Tagged Aging

Gov. Walker Seeks To Make Wisconsin First State To Impose Drug Testing For Medicaid

Critics are mobilizing against the screening and testing requirement because they say it could unfairly stigmatize the poor and complicate an already difficult application process. News outlets also report on Medicaid news from Arkansas and Ohio.

Boston Globe: Wisconsin Seeks To Mandate Drug Tests For Medicaid Recipients 
Low-income residents seeking government help in Wisconsin often slog through a frustrating, outdated bureaucracy at a run-down state building in Milwaukee, enduring a process that generates complaints about the difficulties of signing up for food assistance, unemployment benefits, and Medicaid. Now, in a first-in-the-nation experiment, Wisconsin Governor Scott Walker plans to raise the bar higher for people seeking Medicaid, with an expansive program of mandatory drug screening, testing, and treatment as a condition of receiving benefits. (Herndon, 4/25)

Arkansas Times: Legislature Set To Tackle Changes To “Arkansas Works” Medicaid Expansion In Special Session
KNWA’s Curt Lanning reports that Rep. DeAnn Vaught, chair of the House Management Committee, sent an email to legislators stating that the legislature will likely immediately reconvene for a special session focusing on health care after adjourning sine die on May 1. The governor is expected to call the special session to get legislative approval of his proposed alterations to the private option (now known as “Arkansas Works”) — the state’s unique version of Medicaid expansion, which uses Medicaid funds to purchase health insurance for low-income Arkansans. (Ramsey, 4/24)

Cleveland Plain Dealer: Ohio Nursing Homes Ask Lawmakers To Delay Medicaid Changes For Long-Term Care Patients 
Ohio’s nursing home lobby is pushing back on proposed budget changes that would make managed care health plans, rather than nursing homes, responsible for overseeing the care of 150,000 Ohioans on Medicaid. Currently, nursing homes and assisted living centers take responsibility for ensuring all aspects of a patient’s care, both in and out of the facility, and bill Medicaid directly for services. (Borchardt, 4/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Colo. Rural Hospitals Face Budget Squeeze; Calif. Dept. Of Public Health Throws 14 Penalty Flags

Media outlets report on news from Colorado, California, Maryland, Missouri, Louisiana, New Hampshire, Minnesota, Oregon, Virginia, Pennsylvania, Iowa, Ohio, Georgia and Alaska.

Denver Post: State Budget Cuts Could Cost Rural Colorado Hospitals Millions, Cause Service Reductions, Layoffs
From his modest office at Lincoln Community Hospital, an hour and a half east of Denver, Kevin Stansbury views the state budget from a different lens. At the Capitol, the debate is focused on balancing $26.8 billion. In Hugo, population 750, the dollar signs are people…Now Lincoln Community faces the prospect of cuts to services, layoffs or worse. It is one of a dozen or so rural hospitals poised to lose millions as part of a deal at the Capitol to balance the budget by trimming hospital payments for uncompensated care. (Ingold, 4/23)

Denver Post: How Colorado’s Hospital Provider Fee Works
Here’s how it works: The hospitals pay fees to the state based on the number inpatient days and outpatient hospital charges. The money is pooled and matched near dollar-for-dollar by the federal government. Minus administration costs, the larger pot of money is then redistributed to hospitals based on a formula that redistributes the wealth. The formula gives more to hospitals that serve large populations of Medicaid patients and those in rural areas. Not all hospitals get back the money they put into the system, and Colorado uses some of the fee collections to cover the Medicaid expansion population under the Affordable Care Act. (Griffin, 4/23)

Los Angeles Times: California Department Of Public Health Issues Penalties To 3 Los Angeles County Hospitals
The California Department of Public Health has issued penalties to 14 California hospitals, including three in Los Angeles County, for incidents that could have caused serious injury or death to patients, the state health agency announced this week. The penalties — as well as more than $1.1 million in fines — were issued for incidents between 2012 and 2016. The Department of Public Health conducted an investigation in each case. (Branson-Potts, 4/21)

The Baltimore Sun: Report: Maryland Better Prepared Than Average For Public Health Emergency
If Maryland were to be hit by a public health emergency — such as a natural disaster or an outbreak of a serious disease — officials here are better prepared than in many other states, according to a new survey. On a 10-point scale, Maryland rates 7.5 for its efforts to prepare for and respond to such emergencies, according to the 2017 National Health Security Preparedness Index.The index is compiled annually by the nonprofit Robert Wood Johnson Foundation to assess preparedness for “community health emergencies.” The foundation looks at more than 100 measures, such as monitoring food and water safety, flu vaccination rates, and numbers of paramedics and hospitals. The measures are grouped into six categories that are given a ranking on the 10-point scale. (Wood, 4/22)

New Orleans Times-Picayune: $100 Million Cancer Treatment Center, 60 Jobs Coming To New Orleans 
A Tennessee-based health care company plans to develop a $100 million cancer treatment center in New Orleans, Greater New Orleans Inc. announced Friday (April 21). The 30,000-square-foot space, to be called the Louisiana Proton Therapy Center, will be housed within the University Medical Center campus on Canal Street and provide an alternative to radiation therapy for cancer patients. Provision Healthcare, a cancer care firm based in Knoxville, partnered on the project with UMC, LCMC Health and LSU Health Sciences Center New Orleans. GNO Inc. estimates that the new center will create 60 new direct jobs with an average salary of around $100,000, plus another 63 new indirect jobs. (Lipinski, 4/21)

Kansas City Star: Smart Home Ideas Being Developed At KU Could Improve Health
Researchers now want to explore the possibilities of a house or apartment crammed with sensors that track everything from how you look in the mirror, to the way you walk from bedroom to kitchen, to what you flush down the toilet. A home outfitted with the right sensors might hail an ambulance when you collapse with a heart attack, or mean the difference between living alone and surrendering to nursing home care. (Canon, 4/21)

The Star Tribune: Eight TB Cases Found In Ramsey County, All Drug-Resistant
Health officials are investigating a cluster of multi-drug-resistant tuberculosis cases in eight elderly Hmong residents in Ramsey County, but say the risk to the general public is low. The outbreak first appeared in 2016, but just one case has been recorded this year and no new cases have been detected since state officials notified health care providers last month. (Howatt, 4/21)

The Star Tribune: Misconception Over Vaccine Helps Fuel Minn. Measles Outbreak 
A measles outbreak in Hennepin County has sickened 12 children — all of them unvaccinated and all of them from Somali families, according to the department — throwing a spotlight on low immunization rates among Somali children. Now state and county public health workers are doing their best to contact Somali parents and underscore the value of immunization. (Mahamud and Howatt, 4/22)

The Oregonian: OHSU And Portland State To Address Gun Violence As Public Health Issue In Community Forum 
Public health professors, physicians and students at Oregon Health & Science University Hospital want to go beyond “stitching up” gunshot and stab wounds of victims who end up in the emergency department. On Saturday, the school will host a community forum to bring together doctors, police and families affected by shootings, domestic violence or suicides, seeking to play a larger role to reduce violence in the metro Portland area…The conference was born out of anger and concern after the June mass shooting at a popular gay nightclub in Orlando, Florida, which left 49 people dead and 53 wounded, followed by a sniper’s attack on Dallas police in July, killing five officers. (Bernstein, 4/21)

The Philadelphia Inquirer: Volunteer ‘Health Pals’ Help Seniors Navigate Medical Care
Penn’s Village is one of around 200 similar organizations around the country that help people who may not have family members nearby age in place by linking them with volunteers and reputable service providers. Stella Buccella, another Penn’s Village volunteer, drove Nettis from her home near the Philadelphia Museum of Art to Jefferson that morning and picked her up afterward. Some volunteers just visit or help seniors with technology. Penn’s Village has about 275 members. A full membership costs $600 a year. Limited funding is available to help low-income residents with dues. (Burling, 4/24)

San Jose Mercury News: Patients Can Teach The Next Generation Of Doctors, Stanford Experts Say
One of the most effective ways of making medicine more inclusive is to have doctors, nurses, pharmacists, social workers, psychologists and occupational therapists all work together to learn about each patient as a person, and help them manage their care… To bring this into practice, medical school programs across the country are starting to bring engaged patients into the classroom, allowing them to share their story and become more than just a statistic in a textbook. (Bansal, 4/23)

The Philadelphia Inquirer: Death, Rapes, And Broken Bones At Philly’s Only Residential Treatment Center For Troubled Youth
Shortly after David Hess died in a struggle with staffers at Wordsworth last fall, the state shuttered the West Philadelphia facility, decrying it as “an immediate and serious danger” to the children who lived there. … Interviews, court records, state inspection reports, and police records reveal a trail of injuries to children, from broken bones to assaults to the suffocation death of Hess. Along the way, lawyers, licensing inspectors, and others found conditions there appalling and sounded the alarm with little success.  (Phillips and Palmer, 4/22)

The Associated Press: Prosecutors: Dentist Pulled Tooth While Riding Hoverboard
Prosecutors say an Alaska dentist charged with Medicaid fraud pulled a sedated patient’s tooth while riding a hoverboard. Seth Lookhart was charged with 17 counts of Medicaid fraud after prosecutors say he billed Medicaid $1.8 million last year for IV sedation used in procedures that didn’t call for it. (4/21)

Cleveland Plain Dealer: Ohio Nursing Home Inspectors Fail To Meet Federal Deadlines Amid Serious Understaffing: A Critical Choice
The agency that provides Ohio’s nursing home inspectors — the officials charged with making sure the state’s most vulnerable receive proper care — is understaffed by at least a dozen employees and, for years, has failed to meet federal deadlines for evaluating facilities… A key deadline for inspecting the state’s nursing homes has not been met since fiscal year 2011, records show. (Caniglia and Corrigan, 4/23)

WABE : Atlanta Health Care Startup Modeled On Bitcoin Technology 
One Atlanta health care technology startup, Patientory, wants to make it easier for patients to access and share their electronic medical records using technology known as blockchain, which is behind the digital currency Bitcoin. Currently, many hospitals may keep things on one central server. (Shamma, 4/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Selling Hearing Aids Over The Counter Could Help Millions Of Americans

One company aims to shift views on the devices from being a sign of aging to “something that’s hip and cool,” as Congress considers a bill that would urge the FDA to allow hearing aids to be sold in drug stores.

NPR: Is It Time For Hearing Aids To Be Sold Over The Counter?
Four out of five older Americans with hearing loss just ignore it, in part because a hearing aid is an unwelcome sign of aging. But what if hearing aids looked like stylish fashion accessories and could be bought at your local pharmacy like reading glasses? That’s the vision of Kristen “KR” Liu, who’s the director of accessibility and advocacy for Doppler Labs, a company marketing one of these devices. She thinks a hearing aid could be “something that’s hip and cool and people have multiple pairs and it’s fashionable.” (Neighmond and Greenhalgh, 4/24)

CQ Roll Call: Giant Audio Manufacturer Pushes Hearing Aid Bill
Consumer electronics giant Bose Corp. is pushing legislation that would allow some hearing aids to be sold over the counter, a change that could accelerate the growth of an industry dominated by just a handful of companies. … Lobbyists and congressional aides say the legislation (S 670, HR 1652) is likely to be tucked into the expected reauthorization of the Food and Drug Administration user fee agreements, which is due by Sept. 30. A hearing on the bill is tentatively scheduled for May 2 in the House Energy and Commerce Committee, lobbyists say. A panel spokeswoman said the committee was reviewing “a number of member priorities” and had no schedule updates. (Williams, 4/24)

In other health news related to aging —

The Washington Post: For Older People Living Alone, Daily Automated Calls Can Mean Safety
Living alone can be tough for seniors. Some don’t have family nearby to check on them, and they worry that if they fall or suffer a medical emergency and can’t get to the phone to seek help, no one will know. That’s why hundreds of police agencies in small towns, suburbs and rural areas are checking in on seniors who live alone by placing an automated call to them every day. (Bergal, 4/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Sexual Abuse Of Those In Nursing Homes Going Unreported, Undocumented

Sexual abuse is nationwide problem facing those living at longterm-care and assisted-living facilities, but too often it’s overlooked.

In other news —

Augusta Chronicle: Prosecution Of Caregivers Of At-Risk Adults Is Rare In Georgia 
Prosecution of caregivers of at-risk adults is rare in Georgia, and it’s not because of a decline in the abuse, neglect and exploitation of elderly and disabled adults. Between 2008 and 2012, reports of such crimes climbed 65 percent in the state. But law enforcement and prosecutors are starting to seriously dig into the crimes. (Hodson, 4/23)

The Oregonian: 11 Elder Care Complaints Oregon Hid From Consumers 
A taxpayer-funded  website for consumers leaves out nearly 8,000 substantiated complaints against senior care centers in Oregon. The complaints include cases of abuse, neglect and substandard care. Every one led the state to find a facility in violation of state rules. Here are 11 examples of complaints the website keeps hidden from view. Facilities are supposed to devise written plans for residents that specify things like how many people are needed to safely move them from a bed to a wheelchair. Under state rules, abuse can include an “active or passive” failure to provide the basic care needed to keep residents healthy and safe. (4/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Report Provides Blueprint Of How Memory Can Be Improved When It’s Lagging

A new study looks at the effects of electrical stimulation on the brain, and how those pulses can improve and impair memory.

NPR: Clues To Failing Memory Found In Brain Stimulation Study
“When memory was predicted to be poor,” he explains, “brain stimulation enhanced memory, and when it was predicted to be good, brain stimulation impaired memory. “In other words, on a bad memory day, stimulation helped. On a good day, it hurt. When stimulation was delivered to the right place at the right time, the researchers found, it could improve memory performance among the patients by as much as 50 percent. (Hamilton, 4/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Despite Notable Silence From White House, Anti-Vaccine Advocates Keep Hopes High

The CDC continues to promote immunizations just as it did under the Obama administration, but vaccine skeptics still feel emboldened by having the new president in the White House. In other public health news: a diet soda link to dementia risk; anxiety in students; a rare tick-borne disease; dietary supplements; and Henrietta Lacks’ cells.

Morning Consult: Despite Campaign Rhetoric, Trump Mostly Silent On Vaccine Policy
On the campaign trail, President Donald Trump met with prominent vaccine skeptics and ranted about the debunked theory that vaccines cause autism. But as the administration approaches its 100-day mark, the White House has given few indications about the direction of its vaccine policy. That vacuum has left experts drawing their own conclusions, fueling the hopes of vaccine skeptics and the fears of advocates. (Reid, 4/20)

CNN: Diet Sodas May Be Tied To Stroke, Dementia Risk
Gulping down an artificially sweetened beverage not only may be associated with health risks for your body, but also possibly your brain, a new study suggests. Artificially sweetened drinks, such as diet sodas, were tied to a higher risk of stroke and dementia in the study, which published in the American Heart Association’s journal Stroke on Thursday. (Howard, 4/20)

Columbus Dispatch: US Students More Anxious Than Global Average In Survey
U.S. teens rank around average for life satisfaction and academic achievement, according to a new international survey. But students in this country, more than their foreign counterparts, feel compelled to compete and are anxious about schoolwork and testing. A larger-than-average percentage of American students also feel like outsiders at school. (Gilchrist, 4/21)

The Washington Post: A Rare Tick-Borne Disease Infected A Baby, The First Case In A New State
It started with fever and vomiting. Then the 5-month-old baby developed facial twitching, stiffening of his right arm and seizures. The family rushed him to Connecticut Children’s Medical Center. Clinicians there performed tests, including a brain MRI that showed clear signs of a serious infection. The testing showed that the baby didn’t have meningitis, an infection in the tissues surrounding the brain. But he did have an unusual pattern of inflammation in the very deep parts of his brain. (Sun, 4/20)

Los Angeles Times: Venture Capitalists Look Beyond Tech To The Dietary Supplements Market
How do you stay sharp and fit despite fatigue and age? By consuming substances extracted from blueberries, flowers and algae, say the makers of a new group of unregulated and unproven health pills. Trusting natural chemicals to solve inevitable ailments is familiar to anyone who has visited a GNC store or contributed to the $30 billion spent annually in the U.S. on dietary supplements. (Dave, 4/21)

The Baltimore Sun: HBO Movie On Henrietta Lacks Puts Spotlight On Johns Hopkins 
As a movie starring Oprah Winfrey about Henrietta Lacks and her groundbreaking cells hits television screens Saturday, one major character in her story has remained muted. Johns Hopkins Medicine, whose doctors took Lacks’ cells without her consent during a diagnostic procedure in 1951, has kept a low profile amid the fanfare surrounding the HBO movie, based on the bestselling book “The Immortal Life of Henrietta Lacks” by Rebecca Skloot. (McDaniels, 4/20)

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Protein Found In Umbilical Cord Could Hold Key To Rejuvenating Memory Center In Brain

In a study, cold blood improved the performance of aged mice as they engaged in memory and learning tasks, such as maze-running and fear-conditioning exercises.

The Washington Post: A Protein From Human Umbilical Cords Revitalizes Memory — At Least In Mice
You leave your car in a vast, crowded parking lot, and when you return, you have no idea where it is. The ensuing search is frustrating, time-consuming and a little embarrassing. That experience occurs more frequently as we get older, because the functions of the part of the brain that encodes spatial and episodic memories — the hippocampus — decline with age. But now neuroscientists at the Stanford University School of Medicine have shown that — in mice — an infusion of plasma taken from human umbilical cords improves the hippocampus’s functioning, resulting in significant gains in memory and cognition needed for tasks such as finding a car in a full parking lot. (Bernstein, 4/19)

NPR: Blood From Human Umbilical Cords Helps Aging Mice Remember
From the beginning, the findings were exciting, complex and, sometimes, contradictory. For example, scientists have shown that young blood can restore cell activity in the muscles and livers of aging mice. They’ve also found that linking old mice to young ones helped reverse heart muscle thickening. On the other hand, researchers weren’t able to replicate some of the most eye-catching findings and another study concluded that, in mice that swapped blood without being connected surgically, the negative effects of being exposed to old blood outweighed the benefits of getting young blood. (Bichell, 4/19)

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How to Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away’

Alzheimer’s disease has an unusual distinction: It’s the illness that Americans fear most — more than cancer, stroke or heart disease.

The rhetoric surrounding Alzheimer’s reflects this. People “fade away” and are tragically “robbed of their identities” as this incurable condition progresses, we’re told time and again.

Yet, a sizable body of research suggests this Alzheimer’s narrative is mistaken. It finds that people with Alzheimer’s and other types of dementia retain a sense of self and have a positive quality of life, overall, until the illness’s final stages.

They appreciate relationships. They’re energized by meaningful activities and value opportunities to express themselves. And they enjoy feeling at home in their surroundings.

“Do our abilities change? Yes. But inside we’re the same people,” said John Sandblom, 57, of Ankeny, Iowa, who was diagnosed with Alzheimer’s seven years ago.

Judith GrahamNAVIGATING AGING

Dr. Peter Rabins, a psychiatrist and co-author of “The 36-Hour Day,” a guide for Alzheimer patients’ families, summarized research findings this way: “Overall, about one-quarter of people with dementia report a negative quality of life, although that number is higher in people with severe disease.”

“I’ve learned something from this,” admitted Rabins, a professor at the University of Maryland. “I’m among the people who would have thought, ‘If anything happens to my memory, my ability to think, I can’t imagine anything worse.’

“But I’ve seen that you can be a wonderful grandparent and not remember the name of the grandchild you adore. You can be with people you love and enjoy them, even if you’re not following the whole conversation.”

The implication: Promoting well-being is both possible and desirable in people with dementia, even as people struggle with memory loss, slower cognitive processing, distractibility and other symptoms.

“There are many things that caregivers, families and friends can do — right now — to improve people’s lives,” said Dr. Allen Power, author of “Dementia Beyond Disease: Enhancing Well-Being” and chair for aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada.

Of course, the final stages of Alzheimer’s disease and other types of dementia are enormously difficult, and resources to help caregivers are scarce — problems that shouldn’t be underestimated.

Still, up to 80 percent of people with dementia are in the mild and moderate stages. Here are some elements of their quality of life that should be attended to:

Focus On Health

One notable study analyzed lengthy discussions between people with dementia, caregivers and professionals at six meetings of Alzheimer’s Disease International, an association of Alzheimer’s societies across the world.

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Those discussions emphasized the importance of physical health: being free from pain, well-fed, physically active and well-groomed, having continence needs met, being equipped with glasses and hearing aids and not being overmedicated. Cognitive health was also a priority. People wanted “cognitive rehabilitation” to help them learn practical techniques for promoting memory or compensating for memory loss.

Up to 40 percent of people with Alzheimer’s disease suffer from significant depression, and research by Rabins and colleagues underscores the importance of evaluating and offering treatment to someone who appears sad, apathetic and altogether disinterested in life.

Foster Social Connections

Being connected with and involved with other people is a high priority for people with dementia. Based on research conducted over several decades, Rabins listed social interaction as one of the five essential elements of a positive quality of life.

But fear, discomfort and misunderstanding routinely disrupt relationships once a diagnosis is revealed.

“The saddest thing that I hear, almost without exception, from people all over the world is that family, friends and acquaintances desert them,” said Sandblom, who runs a weekly online support group for Dementia Alliance International, an organization for people with dementia that he co-founded in January 2014.

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Adapt Communication

Not knowing how to communicate with someone with dementia is a common problem.

Laura Gitlin, a dementia researcher and director of The Center for Innovative Care in Aging at Johns Hopkins School of Nursing, offered these suggestions in an article in the International Encyclopedia of Rehabilitation: Speak slowly, simply and calmly, make one or two points at a time, allow someone sufficient time to respond, avoid the use of negative words, don’t argue, eliminate noise and distraction, make eye contact but don’t stare, and express affection by smiling, holding hands or giving a hug.

Also, understand that people with dementia perceive things differently.

“You have to understand that when you have dementia you lose a lot of your natural perceptions of what others are doing,” Sandblom said. “So, a lot of us get a little nervous or suspicious. I think that’s a natural human reaction to knowing that you’re not picking up on things very well.”

Address Unmet Needs

Needs that aren’t recognized or addressed can cause significant distress and a lower quality of life. Rather than treat the distress, Power suggested, try to understand the underlying cause and do something about it.

Which needs are commonly unmet? In a study published in 2013, Rabins and colleagues identified several: managing patients’ risk of falling (unmet almost 75 percent of the time); addressing health and medical concerns (unmet, 63 percent); engaging people in meaningful activities (53 percent); and evaluating homes so that they’re safe and made easier to navigate (45 percent).

Respect Autonomy And Individuality

Rabins called this “awareness of self” and listed it among the essential components of a positive quality of life. Sandblom called this “being seen as a whole person, not as my disease.”

At the Alzheimer’s Disease International meetings, people spoke of being listened to, valued and given choices that allowed them to express themselves. They said they wanted to be respected and have their spirituality recognized, not patronized, demeaned or infantilized.

In a review of 11 studies that asked people with dementia what was important to them, they said they wanted to experience autonomy and independence, feel accepted and understood, and not be overly identified with their illness.

None of this is easy. But strategies for understanding what people with dementia experience and addressing their needs can be taught. This should become a priority, Rabins said, adding that “improved quality of life should be a primary outcome of all dementia treatments.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation and coverage of aging and long-term care issues is supported by The SCAN Foundation.

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State Highlights: Ariz. Tops Federal Tally For Complaints Against Medical-Debt Collectors; Fla. Republicans Push To Undo Hospital Certificate-Of-Need Rule

Outlets report on news from Arizona, Florida, Michigan, New Hampshire, Louisiana, California, Georgia and Tennessee.

Arizona Republic: Complaints Mount Against Medical-Debt Collectors
The complaints offer a narrow glimpse into what can happen long after a patient leaves a doctor’s office or hospital and disputes or refuses payment of a bill. Hospitals and doctors often deal with unpaid bills. Some turn to debt collectors to get what the insurance company, the consumer or both refused to pay. (Alltucker, 4/18)

Miami Herald: House Republicans Push To Give Hospitals Greater Say In Expansion 
For four decades, hospitals wanting to expand or open new facilities have had to get the state to agree there’s a need for more healthcare in their community. It’s a rule that Republicans in the Florida House say creates unnecessary burdens on the free market. This week, they’ll be passing a bill to repeal it. (Auslen, 4/18)

Arizona Republic: CVS MinuteClinics To Relieve Stress On Phoenix VA, Open Doors To Many Veterans In Arizona
Veterans in the Phoenix VA Health Care System can now get immediate medical treatment for minor illnesses and injuries from CVS MinuteClinics under a pilot project announced Tuesday. The program will be open to about 120,000 veterans, enabling them to call VA triage nurses and, if their symptoms qualify, receive an appointment within two hours at one of the drugstore chain’s 24 clinic outlets in central Arizona. (Wagner, 4/18)

New Hampshire Union Leader: Business Is Booming For Long Term Care Partners 
A Portsmouth company that fills a unique niche in the insurance market is confident its services will be in demand for years to come. Long Term Care Partners on Arboretum Drive is a third-party administrator of insurance services for federal employees. Under a seven-year contract regulated by the U.S. Office of Personnel Management, LTC is responsible for the Federal Long Term Care Insurance Program, which has about 275,000 enrollees and an eligible population of 4.4 million-plus federal employees, annuitants and qualified family members. LTC is also contracted to administer BENEFEDS, an exchange and service platform through which more than 2.5 million federal employees can manage their dental and vision coverage, with the choice of coverage from more than a dozen major national carriers. (Haas, 4/18)

New Orleans Times-Picayune: Registry Tracks New Orleans Elderly, Disabled For Evacuations 
New Orleans has a plan in place to help evacuate around 40,000 people who might not be able to get out on their own ahead of a hurricane. But during an evacuation, how does the city know where to find of the most vulnerable people, the elderly and disabled? Enter the Special Needs Registry, created to provide transportation and shelter for New Orleanians with special medical needs during emergencies such as a power outage, evacuation or hurricane. The registry keeps a database of information on around 4,400 people who will need extra help during an evacuation, and comes equipped with a small outreach team to update the records and annually. (Evans, 4/18)

California Healthline: As California Weighs Soda Warning Labels, Tax In Berkeley Shown To Dilute Sales
A new study of the soda tax in Berkeley, Calif., shows that residents are doing what public health experts had hoped — they’re ditching sugary drinks and opting for healthier beverages. The study, the largest to date of Berkeley’s soda tax, comes as California lawmakers this week again consider legislation to put a warning label on sweetened beverages — a bill that died in committee three times in three years. (Ibarra, 4/18)

Sacramento Bee: Disabled Placards For Thousands Of Dead Californians Part Of Program Abuse 
California’s Department of Motor Vehicles needs to significantly beef up efforts to prevent fraud and abuse in the state’s disabled person placard program, a new state audit recommends, noting that officials accept applications lacking required medical documentation, issue too many duplicates, and fail to cancel the placards of people who have died. Almost 3 million people had disabled placards or special license plates as of June 2016, according to Tuesday’s Bureau of State Audits report. (Miller, 4/18)

Georgia Health News: Fraudsters, Beware! Health IT Firm Launched In Georgia Is After You 
Companies in the industry provide a range of products and services, from electronic health records, medical billing and revenue management to diagnostics, preserving the security of information exchanges, and consumer health information… The revolution in patients’ medical records has accelerated the IT spurt, with physicians’ offices across the U.S. giving up folders full of written notes and turning to digital data. (Miller, 4/18)

Nashville Tennessean: For Stealing $1.5M From Children’s Food Program, Tennessee Woman Gets 3 Months Prison
A La Vergne woman who stole $1.5 million from state programs that feed children in need was sentenced last week to three months in prison, records show. Federal sentencing guidelines recommended more than five years prison time, according to court records. The reason U.S. District Judge Aleta Trauger handed LaShane Hayes the shorter term is unclear because several court documents are sealed, however other filings indicate Hayes wanted a probation sentence because of a medical condition. (Barchenger, 4/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Minn. Gov. Reappoints 2 Members To State Insurance Marketplace Board; Calif. In-Home Care Program In Budget-Cut Crosshairs

Outlets report on news from Minnesota, California, Oregon, Florida, Georgia, Tennessee, Pennsylvania, Kansas and Texas.

Pioneer Press: Mark Dayton Reappoints Two MNsure Board Members 
Two members of MNsure’s board of directors will get another four years leading the state-run health insurance marketplace — provided it continues to exist. Minnesota Gov. Mark Dayton on Monday reappointed MNsure board chair Pete Benner and board member Phil Norrgard to new four-year terms. Their terms were previously scheduled to expire next month. Dayton appointed the original six members of MNsure’s board in 2013. (The seventh spot is automatically filled by the state’s Human Services Commissioner.) Four of the original six have since left the board, replaced by new appointees as their terms expired. Benner and Norrgard are the first board members Dayton has reappointed. (Montgomery, 4/17)

Los Angeles Times: An In-Home Care Program For California’s Elderly And Disabled Is Constantly At The Heart Of Budget Battles. Here’s Why
California’s program to provide in-home care for its low-income elderly and disabled residents finds itself once again at the heart of a state budget standoff. It is familiar territory for the workers, advocates and administrators of the In-Home Supportive Services program. The current flare-up — between the state and county governments over how to divvy up IHSS costs — is the latest example of how California’s signature program, meant to keep people in their communities and out of nursing homes, has continually been the source of budget friction in recent years. (Mason, 4/18)

East Oregonian: Massive Health Care Cuts On Possible Budget Reduction List 
With about a month to go before a critical revenue forecast, Oregon’s budget writers released a more detailed list of cuts Monday to address the state’s approximately $1.6 billion budget gap if new revenue isn’t raised. The cuts are across the board and intended to show what it would take to balance the state’s budget. For example, about 350,000 Oregonians would no longer be eligible for coverage under the recent Affordable Care Act Medicaid expansion, and a ballot measure to require the state to pay dropout prevention, college readiness, and career and technical education for high school students would only be partially funded. (Withycombe, 4/17)

ProPublica: California Group Home Liable For Millions In Case Of Abused Boy
A jury in Sacramento, California, last week awarded more than $11 million to the family of a 16-year-old-boy who had been sexually assaulted by a peer at his group home in Davis. The jury found that operators of the group home failed to look after the boy as the facility for troubled youngsters descended into a prolonged period of chaos and violence. (Sapien, 4/17)

The Star Tribune: Minnesota Confirms 9th Measles Case, All Children Unvaccinated 
Minnesota health officials have confirmed a ninth case of measles in the Hennepin County outbreak that began last week, and they expect the count to rise as additional lab specimens are tested. The patients, all children, were not vaccinated. Most of the cases have occurred in the Twin Cities Somali-American community, where vaccination rates have been relatively low. (Howatt, 4/18)

The New York Times: A California Court For Young Adults Calls On Science
Researchers have long known that the adolescent brain is continually rewiring itself, making new connections and pruning unnecessary neurons as it matures. Only recently has it become clear that the process stretches well into early adulthood. Buried in that research is an uncomfortable legal question: If their brains have not fully matured, how responsible are adults ages 18 to 24 for their crimes? (Requarth, 4/17)

Nashville Tennessean: Vanderbilt University Medical Center Among Tops For NIH Funding
For Vanderbilt University School of Medicine, 2016 was a banner year: It netted its largest ever amount of grant funding from the National Institutes of Health. The medical school received $340 million in 2016 — placing it eighth in the country for grants awarded to a medical school. The school moved up two spots on the ranking from the year prior in part because it received a five-year $71.6 million grant to establish in Nashville a key component of the national initiative to further research and use of precision medicine. (Fletcher, 4/17)

The Philadelphia Inquirer/Philly.com: U.S. Ordered To Pay Half Of Temple Hospital’s $8 Million Birth Injury Settlement
A federal judge has ordered the U.S. government to contribute half of Temple University Hospital’s $8 million settlement of a birth injury lawsuit. The hospital sued the government seeking exemption from legal responsibility, or indemnity, arguing that the obstetrician liable for the birth injuries was a federal employee — even though that doctor was also working in labor and delivery at Temple. (McCullough, 4/17)

Los Angeles Times: L.A. County Seeks To Strengthen The Safety Net For Its Neediest Residents With Funding For The Homeless, Social Workers And Healthcare
Los Angeles County pressed forward with an effort to strengthen the safety net for its most vulnerable residents Monday with a budget plan that carves out significant allotments for social services, healthcare and other support for the poor. The proposed budget is a slight increase from last year, and officials said they are trying to channel some of that money toward helping those who rely on county government for critical services. (Agrawal, 4/17)

San Francisco Chronicle: Berkeley Couple’s Mysterious Deaths Raise Public Health Fears 
No one knows how a young Berkeley couple and their two cats were fatally poisoned with carbon monoxide during a storm one night in January… But three months, one lawsuit and a procession of experts later, the source of the carbon monoxide remains a mystery. Toxicology professionals say that’s not just bizarre, but a possible danger to public health. (Veklerov, 4/17)

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Viewpoints: The Need For More Patient Safety Measures; The FDA And Pizza

A selection of opinions on health care from around the country.

The New York Times: Real Malpractice Reform: Investing In Patient Safety
Congressional Republicans have recently revived efforts to overhaul malpractice laws, including capping certain kinds of suits at $250,000. A perennial argument of supporters of such measures is that many claims are frivolous, clogging the court system and driving up health care costs for everyone. But does the evidence support this? (Aaron E. Carroll, 4/17)

The Wall Street Journal: The FDA’s Pizza Minders
The Food and Drug Administration can’t possibly fulfill all of the responsibilities it claims to have, and here’s one way the Trump Administration can set better priorities: Direct the agency to end its effort to inform Americans that pizza contains calories. (4/16)

Stat: Balancing Hope And Realism Can Be A Challenge For Doctors
Conveying the right balance of hope and realism is largely learned through experience during medical training. Young doctors patch together a framework for navigating discussions that hinge on uncertainty, often pilfering mentors’ phrases and techniques. Most of all we learn from our own missteps, and from those of our colleagues. I know that many patients prefer to hear realistic interpretations of their illness, and that these discussions are increasingly important as providers lean toward shared decision-making, which has been linked to greater patient satisfaction. Still, it’s sometimes a challenge to truthfully discuss a serious medical issue while leaving the door open to the hope that is so vital for patients and families. (Allison Bond, 4/14)

Stat: Gaps In Care For Babies With Zika Highlight A Deeper Problem In Medicine
A new report from the Centers for Disease Control and Prevention highlights the damage that the Zika virus can do to unborn babies. It also shows that US doctors poorly follow evidence-based guidelines. According to the CDC, among pregnant women who tested positive for Zika, 1 in 10 had babies with microcephaly or another birth defect. That was the number that grabbed headlines. But there were two other numbers that worried me: Just 65 percent of babies born to mothers who tested positive for Zika were themselves tested for it, and only 25 percent received brain scans — despite recommendations that 100 percent of such babies be tested. (Amesh A. Adalja, 4/14)

Morning Consult: Ensure Medicare Access To Blood And Marrow Transplants For Seniors With Cancer
Last year, the Centers for Medicare and Medicaid Services enacted a significant policy change improving access to blood and marrow transplants for Medicare patients diagnosed with life-threatening blood cancers. The change came in the form of a Medicare rule on how outpatient blood and marrow transplants are reimbursed by the federal health care program beginning on Jan. 1, 2017. While this move a step in the right direction, this rule does not address the vast majority of transplants (97 percent) that are performed in the inpatient setting. Sadly, Medicare continues to provide inadequate reimbursement to hospitals performing inpatient transplants and this limitation threatens to limit access to seniors needing this lifesaving therapy. (Krishna Komanduri, 4/17)

Boston Globe: We Should Be Expanding Scientific Research Spending
A large majority of Americans agree that we should increase the money we spend on research. If we can’t come together as a country and make this happen — if we can’t, at the very least, double the tiny fraction of our federal budget that we invest in basic research — then what kind of future do we believe in? … Alzheimer’s disease offers the perfect example of how foolish it is to shortchange investments in research. (Sen. Elizabeth Warren (D-Mass.), 4/15)

The New York Times: You Draw It: Just How Bad Is The Drug Overdose Epidemic?
How does the surge in drug overdoses compare with other causes of death in the U.S.? … Since 1990, the number of Americans who have died every year from drug overdoses has increased by more than 500 percent. In 2015, more Americans died from drug overdoses than from car accidents and gun homicides combined. It’s the worst drug overdose epidemic in American history (Josh Katz, 4/14)

The Washington Post: 10 Years After The Virginia Tech Massacre, Virginia Still Falls Short On Mental Health Care
It is hard to believe that it has been 10 years since the horrific day at Virginia Tech when 32 students and faculty were killed and many others were injured by a young student with untreated mental illness. Ten years since countless lives and families were altered forever, including my own. … Although progress has been good, Virginia sits in the bottom half of states in overall ranking for mental health care per person. Virginia still needs funding to establish consistent and comprehensive services in all communities; to expand intervention, treatment and transition programs for young adults, especially for those experiencing the first signs of mental illness; to attract and retain mental-health providers in the face of a critical workforce shortage; and to establish strict quality and performance outcomes to meet the needs of families and communities in our commonwealth. (Elizabeth Hilscher, 4/14)

Des Moines Register: When Iowa’s Mental Health Crisis Lands Next Door
[W]hat we didn’t know, what most people don’t know or see that goes on behind closed doors when someone is mentally ill, were what relatives recounted later: Chase’s multiple suicide attempts. We didn’t see the countless appointments with doctors, psychiatrists and counselors, the rounds of various medications to find just the right cocktail and the battles to get Chase to take them. We didn’t see the self-harm, the many trips to the hospital when Chase was in crisis, only to be sent home days or hours later when there were no beds available, or Charla’s early retirement from her job as a Des Moines Public Schools teacher so she could better monitor and care for her son. And we didn’t see all the tears they likely shed, the arguments and moments of despair that no doubt occurred in their household in trying to deal with their sick son the best they could. (Kali VanBaale, 4/14)

Milwaukee Journal Sentinel: Why We Need Equal Access To Clean Water In Wisconsin
This week, the Senate passed SB 76, a bill that substantially unravels oversight of high-capacity wells in the state. It’s a bald-faced giveaway to large-scale farming and feedlot operations, mostly, with almost no consideration for how pulling millions of gallons of water a day out of the ground affects surrounding communities. The bill allows for drilling wells that pump large amounts of water without review by state regulators, so long as the new wells replace existing, permitted wells. (Emily Mills, 4/14)

Los Angeles Times: California’s Vaccination Rates Are Up. Let’s Keep It That Way
The controversial 2015 law doing away with an exemption that had allowed public school students to skip vaccinations based on their “personal beliefs” appears to have worked. California state officials reported this week that 95.6% of kindergartners are fully vaccinated. That’s the highest rate recorded at least since 1998, when a now-debunked study purported to show a link between vaccinations and autism. (4/14)

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State Highlights: Judge Delays N.H. Malpractice Insurance Payouts; Ga. Fails To Offer Protections To Personal Care Home Residents

Outlets report on news from New Hampshire, Georgia, Kansas, Texas, Florida, Missouri, Minnesota, Virginia, California, Illinois and Oregon.

NH Times Union: This Time, Insurance Payout Is $50 Million
Merrimack County Superior Court Judge Richard McNamara recently put the brakes on releasing $50 million in surpluses from the New Hampshire Medical Malpractice Joint Underwriting Association to 6,200 policyholders — even though all parties to this case were on board. That’s because nothing about this state-run group supplying malpractice insurance to doctors, hospitals and other health care providers for the past 40 years has been done quickly or without debate. In 2009, at the height of peak earnings and its position in the marketplace, the JUA’s surplus attracted the attention of former Gov. John Lynch. (Landrigan, 4/16)

The Augusta Chronicle: Personal Care Home Owners Or Employees Rarely Face Criminal Charges 
An investigation by The Augusta Chronicle found many examples just in Augusta where personal care home residents were left alone, went without food and medicine, and at least in one case was left in his own waste, locked inside a dark room. Georgia has criminal laws designed to protect at risk-adults – such as exploitation of an elderly or disabled adult, aggravated cruelty to an elderly adult, and abuse and neglect of an elderly or disabled person. Approximately 82 people are in prison serving time for these crimes. (Hodson, 4/15)

KCUR: Law Allowing States To Deny Planned Parenthood Funding Won’t Have Immediate Effect Locally 
The law signed on Thursday by President Trump allowing states to cut off family-planning funding to Planned Parenthood won’t have an immediate effect on the organization’s affiliates in Missouri and Kansas. That’s because Kansas barred Planned Parenthood from receiving Title X family planning funds several years ago – a move later upheld by a federal appeals court. And Title X funds continue to flow to Planned Parenthood’s affiliates in Missouri because the Missouri Family Health Council, not the state, is the recipient of the funds. The council in turn makes the funds available to Planned Parenthood. (Margolies, 4/14)

Politico Pro: Court Victories Don’t Restore Abortion Access In Texas 
The Supreme Court last June threw out restrictive Texas laws that had forced many clinics to close, leaving large regions of a vast state with no abortion providers at all. By and large, the clinics have not mustered the resources to reopen in a politically hostile, regulation-heavy environment. (Rayasam, 4/17)

Pioneer Press: Hennepin County Measles Outbreak Now Includes 8 Children 
A Hennepin County outbreak of childhood measles now includes eight cases, after five more cases were confirmed by the Minnesota Department of Health. The department said Friday that all eight cases are unvaccinated children between the ages of 1 and 4. Investigators are trying to trace the infections and protect others who may have been exposed. Seven of the confirmed cases are Somali-American children, and all but one have common contact. Six of the children were hospitalized. (4/14)

The Star Tribune: Five New Cases Of Measles Confirmed In Hennepin County 
Minnesota health officials have confirmed five new cases of measles in young children in Hennepin County, bringing the total number of cases in the outbreak to eight. All eight are unvaccinated children ranging in age from 1 to 4, the Minnesota Department of Health said in a Friday night news release. (Zamora, 4/15)

Richmond Times-Dispatch: Mental Health System Has Improved Since Tech, But Has A Long Way To Go, Experts Say 
Snook and several others agree that Virginia has been fairly adept at responding to crises — but they say lawmakers haven’t been as successful at addressing the mental health system’s underlying problems. Decades ago, Virginia shut down many of its state-run mental hospitals in response to a growing national trend but didn’t lay the groundwork for community-based care that would keep residents with mental illness from spiraling out of control. (Kleiner, 4/14)

Health News Florida: An Unknown Future For Military Caregivers Of Post-9/11 Veterans 
For the last decade, Patti Katter has managed her husband’s medical appointments, medications and rehabilitation. … She learned to care for herself and found a job with a non-profit, Hope for the Warriors. She now works from home helping other military caregivers navigate the system. And she is a fellow with the Elizabeth Dole Foundation that advocates for military and veteran caregivers. (O’Brien, 4/14)

California Healthline: California Lawmakers Mull Improvements To Troubled Dental Program
California lawmakers are considering several bills to improve and expand access to Denti-Cal, the state’s troubled dental program for low-income people — including ones that would draw from the state’s new tobacco tax to boost dentists’ pay. Assembly Bill 753, introduced by Assemblywoman Anna Caballero (D-Salinas), would direct money from the state’s new tobacco tax to broaden access to Denti-Cal, which for years has been faulted in state and federal reports. The bill will be heard in the Assembly Committee on Health on Tuesday. (Ibarra, 4/17)

WBUR: California Tries Again To Move On Universal Health Care 
Many Californians are rallying around the idea of a single-payer health system, similar to those in Canada and parts of Europe. Efforts to establish universal health care in California have failed in the past. But with Republican leaders in Washington planning to repeal and replace the Affordable Care Act, voters are eager to try again. (Feibel, 4/14)

Chicago Tribune: Feds Subpoena Baxter Employee Over National Shortage Of IV Solutions 
The federal government has subpoenaed a Baxter International employee as part of a criminal investigation related to a nationwide shortage of intravenous saline solution, the Deerfield-based company revealed Friday. The subpoena asks for documents about the pricing, sale, manufacture and shortage of intravenous solutions, including saline solution, which is used in IVs to hydrate patients, and other injectable medications. It also seeks Baxter’s communications with competitors over the issue, according to a regulatory filing. (Schencker, 4/14)

San Francisco Chronicle: Hawaii Accused Of Downplaying Parasite That Struck SF Couple 
Health officials in tourist-friendly Hawaii are defending themselves from criticism that they have for years downplayed the severity of a rare, brain-invading parasite that has infected dozens on the islands, including a San Francisco couple stricken by the disease on a recent honeymoon. A cluster of rat lungworm cases in Maui caught widespread attention last week when Eliza Lape of San Francisco and her husband, UC Berkeley journalism professor Ben Manilla, revealed they had become severely ill in January after they eloped on the island. (Lyons, 4/14)

Georgia Health News: Georgia Aims To Avoid Snags As It Launches Program For Public Benefits 
Georgia is rolling out an expensive eligibility determination system for Medicaid, food stamps and other public benefits, with officials hoping to avoid the massive problems with a similar set-up in Rhode Island, operated by the same vendor. The new computer system, delivered by Deloitte Consulting, has a price tag of $380 million, with all but $33 million paid for by the federal government under the Affordable Care Act. The rest comes from state money. (Miller, 4/14)

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Getting To Delivery Room A Harrowing Journey For Some Amid Rural Hospital Crisis

Because of financial strain, many rural hospitals are shutting down their labor and delivery services. Women in those areas are then faced with long drives to get to a safe place to deliver their babies. In other public health news: infectious diseases, strokes, young blood, genetic testing, fertility treatments, trauma care and more.

Stat: A Crisis In Rural Health Care Puts Mothers-To-Be On A Risky Road
Financial pressures, insurance problems, and doctor shortages forced more than 200 hospitals to close their birthing units between 2004 and 2014, according to the University of Minnesota’s Rural Health Research Center. That’s left millions women of reproductive age facing longer drives to deliver babies — who sometimes arrive en route. The long drives, understandably, increase anxiety. They also make mothers and babies less safe; studies show these distances bring with them increased rates of complications and infant deaths, as well as longer stays in neonatal intensive care units. (Ross, 4/17)

Stat: Former CDC Head: Outbreaks ‘Tremendous Threats To Business’
The world has faced a string of infectious disease threats in the past dozen or so years, with SARS, bird flu, swine flu, MERS, and Ebola wreaking havoc. Yet despite the abundance of evidence that microbes pose major threats, both to human health and economies, global preparedness is not where it needs to be, Dr. Julie Gerberding warned this week. Gerberding was a former director of the Centers for Disease Control and Prevention — a post she held during the 2003 SARS outbreak. She is now Merck’s executive vice-president for strategic communications, global health policy and population health. (Branswell, 4/14)

The Washington Post: Giving Young Blood To Older Animals Raises Tantalizing Possibilities For People
Dracula may have been onto something. It wasn’t just blood, but the blood of youth that was the secret to staying alive for centuries. The rejuvenating effect of young blood has been demonstrated in strange, draculoid experiments first done 150 years ago. Two genetically compatible animals, one young and one old, are sewn together. With their circulatory systems connected, the old animal gains access not only to the younger animal’s blood but also to the detoxifying and metabolizing function of its organs. The state is known as heterochronic parabiosis. (Brown, 4/14)

Los Angeles Times: What The New, FDA-Approved 23andMe Genetic Health Risk Reports Can, And Can’t, Tell You
Genetic testing firm 23andMe got approval from the Food and Drug Administration last week to sell reports that show customers whether they have an increased genetic risk of developing certain diseases and conditions. The go-ahead is the first time the federal agency has approved such direct-to-consumer genetic tests and comes about three years after the FDA warned Mountain View, Calif.-based 23andMe to stop marketing its health reports because they lacked agency authorization. (Masunaga, 4/14)

Tampa Bay Times: Here’s Why Two Doctors Who Treated Pulse Victims Oppose A Plan For More Trauma Centers
But many trauma doctors, including some who treated the Pulse shooting victims, say that’s a bad idea. They say caps on the number of trauma centers ensure each is filled with highly trained specialists, in densely populated areas where they get plenty of practice treating everything from bullet wounds to car crash injuries. Critical lawmakers say Republicans are trying to fix something that already works. (Auslen, 4/17)

Dallas Morning News: Are Heartburn Medicines Linked To A Serious Gut Infection?
The pills you take to control heartburn and suppress stomach acid may be linked to increased risk of a serious gut infection. A study published late last month in JAMA Internal Medicine reports that people who take commonly used prescription and over-the-counter indigestion medicines such as Prilosec and Zantac are at risk of repeat infection with the bacteria Clostridium difficile. (Yasmin, 4/15)

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Dementia Patients Hold On to Love Through Shared Stories

Photo

Credit Paul Rogers

Can you keep the love light shining after your partner’s brain has begun to dim? Just ask Denise Tompkins of Naperville, Ill., married 36 years to John, now 69, who has Alzheimer’s disease.

The Tompkinses participated in an unusual eight-week storytelling workshop at Northwestern University that is helping to keep the spark of love alive in couples coping with the challenges of encroaching dementia.

Every week participants are given a specific assignment to write a brief story about events in their lives that they then share with others in the group. The program culminates with a moving, often funny, 20-minute written story read alternately by the partners in each couple in front of an audience.

Each couple’s story serves as a reminder of both the good and challenging times they have shared, experiences both poignant and humorous that reveal inner strength, resilience and love and appreciation for one another that can be easily forgotten when confronted by a frightening, progressive neurological disease like Alzheimer’s.

“It’s been an amazing experience for us,” Mrs. Tompkins said of the program. “Creating our story revealed such a richness in our life together and is helping us keep that front and center going forward.”

She added that the program provides “an opportunity to process what you’re going through and your relationship to each other. It helped me digest all the wonderful things about John and how well we relate as a couple, things that don’t go away with Alzheimer’s disease. John is so much more than his disease.”

Ditto for Robyn and Ben Ferguson of Chicago, married 42 years in 2012 when they learned that Ben, a psychologist, had Alzheimer’s disease. “The diagnosis was crushing,” said his wife, who is also a psychologist. “Telling people in the program about it helped us recognize the impact on our lives and relationship and really face that. It made things feel not quite so bad.”

The Fergusons have publicly presented their 20-minute story together 19 times so far, helping to enlighten medical students and those training in social work and pastoral care, as well as researchers and members of the general public. “It reinforces our relationship as a couple, rather than caregiver and patient, even though he is 85 percent dependent on me for the activities of daily living.”

Dr. Ben Ferguson, now 69, said, “I feel we’re giving people information that could be very valuable in their future. It’s helpful to them to see us smile, have a good time and give a good report – as well as a bad report – about what goes on with this disease. It’s helpful for people to hear it from someone who has it, and it’s helped us avoid getting so morose.”

As for their presentations, which they now give almost monthly, his wife said, “They help us stay positive and give us a sense of purpose. We both feel a real need to do advocacy work, and this is the best thing we can do right now. We know there’s a sell-by date on this – we won’t be able to do it forever. But we don’t think about that now. Now we’re focused on helping people understand that your life doesn’t stop with the diagnosis. We want people to hear that you go on with your life, even though you may need a lot of help.”

Another workshop participant, Sheila Nicholes, 76, of Chicago, said of her husband, Luther, who has vascular dementia, that the storytelling “brings him back to being funny again. Writing our story together gave us a way to talk about these things, to think about where we were then and where we are now.”

Noting that dementia is “a very hush-hush illness in our black community,” Ms. Nicholes said she hoped that telling their story would help others speak more openly about it and learn to “just roll with the flow.”

The storytelling workshop, which started in January of 2014, was the brainchild of Lauren Dowden, then an intern in social work at Northwestern’s Cognitive, Neurological and Alzheimer’s Disease Center. She quickly learned from family members in a support group that “their concerns were not being addressed about dealing with loss, not just of memory, jobs and independence, but also what they shared as a couple.”

During the group sessions, Ms. Dowden said, “there’s so much laughter in the room, so much joy and love of life as well as poignancy and tears. As they move forward, as the disease progresses, they can be reminded of who they are, their strength and resilience, what has made their relationship strong, what they loved about the person, as opposed to just being patient and caregiver.”

As the program moves week to week, Ms. Dowden said, “there’s more touching, affection, looking at one another and laughing. There are delightful moments of connection when one member of a couple reveals something the other didn’t know.”

The weekly story assignments require that the couple collaborates, “and they learn how to work together in new ways, how to make adjustments, because they’ll have to make thousands and thousands of adjustments throughout the course of the disease.”

In executing the workshop assignments, Dr. Ferguson said she would ask her husband questions, he would answer and she would write down what he said. “The workshop was really transformative,” she said. “It gave us hope for our future together in dealing with this disease.”

Ms. Dowden said the feedback from those in the audience for the 20-minute joint stories has been heartening. She explained, “Students learn about the biology of neurodegenerative conditions. These stories enable them to see the human side of the disease, what it’s like to live with it, and may help them develop programs that help these families live better. In addition to the stigma, there’s a tendency to write off people with dementia.”

Ms. Dowden said she is currently refining the workshop curriculum so that it can be used as a model for other institutions to replicate. She is also expanding it to include mother-daughter and sibling pairs.

She realizes, of course, that a storytelling workshop may not be suitable for every couple. “It’s not good if there’s a lot of behavioral issues, a lot of conflict, and no insight,” she said. “But for those it does fit, it’s an opportunity to tap into the core of relationships, to still grow and learn and be delighted by one another.”

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Breast-Fed Babies May Have Longer Telomeres, Tied to Longevity

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Credit Roberto Schmidt/Agence France-Presse — Getty Images

Breast-fed babies have healthier immune systems, score higher on I.Q. tests and may be less prone to obesity than other babies.

Now new research reveals another possible difference in breast-fed babies: They may have longer telomeres.

Telomeres are stretches of DNA that cap the ends of chromosomes and protect the genes from damage. They’re often compared to the plastic tips at the end of shoelaces that prevent laces from unraveling. Telomeres shorten as cells divide and as people age, and shorter telomeres in adulthood are associated with chronic diseases like diabetes. Some studies have linked longer telomeres to longevity.

The new study, published in The American Journal of Clinical Nutrition, is a hopeful one, its authors say, because it suggests telomere length in early life may be malleable. The researchers, who have been following a group of children since birth, measured the telomeres of 4- and 5-year-olds, and discovered that children who consumed only breast milk for the first four to six weeks of life had significantly longer telomeres than those who were given formula, juices, teas or sugar water.

Drinking fruit juice every day during the toddler years and a lot of soda at age 4 was also associated with short telomeres.

Socioeconomic differences among mothers can muddy findings about breast-feeding because the practice is more common among more educated mothers. However, this group of children was fairly homogeneous. All of them were born in San Francisco to low-income Latina mothers, most of whom qualified for a government food program.

“This adds to the burgeoning evidence that when we make it easier for mothers to breast-feed, we make mothers and babies healthier,” said Dr. Alison M. Stuebe, an expert on breast-feeding who is the medical director of lactation services at UNC Health Care in Chapel Hill, N.C., and was not involved in the study. “The more we learn about breast milk, the more it’s clear it is pretty awesome and does a lot of cool stuff.”

The study did not establish whether or not breast-feeding enhanced telomere length. It may be that babies born with longer telomeres are more likely to succeed at breast-feeding. A major drawback of the research was that telomere length was only measured at one point in time, when the children were 4 or 5 years old. There was no data on telomere length at birth or during the first few months of life.

“We don’t have a baseline to see if these kids were different when they came out,” Dr. Stuebe said. “It could be that really healthy babies can latch on and feed well, and they already had longer telomeres. It could be successful breast-feeding is a sign of a more robust kid.”

The researchers were following children who were part of the Hispanic Eating and Nutrition study, a group of 201 babies born in San Francisco to Latina mothers recruited in 2006 and 2007 while they were still pregnant. The goal of the research was to see how early life experiences, eating habits and environment influence growth and the development of cardiac and metabolic diseases as children grow.

Researchers measured the babies’ weight and height when the children were born. At four to six weeks of age, they gathered detailed information about feeding practices, including whether the baby had breast milk and for how long, and whether other milk substitutes were used, such as formula, sugar-sweetened beverages, juices, flavored milks and waters. Information was also gathered about the mothers.

Children were considered to have been exclusively breast-fed at 4 to 6 weeks of age if they received nothing but breast milk, as well as medicine or vitamins.

When the children were 4 and 5 years old, researchers took blood spot samples that could be used to measure the telomeres in leukocytes, which are white blood cells, from 121 children. They found that children who were being exclusively breast-fed at 4 to 6 weeks of age had telomeres that were about 5 percent longer, or approximately 350 base pairs longer, than children who were not.

The new findings may help explain the trove of benefits that accrue from breast-feeding, said Janet M. Wojcicki, an associate professor of pediatrics and epidemiology at the University of California, San Francisco, and the paper’s lead author.

“What’s remarkable about breast-feeding is its ability to improve health across organ systems,” Dr. Wojcicki said. “Telomere biology is so central to the processes of aging, human health and disease, and may be the link to how breast-feeding impacts human health on so many levels.”

There are several possible explanations for the correlation between breast-feeding and longer telomeres. Breast milk contains anti-inflammatory compounds, which may confer a protective effect on telomeres. It’s also possible that parents who exclusively breast-feed their babies are more scrupulous about a healthy diet generally.

Yet another possibility is that breast-feeding is a proxy for the quality of mother-child attachment and bonding, said Dr. Pathik D. Wadhwa, who was not involved in the research but studies early-life determinants of health at the University of California, Irvine School of Medicine. “We know from studies looking at telomere length changes in babies who came from orphanages that the quality of the attachment and interaction, and more generally the quality of care that babies receive, plays a role in the rate of change in telomere length,” he said.

When children are exposed to adversity, neglect or violence at an early age, “psychological stress creates a biochemical environment of elevated free radicals, inflammation and stress hormones that can be harmful to telomeres,” said Elissa Epel, one of the authors of the study who is a professor at the University of California, San Francisco, and director of the Aging, Metabolism and Emotions Lab.

“The idea that breast-feeding may be protective for telomeres is heartening because we don’t know much about what’s going to help protect them in children, besides avoiding toxic stress. And boy, do we want to know,” Dr. Epel said.

Although genes can’t be changed, Dr. Epel said, “This is part of the genome that appears to be at least partly under personal control.”

Meet the Super Flasher: Some Menopausal Women Suffer Years of Hot Flashes

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Credit Kim Murton

What kind of hot flasher are you?

The hot flash — that sudden feeling of warmth that can leave a woman flushed and drenched in sweat — has long been considered the defining symptom of menopause. But new research shows that the timing and duration of hot flashes can vary significantly from woman to woman, and that women appear to fall evenly into four hot-flash categories.

Some women, called “early onset” hot flashers, begin to experience hot flashes long before menopause. Symptoms can begin five to 10 years before a woman’s last period, but the symptoms stop with the end of the menstrual cycle.

Then there are women who don’t experience their first hot flash until after menopause, the “late onset” hot flasher. And some women fall into a group the researchers called the “lucky few.” Some of these women never experience a single hot flash, whereas others briefly suffer only a few flashes when they stop menstruating.

And then there are the “super flashers.” This unlucky group includes one in four midlife women. The super flasher begins to experience hot flashes relatively early in life, similar to the early onset group. But her unpleasant symptoms continue well past menopause, like those in the late onset group. Her symptoms can last 20 years or more.

The findings come from the Study of Women’s Health Across the Nation, or SWAN, a 22-year-old study that has been tracking the physical, biological and psychological health of 3,302 women from a variety of racial and ethnic backgrounds. The study is being conducted at seven research centers around the country and is paid for by the National Institutes of Health.

“It explodes our typical myth around hot flashes, that they just last for a few years and everyone follows the same pattern,” said Rebecca Thurston, the senior author and a professor of psychiatry and epidemiologist at the University of Pittsburgh. “We may be able to better help women once we know in what category they are more likely to fall.”

That includes women like Lynn Moran, a 70-year-old retired financial planning assistant who lives near Pittsburgh and falls into the “super flasher” category. She remembers having her first hot flash around the age of 47. While the symptoms were subtle at first, soon the hot flashes became more bothersome. “It was enough to wake me up out of a sound sleep,” she said. “I wasn’t sleeping well because they were coming all night long and during the day. I was just miserable.”

Ms. Moran began hormone therapy, which helped but did not eliminate the symptoms. But when medical studies began to show health risks associated with the treatment, her doctor advised her to stop using hormones. She waited another 18 months until she retired, then stopped taking hormones in 2005.

The hot flashes “came back with a vengeance” and haven’t stopped since.

“I still have them. I still laugh about them,” she said, noting that she may experience several hot flashes a day. “I’ll be trying to get ready to go somewhere, curling my hair and have to redo everything and dry my hair again because I’ll be drenched. My makeup will literally run down my face. Here I am, 70 years old, complaining of hot flashes.”

Dr. Thurston notes that understanding variations on hot flashes is important to understanding women’s health in midlife. A 2012 study, published in the journal Obstetrics and Gynecology, suggested that the timing and duration of hot flashes may be an indicator of a woman’s cardiovascular health. The study found that frequent hot flashes were associated with higher cholesterol markers, particularly in thin women.

The latest findings from the SWAN study identified some patterns around the four subsets of women who experienced varying degrees of hot flashes. Women were distributed about equally among the groups, meaning 75 percent of women experienced some degree of hot flashes, while only 25 percent escaped the symptom.

Women in the early onset group were more likely to be white and obese. Women in the late onset group tended to be smokers. The lucky few women who had no hot flashes or only a few were more often Asian women and women in better health. The super flashers were more likely to be African-American, to be in poorer health and to consume alcohol. But the researchers cautioned that while they identified some statistical trends in each group, it’s important to note that each subset of hot flashers included a variety of women representing all races, ethnicities, body weights and health categories. No one factor appeared to determine a woman’s risk for any hot flash category.

For instance, while African-American women were three times as likely to be in the super flashers group, they represented only 40 percent of that group. The remaining 60 percent were white women, some Asian women and other groups.

Dr. Thurston said it is important that doctors understand that 75 percent of women have hot flashes in midlife and that they persist in at least one in four..

“It flies in the face of the traditional wisdom that women have these symptoms for three to five years around the final menstrual period,” she said. “We now know that is patently wrong.”

Talking to Younger Men About Growing Old

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For Robert Goldfarb, 85, resisting the decline of old age goes beyond the treadmill.

For Robert Goldfarb, 85, resisting the decline of old age goes beyond the treadmill.Credit

An electronic display on the treadmill in my local gym reminds me I’m not only running on the machine, but out of time. Its graph comparing changes in the runner’s heart rate to that of peers goes no further than age 70. I’m 85, and find it ominous that the machine presumes that anyone that old shouldn’t be on the thing.

Reminders that I’m now officially one of the old-old appear with greater frequency. Some are subtle, like the treadmill display; others are more jarring, like my daughter’s approaching 60th birthday. Most reminders are well-meaning: a young woman offering her seat on a bus, an airport employee hurrying over with a wheelchair, happily telling me I won’t have to walk to the gate or stand in line. I graciously decline their kindness, struggling not to protest, “But, I’m a competitive runner!” That I feel robust doesn’t matter; the man I see and the man they see are two very different people.

I recently read something the philosopher Montaigne wrote over 400 years ago: “The shorter my possession of life, the deeper and fuller I must make it.” His words inspired me to seek a path through old age without surrendering to it or ignoring its reality.

I began by fighting memory lapses. Rather than substituting “whatever” for an elusive word, I now strain to recall that word, even if means asking others to bear with me for a bit. I avoid phrases that suggest the end of things, like “downsizing” or “I no longer do that.” I subscribe to internet memory games. To recapture the excitement I felt in long-ago classrooms, I began rereading books I read in college.

I also decided to reach out to men my age to learn how they navigate through growing old. Like most of the men I began speaking with, I’m a product of the 1950s and its pressure to conform, to avoid risk, to shun anything that marked one as “different.” Many young people then were warned by parents that signing petitions bearing words like “protest” or “progressive” would get them rejected for a job or fired when they grew up. Men in my platoon didn’t embrace when we parted after serving in the Korean War. Closer than brothers, we settled for a handshake, knowing that’s what men did.

Almost immediately, I found conversations with men my age awkward. Attempts I made to discuss aging were met with jokes about the alternative. With few exceptions, those I spoke with regarded feelings as something to be endured, not discussed. It quickly became clear I was free to contemplate growing old, but not with them.

My wife suggested I meet with younger acquaintances to learn if they would talk with me about aging. I did, and found that men just 10 years younger spoke openly about changes in their minds and bodies. No one joked or changed the subject when one of them confided, “My father had Alzheimer’s, and I’m beginning to forget the same things he did,” or, “My firm’s managing partner said I was slowing younger associates and had to retire.”

It puzzled me that they felt so much freer to discuss feelings than men born just a decade earlier. Could it be because they were shaped by the ’60s, rather than the ’50s? Growing up, they protested what we accepted, challenged authority we obeyed, celebrated their individuality while we hoped to be one of the men in a gray flannel suit. They were the “me” generation, defined by Woodstock and rock ‘n’ roll, while my generation found comfort in Eisenhower’s paternal leadership and listening to soothing ballads like George Shearing’s “I’ll Remember April” and Margaret Whiting’s “Moonlight in Vermont.” Separated by a sliver of time, the two decades seem an eternity apart.

As I seek to reinvent myself, questioning what I do out of habit and what I’m not doing that could be liberating, it’s the voices of these younger men that I hear as I run on the treadmill today. That and the voice of Frank Sinatra from the ’50s, crooning a line from “September Song” that captures what I’ve been feeling: “But the days grow short when you reach September.” It’s realizing that I’ve reached November that presses me forward, ignoring the treadmill’s display, hoping I can lead a deeper and fuller life before I run out of time.

Robert W. Goldfarb is a management consultant and author of “What’s Stopping Me From Getting Ahead?”

Downward Facing Dog and High Heels

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Tao Porchon-Lynch teaches a yoga class in Scarsdale, N.Y. “I haven’t finished learning,” says Ms. Porchon-Lynch, who is 97. “My students are my teachers.”

Tao Porchon-Lynch teaches a yoga class in Scarsdale, N.Y. “I haven’t finished learning,” says Ms. Porchon-Lynch, who is 97. “My students are my teachers.”Credit Gregg Vigliotti for The New York Times

Tao Porchon-Lynch, 97, breezed into her regular Wednesday evening yoga class in a brightly colored outfit: stretch pants, sleeveless top, flowing scarf and three-inch heels.

She put down a mat, folded her long, limber legs into a lotus position, and began teaching her zillionth session. Softly, she guided the 15 or so students through stretching and strengthening moves, and meditative breathing.

The group, at the JCC of Mid-Westchester in Scarsdale, ranged from rank beginners to 20-year veterans of Ms. Porchon-Lynch’s classes, which she has been teaching for decades. She walked the room, adjusting poses, as her students shifted from dog to cobra to camel.

Ms. Porchon-Lynch herself moved through the poses with no apparent effort. At one point, she suspended herself above the floor, supported by her arms.

“Feel your whole body singing out, and hold,” she instructed.

“The ladder of life will take you to your inner self,” said Ms. Porchon-Lynch, who said that before the class, she had knocked out two hours of ballroom dancing.

“I did the bolero, tango, mambo, samba, cha-cha and, of course, swing dancing,” she said.

After the class, she slipped back into her heels — modest height, by Tao standards. Six-inch stilettos are more her speed because the lift helps the flow of energy from the inner feet up through the body, she said.

Back at her apartment in White Plains, she pointed to a photo of herself being dipped dramatically by a dance partner in a competition.

“He was 70 years younger than me,” she crowed. When Ms. Porchon-Lynch was in her 80s she began competitive ballroom dancing and competing widely, even appearing on “America’s Got Talent.”

“I’m very silly. I haven’t grown up yet,” she said. Then she sat and described her “I was there” life story, a march through history that rivaled a Hollywood film.

She said she was raised by an uncle and aunt in Pondicherry, India, after her mother died giving birth to her on a ship in the English Channel in 1918 toward the end of World War I.

At age 8, she began practicing yoga when few women did, and she traveled widely as a child with her uncle, a rail line designer.

Her father, she said, came from a French family that owned vineyards in the South of France, and she moved there as World War II approached. She and an aunt hid refugees from the Nazis as part of the French Resistance.

In London, she entertained troops as a cabaret dancer, and after the war she began modeling and acting in Paris, she said.

She spoke of English lessons with Noël Coward, and hobnobbing with the likes of Marlene Dietrich and Ernest Hemingway.

She said she had acted in Indian films and around 1950 was signed by Metro-Goldwyn-Mayer and had bit roles in big films such as “Show Boat” and “The Last Time I Saw Paris.”

She had stories about marching with Mohandas K. Gandhi and, years later, with the Rev. Dr. Martin Luther King Jr. and attending demonstrations with Charles de Gaulle.

Ms. Porchon-Lynch said she had studied yoga over the years with prominent teachers such as Sri Aurobindo, Indra Devi and B. K. S. Iyengar and taught yoga to many actors in Hollywood.

Even after three hip replacement surgeries, she still drives her Smart car daily and travels widely to teach yoga.

“I haven’t finished learning,” she said. “My students are my teachers.”

Ms. Porchon-Lynch, a longtime widow with no children, attributed her longevity to keeping her vortexes of energy flowing with “the fire of life,” and waking up each morning with the positive attitude that each day will be your best.

“Whatever you put in your mind materializes,” she said. “Within yourself, there’s an energy, but unless you use it, it dissipates. And that’s when you get old.”

Five hours of sleep a night is plenty, she said.

“There is so much to do and think about,” said Ms. Porchon-Lynch, a lifelong vegetarian and a wine enthusiast who still enjoys imbibing.

At the JCC class, she took her students through sun salutation movements and told them, “Remember, the sun salutation means that the dawn is breaking over the whole universe.”

Finally, she talked them through a wind-down period of relaxing meditation.

“Bring your consciousness back down to the physical plane,” she said. “May the light of the union of all things join our mind, our body and our spirit.”

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After Cataract Surgery, Hoping to Toss the Glasses

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How the World Looks With Cataracts

This video shows what it is like to see the world when you have cataracts.

By CLINIC COMPARE on Publish Date May 4, 2016.

Two years ago, Anne Collins of Arlington, Va., who has been wearing glasses since fifth grade, noticed she had trouble reading the overhead street signs while driving. Cataracts, the clouding of the natural lenses that occur with age, were taking their toll.

She decided it was time for cataract surgery.

Mrs. Collins, now 61, chose to have her lenses replaced with two different intraocular lenses – one for seeing far and the other for seeing near — in a procedure known as monovision cataract surgery.

“I thought it was a miracle,” Mrs. Collins said after the surgery was completed. “It was like I was back in second grade and didn’t have any problems with my eyes.” Still, her vision isn’t perfect. Mrs. Collins still needs glasses to read the newspaper, but she can see her cellphone just fine.

By age 80, more than half of all Americans either have a cataract or will have had cataract surgery, according to the National Eye Institute. The average age for the surgery is the early 70s.

Cataracts typically develop in both eyes, and each eye is done as a separate procedure, usually one to eight weeks apart. Patients most commonly have their clouded lenses replaced with artificial monofocal lenses that enable them to see things far away. Most will still need glasses for reading and other close-up tasks.

With monovision surgery, the patient’s dominant eye receives a replacement lens for distance vision. In a subsequent operation, the less dominant eye receives a lens for close vision. Once surgery on both eyes is completed, the brain adjusts the input from each eye and patients typically can see both far and near. Some people can stop wearing glasses altogether, although many, like Mrs. Collins, still need them for certain tasks.

But monovison takes some getting used to. The ideal candidates may be people who already have tried a monovision approach with contact lenses for 15 or 20 years, before they even have developed cataracts, said Dr. Alan Sugar, a professor of ophthalmology at the University of Michigan. “People who have worn contact lenses in their 40s, with one contact for near vision and one for distance, are good candidates,” he said.

Others may be able to give monovision a trial run. The cataract surgeon replaces the first eye with a lens that corrects for distance vision and then, if the cataract in the second eye hasn’t progressed too far, can let the patient use a contact lens for near vision in the second eye, Dr. Sugar said. If the patient is comfortable with the trial monovision, the surgeon can then implant a lens for near vision in the second eye.

Experts caution that monovision surgery is not for everyone. “Many patients get misled by asking how their friends like monovision,” said Dr. David F. Chang, a clinical professor of ophthalmology at the University of California, San Francisco, and past president of the American Society of Cataract and Refractive Surgery. “Some individuals hate what another individual loves.”

After any cataract surgery, including monovision surgery, patients may also experience what doctors call “dysphotopsia,” or visual disturbances like seeing glare, halos, streaks or shadows. Moderate to severe problems occur in less than 5 percent of patients, said Dr. Tal Raviv, an associate clinical professor of ophthalmology at the New York Eye & Ear Infirmary of Mount Sinai Icahn School of Medicine. Symptoms often improve during the first three months after surgery without treatment, he said, though in a small number of cases one or both lenses may need to be replaced.

In addition, some patients who get monovision surgery will need a separate pair of glasses that focus both eyes for distance vision for driving at night. “Night driving is more difficult if both eyes are not optimally focused at distance,” Dr. Chang said.

Another option in cataract surgery for those hoping to get rid of the glasses altogether is the use of multifocal lenses, which focus each eye for both near and far viewing, something like the progressive lenses in eyeglasses. In one study of around 200 patients who had either multifocal or monovision cataract surgery, just over 70 percent of the multifocal group could forgo glasses altogether, compared to just over 25 percent of the monovision group.

But patients who undergo multifocal surgery are more likely to have side effects like glare and halos, according to Dr. Mark Wilkins, the lead author of the study and a consultant ophthalmologist and head of clinical services at Moorfields Eye Hospital in London. In his study, six of 94 patients in the multifocal group had to have second surgeries to get replacement lenses, versus none in the monovision group.

Typically, Medicare covers regular cataract surgery and implantation of standard monofocal lenses but does not pay for multifocal lenses, so insurance reimbursements may be limited.

The key to deciding which type of cataract surgery is right for you is to understand your eyes and goals. “Talk about the pros and cons” of each type of cataract surgery, Dr. Wilkins said. “There’s no other way really.”

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Aging in Place

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Credit Paul Rogers

When I asked the other three members of my walking group, all of whom are in their mid to upper 70s, whether they had any concerns about future living arrangements, they each said they had none despite the fact that, like me, they live in multistory private homes without elevators and, in two cases, without bathrooms on every floor.

My Los Angeles son asked recently what I might do if I could no longer live in my house, and I flippantly replied, “I’m coming to live with you.” The advantages: I’d be surrounded by a loving and supportive family, and the warm weather is a benefit for someone like me who becomes increasingly intolerant of the cold with each passing year. The disadvantages: I’d lose a familiar community and a host of friends, and his house, unlike mine, is on a steep hill with no nearby stores; if I could no longer drive, I’d have to be chauffeured everywhere.

Probably my biggest deterrent would be relinquishing my independence and the incredible number of “treasures” I’ve amassed over the last half century. The junk would be easy, but parting with the works of art and mementos would be like cutting out my heart.

I suspect that most people are reluctant to think about changing where and how they live as long as they are managing well at the moment. Lisa Selin Davis reports in AARP magazine that “almost 90 percent of Americans 65 or older plan to stay in their homes as they age.” Yet for many, the design of their homes and communities does not suit older adults who lack the mobility, agility and swiftness of the young.

For those who wish to age in place, the authors of “70Candles: Women Thriving in Their 8th Decade,” Jane Giddan and Ellen Cole, list such often-needed home attributes as an absence of stairs, wide doorways to accommodate a walker or wheelchair, slip-resistant floors, lever-style door knobs, remotely controlled lighting, walk-in showers, railings, ramps and lifts. Add to these a 24-hour help system, mobile phone, surveillance cameras and GPS locaters that enable family members to monitor the well-being of their elders.

In many communities, volunteer organizations, like Good Neighbors of Park Slope in Brooklyn and Staying in Place in Woodstock, N.Y., help older residents remain in their homes and live easier and more fulfilling lives.

While many young adults chose to live and bring up children in the suburbs, a growing number of empty-nested retirees are now moving to city centers where they can access public transportation, shop on foot for food and household needs, and enjoy cultural offerings and friendly gatherings without depending unduly on others.

One reason my friends and I are unwilling to even consider leaving our Brooklyn community is our ability to walk to supermarkets, banks, food co-ops, hardware stores, worship and recreational facilities, and get virtually everywhere in the city with low-cost and usually highly efficient public transportation. No driving necessary.

We also wallow in the joys of near-daily walks in a big, beautiful urban park, remarking each time about some lovely vista — the moon, sunrise, visible planets, new plantings and resident wildlife.

Throughout the country, communities are being retrofitted to accommodate the tsunami of elders expected to live there as baby boomers age. Changes like altering traffic signals and street crossings to give pedestrians more time to cross enhance safety for people whose mobility is compromised. New York City, for example, has created Aging Improvement Districts, so far in East Harlem, the Upper West Side and Bedford-Stuyvesant, to help older people “live as independently and engaged in the city as possible,” Ms. Giddan and Ms. Cole wrote. In East Harlem, for example, merchants have made signs easier to read and provided folding chairs for seniors who wish to rest before and after shopping.

In Philadelphia, a nonprofit organization, Friends in the City, calls itself a “community without walls” designed to bring members closer to the city’s resources and to one another. It offers seniors a daily variety of programs to suit many cultural and recreational interests.

Also evolving is the concept of home sharing, in which several older people who did not necessarily know one another get together to buy a home in which to live and share responsibilities for shopping, cooking, cleaning and home repair. For example, in Oregon, Let’s Share Housing, and in Vermont, Home Share Now, have online services that connect people with similar needs, Ms. Giddan and Ms. Cole report. There’s also an online matching service — Roommates4Boomers.com — for women 50 and over looking for compatible living mates.

Of course, there are still many older adults, widows and widowers in particular, who for financial or personal reasons move in with a grown child’s family, sometimes in an attached apartment or separate floor. Host families may gain a built-in babysitter, and children can develop a more intimate relationship with grandma or grandpa.

For those with adequate finances, there is no shortage of for-profit retirement communities that help older people remain independent by providing supportive services and a host of amenities and activities. Some have extensive recreational and exercise facilities, as well as book and craft clubs, discussion groups and volunteer opportunities. Some take residents to theatrical productions and museums and on trips to nearby attractions.

I confess that retirement communities that house only older adults are not my style. I can’t imagine living in a place where I don’t see and interact with children on a daily basis. I find that nothing cheers me more than a smile or comment from a toddler. I guess I take after my father, who used to flirt with every child he noticed in a car near his. But I realize that, just as some people are averse to dogs, not everyone enjoys the companionship of a high-energy child.

For older people likely to require help with the activities of daily living, there are many assisted living facilities where residents can get more or less help, including aid with medications, feeding and ambulation, according to their changing needs.

And should I ever have to leave my home, Ms. Giddan and Ms. Cole point out that there is a new and growing cadre of professional organizers and moving managers to “help people sort through accumulated belongings, distribute and disperse what won’t be needed in the new setting, and assist with all stages of packing, moving and then unpacking, and staging the new home.”

This is the second of two columns about adjustments to aging. Read the first part: “Thriving at Age 70 and Beyond.”

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Ask Well: Why Is Arthritis More Common in Women Than Men?

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Credit Stuart Bradford/The New York Times

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Retirement May Be Good for You

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Vinny Volpicelli, 57, works out at Symphony Villiage retirement community in Centerville, Md.

Vinny Volpicelli, 57, works out at Symphony Villiage retirement community in Centerville, Md.Credit Jonathan Hanson for The New York Times

Retirement may be good for your health, a new study suggests.

Australian researchers followed a group of 27,257 men and women, 3,106 of whom retired during the three-year study period. They compared retirees with their peers who were still working, looking at such health measures as smoking, alcohol consumption, physical activity, diet and sleep.

Retirees were also asked why they retired: health problems, caring for others, lack of job opportunities or lifestyle reasons like the desire to travel or study. The study is in the American Journal of Preventive Medicine.

After adjusting for initial health risks, they found that on average, retirees walked for 17 minutes more a week, and engaged in moderate-intensity exercise 45 minutes more a week. They slept about 15 minutes more a night than they did when they were working. Women retirees were more likely to quit smoking than their still-working peers.

There were no significant differences between retirees and those still working, when it came to alcohol use or fruit and vegetable consumption.

The authors had no information about the participants’ type of occupation, and they acknowledge that the follow-up period was short.

“This points to a happier picture,” said the lead author, Melody Ding, a senior research fellow at the University of Sydney. “It allows people to look at retirement optimistically. But there are successful and unsuccessful retirements. It’s important not to over-generalize these results.”

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Reinventing Yourself

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Credit Paul Rogers

Maybe you lost your job, or your interest in the job you’ve been doing. Maybe a divorce or death in the family has threatened your economic stability. Maybe you think you’re now too old or lack the training to switch to something more satisfying or remunerative.

I interviewed several people in similar circumstances who reinvented themselves, sometimes against considerable odds, other times in surprising ways.

After 25 years in family practice in Park Slope, Brooklyn, Dr. Kenneth Jaffe resisted the encroachment of managed care and found he could no longer take the time he needed to care for his patients and make a living at it.

So at 55, inspired by courses he took at the Columbia University Mailman School of Public Health, he quit medicine, moved upstate to an economically depressed area where the land was plentiful and cheap, and began raising grass-fed beef free of hormones and antibiotics. He named his enterprise Slope Farms in honor of his old neighborhood and the Park Slope Food Coop, which sells meat from his 200 head of cattle.

Now 66, Dr. Jaffe said he remained fulfilled by his work in sustainable agriculture. He helps other farmers near his home in the Catskills do the same, and supports a farm-to-school program that brings grass-fed beef to children in kindergarten through 12th grade.

Mary Doty Sykes had been a social worker for 30 years, counseling and teaching teenage parents and adolescent girls about sexuality, self-image, family issues and job training, first in Chicago and then in New York City public high schools. When she became a divorced empty-nester in her early 50s, she decided it was time to get out of the city.

“I rented my house to pay for schooling as a massage therapist,” an interest she developed after techniques in alternative medicine helped her recover from serious injuries sustained in a car accident. Starting at 55 as a licensed therapist, for 13 years she did therapeutic massage at various sites, often for older adults, in western Massachusetts. Now 75 and back in New York, Ms. Sykes offers reiki therapy, and participates in a variety of dance classes. “I’m lucky I can do it all; I have a lot of fun,” she said.

“Fun” is an understatement for Richard Erde, also 75, who worked as a computer programmer for 28 years. After he retired in 2005, Mr. Erde indulged a longstanding interest in opera by auditioning to become an extra, or supernumerary, at the Metropolitan Opera.

“I’ve been on stage at the Met literally hundreds of times with world-famous singers and I never sang a word,” the Brooklynite chuckled. “I’ve worn all kinds of costumes, from Buddhist priest to Russian soldier. It’s ecstatic at times, plus I get paid to do it.” When the Met season ends in late spring, he does the same with American Ballet Theater, where the “supers” are often integrated with the corps de ballet as it moves around the stage.

From age 21, Beth Ravitz worked as a fabric designer, mostly in her own successful business in New York. Then at 40, she gave it up to spend more time with her three young children and two stepchildren. The family moved to Coral Springs, Fla., where, she said, “I didn’t want to think about money; I wanted to nourish my soul and become a real artist.”

While enrolled in a ceramics class at a community college, she saw ads seeking applicants to create public art, decided to go for it, and was hired to do a project. After earning bachelor’s and master’s degrees in fine art, she was able to teach at the college level, a job she loved, and ultimately became what she is now at 66: a public art consultant for two Florida cities (Lauderhill and Tamarac) and an advocate for artists whose work she said is too often undervalued. “I love the fight, and I love that I can make a difference,” Ms. Ravitz said.

Although I have been like a horse with blinders, starting at 23 as a science and health writer and never straying from my chosen path for 52 years, I have great admiration for the courage, imagination and determination of people like these four, who reinvented themselves by believing that you never know what you can do until you try.

Rather than embark on a new career in semiretirement, I’m expanding my horizons by learning Spanish; going to more concerts, operas, lectures and museums; and traveling. I recently took my four grandsons on an Alaskan nature cruise and a tenting safari in Tanzania.

I also adopted a puppy and trained him to be a therapy dog to cheer patients and staff in our local hospital. And if I can find a teacher with a flexible schedule, I hope to learn a new instrument, preferably the bandoneon, a kind of concertina featured in Argentine tango music. (Suggestions for teachers, anyone?)

One thing I’m already learning is my limits: knowing when to say no so I will have the time and energy to do what is most important to me in the last quarter of my life.

Although only 37, Dorie Clark, a teacher at Duke University School of Business and author of “Reinventing You,” is expert at self-reinvention and helping others make changes in their lives.

“Broadly speaking,” she said, “the same principles apply whatever your age.” But she has particular advice for people over 50.

■“Make a special effort to familiarize yourself with social media and the new technology — they’re a proxy for how ‘with it’ you are.”

■“Recognize that you’re likely to be overqualified for certain jobs. It could be the elephant in the room, so it’s important to bring it up first. Maybe say that you’re looking for a new adventure, you don’t need to be the boss, you’re ready to be a team player.”

■“Surprise people to counter any fixed image they may have of you. Your résumé may say one thing, but that doesn’t mean it’s the only thing you can do. Show you’re serious about reinventing yourself, perhaps by volunteering or writing a blog — something that forces people to see you in a new way.”

She also suggests “reconnecting with dormant ties” — people you had a good relationship with years earlier. They may be able to open doors or have ideas that you hadn’t thought of.

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Using the Arts to Promote Healthy Aging

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Credit Paul Rogers

Throughout the country, the arts are pumping new life into the bodies and minds of the elderly.

Two summers ago, a remarkable documentary called “Alive Inside” showed how much music can do for the most vulnerable older Americans, especially those whose memories and personalities are dimmed by dementia.

The film opens with a 90-year-old African-American woman living in a nursing home being asked about her life growing up in the South. All she could say in response to specific questions was, “I’m sorry, I don’t remember.”

But once she was fitted with an iPod that played the music she had enjoyed in her youth, her smile grew wide and her eyes sparkled as vivid memories flooded her consciousness. She was now able to describe in detail the music and dances she had relished with her young friends.

At another nursing home, a man named George with advanced dementia refused to speak or even raise his head when asked his name. He too was outfitted with an iPod, and suddenly George came back to life, talking freely, wiggling to the music in his wheelchair and singing along with the songs he once loved.

The Music and Memory project that provided the iPods was the inspiration of a volunteer music lover named Dan Cohen, and has since spread to many nursing homes and facilities for the aged around the country. Alas, not nearly enough of them. Medicaid, which fully covers the cost of potent drugs that can turn old people into virtual zombies, has no policy that would pay for far less expensive music players. So the vast majority of nursing home residents who might benefit are deprived of this joyous experience.

Nonetheless, across the country, the arts in their myriad forms are enhancing the lives and health of older people — and not just those with dementia— helping to keep many men and women out of nursing homes and living independently. With grants from organizations like the National Endowment for the Arts and the National Institute on Aging, incredibly dedicated individuals with backgrounds in the arts have established programs that utilize activities as diverse as music, dance, painting, quilting, singing, poetry writing and storytelling to add meaning, joy and a vibrant sense of well-being to the lives of older people.

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Walter Hurlburt, 90, decorates rooms at the Burbank Senior Artists Colony, a retirement facility where he lives.

Walter Hurlburt, 90, decorates rooms at the Burbank Senior Artists Colony, a retirement facility where he lives.Credit

Through a program called EngAGE in Southern California, 90-year-old Walter Hurlburt, who once made a living as a sign painter, now decorates rooms at the Burbank Senior Artists Colony, a retirement facility where he lives, with lovely oil paintings he creates from pictures he finds in magazines and books. Mr. Hurlburt regularly attends classes on various art forms at the residence where, he told me, “I’m always learning something new.”

His buddy at the residence, Sally Connors, an 82-year-old former schoolteacher, surprised herself by writing and directing a screenplay that was performed by fellow residents. Then, with Dolly Brittan, 79, a former early childhood educator, they both surprised themselves by writing their life stories in rap and performing their rap memoirs on a stage for at-risk teenagers they were mentoring.

Both she and Ms. Connors said their newfound involvement with the arts has made them feel decades younger.

Tim Carpenter, the executive director of EngAGE, is now working to expand this approach to senior living in other cities, including Minneapolis, Portland, Ore., and Raleigh, N.C. His goal is to create a nationwide network of programs for seniors that keep them healthy, happy and active through lifelong learning in every conceivable art form, enabling them to live independently as long as possible.

As in Burbank, Mr. Carpenter is promoting the development of arts colonies in senior residences where residents can study and create art in all its forms and where they can see their artistic creations come to life on a stage.

Dr. Gene D. Cohen, a gerontologist at George Washington University who died in 2009, was a staunch advocate for the mental and physical benefits of creativity for the elderly. He directed the Creativity and Aging Study, a controlled study sponsored by the National Endowment for the Arts at three sites, including Elders Share the Arts in Brooklyn, N.Y., that showed after only a year that the health of elders in the cultural groups stabilized or improved in contrast to a decline among those in the control groups.

In a film called “Do Not Go Gently,” Dr. Cohen, who founded the Creativity Discovery Corps, featured an architect who, at age 96, submitted a plan for redeveloping the World Trade Center site. Dr. Cohen pointed out that creativity challenges the mind and results in the formation of new dendrites, the brain’s communication channels.

At 26 different facilities in the Washington, D.C., area, 15 teaching artists work with seniors in centers where they live or visit regularly. Janine Tursini, director of Arts for the Aging in Rockville, Md., seeks to “get at what best jazzes up older adults.” Groups of about 20 older adults get involved in what she calls “art making” — music, dance, painting or storytelling.

Ms. Tursini said the N.E.A.-sponsored study showed that when older people become involved in culturally enriching programs, they experience a decline in depression, are less likely to fall and pay fewer visits to the doctor. In another study among people with Alzheimer’s disease, a sculpting program improved the participants’ mood and decreased their agitation even after the program ended.

“The arts open people up, giving them new vehicles for self-expression, a chance to tell their stories,” Ms. Tursini said. “The programs capitalize on assets that remain, not on what’s been lost.”

Naomi Goldberg Haas created the Dances for a Variable Population program to get older adults dancing. People who haven’t moved in years, even those who can no longer stand, can participate. Young professionals and older dancers go to various sites — libraries, churches, senior centers — where elders gather and encourage them to “move more.”

“Movement enriches the quality of their lives,” Ms. Haas said. “It’s absolutely healing. Balance, mobility, strength — everything improves.”

Social engagement, which nearly all these programs provide, has been repeatedly found in major population studies to prolong life and enhance healthy aging. Clinically, the programs have been linked to lowered blood pressure, reduced levels of stress hormones, and increased levels of the “happiness hormones” that are responsible for a runner’s high.

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