ChangingAging.org

ChangingAging Weekly Blog Roundup August 27 to Sept. 2

2010-09-02T18:00:53Z

Welcome to the new ChangingAging.org weekly blog roundup for August 27 to Sept. 2, 2010.

More than 1,000 of our regular readers follow ChangingAging.org and Dr. Bill Thomas on Facebook, and we’d love to get that number to 10,000! Can you help us? If you haven’t already “Followed” ChangingAging.org or “Liked” us on Facebook it’s super easy. If you’re on Facebook and not already a “fan”, there will be a little “Like” button on the Facebook box on the home page at ChangingAging.org. Just click it — that’s it, it’s that easy! And please help spread the word by forwarding this email to your friends or connecting with our other social networks below!

RealCareNow

Dr. Al Power

Powerup Friday: More “Broken Hearts”

The comments continue with very challenging real life concerns. So I’ll use my Friday space to address the two latest questions in the “Broken Bones and Broken Hearts” thread. The first relates to a relative who has broken vertebrae due to osteoporosis and presumably is at risk for falls, who is now distressed by the “lap strap” that is used to prevent her standing on her own. There are no doubt many factors at play here. But number one is–the lap strap has to go. Let me explain:
Click here to continue reading

Dr. Bill Thomas

Elder-Friendly ER Opening in Port Huron, MI

I was in St. Joseph Mercy Hospital in Port Huron, Mich., today. Chances are you’ve probably never heard of it before. Well, this October, St. Joseph Mercy will complete renovations and open one of the nation’s first senior-specific emergency departments. It’s part of a project that was first piloted by Holy Cross Hospital in Silver Spring, Md., and has been a smashing success for elders, their families and caregivers at the hospital.

Culture Change

Kavan Peterson

What People are Saying: ChangingAging on LinkedIn

In the past few months nearly 300 people have joined ChangingAging’s LinkedIn group, a network of professionals connecting, sharing stories and fostering conversations about their experiences changing the culture of aging.

The group includes a diverse mix of people, such as Holly Whiteside, a caregiving coach and Eden Associate who recently published the book “The Caregiver’s Compass;” Madeleine Kolb, a great pro-aging champion and blogger at http://agemyths.com; Patti Bertschler, a professional elder mediator and meditation advocate; Sheila Lehner, founder of Benevolent Ballet, a dance program for people of all ages and abilities; and Charles de Vilmorin, a social scientist from Georgetown University who recently launched a startup company “Linked Senior,” to better use technology to enhance the lives of elders.
Each week, we will highlight a popular discussion from the LinkedIn Group and introduce new members.

Generations

Virgil Thomas

The Tao of Travel

What I truely love about travel is not as much the sights but the people. I first noted this in my travels across the country. I did not expect to find any noticeable differences as I crossed from east to west, but I did. However, it was a change in culture not society. Click here to continue reading.

Dr. Bill Thomas

Human Cannonball

When I was a kid I dreamed of being an astronaut, little did I think at the time that I would wind up leading expeditions into the unexplored country of aging.
Even so, stories about spaceflight still catch my eye.
I liked this one because the scientists have questioned what seem to be the foundations of spaceflight.
Nice thinking, now we will have to wait and see if it works. Click here to continue reading.

Social Media

Kavan Peterson

Social Networking Surges Among 50+

Here’s a must-read piece from NPR detailing the explosive growth of social networking among 50 and older adults:

Grandma is posting a photo on Facebook.
Grandpa is looking for former colleagues on LinkedIn.
And more and more people over 50 are joining social networks, according to a new report by the Pew Research Center’s Internet & American Life Project. The study found that social networking has almost doubled among this population — growing from 22 percent to 42 percent over the past year.

THE GREEN HOUSE Project

Kavan Peterson

Green House ChangingAging on Facebook

From The Green House Project Facebook Page, a Shahbaz* shares this gem about why she loves her job:

Why I love my job reason #792:
As we were preparing supper, an elder decided to go back to their room and started playing their piano. As elders in the hearth recognized the hymns and old time favorites that were being played, they started to sing along.

Click here to “Like” the Green House Project on Facebook.

What People are Saying

From ChangingAging on LinkedIn

Laura Bramly asked about email programs and other computing devices for elders with vision problems and short-term memory loss.

Ann V Quinlan said

Laura – Check out MIT library – one of the best sources of new thinking in aging. Older People Adaptive Devices (?) or something like that. MIT has a very progressive research project dedicated to keeping elders safe on the road and in the home. You have to browse a bit to locate what you are looking for. I love research and get easily get lost in there! Another suggestion for this elder would be to locate a techie student willing to volunteer setting her up with something. If her print is enlarged that makes a huge difference.

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What People are Saying: ChangingAging on LinkedIn

2010-09-02T11:57:22Z

Each week, we will highlight a popular discussion from the LinkedIn Group and introduce new members. This week’s conversation was started by Laura Bramly:

A question about email program and other computing devices for elders with vision problems and short-term memory loss.

My friend’s grandmother is in her 90s, has trouble seeing, and her short term memory is going. She is in that vicious cycle of not wanting to go out and just sits at home watching TV or playing solitaire on her computer all day, which is leading to boredom and depression, which just makes her want to watch TV all day. Her extended family is looking for ways for her to exercise her brain and socialize — she’s pretty much home bound and doesn’t like to go out.

She used to have a computing device that was dedicated to email and she loved it, but her family talked her into getting rid of it and getting a computer instead (Seeing as she loved the email so much, they figured she should just go whole hog). However, the computer is too confusing thus far, and she isn’t keeping in touch with her friends anymore via email, although she knows how to play solitaire on it!

I suggested to my friend that perhaps there is an email program out there that is simple, not web-based, and that could be activated at the click of one button. Does anyone know of such an email program? How about a web interface that simplifies accessing the Internet? She is not doing too badly with the mouse but it’s starting to become an issue due to arthritis. Are there any other devices that might be easier to use (I’m thinking that perhaps there is a joystick or something). She has a magnifier over her screen to make it easier to see, and the family is willing to hire someone to come in regularly to teach her how to use the computer. Ideas?

Click here to read over 11 responses to Laura’s discussion.

Meet all our new members and join the conversation by introducing yourself here.

The Tao of Travel

2010-09-02T10:37:15Z

Virgil Thomas

Every one I met was culturally American, all have the same language and for the most part the same accent, with a notable exception of our friends in Minnesota, eh. Though the differences were slight they were still measurable.

On the way to Montana I noted a change in dialect. Phrases and mannerisms are unique to each region. For example, I was told that adding “and stuff” to the end of a sentence is a very east coast thing to do.

England is a differnt story — the people here are, as you might guess, very English, while familiar enough as to avoid inducing culture shock. Because
the transition is smoother the fine details are easier to see.

They have their own accent, and unique terms. Pants are trousers, and underwear is pants, sneakers are trainers, garbage cans are dust bins, and
to them the meaning of the word “Brit” is slightly different than we Americans understand.

If you ask the question, as I did, what is the difference between a Brit and an Englishman, you may receive a passionate response. A Brit, I was
told, is some one from the UK in general, and an Englishman is someone specifically from England.

The best parallel I can draw is if you were to tell a Marine he is really just in the Army. Some are very conscious of this while others are oblivious.

These nuanced experiences are the gold nuggets of travel. Anyone can see the tower of london or buy an “I heart NY” tee shirt. The real adventure
comes from keeping your cup empty as you immerse yourself in a foreign culture.

Fist City

2010-09-01T13:02:30Z

I like this Loretta Lynn hit, “Fist City

It topped the country charts in 1968 a year also looms large in Hippie history.

The song is a good reminder that most Americans in 1968 were Squares– they loved country music, beehive hairdoos and hardluck songs about disloyal lovers.

Haight Ashbury was a tiny dot in a far away city.

Elder-Friendly ER Opening in Port Huron, MI

2010-08-31T21:18:02Z

St. Joseph Mercy Hospital in Port Huron, Mi.

I took the opportunity to grab a quick hello from Karen Harris — stay tuned for more information when the ER opens in October!
Senior Emergency Center

Green House ChangingAging on Facebook

2010-08-31T13:16:41Z

From The Green House Project Facebook Page, a Shahbaz* shares this gem about why she loves her job:

Why I love my job reason #792:
As we were preparing supper, an elder decided to go back to their room and started playing their piano. As elders in the hearth recognized the hymns and old time favorites that were being played, they started to sing along.
Later that evening we watched Lawrence Welk (a long time tradition for many of our elders). I had the privilege of experiencing elders who often are reserved and keep to themselves in the evening come alive as they recognized familiar songs of yesteryear and began singing proudly or tapping their toes along with the music while sharing their fond recollections of memories associated with the songs and dancing…and even a few comedic gems thrown in (my favorite line of the night: “we used to go barn dancing and the guy would say ’swing your partner/ swing her again/ swing your partner/ and kick her in the shin!’” LOL)
I love what a powerful common denominator music is!

The Green House Project has nearly 400 friends on Facebook — have you “Liked” them yet? All you have to do is log into Facebook, and then click on the “Like” button below — it’s that easy!

*Shahbaz (plural form is Shahbazim): A universal worker who provides a wide range of assistance and care to elders living in a Green House. Click here to learn about the origins of Shahbazim.

Ageism in Health Care

2010-08-31T09:26:48Z

I am on my way to Detroit to talk about Ageism in health care. The talk is part of an effort to convert seven Trinity hospitals in Eastern Michigan to the “Senior ED” model of emergency care for older people.

I am going to try to post some video through out the day.

Hope it works!

What’s on your mind today?

Human Cannonball

2010-08-28T15:16:06Z

When I was a kid I dreamed of being an astronaut, little did I think at the time that I would wind up leading expeditions into the unexplored country of aging.

Even so, stories about spaceflight still catch my eye.

I liked this one because the scientists have questioned what seem to be the foundations of spaceflight.

Nice thinking, now we will have to wait and see if it works…

Up Up and Away

Why build a human cannonball instead of a more conventional rocket?

Traditionally, astronauts are launched into space lying on their backs. This means that you have high g-tolerance [can withstand large accelerations], but it’s very expensive because it needs a relatively large rocket booster. What we’ve done, which is very controversial, is to say, “Let’s put this man standing.”

This gives us a lot of benefits. The rocket becomes a lot smaller – it’s only 65 centimetres in diameter – and therefore lighter. Second, it gives the astronaut the visual experience of leaving Earth and travelling up through the atmosphere. This has never happened in the history of space flight.

But how does the standing astronaut survive?

We can choose to design our rocket engines to expose the standing astronaut only to limited g-loads, on the order of 3 to 4 g [three to four times the effect of Earth's gravity] – and only during the first 20 seconds of the flight. That’s less than you expose yourself to in a rollercoaster.

We have already used a “human centrifuge” here in Copenhagen to expose people to 5.5 to 6.5 gs. It was crystal clear that this type of g load, at this level and for this period of time, is relatively uncritical to our astronaut.

Will this be the smallest spacecraft ever to carry an astronaut?

You should consider our spacecraft as something totally different. The vessel should be considered like clothes, and the nose-cone a helmet that protects you from the vacuum of space. It’s a very different kind of space flight; the person is submerged in the cosmos.

Rust Never Sleeps

2010-08-28T13:39:13Z

I like this blog.

The writer is Canadian and his take on economics and the environment seem both insightful and provocative. That is not an easy combination to pull off.

Here is a taste test…

TED 2009 Prize winner Sylvia Earle discusses the state of the oceans, with striking footage. Her TED Prize wish:
I wish that you would use all means at your disposal – films! expeditions! the web! more! – to ignite public support for a global network of marine protected areas, hope spots large enough to save and restore the ocean, the blue heart of the planet.

“How can I bring you
To the Sea of Madness
I love you so much
It’s gonna bring me sadness
I’ve never seen you
Through these eyes before
Now I don’t believe it.” CSNY…

Social Networking Surges Among 50+

2010-08-27T18:32:18Z

Here’s a must-read piece from NPR detailing the explosive growth of social networking among 50 and older adults.

Full-disclosure, I used to work with both the report’s author, Mary Madden, a great researcher at the Pew Research Center, and the NPR reporter, Joshua Brockman, who wrote the story. But I came across this piece randomly on Twitter. It’s a small world and even smaller digital world!

Social Networking Surges For Seniors

Grandma is posting a photo on Facebook.

Grandpa is looking for former colleagues on LinkedIn.

And more and more people over 50 are joining social networks, according to a new report by the Pew Research Center’s Internet & American Life Project. The study found that social networking has almost doubled among this population — growing from 22 percent to 42 percent over the past year.

According to comScore, a digital measurement company, 27.4 million people age 55 and over engaged in social networking in July, up from 16 million one year ago.

“I’ve connected with friends and acquaintances that I have lost contact with through the years — people I’ve graduated high school with and people from my home town,” says Claire LeSage, 63, who has been using Facebook for about a year and a half.

…

Older Americans are becoming increasingly computer literate and that means they’re also becoming more comfortable using the Internet. This has the potential to boost e-commerce, computer and gadget sales as well as subscriptions for high-speed Internet access among this population.

The promise of social networking — as a tool that can enable people to share photos, videos, links, contacts and status updates — has some unique applications for senior Americans.

“E-mail is still at the center of older adults’ social communications,” says Mary Madden, senior research specialist for the Pew Internet & American Life Project. But she says social networking is supplementing their daily communications, and once they start they are using it more frequently.

…
The Pew report also found that social networking users are much more likely to reconnect with people from their past. These contacts can build and enhance support networks as people begin a second career or near retirement.

…

Nearly 19 million people age 55 and over used Facebook in July, up from about 9 million one year ago, according to comScore.

But with more and more older Americans joining social networking, there also are some user hazards.

“Because many of them are new to social networks, they are more apt to fall prey to scams,” Gordon says. “We alert them to ones that are making the rounds, but we also encourage everyone to get familiar with privacy settings.”

Twitter use has also grown. Ten percent of Internet users over 50 say they’re using Twitter or other status update services, according to Pew.

Click here for the full story- http://n.pr/b6mNu9

More “Broken Hearts”…

2010-08-27T14:37:51Z

The comments continue with very challenging real life concerns. So I’ll use my Friday space to address the two latest questions in the “Broken Bones and Broken Hearts” thread.

The first relates to a relative who has broken vertebrae due to osteoporosis and presumably is at risk for falls, who is now distressed by the “lap strap” that is used to prevent her standing on her own. There are no doubt many factors at play here. But number one is–the lap strap has to go. Let me explain:

The lap strap is a restraint and it hampers her ability to move or feel free, thus increasing her level of distress. It will ultimately make her weaker, through immobilization and atrophy and more likely to fall when she does stand. It will also increase discomfort and stiffness, and elevate the risk of other problems (leg edema, constipation, pressure sores, etc).

Try this exercise: Put yourself in the lap strap for one hour. Not 45 minutes, not 55. No fudging. Gotta go to the bathroom? Sorry. Can’t quite reach that pad and pencil across the table? Too bad. The chair you though was comfy starts to be very unyielding when you can’t shift you weight. Your butt becomes uncomfortable and your knees stiffen. Then imagine you are confused and when your caregiver walks out of sight, how trapped you might feel. Now imagine wearing it for hours on end.

Restraints don’t work, but they are necessitated when care partners become overwhelmed by the challenge and cannot find another safe solution. Unfortunately, the next step is usually to medicate the distress caused by the restraint. It’s like hitting someone on the head repeatedly and giving them Tylenol for the pain.

The reality is that if a care environment is stressed to the point that restraints and sedation are the best options, then it may well be an indication that this is no longer the best care for the individual. Because of their fear of nursing homes (not totally unfounded, I might add), people cling to home-based care to the point where it becomes a more detrimental situation. When a person needs to be restrained at home (if this is the case here), then a good-quality nursing home is a better situation for all concerned.

The second writer expresses the very common feelings of (1) grief at the loss of communion with a loved one whose cognition has changed, and (2) fear that the same might happen to him. He shares the very common feeling that he would rather be “put to sleep” than experience the illness. Many people do just that–commit suicide when they learn of their dementia.

Without trying to sugar-coat this very challenging illness, I would like to offer that much of the grief we feel is a result of the stigma, negative imagery and excess disability that has resulted from a system of care that fears Alzheimer’s so greatly that all we see in our approach to care is disease, deficits and death. This leads to overmedication, disempowerment, isolation and institutionalized life (which can occur in ANY living environment). By moving from a fear-based approach (that biases our views of the person’s capability for well-being and active engagement) to more of the approach espoused in my book, by the Real Care movement and others (such as Jane Verity’s Spark of Life approach), people have experienced unexpected moments of joy and connection, and have reignited the spirits of people who were thought to be long-lost to the illness.

Sorry folks, but there is no cure on the horizon. Rather than despair, however, this should be a call to find the very real ways that we can totally re-make the experience of Alzheimer’s for those who live with the illness and their care partners.

Please write back if any of this needs further explanation. It is a difficult and complex topic.

ChangingAging Weekly Blog Roundup August 16 to August 26

2010-08-26T13:39:17Z

Welcome to the new ChangingAging.org weekly blog roundup for August 16 to August 26, 2010.

RealCareNow

Dr. Bill Thomas

Broken Bone Broken Hearts

Reader Kristin Stevens writes…

What should we do for a 86 year old with mid stage ALZ with a femur neck fracture without option for repair because of critical aortic stensis, who is who unable to get out of bed, unable to toilet out of bed, who is very frustrated and confused and anxious and angry about not being able to get up, who tries over and over and over again to get up who can’t remember that he has a fracture. Efforts to redirect, to just stay present, to be with what is happening fail. Drugs loom as the “solution”…loving, skillful care partner is at bedside 24/hr. How would REAL CARE address this dilemma?

First of all we can all pause, for a moment, and feel compassion for a daughter and her father as they struggle together through difficult and unfamiliar terrain. The situation is painful and seems to offer no good answers.

Second, we can take refuge in the principles of person-centered care. The answer to “What should we do for a-” depends entirely on the individual in question.
Read the full story here.

Dr. Bill Thomas

Fear of the Unknown

Simple things can work surprisingly well. This is the new frontier of health care. It’s not about the molecules anymore. The new frontier is all about ideas and insights into what constitutes real care and then organizing resources in a way that makes real care happen— every time. Consider this insight from Atul Gawande for example.

Dr. Al Power

Power-Up Friday: Real Problems, Real Solutions

The University of Iowa’s Geriatric Education Center recently sent out a summary of studies year-to-date regarding “Management of Behavioral and Psychological Symptoms of Dementia”. Here’s a brief summary of the nine studies quoted:
(1) One study could not prove that stroke incidence was increased with antipsychotics, while another said it likely was increased.
(2) Antipsychotic use has increased in recent years in nursing homes without evidence of any coherent thought process, and out-of-proportion to any increase in dependency or behavioral symptoms over the years.
(3) Several studies were so “brave” as to say that “caution” should be exercised before using antipsychotic drugs in dementia, even though their data suggest that this wording is too mild.
Here’s a challenge: The REAL problem is not that these drugs are largely ineffective and dangerous when used for behavioral distress. The REAL problem is not even that we over-medicate people with dementia.
The REAL problem is that the very notion that this distress requires any pill is a flawed paradigm.
The REAL solution is not to find better pills. The REAL solution is Real Care.

Social Media

Kavan Peterson

Race, Eldercare and iPhone Apps

Yes, there is an App for everything these days — including the new free “Geriatrics Cultural Navigator” iPhone App for eldercare workers:

Are you a clinician caring for older adults from different ethnicities? Do you want to better understand the role of culture and ethnicity in health care in order to make better decisions about these patients? Then the Geriatrics Cultural Navigator is just the tool for you.

Elderhood

Dr. Bill Thomas

What to Call the Boomers

The Boomers have not been babies for a very long time.
In order to understand them at this point in their lives I think it makes the most sense to refer to them as members of the “Post War Generation.” I’ll be writing much more about this in the months to come.

Cult of Adulthood

Dr. Bill Thomas

Forced Retirement

It’s more common than I thought and the Great Recession is worsening the trend:

According to a new study by Sun Life Financial, more than 20% of American workers are forced into early retirement by layoffs, cutbacks, and shutdowns. In an age where pensions have gone by the wayside and the future of social security is in doubt, the report finds they often find themselves with half of the expected savings and investments they anticipated for their golden years.

Watch a conversation about forced retirement here:

Dr. Bill Thomas

Ageism and Sexism are Cousins

A woman challenges the Thai Buddhist hierarchy for the right to be a monk. The objection here is derived from the same rotten core that we find at the heart of ageism. Rather than being judged as an individual this female monk is being judged as a member of a class. The same kind of thinking drives mandatory retirement schemes.

Dr. Bill Thomas

Anderson Cooper

Posted with out comment:

Anderson Cooper Offered $1 MILLION To Ditch Gray Hair
Anderson Cooper has reportedly been offered $1 million to get rid of his gray hair for the next five years, the Sun-Sentinel reports.

generations

Dr. Bill Thomas

The War Between the Generations

Elders and the very young have long been allies. In fact, there is an old joke that goes, “Why do grandparent and grandkids get along so well? They share a common enemy.” Life in a modern, post industrial, economy frays these ancient bonds.
Let’s look at a blogospheric exchange in reaction to last week’s New York Times Magazine Cover Story “What Is It About 20-Somethings?”
Click here.

Dr. Bill Thomas

Getting the Job

In the comments, Pat Blanchard offers some good advice that deserves broader attention. I’ve gone ahead and added hyperlinks to her original comment. If you have a minute, click on some of the the links and note how the related material further illuminates what Pat has to say. Even though social media can seem new and new fangled, it allows people to extend and develop elements of an ongoing conversation and, in that sense, it’s as old as humanity:

One reason it’s harder for older job seekers to find jobs today is that job search techniques and strategies have changed drastically over the past 20 years ago. A long, detailed work history listed in chronological order can be a deal killer, whether it’s written on a resume or verbalized in an interview.

Aging

Dr. Bill Thomas

Denial: It’s not just a river in Egypt

We are going to run a series on anti-aging quackery.
Here’s our first entry. By the way, I could not make it all the way through the video. I feel sorry for this nice lady and wish she could feel more comfortable with her true self:

Dr. Bill Thomas

Immortality?

This is a recollection written by James Boswell which records his death bed visit with the great philosopher David Hume.
Hume was well known as a “free thinker” which meant that he did not accept any religious dogma and doubted the existence of an afterlife.
Boswell wondered if the approach of death may have changed the great man’s mind.
What do you think he found?

Culture Change

Dr. Bill Thomas

Institutional Home Care

It is easy to point at nursing homes and criticize the way that they institutionalize care. Home care, we often assume, must be warm and friendly and– person-centered. Unfortunately, home care can drift into institutional patterns despite the care team’s best efforts. How does this happen?
Click here to find out.

Dementia

Dr. Al Power

Power-Up Friday: The Medicalizaton of Dementia

In their 2008 book, The Myth of Alzheimer’s: What You Aren’t Being Told about Today’s Most Dreaded Diagnosis, Drs. Peter Whitehouse and Daniel George entertain a radical possibility–that Alzheimer’s disease may be less of a distinct disease than part of the spectrum of brain aging. They discuss the ways in which the lives of people who live with dementia have become medicalized, and the industry that has grown around this process.
Now, a study from UC San Francisco lends some interesting support to this argument.

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Denial: It’s not just a river in Egypt

2010-08-26T12:47:23Z

We are going to run a series on anti-aging quackery.

Here’s our first entry.

By they way I could not make it all the way through the video.

I feel sorry for this nice lady and wish she could feel more comfortable with her true self…

Broken Bone Broken Hearts

2010-08-25T13:31:31Z

Kristin Stevens writes…

What should we do for a 86 year old with mid stage ALZ with a femur neck fracture without option for repair because of critical aortic stensis, who is who unable to get out of bed, unable to toilet out of bed, who is very frustrated and confused and anxious and angry about not being able to get up, who tries over and over and over again to get up who can’t remember that he has a fracture. Efforts to redirect, to just stay present, to be with what is happening fail. Drugs loom as the “solution”…loving, skillful care partner is at bedside 24/hr. How would REAL CARE address this dilemma?

Second, we can take refuge in the principles of person-centered care. The answer to “What should we do for a…” depends entirely on the individual in question. What does he want? What are his preferences? What are is previously expressed wishes? As you describe him, your father does not, at this time, possess decision-making capacity. That is he does not seem capable of weighing the future consequences of different courses of action and choosing among them. Has he named a proxy? Is there conflict between the sibling? If he cannot choose for himself, is there a person who can choose for him?

Third, we can integrate professional medical insights into the picture. Is the fracture displaced? Are the fragments aligned? Is there an option for stabilizing the fracture that does not include general anesthesia? What will happen if he bears weight on the fracture? (one possible answer is “nothing”) Is there an orthopedist who will operate despite the heart defect? Everyone involved should understand that confining such a man to bed for the indefinite future will likely prove to be just a lethal as major surgery. What is the full range of choices?

Fourth, how can we reduce suffering for both the family and the elder? In addition to seeking answers to the questions listed above I would add the following thoughts. Pain control is vital but high doses of medication can also diminish cognition in people living with dementia. Finding a good balance will take skilled care. People who don’t remember that they have as fracture may not be feeling much pain from it. This may allow for greater mobility than you currently suppose is possible.

In sum, the hard truth is a a 86 year-old man with critical aortic stenosis with a femoral neck fracture can be said to have suffered a life-limiting injury. His time is precious and we can and should help him spend that time the way he wants to– even if doing so may worsen the fracture. That sounds strange because we are so accustomed to “curing” bone breaks. In this case, it is quality of life that matters most. Pain control and freedom of movement, rather than a cure, seem to be the highest virtues here.

I’d also like to hear Al Power’s thoughts on this.

Race, Eldercare and iPhone Apps

2010-08-24T15:11:04Z

Kavan Peterson

Yes, there is an App for everything these days — including the new free “Geriatrics Cultural Navigator” iPhone App for eldercare workers:

Are you a clinician caring for older adults from different ethnicities? Do you want to better understand the role of culture and ethnicity in health care in order to make better decisions about these patients? Then the Geriatrics Cultural Navigator is just the tool for you. The Navigator offers quick guidance on different cultures — including preferred forms of address, nonverbal communication, acculturation, culture-specific health risks, disclosure and consent, tradition and health beliefs, gender issues, approaches to decision-making, and use of advanced directives.

Developed by the American Geriatrics Society (AGS), this App “reflects our melting pot — providing clinical decision-making support for Americans from a variety of cultures.”

Cultural and racial sensitivity is no joke in nursing home and other eldercare settings and we strongly applaud AGS for developing this App. Although the idea of a multi-culti iphone App may sound trite or overly PC at first blush, a glance at some screenshots from the App shows some pretty useful cultural insight for caregivers:

(Click image to enlarge)

Of course, anyone who has worked in a nursing home has dealt with racial issues related to caregiving and they might point out that it’s often the elders who are in need of a racial-sensitivity App. This news story from McKnight’s Long Term Care News is a case in point:

Racial preference ruling disseminated to state’s nursing homes

All nursing homes in Indiana will be notified of a recent court ruling that declared that nursing home residents cannot specify treatment from a particular caregiver based on race, state health officials said recently.

The ruling stems from the recent case of Brenda Chaney, a black nursing assistant who was prohibited by her facility from treating a patient who preferred only white caregivers.

The AP reports that this decision will likely be the national model for all nursing homes, which are regulated by the federal government.

I’m very curious to hear what our readers think about racial sensitivity and eldercare. Is anyone out there going to download this App and try it out? And what do you think about the Indiana ruling?

H/T to GeriPal for blogging the Geriatrics Cultural Navigator.

Power-Up Friday, Real Problems, Real Solutions

2010-08-24T14:14:22Z

The University of Iowa’s Geriatric Education Center recently sent out a summary of studies year-to-date regarding “Management of Behavioral and Psychological Symptoms of Dementia”. Here’s a brief summary of the nine studies quoted:

(1) One study could not prove that stroke incidence was increased with antipsychotics, while another said it likely was increased.

(2) Antipsychotic use has increased in recent years in nursing homes without evidence of any coherent thought process, and out-of-proportion to any increase in dependency or behavioral symptoms over the years.

(3) Several studies were so “brave” as to say that “caution” should be exercised before using antipsychotic drugs in dementia, even though their data suggest that this wording is too mild.

Here’s a challenge: The REAL problem is not that these drugs are largely ineffective and dangerous when used for behavioral distress. The REAL problem is not even that we over-medicate people with dementia.

The REAL problem is that the very notion that this distress requires any pill is a flawed paradigm.

The REAL solution is not to find better pills. The REAL solution is Real Care.

Not Quite this Hard

2010-08-23T20:04:18Z

Blogging can fun!

But there is a process.

I usually skip the part with the knife.

Ageism and Sexism are Cousins

2010-08-23T17:23:47Z

A woman challenges the Thai Buddhist hierarchy for the right to be a monk.

The objection here is derived from the same rotten core that we find at the heart of ageism.

Rather than being judged as an individual this female monk is being judged as a member of a class.

The same kind of thinking drives mandatory retirement schemes.

The War Between the Generations

2010-08-22T18:37:55Z

Elders and the very young have long been allies. In fact, there is an old joke that goes, “Why do grandparent and grandkids get along so well? They share a common enemy.”

Life in a modern, post industrial, economy frays these ancient bonds.

Let’s look at a blogospheric exchange.

At Pandagon blogger Amanda Marcotte writes….

When I first read this article in the NY Times Magazine about how 20-somethings are delaying the supposed markers of adulthood—marriage, kids, financial independence—longer than they had in the past, I thought that the main flaw of it was that it didn’t address why financial independence was so hard to achieve. By casting the entire situation as a matter of desire and choice, the author missed the big picture, which is that people delay adulthood because the ability to be an adult requires a certain amount of privilege increasingly unavailable to young people. I tweeted about it at the time, noting the answer to the question, “Why don’t people grow up faster?” is incredibly, stupidly simple—because they are no longer any jobs for people in their early 20s that provide the means to be a full adult. Full stop.

Youth, like Elderhood, is a socially constructed form, not an immutable reality.

I don’t mean that entry level jobs only pay enough for a small apartment or a simple lifestyle. Often, they don’t pay enough to cover the rent on that small apartment—if they can find those jobs in the first place—and that’s why people move back in with their parents.
Which is why I saw red when I read this smarmy, self-righteous screed from some Baby Boomer.

What is this self-righteous screed from some Baby Boomer? Here are the high (low?) lights.

Robin Marantz Henig explores possible reasons that 20-somethings no longer use that decade of life to move through what sociologists have long considered the five milestones that signify adulthood: the end of formal education, separation from the family, financial independence, marriage and parenthood…

The phenomenon of 20-somethings living with their parents (partially or even fully supported by them) is so widespread that most people reading this have surely witnessed it, many within their own families. It’s a frequent topic of puzzled discussion among people my age, who wonder why things have changed so much in a generation…

Some people have theorized that what we are seeing is not a generational change or a response to economic conditions, but a developmental stage (Jeffrey Jensen Arnett’s “emerging adulthood” being the preferred nomenclature) that people pass through in their 20s before reaching full adulthood…

A shorter version would be, “We Boomers grew up, you slackers are too lazy or just don’t care.

How does Amanda feel about that charge?

It’s a classic example of being born on third and thinking you hit a triple. She assumes that her ability to pay rent with her first job out of college is strictly because she’s so much more f%&%&%g awesome than you spoiled kids these days, and her parents were so much more responsible than the softies of today. For a millisecond, she ponders the possibility that things have changed because of financial constraints, but then dismisses that possibility with a handwave. It’s so much more fun to be self-righteous! It’s way more fun to wag your finger at young people and tell them how you lived on Ramen and beans to afford your apartment, never pausing for a moment to wonder if those kids might not be able to afford that apartment even if they lived on dog food

Here’s the kicker from Amanda.

The fact that there was a brief period in American history where there was enough wealth going around that parents of all sorts of classes could provide enough for their kids to create “financial independence” at a young age is no reason to shame people who have to revert to the old ways now that our economy has reverted to the old ways of huge disparities in wealth between the classes. If you think that it’s so important for every 22-year-old to live on their own, with the illusion of having no help, then we need to return to the economic situations of the mid-century in America that allowed that to happen. And some of that may be hard to achieve, such as the far more affordable housing of that era.

… I will point out that for all her preening, the Salon author didn’t actually achieve the financial independence and adulthood she’s so sure about:

[The Boomer writes] The eyes of 20-somethings glaze over when we recount how we lived — sharing living quarters with a pile of friends, having only battered old belongings (and few of them to boot), eating cheap food we cooked ourselves, and spending little or nothing on entertainment.

She is of course, still full of s&*&t, since that’s exactly how most people that age still live if they live on their own. Hell, I didn’t buy a single piece of real new furniture until I was about 30, and even then it was 50% off and from Penney’s. And technically, that’s still the only real piece of substantial furniture I own that’s new.

The Elders need to be the young people’s allies in this cat fight.

Anderson Cooper

2010-08-21T01:27:41Z

Posted with out comment…

Anderson Cooper Offered $1 MILLION To Ditch Gray Hair
Anderson Cooper has reportedly been offered $1 million to get rid of his gray hair for the next five years, the Sun-Sentinel reports.

Institutional Home Care

2010-08-20T23:42:59Z

It is easy to point at nursing homes and criticize the way that they institutionalize care. Home care, we often assume, must be warm and friendly and– person-centered.
Unfortunately, home care can drift into institutional patterns despite the care team’s best efforts.

How does this happen?

1) Gradually, the professionals begin to substitute their judgments about what is best for the person/persons being cared for in place of what the family or the person thinks is best.

2) Gradually, the convenience and customary routine of the staff take precedence over the needs and desires of the family and those receiving care. Routines overtake even the possibility of variety and spontaneity. When the people being cared for, or their families, interfere with staff routine, they are sharply criticized.

3) Gradually, conversation between and among the professional caregivers begin to function as a clearing house for an emerging “official” position on what should or should not be be done with or for the person/persons receiving care.

4) Gradually, the family begins to be caricatured in negative ways and the caregivers begin to assume that they know best and that the family should, always, accede to their wishes and routines.

5) Gradually, empathy for the distinctively different experience of the family and the unique needs of the family and those who are being care for is lost. The needs and priorities of the professional caregivers move to the forefront and direct challenges to the professionals are discouraged with judgmental statements which imply that the family no longer has a right to such objections.

In this way, the home becomes its own form of institution. Families very often feel beholden to caregivers and fear offending them. Communication is cut off and the decline accelerates.

How can this form of institutionalization be stopped?

It is important to recognize that everyone involved has the best of intentions and wants what is best for those receiving care. Second, there must be a collective recommitment to the ideals of person-centered care delivered in the home. The family’s needs and preferences are not incidental, they must form the core of the care experience. This is real care and it is, in fact, what most professionals want to deliver. We live in a world that, for now, bends toward institutionalization but that can change. How can it change? The answer can be found through conversation, respectful, open conversation that is places the person above tasks and comfortable routine.

Beat It Mash Up

2010-08-19T20:26:03Z

Regular readers already know that I am a sucker for these things.

Have at it…

Immortality?

2010-08-15T22:20:08Z

This is a recollection written by James Boswell which records his death bed visit with the great philosopher David Hume.

Hume was well known as a “free thinker” which meant that he did not accept any religious dogma and doubted the existence of an afterlife.

Boswell wondered if the approach of death may have changed the great man’s mind.

What do you think he found?

On Sunday forenoon the 7 of July 1776, being too late for church, I went to see Mr David Hume, who was returned from London and Bath, just adying. I found him alone, in a reclining posture in his drawing-room. He was lean, ghastly, and quite of an earthy appearance. He was dressed in a suit of grey cloth with white metal buttons, and a kind of scratch wig. He was quite different from the plump figure which he used to present. He had before him Dr. Campbell’s Philosophy of Rhetoric. He seemed to be placid and even cheerful.

Boswell was a renowned biographer and this is, no doubt, a well turned description. But what of the substance of the question?

He said he was just approaching to his end. I think these were his words. I know not how I contrived to get the subject of immortality introduced. He said he never had entertained any belief in religion since he began to read Locke and Clarke. I asked him if he was not religious when he was young. He said he was, and he used to read The Whole Duty of Man; that he made an abstract from the catalogue of vices at the end of it, and examined himself by this, leaving out murder and theft and such vices as he had no chance of committing, having no inclination to commit them.

A religious youth, he took the matter of faith seriously and that, for him, entailed detailing its faults and gaps. Boswell wanted to know…

..if he persisted in disbelieving a future state even when he had death before his eyes. I was persuaded from what he now said, and from his manner of saying it, that he did persist. I asked him if it was not possible that there might be a future state. He answered it was possible that a piece of coal put upon the fire would not burn; and he added that it was a most unreasonable fancy that we should exist for ever. That immorality, if it were at all, must be general; that a great proportion of the human race has hardly any intellectual qualities; that a great proportion dies in infancy before being possessed of reason; yet all these must be immortal; that a porter who gets drunk by ten o’clock with gin must be immortal; that the trash of every age must be preserved, and that new universes must be created to contain such infinite numbers. This appeared to me an unphilosophical objection, and I said, ‘Mr. Hume, you know spirit does not take up space’.

Boswell gives one last pitch for religion to a dying philosopher.

[Hume] had once said to me, on a forenoon while the sun was shining bright, that he did not wish to be immortal. This was a most wonderful thought. The reason he gave was that he was very well in this state of being, and that the chances were very much against his being so well in another state; and he would rather not be more than be worse. I answered that it was reasonable to hope he would be better; that there would be a progressive improvement. I tried him at this interview with that topic, saying that a future state was surely a pleasing idea. He said no, for that it was always seen through a gloomy medium; there was always a Phlegethon or a hell. ‘But,’ said I, ‘would it not be agreeable to have hopes of seeing our friends again?’ and I mentioned three men lately deceased, for whom I knew he had a high value.

Hume passed from this earth soon thereafter and his fate is still unlearned…

On The Road: Rockies National Park

2010-08-18T20:57:25Z

I was passing through Colorado’s Rocky Mountain National Park this morning and snapped this series of photos, which an iPhone App called Pano seamlessly stitched together into a dramatic panorama.
Can your phone do that?
– Kavan

What to Call the Boomers

2010-08-18T20:42:05Z

The Boomers have not been babies for a very long time.

In order to understand them at this point in their lives I think it makes the most sense to refer to them as members of the “Post War Generation.”

I’ll be writing much more about this in the months to come.