Tag: seniors

California/Education/General interest/Health/Lifestyle/Money/seniors/USA
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On learning at 30… or 40… or…

by Fran Johns

True/Slant contributor Gina Welch, on turning 30 just now, posted a fine list of 20 things she learned in her twenties, at the precise moment when I’d been musing about the passage of time myself. A somewhat more elderly muse, that is, since mine was prompted by the realization that day before yesterday marked the 85th anniversary of my parents’ marriage. In case that doesn’t sound elderly enough, my parents were both born in 1897, whew.

So in response to Gina’s wisdom here are six things I learned in my sixties (which are way past, at that.) It was terribly hard not to plagiarize, especially Gina’s Listen to your mother, even if it’s only to her long-departed voice in your head, or Wallow not, advice that improves exponentially with age.

1 – Get up early in the morning. It’s way more fun when you aren’t doing it because the baby’s crying, the school bus is waiting or the boss is calling… but just because the To-Do list actually contains stuff you want to do. Plus, days have fewer hours in them.

2 – Go back to school. Classmates a generation or two younger can be wise beyond your years. After a lifetime of writing for newspapers and magazines (you remember print journalism?) I joined the Class of ’00 at the University of San Francisco to pick up an MFA in short fiction. Who knew? If you run into anyone ready to publish my short story collection, let me know. A few of them have actually seen the light of publication, but I’m going to publish The Marshallville Stories in full if I live long enough… or perhaps if I learn enough in my 70s.

3 – Medicare is good. Imagine not having to freak out at every bodily suggestion that fatal expenses could be right around the corner. Imagine everybody having that unfreakable experience. How about we pass health reform?

4 – Listen to your daughter. She can probably teach you a LOT about changing mores, gender identities, adventure travel and how to see the world. Not to mention low fashion, hair styling, organic food and living well.

5 – Listen to your granddaughter. She can definitely teach you about computer programs, digital photography, what 18-year-old college art students are doing, and teenage music. You can close your ears when the teenage music part comes.

6 – Count your blessings. Seriously. If you’re still able to get up in the morning and remember how to count, this is good exercise. And if you count forwards and then repeat the same numbers backward you have exercised your brain, which is increasingly important. At a certain point in life it is tempting to reflect on the world when nobody locked their doors and you dashed onto airplanes just as they were pulling up the steps. And people apologized if they inadvertently used the D-word in front of your mother (there’s her voice again in my head…) So it’s okay to count nostalgic blessings, too; just don’t forget about par courses or contemporary chamber music or sunsets over the Pacific or that grandson who speaks Mandarin and Spanish at 17…

Thanks, Gina. Happy Birthday.

General interest/Health/seniors/USA/Women
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New Cancer Guidelines: One Good Message

by Fran Johns

News about changing guidelines for cervical and breast cancer screening have some women cheering, a lot of women fuming, and most women feeling confused. Or betrayed, or mistreated or worse.

There is one universal message in it all: every woman has to be her own advocate.

For most of us, that is no big deal. We’ve known for a long time that no two of us (and surely no four collections of breast tissue or no two histories of sexual activity) are alike, and most of us have gotten used to asking a lot of questions. It’s unfortunate that so many changes have been announced at almost the same time, and especially that the issue has become politicized.

New York Times health writer Denise Grady summed up the latest developments, and the issues that have caused confusion and anger in a November 20 article:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

Still, the new recommendations for Pap tests are likely to feed a political debate in Washington over health care overhaul proposals. The mammogram advice led some Republicans to predict that such recommendations would lead to rationing.

It boils down to this: every woman will need to pay close attention to her own health care. That is bad news for the less educated, the less aggressive, and those with less access to care, and not particularly good news for many older women who grew up with “The doctor knows best” excuse for not paying attention.But it’s good news for those of us, particularly older women, who have questioned what sometimes seemed too-frequent testing and screening.

Asking questions just got more respectable.

Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.

General interest/Health/Money/seniors/USA
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Facing Up to Dental Terrors

by Fran Johns

The only thing worse than toothache/jaw pain, to be cruelly specific, is toothache/jaw pain without insurance. Most of us are without such insurance. It has not even been on the radar of health reform advocates, which is just as well — if you add dental terrorism to abortion and public options we won’t see reform for another few decades.

Nevertheless, tooth reform, euphemistically referred to as full mouth restoration in some circles, is ahead for increasing numbers of Americans sooner or later. It comes down roughly to a choice between fixing the mouth or buying a yacht, but if your jaw aches, you forgo the yacht.

New York Times health writer Jane Brody traced the new path of dental repair journeys in a thoughtful article yesterday, explaining her own costly route from tooth decay to bridges to implants, and throwing out an estimate of approximately $3,500 to $4,000 per tooth for the now-preferred latter. Multiply this by at least three or four times if you have other issues, which most of us do once things start going south in the mouth, needing attention. That would be gum problems, repair to surrounding teeth or necessary attention to bone.

I write with authority. Some years ago, facing all of the above, I visited an assortment of dentists with an assortment of solutions that frequently had me in tears when contemplating the time, details (one would have had screws in my jawbone which I would tighten every few days for months as it rebuilt itself) and costs. Like Brody, I grew up before the days of fluoridated water and have had more repair work since childhood than the Bay Bridge. It was a mess in there.

Finally my husband, whose best wives have been born in 1933 but with bad teeth, said, “Just do it all. Don’t be going patch-patch-patch; do it all.” I proceeded to choose the most sympathetic and understandable (most of them were, except for the screws-in-the-jaw guy) dental professionals, assembled a team and went to work. Or rather, I scrinched my eyes shut while they went to work. Some 18 months and $40,000 later we were free at last.

(Out of this experience, during which I was doing a great deal of entertaining just to keep us happy and sane, came one of my finer unpublished books, Cooking for the Dentally Impaired: Recipes and Menu Suggestions for the Impaired and Unimpaired in Difficult Times. I think it’s a book whose time has come; my agent disagrees.)

Brody’s article is a must-read for anyone stewing over this issue. The following are abbreviated tips for anyone with teeth and plans to keep them:

1 – Consider early-decision. The sooner things like gum surgery, crowns, implants-v-bridges or bone issues are dealt with, the likelier all can be made well and kept that way.

2 – Get second opinions. You may even choose the screw-in-the-jaw route, but there are many different procedures and it is good to find one suited to your temperament and bank account.

3 – Ask questions. I asked so many that I was fired by one team; a polite letter said they did not believe they should take my case. It’s just as well. Those I wound up with answered my questions and seemed happy to do so.

4 – Ask for references. Brody suggests this, and I agree. Because I already knew several people who had been patients of the dentists with whom I eventually invested all that time and money, talking with them about their experiences helped keep me from any surprises.

5 – Talk finances. Several friends of mine have had major dental expenses that were far outside their budget, but worked out payment schedules with their dentists so that necessary work could be done sooner rather than later.

Meanwhile: floss.

Health/Women
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Skip mammograms, quit breast self-exams, and maybe lighten up on 'defensive medicine' while we're at it

by Fran Johns

All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.

As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.

LeBlanc illustrates the issue with a story that rings sadly true:

Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.

After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.

We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.

We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.

I’m also not having any more mammograms any time soon.

New advice: Skip mammograms in 40s, start at 50 – Yahoo! News.

California/General interest/Lifestyle/Money/Sports/USA
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Finances after 50: Have we learned anything from the Great Recession?

by Fran Johns

Too soon poor, too late smart? A story by WSJ staff reporter Glenn Ruffenach in the November 14/15 Wall Street Journal “Encore” section  asks if we’ve learned any lessons from the financial crisis. And just in case you’re feeling smug about having done so, a quiz inside may shine a sober light of reality. It also contains a lot of data you will find useful, interesting and possibly surprising.

Amid the tumult of the past year, financial advisers are telling us that the Great Recession has produced one invaluable benefit: an education.

We now know, for instance, that our nest eggs can lose almost half their value in a matter of months; that “diversifying” our holdings doesn’t necessarily safeguard those holdings; and that our homes—our one investment for later life that was supposed to be foolproof—can make us look like, well, fools.

How much have you taken away from the events of the past year? Try our quiz and find out.

OK, so it isn’t much of a silver lining. But even worse is that we’ve supposedly learned these lessons before—after each recession, sell-off and market bubble since the 1960s. And yet, we continue to make the same mistakes.

How much have you learned about retirement finances in the past year? And has it sunk in this time? Our quiz will offer you a chance to see if you know where you stand—and provide some guidance for the future.

You’ll have to pick up the Weekend Journal for the quiz, but here’s one freebie in advance:

Q – In retirement, Social Security will likely replace what percentage of your pre-retirement income: (a) 23%; (b) 33%; (c) 43%; (d) 53%.

A – Well, don’t guess high.

Or:

Q – The single best cure for a battered nest egg is: (a) invest more aggressively; (b) save more money; (c) Work longer; (d) Plan to withdraw less money from retirement savings

A – And just when that pile of books to read is so inviting… sorry. (c)

The quiz is full of useful data and interesting insight (fully 40% of men and 41% of women ages 40-50 are considered obese by the Centers for Disease Control & Prevention, for instance; you knew?) One overall message seems to be, in fact: If you have one, don’t quit your day job.

General interest
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Fear (and the high cost) of falling

by Fran Johns

My husband was face down on the floor of the breakfast room, stretched below the table with one hand resting beside a chair he had pushed into the corner. As I came up from the garage, returning from a long opera just before midnight, he called out, hoping to spare me from alarm or a heart attack of my own. This is the sort of scene that tends to cause alarm at any age. According to an article in last Sunday’s New York Times, a similar scene occurs with alarming frequency: more than one-third of people ages 65 or older fall each year, writes Steve Lohr in an “Unboxed” feature, “Watch the Walk and Prevent a Fall.”

In our recent case, all was soon well. My husband had lost his balance while setting dinner on our not-too-sturdy table, and more or less slid to the floor. Still recovering from spinal fusion surgery 8 months earlier, he had done everything possible not to break anything — old bones or new rods and bolts that is; he wasn’t worried about the china — as he went down. But once down, getting back up was not an easy assingment. You know those awful “I’ve fallen, and I can’t get up” ads? Believe them. He tried shoving a chair into the corner to gain traction, but soon realized there was not enough strength in his lower legs to do the job, and decided just to wait. (Some people do carry cell phones… but that’s another story.) At 6’3″ and over 200 pounds, Bud outweighs me approximately two to one, so my getting him up was, we already knew, not an option. Happily we have a neighbor who seldom goes to bed early. Once he came over and the three of us strategized a while we were able to set my husband upright again. More specifically, John and Bud accomplished the deed; I supervised. Bud was tired and hungry, but otherwise fine.

Most of the falling elderly are not so lucky. About one fall in 10 results in serious injury such as a hip fracture, according to the Times story. Some 20 percent of older adult victims of hip fractures die within a year. If that weren’t enough to get one’s attention, reporter Lohr writes that “the estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted living costs are added to medical expenses.”

The last time I fractured my ankle, which I tend to do with dismaying frequency, I grumbled to a friend about “that dumb accident.” There are no smart accidents, she replied. (I was running late, and carrying a very large empty computer box down the stairs.) And this is a good thing to keep in mind. Somewhere not far past the age of 50 (I throw that in for all those weekend soccer-playing dads) bone breakage gets easier and healing begins to take longer. Somewhere a little farther along in the aging process, falling takes over from dumb accidents as #1 cause.

“Watch the Walk and Prevent a Fall” focuses on early research, backed by the National Institute on Aging, into the relationship between activity patterns and falls. “Fall prevention also promises to be part of an emerging — and potentially large — worldwide industry  of helping older people live independently in their homes longer,” Lohr writes. New technologies such as sensors that track behavioral and activity patterns will play growing roles in fall prevention, along with customized exercise programs and close attention to the role of medications.

Considering the risks and the cost, fall prevention may fast claim serious attention. But for now, especially if you’re over 65: get up slowly, watch your balance, and be careful setting your dinner plate down on a wobbly table.

General interest/Health/Lifestyle
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Moving Mom and Dad

by Fran Johns

The folks are getting on in years, the old house needs work, the Stuff is piling up everywhere — it’s time to look at moving. But the big question is, where to? Urban condo? Assisted living? Retirement village? LifeCare facility? Co-housing? Maybe even the dreaded Nursing home or dementia facility?

Making the decision to move into what is likely the last residence on this side of the hereafter can be daunting, sometimes devastating. Whether it involves oneself or one’s older family members, the Final Move often exhausts patience, finances and family resources. But good choices are out there, and good help (sometimes free, more often adding to the growing costs of this life event) can be found. In previous posts this space has offered glimpses of these choices and experiences: Helping Mom Die (10/16); Hanging in the ‘Hood (9/29); Justice Souter’s Retirement Housing (8/10.) What follows is a look into the LifeCare option. I should first insert a grateful nod to the source of this headline, a great book by Sarah Morse and Donna Quinn Robbins.

I have just returned from a visit with my sister Helen and her husband, newly installed in a spacious two-bedroom cottage at Kendal at Ithaca (NY), a Continuing Care Retirement Community. To do this necessitated cleaning out and selling (of course, the sale fell through when everything was on the moving vans, but last-minute calamity is to be expected) the far more spacious four-bedroom plus roof deck 1920s condominium in Boston they have called home for nearly 40 years. It was not pretty. Despite my earlier Boston visits to whittle down the Stuff factor and later urgings to connect Helen with the National Study Group on Chronic Disorganization, the job tested the limits of patience and strength of their four extraordinarily loving children.

Nonetheless the deed did get done, and Kendal at Ithaca is perfect for Helen and Clare, thanks to a confluence of happy circumstances: their physician daughter has relocated from Seattle to Ithaca; Manhattan is a comfortable Cornell bus trip away; desired features are in place. KAI includes a community center with a dining room in which their monthly fees entitle them to one meal per day, a fitness center, a large library, a van to take residents to doctors’ appointments etc. Best of all, says Clare, who has Parkinson’s, “they can’t throw me out.” The major appeal of LifeCare, or Continuing Care communities, for many seniors, is the inclusion of facilities for different levels of care which one may require in the future. (Worst of all, Clare adds, is the fact that “we have a lot of Parkinson’s, so I see myself 3 years down the road… 6 years down the road.”)

Continuing Care communities do not come cheap. But for seniors who have a chunk of change from a home sale or other source and a comfortable retirement income, they fortunately exist in growing numbers across the country.

For my own part, and I am certainly very senior, I was suffering anxieties and depression after one day. I need regular infusions of 30-somethings and 40-somethings for basic survival. Again, from what I’ve heard about co-housing — the perfect choice for many others as they age — that arrangement would feel crowded and disorderly. But there is the growing aging-in-place “Village” movement, which many would not choose but seems perfect to me.

Thank heaven for choices. It is seldom too early for Boomers, or Beyonders, to start considering them — and while you’re at it, you may want to clean out the attic.

General interest/Health/Politics & Causes
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End-of-life counseling stays in health care bill

by Fran Johns

Here’s a piece of very good news just in from Associated Press reporter Ricardo Alonzo-Zaldivar:

It’s alive. The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to “death panels” for seniors is staying in the latest Democratic health care bill unveiled Thursday. The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

The business of thinking ahead toward end-of-life decisions and making  one’s own wishes known through legal documents such as advance directives has long been encouraged by federal policies. But when coverage for talking things over with one’s doctor was incorporated into health reform it was quickly distorted by Republicans.  Sen.Charles Grassley led the successful campaign to strike it from the Senate bills. But saner heads have prevailed in the House.

“There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,” said Rep. Earl Blumenauer, D-OR. “I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it’s been kept in the bill.” The legislation would allow Medicare to pay for a counseling session with a doctor or clinical professional once every five years. The bill calls for such sessions to be “completely” voluntary, and prohibits the encouragement or promotion of suicide or assisted suicide.

The counseling provision is supported by doctors’ groups and AARP, the seniors’ lobby. It was not included in health care bills passed by two Senate committees.

It’s alive! End-of-life counseling in health bill.

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