grandmother would today be easily identified as clinically, chronically, severely depressed. My sister Mimi and I devised a game, after the first few days of jockeying for position as the one not to have to spend the afternoon with Grandmother. Whoever came up with the most hilarious joke to tell and see if we could make her laugh, or the most bizarre question (“Did Uncle James really go to jail, like we’ve heard?”) to prompt a family story, would win. I don’t know if this technique has real merit but it worked for us. We laughed a great deal, and Grandmother got to tell a LOT of previously untold family stories. Some of them were even true.

Siblings Overcome Conflicts to Care for Aging Parents – WSJ.com.

Moving Mom & Dad – but to where?

With the over-5o population expected to grow from 100 million this year to 130 million in 2030, the question of how and where to house these older adults is one that’s not going away. And it is not just a question of quantity and variety — enough houses, apartments, retirement communities — it’s how to ensure that needed services will be accessible to all.

A new report just released by AARP’s Public Policy Institute and authored by the Center for Housing Policy offers a comprehensive look at a complicated picture. Insight on the Issues: Strategies to Meet the Housing Needs of Older Adults and is designed to help state and local policy makers understand the needs of this growing population segment.

All of these Boomers, who are now beginning to swell the ranks of the Seriously Senior, have specific wish lists: independence, security, and above all avoidance of the N-word — the dreaded nursing home. The wish lists change almost by the day, but some things stay the same.

“With the population of older adults on the rise, this report helps to identify the essential housing policy strategies that can help them to balance their increasing needs with a desire to continue to stay closely connected to their families, communities and society,” said Center for Housing Policy Chair John K. McIlwain, senior resident fellow and the J. Ronald Terwilliger chair for housing at the Urban Land Institute.

According to Susan Reinhard, AARP Senior Vice President and Director of the AARP Public Policy Institute, “These resources will be invaluable for policymakers at the state and local levels as they adapt to the changing needs of an aging population.”

If you, or your parents or grandparents, are over 50, chances are you have already had The Talk. Where in the world will Mom and Dad go, and how in the world will they stay there? What’s going to be comfortable? How will we afford it?

Nine fact sheets accompanying the newly released report are divided into three sections. It all makes the task of plowing through the talk a little easier, especially if local and state policy makers are paying attention at the same time.

This space will be looking at the different points over the coming weeks. Your comments and personal stories are welcome.

Moving in with mom and dad

Waiting lines at the bathroom? Overflow in the kitchen cabinets? Welcome to the suddenly multi-generational family home.

Yesterday a friend of mine was alternately laughing and crying (I mean, literally) over the tales of her once comfortable, now overstuffed home. Her daughter and son-in-law, both unemployed for an extended time and overwhelmed by mounting debt and loss of health insurance, recently moved in with the older generation. With them came three grandchildren, ages 3, 8 and 11. It could make a great sitcom pilot. “My husband was so desperate to get into one of our two and a half bathrooms the other day,” she said, “that he suggested getting one of those take-a-number things they have in hospital waiting areas. The kids put labels on their snack bar boxes, but now I can’t even find which shelf the boxes got stuffed into or what they’re hiding behind.”

Welcome to the brave new world of extended-family housing.

The extended family is making something of a comeback, thanks to delayed marriage, immigration and recession-induced job losses and foreclosures that have forced people to double-up under one roof, an analysis of Census Bureau figures has found.

“The Waltons are back,” said Paul Taylor, executive vice president of the Pew Research Center, which conducted the analysis.

Multigenerational families, which accounted for 25 percent of the population in 1940 but only 12 percent by 1980, inched up to 16 percent in 2008, according to the analysis.

For the rapidly growing 65+ segment of the population, there’s good news and bad news in this. Loneliness is often cited as a great fear among the aged. At talks and workshops this writer often does on end-of-life issues (advance directives, end-of-life choices, etc.) the response to any “What do you fear most?” question is never “death,” almost always “pain,” “isolation” or “loneliness.” When younger generations move in, loneliness is unlikely, but other problems may well take its place.

The analysis also found that the proportion of people 65 and older who live alone, which had been rising steeply for nearly a century — from 6 percent in 1900 to 29 percent in 1990 — declined slightly, to 27 percent.

At the same time, the share of older people living in multigenerational families, which plummeted to 17 percent in 1980 from 57 percent in 1900, rose to 20 percent.

While the pre-World War II extended family may have been idealized as a nurturing cocoon, the latest manifestation is too recent and a result of too many factors, positive and negative, to be romanticized.

“It calls to mind one of the famous lines in American poetry, from Robert Frost: ‘Home is the place where, when you have to go there, they have to take you in,’ ” Mr. Taylor said. “I don’t know that I can offer a value judgment of whether it’s good or bad. It reflects our time.”

The decline of extended families coincided with an exodus to the suburbs, where many young adults preferred to raise their children, and the enactment of Social Security and Medicare, which made older adults more financially independent.

A lot of factors combine to create the more than 49 million adults currently living in multi-generational homes, the census figures show. We’re living longer, getting married later, getting divorced more often, losing jobs and losing homes. One ray of good news is that the homes now housing multiple generations tend to be larger than a generation ago. Two and a half bathrooms for three generations still beats the olden days of one bathroom for a family of five. But not many families get along as well as the Waltons did. “We love the kids and the grandchidren,” remarked my stressed-out friend mentioned above, “but my son-in-law’s first paycheck is going to go for the down payment on a new apartment.”

Households With Extended Families Are on the Rise, Census Shows – NYTimes.com.

The Elderly: root of society's ills

This is a bad way to start a geezer’s day:

Deakin University researchers questioned 113 people about their views on the over-65s for a report commissioned by the Victorian aged care organisation Benetas. The university’s Associate Professor David Mellor says young people and baby boomers perceived older people as unproductive.

“While older people are seen as friendly and pleasant, ultimately, they’re seen to be unproductive,” he said. “Now, that ties in with baby boomers talking about older people as having no ambition, or as being fragile and being a burden on society.”

OK, “friendly and pleasant,” I’m good with that. But fragile. Come on, professor, I’m still doing my par course workouts.

Professor Mellor says the research revealed a number of reasons why older people are not treated with respect. “Things like the smaller family size, broken families, the pressure of time that affects people who are working, and the rise of technology,” he said. “All of those kind of factors were seen to be barriers to younger people giving respect or expressing respect to older people.”

However. That ‘ABC’ refers to the Australian Broadcasting Corporation, not the American. And can any study commissioned by a Victorian aged care organisation be fully trusted? Let’s have a little respect here, please.

Elderly seen as ‘burden on society’ – ABC News (Australian Broadcasting Corporation).

An elder revolution? It's possible

If you are over 50, or plan to be over 50 at some future date, you have just been issued a challenge. You might call it a leadership alert.

New York Times columnist David Brooks, who does have a good head on his shoulders, yesterday published an interesting column advancing the theory that real social change will come from the geezer generation. Those at the time of life traditionally perceived as fuzzy, withdrawing and passive. Or at best, the time of life in which most are inclined to let the young folks do the heavy lifting. But those times, Brooks maintains, have changed.

Citing studies undertaken over past decades, Brooks explains that the geezer generation (in which I am a fully accredited member) is now understood to be not so dimwitted and inept as long thought. Beyond new research that shows brains can continue to thrive and develop into one’s late years, people who had been studied over a 50-year period proved to be increasingly outgoing, self-confident and compassionate.

That’s the good news.

The bad news is that we geezers — a population about to boom as the Boomers hit Medicare age — are eating up a way disproportionate share of the GDP. So pensions are going to keep getting money that would better be spent on education, taxes will go to fulfill earlier promises, etc.

Then, though, Brooks turns it all around a new corner:

In the private sphere, in other words, seniors provide wonderful gifts to their grandchildren, loving attention that will linger in young minds, providing support for decades to come. In the public sphere, they take it away.

I used to think that political leaders could avert fiscal suicide. But it’s now clear change will not be led from Washington. On the other hand, over the past couple of years we’ve seen the power of spontaneous social movements: first the movement that formed behind Barack Obama, and now, equally large, the Tea Party movement.

Spontaneous social movements can make the unthinkable thinkable, and they can do it quickly. It now seems clear that the only way the U.S. is going to avoid an economic crisis is if the oldsters take it upon themselves to arise and force change. The young lack the political power. Only the old can lead a generativity revolution — millions of people demanding changes in health care spending and the retirement age to make life better for their grandchildren.

It may seem unrealistic — to expect a generation to organize around the cause of nonselfishness. But in the private sphere, you see it every day. Old people now have the time, the energy and, with the Internet, the tools to organize.

The elderly. They are our future.

We could start by convincing seniors to ignore the scare tactics of their conservative friends and support health reform. Mount a movement for what is morally right: health care for all Americans. Their grandchildren will thank them.

Not being a community organizer myself, I don’t know how to start this campaign. But if you have any suggestions I’ll join the movement.

Op-Ed Columnist – The Geezers’ Crusade – NYTimes.com.

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