Tagged Aging

State Highlights: Ohio Tensions Rise Over Drug-Pricing Transparency Ballot Measure; Number Of Calif. Dialysis Patients Spikes

Media outlets report on news from Ohio, California, Texas, Maryland, Pennsylvania, Minnesota and Iowa.

Stat: In Ohio, Tension Brews Over Who’s Funding A Drug Price-Control Ballot Measure
It was supposed to be a battle over high drug prices, but right now, it’s become a battle over transparency — specifically, which drug makers are funding an effort to block a measure on the ballot in Ohio this November that seeks to rein in drug prices in the state. The proposal in Ohio is similar to the one that California voters shot down last November following a huge oppositional push from drug companies; it’s even backed by the same group, the AIDS Healthcare Foundation, which runs a nonprofit network of clinics. (Robbins, 8/14)

California Healthline: Number Of Dialysis Patients In California Surges
The number of Californians who are getting care at dialysis centers has spiked in recent years — but not because kidney disease is more prevalent. The reason is that people are living longer with end-stage renal disease, said Anjay Rastogi, a professor of nephrology at UCLA’s David Geffen School of Medicine. The number of new cases has generally leveled off in recent years, Rastogi said. “The same number of patients are being put on dialysis, but they stay on dialysis,” he said. (Bartolone, 8/15)

Austin American-Statesman: Senate Tentatively OKs $563 Million For Schools, Retired Teachers
With two days left in the special legislative session, the Texas Senate early Tuesday morning approved 25-6 a bill to pump an extra $351 million into the public education system over the next two years — a $1.5 billion cut from what the House had proposed. Tuesday morning’s vote sends the watered-down version of House Bill 21 into conference committee where Senate and House members will continue negotiations that began over the weekend. (Chang, 8/14)

Politico Pro: Latest Texas Abortion Curbs Designed To Avoid Legal Fireworks
Two new abortion curbs the Republican-controlled Legislature fast-tracked for Gov. Greg Abbott’s signature over the weekend represent an alternative approach that could avoid the kind of legal fireworks surrounding recent state efforts to limit access to the procedure. …If the two bills are signed into law, as expected, Texas lawmakers will have passed half a dozen new abortion measures this year. (Rayasam, 8/14)

Austin American-Statesman: Texas Is 18th Most Expensive State To Have A Baby, Online List Says
In WalletHub’s new ranking of the best and worst states to have a baby, the Lone Star State arrived at No. 34 overall, No. 32 in terms of birth costs, No. 35 in terms of health care rank, No. 38 in terms of “baby-friendliness” and No. 29 in terms of “family-friendliness.” Its ranking of No. 34 out of all 50 states and Washington, D.C. means that Texas is the 18th most expensive place to have a baby in America. (Harris, 8/14)

The Baltimore Sun: Maryland School Of Alternative Medicine To Offer New Naturopathic Program 
The Maryland University of Integrative Health is establishing a school of naturopathic medicine and plans to admit the first students to the program next year. The school of naturopathic medicine will be the first in the mid-Atlantic region and one of only a handful of schools nationwide that operate within a regionally accredited university, officials with the university of integrative health said. (McDaniels, 8/14)

The Baltimore Sun: Maryland Regulators Approve Eight New Medical Marijuana Growers 
Maryland’s medical marijuana regulators approved final licenses for eight growing companies on Monday, allowing them to start cultivating the drug. Several companies said they are ready to begin growing immediately, while others say they will take weeks to get started. …Until Monday, just one of the 15 selected firms had received final permission to start cultivating medical marijuana, which was first legalized in the state in 2013. Even at full capacity, one firm could not produce nearly enough to support 102 planned dispensaries. (Cox, 8/14)

The Philadelphia Inquirer/Philly.com: Conshy’s Symphony Health Drug-Data Firm Sold For $520M
PRA Health Sciences Inc., a North Carolina-based clinical research organization that tests drugs, has agreed to pay $520 million for Symphony Health Solutions Corp., a Conshohocken-based medical data company assembled by Silicon Valley investors from mostly suburban Philadelphia-based firms that collected patients’ drug prescriptions from doctors and sold the information to drug makers. …With sales of around $200 million a year, Symphony employs around 250, according to PRA. That’s down from 500 in 2012. The company’s profit margin, before financial expenses, was 20 percent last year, PRA chief financial officer Linda Baddour told investors in the conference call. (DiStefano, 8/14)

The San Diego Union-Tribune: Aztecs Cancel Monday Night’s Practice As Chickenpox Count Grows To Five Players 
San Diego State postponed Monday night’s football practice amid a rash of chickenpox cases that has increased from three to five Aztecs players. SDSU head coach Rocky Long said the move was made as a precaution in an effort to prevent the disease from spreading even further. …The SDSU weight room is shared by all the school’s sports teams, including in recent weeks the other fall sports of men’s and women’s soccer, women’s volleyball and women’s cross country. School officials said no chickenpox cases outside of the football team have been reported. (Kenney, 8/14)

San Jose Mercury News: Check Your Kids’ Vaccine Record As School Year Starts
August — ouch — is National Immunization Awareness Month and the start of school for many, timely reminders why local and state public health​ officials are urging parents to make sure their children are up to speed with their vaccines, preventing diseases like measles and whooping cough that can easily spread in childcare and school settings. Actually, it’s not just a reminder, it’s the law — and one that got even tougher in California starting last summer when parents no longer were allowed to opt out of immunizations for their children, save for legitimate medical exemptions. (Seipel, 8/15)

San Jose Mercury News: Healthcare Workers Rally To Halt Oakland Nurse’s Deportation
Health care workers and other community members are rallying at noon Monday in front of Highland Hospital to demand that U.S. immigration officials halt the imminent deportation of registered nurse Maria Sanchez and her husband on Tuesday. The couple, who moved to the Bay Area in the early 1990s from a small town in Mexico, are undocumented immigrants. (Seipel, 8/14)

San Jose Mercury News: Santa Clara County Hiring Transgender Services Manager
Santa Clara County is bolstering its services aimed at the South Bay’s diverse and often marginalized transgender community through a new program manager dedicated to that population — the second such post in the nation. The program manager will serve as a “trainer, mediator and facilitator” for the transgender community, who face unique challenges at school, the workplace, in hospitals, correctional facilities and elsewhere. (Kurhi, 8/14)

Iowa Public Radio: Data On Gunshot Wounds Lacking
Nationally, more people between the ages of 15-24 are shot than any other age group. Dr. Denville Myrie, a trauma surgeon at Mercy Medical Center, says that’s true for the ER he works for in Des Moines. (Moon and Kieffer, 8/14)

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

Hospital Officials Question Whether Medicare Readmissions Penalties Have Run Their Course

The program, mandated by the health law, has been credited with helping bring down costly readmissions. But hospital and industry leaders say that has hit a standstill. Also in the news, a new report spotlights a slowing of health care price increases, and WebMD’s CFO talks about plans for the company.

Modern Healthcare: Private Payers Tamp Down Hospital Prices In June
Consumers are getting some relief on healthcare prices this summer. The increase in June was just 1.5% compared with the prior-year period at 1.9%, according to a new report by the Altarum Institute’s Center for Sustainable Health Spending. Hospitals, whose privately insured patients paid just 1.8% more for services in June compared with the year before led the moderation. That’s the smallest monthly increase in that category since Altarum started tracking the private-payer pricing data in June 2014. (Barkholz, 8/11)

The Wall Street Journal: WebMD Wants To Go Beyond Medical Information
According to [WebMD’s] chief financial officer, Blake DeSimone, who was appointed to the position in September, WebMD is in the process of transforming its flagship site for consumers, WebMD.com, from a one-stop shop for information to a platform people can engage with and take action to improve their health. WebMD last month agreed to be acquired by private-equity firm KKR & Co. for $2.8 billion, after publicly putting itself in play early this year. (Stratton, 8/13)

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

End-Of-Life Advice: More Than 500,000 Chat On Medicare’s Dime

The 90-year-old woman in the San Diego-area nursing home was quite clear, said Dr. Karl Steinberg. She didn’t want aggressive measures to prolong her life. If her heart stopped, she didn’t want CPR.

But when Steinberg, a palliative care physician, relayed those wishes to the woman’s daughter, the younger woman would have none of it.

“She said, ‘I don’t agree with that. My mom is confused,’” Steinberg recalled. “I said, ‘Let’s talk about it.’”

Instead of arguing, Steinberg used an increasingly popular tool to resolve the impasse last month. He brought mother and daughter together for an advance-care planning session, an end-of-life consultation that’s now being paid for by Medicare.

In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show.

Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled.

Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year.

That’s good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives. Patients and, often, their families discuss with a doctor or other provider what kind of care they want if they’re unable to make decisions themselves.

“I think it’s great that half a million people talked with their doctors last year. That’s a good thing,” said Paul Malley, president of Aging with Dignity, a Florida nonprofit that promotes end-of-life discussions. “Physician practices are learning. My guess is that it will increase each year.”

Still, only a fraction of eligible Medicare providers — and patients — have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions.

Nationwide, slightly more than 1 percent of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received advance-care planning talks, according to calculations by health policy analysts at Duke University. But use varied widely among states, from 0.2 percent of Alaska Medicare recipients to 2.49 percent of those enrolled in the program in Hawaii.

“There’s tremendous variation by state. That’s the first thing that jumps out,” said Donald Taylor Jr., a Duke professor of public policy.

In part, that’s because many providers, especially primary care doctors, aren’t aware that the Medicare reimbursement agreement, approved in 2015, has taken effect.

“Some physicians don’t know that this is a service,” said Barbie Hays, a Medicare coding and compliance strategist for the American Academy of Family Physicians. “They don’t know how to get paid for it. One of the struggles here is we’re trying to get this message out to our members.”

There also may be lingering controversy over the sessions, which were famously decried as “death panels” during the 2009 debate about the Affordable Care Act. Earlier this year, the issue resurfaced in Congress, where Rep. Steve King (R-Iowa) introduced the Protecting Life Until Natural Death Act, which would halt Medicare reimbursement for advance-care planning appointments.

King said the move was financially motivated and not in the interest of Americans “who were promised life-sustaining care in their older years.”

Proponents like Steinberg, however, contend that informed decisions, not cost savings, are the point of the new policy.

“It’s really important to say the reason for this isn’t to save money, although that may be a side benefit, but it’s really about person-centered care,” he said. “It’s about taking the time when people are ill or even when they’re not ill to talk about what their values are. To talk about what constitutes an acceptable versus an unacceptable quality of life.”

That’s just the discussion that the San Diego nursing home resident was able to have with her daughter, Steinberg said. The 90-year-old was able to say why she didn’t want CPR or to be intubated if she became seriously ill.

“I believe it brought the two of them closer,” Steinberg said. Even though the daughter didn’t necessarily hear what she wanted to hear. It was like, ‘You may not agree with your mom, but she’s your mom, and if she doesn’t want somebody beating her chest or ramming a tube down her throat, that’s her decision.”

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

Categories: Aging, Medicare, Public Health

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Medicare’s Observation Care Policy More Likely To Affect Low-Income Seniors

A new study finds that low-income patients are more likely to be kept in the hospital under observation, and the higher out-of-pocket spending that accompanies not being officially admitted is a bigger burden for them. Also in the news, long-term care hospitals are pressing Medicare for a change that may cut their reimbursement rates.

Reuters: Poor Medicare Patients May Spend More On Hospital Stays
Out-of-pocket spending for hospital care by people with Medicare may be higher for those with lower incomes, because they’re more likely than wealthier Medicare beneficiaries to be kept in the hospital without being officially admitted, a new study suggests. Under Medicare, the government insurance program for the elderly and disabled, people admitted to the hospital pay a fixed out-of-pocket fee that covers the majority of their care there …. But people who aren’t sick enough for an inpatient admission may be kept in the hospital for observation, which not only carries a one-time out-of-pocket fee but also requires patients to pay 20 percent of the bills for hospital services and pick up the tab for certain drugs. The poorest people on Medicare had more hospitalizations for observation, researchers found. (Rapaport, 8/9)

Modern Healthcare: Hospitals Hope Trump’s Pause Of A Medicare Reimbursement Cut Will Become Permanent 
Long-term care hospitals around the country are hopeful the Trump administration will permanently abolish a proposed policy that would dramatically reduce their Medicare reimbursement. The Trump administration said Aug. 2 that it will freeze the so-called 25% rule that dings Medicare reimbursement rates for hospitals for one year while it assesses whether the policy is needed. Under proposed rule, if more than a quarter of a long-term care hospital’s patients come from a single acute-care hospital, the long-term care hospital would receive a reduced Medicare reimbursement rate for patients exceeding that threshold. (Dickson, 8/9)

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

Asthma, More Deadly With Age, Takes Heavy Toll On Older Adults

In early June, Donna Bilgore Robins stood on a patio in Beaver Creek, Colo., under a crystal-clear blue sky and tried to catch her breath.

She couldn’t.

With mountain vistas around her, Robins felt as if she was drowning. She gasped for air hungrily again and again.

Robins knew all too well what was happening. Something — some kind of plant?  something in the mountain air? — had triggered her asthma, a lifelong condition.

She also knew she was in danger, even with a rescue inhaler at hand. “I don’t slowly get sick — I just drop,” said Robins, who with help from her husband was soon on the road to seek medical attention over 100 miles away at National Jewish Health in Denver, a leading hospital for people with respiratory conditions.

For people like Robins, 63, diagnosed with asthma as a young child, aging with this condition can be fraught with difficulty.

Death rates for older adults with asthma are five times that of younger patients, according to a new review of asthma among seniors. And medical complications are more common.

As the prevalence of asthma climbs in people 65 and older, more seniors will grapple with its long-term impact. Estimates vary, but up to 9 percent of older adults are thought to have asthma — a respiratory condition that inflames the lungs and interferes with breathing.

With the advance of years, physical changes take a toll. People’s lungs become less elastic, their chest walls more rigid, and the muscles that help power the respiratory system less strong, exacerbating breathing problems, explained Dr. Michael Wechsler, a professor of medicine and co-director of the Cohen Family Asthma Institute at National Jewish Health, and co-author of the new review.

Compromised vision, fine motor coordination and cognition can make it difficult for seniors to use inhalers correctly. Fewer than half of older adults with asthma do so, some research suggests, and many people on fixed incomes can’t afford these expensive medications, which can cost up to $300 a month.

Judith GrahamNAVIGATING AGING

With age, the immune system’s response to inflammation — a key contributor to asthma — becomes blunted, making it harder to fight off infections that can trigger asthma exacerbations.

Other biological changes, notably shifts in patterns of inflammation, may reduce older patients’ response to inhaled corticosteroids such as Advair or Flovent — medications that need to be taken daily to control inflammation.

“Either patients have more inflammation and they need higher doses or they have a different kind of inflammation and steroids may not work as well,” Wechsler said.

Then, there are other medical conditions such as chronic obstructive pulmonary disease, congestive heart failure and heart disease that can coexist with asthma and complicate diagnosis and treatment.

Research shows that older adults tend to prioritize other medical conditions over asthma, perhaps because they minimize symptoms and underestimate their impact, suggested Miichael Wolf, a professor of medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

“Older adults have a tendency to ignore difficulties with breathing,” noted Dr. Rachel Taliercio, a pulmonologist at the Cleveland Clinic. “Instead of thinking this could be asthma, they think, ‘I’m overweight, I’m out of shape, I’m getting older, and this is normal at this time of life.’”

Physicians can be slow to recognize asthma as well. “In the elderly, sometimes the only manifestation of asthma is shortness of breath and a cough,” said Dr. Kaiser Lim, a pulmonologist and critical care specialist at the Mayo Clinic in Rochester, Minn. “But some primary care doctors kind of shrug off these symptoms.”

Up to half of older adults with asthma haven’t been accurately diagnosed, according a review article in The Lancet. That includes people with adult-onset asthma who first developed this condition in middle age or later.

Wechsler tells of a patient who started coughing, wheezing and becoming short of breath in his 60s. Diagnosed with chronic obstructive pulmonary disease by two physicians, he was given a rescue inhaler but was not treated for ongoing airway inflammation. When the patient failed to improve, he went to National Jewish, which performed a round of sophisticated tests that indicated asthma.

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“I prescribed a high dose of inhaled corticosteroids in combination with a long-acting bronchodilator, and he came back a month later and said, ‘I don’t know what the hell you gave me, doctor, but I haven’t breathed this well in five years.’ ”

When Robins arrived in Denver, with an acute asthma exacerbation, her treatment was far more difficult.

Diagnosed with severe allergies and intractable asthma as a child, she’d lived full time in a dormitory at National Jewish from age 6 to 8, along with a group of youngsters with life-threatening variants of these conditions.

Robins learned to hide the severity of her illness in the years that followed.  “Everyone knew I had asthma, but no one except a few close friends and family knew how bad it was,” she recalled.

Youth afforded her a form of protection. “Even when you have setbacks, there’s a vigor and a lust for life when you’re young that will not be denied,” Robins said.  “You feel you’re invincible, and even if you don’t feel great, it’s like, so what, I’ll get better.”

Despite asthma exacerbations that required hospitalization, Robins managed fairly well until she reached her 50s. “Things became very different as I got older,” she explained. “I couldn’t recoup from exacerbations as easily. The episodes were longer. The periods where I felt decent were shorter.”

In Denver, Robins hoped she’d stabilize in a few days. Instead, she stayed nearly seven weeks, being treated with a higher dose of intravenous steroids than she’d ever had, before returning home to Florida in late July.

Toward the end of her treatment at National Jewish, Robins reflected on growing older with a serious chronic illness. “I used to feel like I was in control of my asthma,” she said, “but I’m not in control anymore, and that has been very difficult to accept.”

“I know now that I can’t get away with putting this on the back burner, the way I did when I was younger,” she continued. “You realize you have to adjust to a different lifestyle, and if you’re not smart about what you can and can’t do, you’ll pay the price.”

Acknowledging her vulnerability after years of toughing out being sick is an ongoing challenge. “It’s empowering to know that you’re doing as much as you can to be healthy. But it’s scary at the same time,” Robins said. “It doesn’t mean you can change things. But you’re doing what you can.”

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.

Categories: Aging, Navigating Aging

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Lag In Brain Donation Hampers Understanding Of Dementia In Blacks

Dorothy and Levi Reeves stand in their Oakland, Calif., home, holding their wedding photo from 57 years ago. Dorothy Reeves agreed to donate both of their brains after death to the University of California-Davis for research. (Anna Gorman/KHN)

OAKLAND, Calif. — The question came as a shock to Dorothy Reeves: Would she be willing to donate her husband’s brain for research?

She knew dementia would steadily take Levi Reeves’ memories of their 57-year marriage, his remaining lucidity and, eventually, his life. But to let scientists take his brain after he died? That seemed too much to ask.

“I didn’t want to deal with the idea of his death,” said Reeves, 79. “I certainly didn’t want to deal with brain donation.”

As an African-American and a former schoolteacher, Reeves is keenly aware of the history of racism in health care, including callous and sometimes deadly experimentation. Reeves said she never personally has had a bad experience with doctors or the medical system. But she’s old enough to remember the infamous Tuskegee Institute syphilis study, during which hundreds of mostly illiterate black sharecroppers were assured they were being treated for “bad blood” even as doctors withheld effective treatment over decades.

Top researchers say such wariness, while understandable, is thwarting efforts to understand and treat Alzheimer’s disease and other forms of dementia in black patients today. African-Americans suffer from these cognitive impairments at two to three times the rate of non-Hispanic whites, yet they are less likely to take part in research.

That has created a vexing challenge for scientists, who are trying to persuade more blacks to participate in studies — both while they are alive and after they die. A critical part of their efforts is asking for brain donations.

“There is a lot of terrible history that we have to acknowledge and move past,” said Lisa L. Barnes, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago. “A lot of minority communities still feel that research involves being a guinea pig. Nobody wants to be used. Nobody wants to be a guinea pig.”

Shirley Fitch, who lives south of Chicago, said no thank you to Rush researchers on behalf of her husband, Clarence. The former university professor died last summer at age 86, seven years after being diagnosed with dementia.

“I’m hesitant because of distrust,” said Fitch. “Once my brain is donated for one purpose, who is to say it won’t be used for another purpose? It is out of your control.”

Although Shirley Fitch is participating in non-Alzheimer’s research at Rush, she said the historical abuses of black people have been “awful and hard to get over.”

Even today, blacks tend to get worse treatment from hospitals, she said. “It all gets stirred in the pot as to feelings about bias.”

Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband. (Anna Gorman/KHN)

The Knowledge Gap

The precise explanations for the disparities among blacks and whites are unknown. Until recently, most of our understanding of the pathology of dementia was largely based on studies of white patients.

“We have a real knowledge gap in accurately knowing if dementia is different in minorities as compared to whites,” said John Olichney, a neurologist and clinical director of the Alzheimer’s Disease Center at the University of California-Davis.

Scientists say blacks’ disproportionate rates of dementia may be related in part to the prevalence of disorders that raise the risk of vascular disease: diabetes and hypertension, for instance. Socioeconomic factors such as higher rates of poverty and lower levels of education also seem to play a significant role, according to research led by the University of California-San Francisco.

Despite advances in imaging technology that allows researchers to peer into the brains of live patients, studying the organ after death is crucial to a deeper understanding of the causes and progression of disease and to developing drug treatments, Olichney said.

The challenge is getting enough brains from different populations to study. It’s not just a matter of assuring potential donors that Tuskegee and other ethical debacles are in the past. To gain trust, Alzheimer’s research facilities such as UC-Davis and Rush University are also trying to diversify their staffs, collaborate with community leaders and study religious and cultural beliefs on brain donation.

For example, some African-Americans don’t want their brain separated from their body when they are buried, said Stephanie Monroe, director of African Americans Against Alzheimer’s, which is engaged in various efforts to educate people about the disease and its effects.

“Many people believe in ashes to ashes and dust to dust,” she said.

A Changing Mindset

Alzheimer’s researchers at UC-Davis recognized about 15 years ago that they needed a more representative slice of the population, especially in diverse Northern California. At the time, centers around the country were mostly studying well-educated, white people who volunteered, Olichney said.

So they started reaching out to both the African-American and Latino communities. “That was a real change in our mindset,” he said.

Today, nearly 400 patients, including about 70 African-Americans, are enrolled in its longitudinal study of the progression of dementia, and they come in yearly for memory evaluations and other tests. Of the study participants, about 270 have agreed to donate their brains after death, more than 40 of them African-American.

At the Rush Alzheimer’s Disease Center, doctors started following a cohort of African-Americans in 2004 and, some seven years later, began to seek brain donation for the study. Close to 500 African-Americans have signed up to donate after death, and 72 brains already have been donated, Barnes said.

Though she is pleased with the high rate of commitment, she noted that more works needs to be done. In another study, about 3,100 white participants agreed to brain donation, with 1,400 already donated. Recruiting African-Americans “takes a lot of effort and a lot of work,” she said. “Every year, we bring it up again and revisit it with those who are reluctant. But if someone is really firm, we don’t push the subject.”

Research on the donated brains has led to intriguing findings. One Rush study, published in 2015, found that blacks with Alzheimer’s disease were more likely than whites to have other disorders, such as Lewy body dementia. Twice as many blacks with Alzheimer’s as whites with the disease also had Lewy body dementia, in which protein deposits build up in nerve cells, according to the study. Blacks with dementia also had more severe disease of the arteries, the study found.

The number of blacks studied was relatively small — 41 compared with 81 whites — yet its findings were potentially important. That’s because the presence of other diseases in the brain means blacks may not respond as white patients do to drugs aimed specifically at Alzheimer’s.

Even for experienced research institutions, getting people to participate in donation remains complicated — in part, because families don’t necessarily agree about it among themselves.

Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research. (Anna Gorman/KHN)

Andrea Gourdine remembers clearly when her mother, Gladys Brown, started behaving oddly. Once, the elder woman forgot a stove burner was on and a dish exploded. Then she stopped bathing regularly. “And she was normally fastidious,” Gourdine said. “Something was really, really wrong.”

Brown enrolled in the research at UC-Davis, was diagnosed with Alzheimer’s in 2005 and soon after agreed to donate her brain. It won’t help me, Brown told researchers, but it could help others. She died in 2012, at 87.

Gourdine also signed up for the UC-Davis study and has consented to donate her brain. She does not have Alzheimer’s, but researchers are seeking brains of those without dementia for comparison.

She is aware of the history of medical abuse of African-Americans but says she doesn’t see any point in focusing on the past.

Gourdine’s sister, India Collins, disagrees with her sister and objected to her mother’s donation.

“I have problems with scientific research and I get very upset with scientific data and outcomes in general,” said Collins. She questions how helpful it is to African-Americans. “Why would you want to participate in their research if it does not benefit you?”

Expanding The Brain Trust

Gwen Gates, a recruiter and research coordinator at the UC-Davis center, goes to churches, health fairs and other events to build trust and develop deeper relationships among the university and minority communities. Patients and families want to know what scientists do with the brains. They worry about how relatives will react. They fear donation will interfere with funeral arrangements or their plans for an open casket.

She assures them it won’t. She explains that brain donations will help future generations, perhaps even in their own family.

Occasionally, families readily agree. Some adamantly refuse. For others, the decision is a process.

Dorothy Reeves declined brain donation initially but agreed to sign up herself and Levi, 81, for observational studies. Then she saw what the disease could do. Her husband, who has Lewy body dementia, went under a table one day to get a magazine and couldn’t find his way out. He forgot her name and those of his children.

She thought about all the other people like Levi.

“It affects people in ways you can’t imagine — regardless of your race,” she said. “It’s almost unbearable.”

Soon the researchers had their answer. Yes, she would agree to donation — for both of them.

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

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Viewpoints: Opioid Epidemic Demands Focus, Urgent Action And Big Spending; Paying For Organs?

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

St. Louis Post-Dispatch: A Well-Founded Call For Urgent Action, Big Spending, To Address The Opioid Crisis
Reports of presidential commissions tend to have the lifespan of a mayfly. They get attention for one day and then are quietly filed away. The nation must insist that that doesn’t happen to the work of President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. The commission, created by Trump’s executive order in March, issued its draft report last week. It called on Trump to “declare a national emergency” to force Congress to fund a multipronged, treatment-based attack on the problem and to “awaken every American to this simple fact: If this scourge has not found you or your family yet, without bold action by everyone, it soon will.” (8/6)

The Washington Post: How To Reverse A Catastrophe
There is, alas, no shortage of ways to measure the damage done by the nationwide opioid epidemic, but perhaps the most dramatic is to consider how it has reversed four decades of progress against preventable deaths in the United States. Between 1975 and 2015, hard work by government, the private sector and individuals cut the motor vehicle accident death rate by nearly half, from 20.6 per 100,000 people to 10.9. A similar all-out effort cut the homicide rate from 9.6 per 100,000 to 4.9. These figures translate into hundreds of thousands of lives saved. Yet the opioid epidemic has driven the national death rate from overdoses of these drugs to 9.3 per 100,000 in 2015, up from 0.4 in 1975, according to data assembled in a stunning new report from the congressional Joint Economic Committee’s Social Capital Project. (8/3)

The New York Times: Should I Help My Patients Die?
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. … California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this. ut that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it. (Dr. Jessica Nutik Zitter, 8/5)

Chicago Tribune: Football And CTE: The Dilemma For Parents
The e names of NFL players tormented by the degenerative brain disease CTE are well-known: Dave Duerson, Mike Webster, Junior Seau, to name a few. Parents would be smart to familiarize themselves with another name linked with chronic traumatic encephalopathy: Zac Easter. Zac began playing organized football when he was 8 and didn’t stop until his senior year of high school in Indianola, Iowa. Concussions marred his days as a linebacker. After he stopped playing, Zac coped with depression, headaches and slurred speech. At 24, he took a shotgun from his father’s truck, drove to a state park, and blasted a hole into his chest. A postmortem examination of Zac’s brain confirmed what the young man had long suspected: He suffered from CTE. (8/6)

RealClear Health: A Solution To Surprise Medical Billing
Imagine two people, with the same health insurance companies, walk into an emergency room. The patients have identical symptoms and receive the same diagnoses and subsequent procedures and treatments. Both patients should get an identical bill, right? But in reality, one patient could receive a bill where nearly everything is covered by insurance, and the other could receive a bill where little or nothing is covered. For some patients, this can be the difference between an emergency room bill that cost several hundred dollars, versus one costing tens of thousands. (Ronnie Shows, 8/7)

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State Highlights: Calif. Assembly Speaker Faces Recall After Sidelining Single-Payer Bill; Vermont Grapples With Funding Care For Those With Disabilities

Media outlets report on news from California, Vermont, Kansas, Wisconsin, Ohio, Texas, Michigan, Minnesota, Florida, Massachusetts, New York and Pennsylvania.

The Associated Press: California Speaker Recall Effort Reflects Democratic Tension
Democrats control every lever of power in California state government, and free from worrying about major losses to Republicans, they’re training fire instead on each other. The latest example is a recall effort against Assembly Speaker Anthony Rendon, a strong progressive now targeted by party activists upset that he derailed a bill seeking government-funded health care for all. (8/5)

WBUR: As Clients And Caregivers Age, Vermont Revamps Services To People With Disabilities
Vermont has long been a leader in supporting adults with developmental disabilities: It was one of the first states in the U.S. to shut down its institutional hospital and move adults with disabilities out into their communities. But the state is now grappling with how to fund quality services for those with disabilities as they — and their caregivers — age. (Weiss-Tisman, 8/4)

Milwaukee Journal Sentinel: Community Health Workers Offer A Bridge To Health In Low-Income Areas
Community health workers often are trusted members of the communities they work in and are able to connect residents to health and social services that are specific to their needs. …Because these workers are familiar with the communities where they work, they have shared experiences and often understand their residents better than a health professional with multiple degrees would. (Guerra Luz, 8/4)

Columbus Dispatch: More Ohio Parents Don’t Want Kids Vaccinated, But Numbers Still Small
This time of year, parents are checking the items off their child’s back-to-school list: pencils, pens, scissors, glue, notebooks, backpack. But there’s another back-to-school-list some parents forget: DTaP, chickenpox, MMR, hepatitis B, polio, and meningococcal — the six vaccinations Ohio law requires students receive before attending school. (Williams, 8/6)

NPR: South Texas Launches New Effort To Diagnose And Treat Tuberculosis
At San Antonio’s largest homeless shelter, huge fans cool off the temporary residents. The courtyard can get crowded. One of the hundreds of nightly boarders is James Harrison. “I lost my apartment and had nowhere else to go,” he explains. Like most people at Haven for Hope, Harrison, who is 55, doesn’t plan on staying long. But while he’s here, he’s taking advantage of some free medical testing — a screening for dormant tuberculosis. (Rigby, 8/4)

Los Angeles Times: What We Know About California’s Largest Toxic Cleanup: Thousands Of L.A. County Homes Tainted With Lead
By this fall, California’s Department of Toxic Substances Control plans to begin removing lead-tainted soil from 2,500 residential properties near the shuttered Exide Technologies battery recycling plant in Vernon. The cleanup — the largest of its kind in California history — spans seven southeast Los Angeles County neighborhoods, where plant operations have threatened the health of an estimated 100,000 people. (Barboza and Poston, 8/6)

Kansas City Star: Dangerous Chemicals In KC Area Water Listed In Database
It’s easy to check, using a database published last week by the national Environmental Working Group, which allows anyone to punch in their ZIP code and see a list of potentially harmful chemicals found in the local tap water. The database, which includes water utilities from all over the Kansas City area, shows test results collected from nearly 50,000 public water systems in all 50 states. (Cummings, 8/4)

Detroit Free Press: Thousands Expected To Seek Free Medical, Dental Care At At Cobo Center
Thousands of uninsured or underinsured metro Detroiters are expected to flood Cobo Center this week for free medical and dental care through a nonprofit that serves the needy population across the country and worldwide. The Motor City Medical Mission (MCMM), which could turn out to be the largest health care clinic ever in Detroit, will operate Thursday through Saturday in downtown Detroit. No identification, address or documentation of need is required. Nor are attendees being asked to register, just simply walk in. Attendees will be seen on a first-come, first-served basis. (Pais-Greenapple, 8/7)

Los Angeles Times: Rich And Powerful Figures Will Set USC Course In Wake Of Scandal, From Behind Closed Doors
How USC handles one of the biggest scandals in its history will be decided behind closed doors by a small group of wealthy and powerful people. Composed of 57 voting members, USC’s board of trustees includes noted philanthropists, accomplished alumni, Hollywood insiders and industrial tycoons. The group’s influence extends from the floor of Staples Center to metropolises in India and China. (Kohli, Parvini, Hamilton and Elmahrek, 8/6)

KCUR: KU Cancer Center To Persist In Quest For Prestigious ‘Comprehensive’ Designation 
The director of the University of Kansas Cancer Center says it will continue to pursue “comprehensive” status after the National Cancer Institute denied it that coveted designation this week. “We’re just going to be absolutely fearless in moving forward with this initiative,” says Dr. Roy Jensen, who has led the KU Cancer Center since 2004.Jensen says it typically takes 10 to 15 years to attain comprehensive status, a recognition that an institution has demonstrated a high level of excellence over an extended period of time. The KU Cancer Center only received National Cancer Institute (NCI) designation in 2012 – a status that was renewed for another five years this week – so the denial of comprehensive status was not entirely unexpected. (Margolies, 8/4)

Tampa Bay Times: How The ‘No Wrong Door’ Approach To Mental Health Treatment Is Playing Out In Hillsborough County
The facility, the only one of its kind in the Tampa Bay area, serves as a behavioral health emergency room with a coordinated web of services to ensure the person in crisis is getting the right level of care, said Gracepoint CEO Joe Rutherford. The concept has existed for years but gained steam statewide last year with the passage of a law that overhauled mental health and substance abuse treatment and mandated a “no wrong door” approach for people entering the system. (Varn, 8/4)

The Star Tribune: Minneapolis City Council Approves Menthol Tobacco Restriction
The City Council approved a restriction on menthol tobacco Friday, limiting sales to adult-only tobacco shops and liquor stores. The vote was the culmination of a community-led effort to reduce access to menthol tobacco, a product that historically has been marketed to black smokers and that anti-smoking activists say makes it easier for young people to start smoking. (Nelson, 8/4)

San Jose Mercury News: Santa Clara: Family Sues City After Police Killed Their Son
Underneath the red, purple and yellow poncho from Colombia bearing the name of her slain son, Amanda Sommers’ shoulders trembled. The mother of Jesús A. Geney, a 24-year-old man killed by Santa Clara police while suffering a mental breakdown, stood in front of Santa Clara City Hall on Saturday to announce her family is suing the city. (Giwargis, 8/5)

The Associated Press: Doctor Told To Stop Marketing 3-Person Baby Technique
U.S. regulators on Friday warned a New York fertility doctor to stop marketing an experimental procedure that uses DNA from three people — a mother, a father and an egg donor — to avoid certain genetic diseases. The doctor, John Zhang, used the technique to help a Jordanian couple have a baby boy last year. (Johnson, 8/4)

The Star Tribune: University Of Minnesota Bioethicist Takes On Clinics Touting Stem-Cell Studies
Listed on a government website, they present the opportunity to participate in clinical trials to test the potential of one of the most promising tools in medicine — the body’s own stem cells. …Now, with a national debate raging over the future of one of the hottest frontiers in 21st-century medicine, a University of Minnesota bioethicist has taken center stage in questioning whether many of these services are legitimate. (Carlson, 8/5)

The Associated Press: Nurse Pleads Guilty To Secretly Filming Female Patients
Authorities say a Pennsylvania nurse has pleaded guilty to secretly filming unclothed female patients as they underwent medical procedures. Bucks County prosecutors say 45-year-old James Close admitted Friday that he videotaped the women, including a 17-year-old girl, during dermatology treatments at Penn Medicine in Yardley. (8/4)

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When Wounds Won’t Heal, Therapies Spread — To The Tune Of $5 Billion

PHILADELPHIA — Carol Emanuele beat cancer. But for the past two years, she has been fighting her toughest battle yet. She has an open wound on the bottom of her foot that leaves her unable to walk and prone to deadly infection.

In an effort to treat her diabetic wound, doctors at a Philadelphia clinic have prescribed a dizzying array of treatments. Freeze-dried placenta. Penis foreskin cells. High doses of pressurized oxygen. And those are just a few of the treatment options patients face.

“I do everything, but nothing seems to work,” said Emanuele, 59, who survived stage 4 melanoma in her 30s. “I beat cancer, but this is worse.”

The doctors who care for the 6.5 million patients with chronic wounds know the depths of their struggles. Their open, festering wounds don’t heal for months and sometimes years, leaving bare bones and tendons that evoke disgust even among their closest relatives.

Many patients end up immobilized, unable to work and dependent on Medicare and Medicaid. In their quest to heal, they turn to expensive and sometimes painful procedures, and products that often don’t work.

According to some estimates, Medicare alone spends at least $25 billion a year treating these wounds. But many widely used treatments aren’t supported by credible research. The $5 billion-a-year wound care business booms while some products might prove little more effective than the proverbial snake oil. The vast majority of the studies are funded or conducted by companies who manufacture these products. At the same time, independent academic research is scant for a growing problem.

“It’s an amazingly crappy area in terms of the quality of research,” said Sean Tunis, who as chief medical officer for Medicare from 2002 to 2005 grappled with coverage decisions on wound care. “I don’t think they have anything that involves singing to wounds, but it wouldn’t shock me.”

A 2016 review of treatment for diabetic foot ulcers found “few published studies were of high quality, and the majority were susceptible to bias.” The review team included William Jeffcoate, a professor with the Department of Diabetes and Endocrinology at Nottingham University Hospitals Trust. Jeffcoate has overseen several reviews of the same treatment since 2006 and concluded that “the evidence to support many of the therapies that are in routine use is poor.”

“I don’t think they have [any therapy] that involves singing to wounds, but it wouldn’t shock me.”

Sean Tunis, former Medicare chief medical officer

A separate Health and Human Services review of 10,000 studies examining treatment of leg wounds known as venous ulcers found that only 60 of them met basic scientific standards. Of the 60, most were so shoddy that their results were unreliable.

While scientists struggle to come up with treatments that are more effective, patients with chronic wounds are dying.

The five-year mortality rate for patients with some types of diabetic wounds is more than 50 percent higher than breast and colon cancers, according to an analysis led by Dr. David Armstrong, a professor of surgery and director of the Southern Arizona Limb Salvage Alliance.

Open wounds are a particular problem for people with diabetes because a small cut may turn into an open crater that grows despite conservative treatment, such as removal of dead tissue to stimulate new cell growth.

More than half of diabetic ulcers become infected, 20 percent lead to amputation, and, according to Armstrong, about 40 percent of patients with diabetic foot ulcers have a recurrence within one year after healing.

Carol Emanuele of Philadelphia shows a photograph of a wound VAC (vacuum-assisted closure) procedure on her left foot after the amputation of her big toe. (Eileen Blass/for Kaiser Health News)

“It’s true that we may be paying for treatments that don’t work,” said Tunis, now CEO of the nonprofit Center for Medical Technology Policy, which has worked with the federal government to improve research. “But it’s just as tragic that we could be missing out on treatments that do work by failing to conduct adequate clinical studies.”

Although doctors and researchers have been calling on the federal government to step in for at least a decade, the National Institutes of Health and the Veterans Affairs and Defense departments haven’t responded with any significant research initiative.

“The bottom line is that there is no pink ribbon to raise awareness for festering, foul-smelling wounds that don’t heal,” said Caroline Fife, a wound care doctor in Texas. “No movie star wants to be the poster child for this, and the patients … are old, sick, paralyzed and, in many cases, malnourished.”

The NIH estimates that it invests more than $32 billion a year in medical research. But an independent review estimated it spends 0.1 percent studying wound treatment. That’s about the same amount of money NIH spends on Lyme disease, even though the tick-borne infection costs the medical system one-tenth of what wound care does, according to an analysis led by Dr. Robert Kirsner, chair and Harvey Blank professor at the University of Miami Department of Dermatology and Cutaneous Surgery.

Emma Wojtowicz, an NIH spokeswoman, said the agency supports chronic wound care, but she said she couldn’t specify how much money is spent on research because it’s not a separate funding category.

“Chronic wounds don’t fit neatly into any funding categories,” said Jonathan Zenilman, chief of the division for infectious diseases at Johns Hopkins Bayview Medical Center and a member of the team that analyzed the 10,000 studies. “The other problem is it’s completely unsexy. It’s not appreciated as a major and growing health care problem that needs immediate attention, even though it is.”

Commercial manufacturers have stepped in with products that the FDA permits to come to market without the same rigorous clinical evidence as pharmaceuticals. The companies have little incentive to perform useful comparative studies.

“There are hundreds and hundreds of these products, but no one knows which is best,” said Robert Califf, who stepped down as Food and Drug Administration commissioner for the Obama administration in January. “You can freeze it, you can warm it, you can ultrasound it, and [Medicare] pays for all of this.”

When Medicare resisted coverage for a treatment known as electrical stimulation, Medicare beneficiaries sued, and the agency changed course.

“The ruling forced Medicare to reverse its decision based on the fact that the evidence was no crappier than other stuff we were paying for,” said Tunis, the former Medicare official.

In another case, Medicare decided to cover a method called “noncontact normothermic wound therapy,” despite concerns that it wasn’t any more effective than traditional treatment, Tunis said.

“It’s basically like a Dixie cup you put over a wound so people won’t mess with it,” he said. “It was one of those ‘magically effective’ treatments in whatever studies were done at the time, but it never ended up being part of a good-quality, well-designed study.”

The companies that sell the products and academic researchers themselves disagree over the methodology and the merits of existing scientific research.

Thomas Serena, one of the most prolific researchers of wound-healing products, said he tries to pick the healthiest patients for inclusion in studies, limiting him to a pool of about 10 percent of his patient population.

“We design it so everyone in the trial has a good chance of healing,” he said.

“If it works, like, 80 or 90 percent of the time, that’s because I pick those patients,” said Serena, who has received funding from manufacturers.

But critics say the approach makes it more difficult to know what works on the sickest patients in need of the most help.

Gerald Lazarus, a dermatologist who led the HHS review as then-director of Johns Hopkins Bayview Medical Center wound care clinic, said Serena’s assertion is “misleading. That’s not a legitimate way to conduct research.” He added that singling out only healthy patients skews the results.

The emphasis on healthier patients in clinical trials also creates unrealistic expectations for insurers, said Fife.

“The expensive products … brought to market are then not covered by payers for use in sick patients, based on the irrefutable but Kafka-esque logic that we don’t know if they work in sick people,” she said.

“Among very sick patients in the real world, it may be hard to find a product that’s clearly superior to the others in terms of its effectiveness, but we will probably never find that out since we will never get the funding to analyze the data,” added Fife, who has struggled to get government funding for a nonprofit wound registry she heads. Not surprisingly, she said, the registry data demonstrate that most treatments don’t work as well on patients as shown in clinical trials.

Patients say they often feel overwhelmed when confronted with countless treatments.

Navy surgeon Capt. Pat McKay examines the healing progress of skin grafts on Navy Cmdr. Peter Snyder at Walter Reed National Military Medical Center. (H. Darr Beiser/for Kaiser Health News)

“Even though I’m a doctor and my wife is a nurse, we found this to be complicated,” said Navy Cmdr. Peter Snyder, a radiologist who is recovering from necrotizing fasciitis, also known as flesh-eating bacteria. “I can’t imagine how regular patients handle this. I think it would be devastating.”

To heal wounds on his arms and foot, Snyder relied on various treatments, including skin-graft surgery, special collagen bandages and a honey-based product. His doctor who treats him at Walter Reed National Military Medical Center predicted he would fully recover.

Such treatments aren’t always successful. Although Emanuele’s wound left by an amputation (of her big toe) healed, another wound on the bottom of her foot has not.

Recently, she looked back at her calendar and marveled at the dozens of treatments she has received, many covered by Medicare and Medicaid.

To help Carol Emanuele get around her Philadelphia home, she places a walker inside the threshold of the doorway to her bathroom so she can easily transfer from wheelchair or a walker in order to stay off her feet. (Eileen Blass/for Kaiser Health News)

Some seem promising, like wound coverings made of freeze-dried placenta obtained during births by cesarean section. Others, not — including one plastic bandage that her nurse agreed made her wound worse.

Emanuele was told she needed to undergo high doses of oxygen in a hyperbaric chamber, a high-cost treatment hospitals are increasingly relying on for diabetic wounds. The total cost: about $30,000, according to a Medicare invoice.

Some research has indicated that hyperbaric therapy works, but last year a major study concluded it wasn’t any more effective than traditional treatment.

“Don’t get me wrong, I am grateful for the care I get,” Emanuele said. “It’s just that sometimes I’m not sure they know what they’re using on me works. I feel like a guinea pig.”

Confined to a wheelchair because of her wounds, she fell moving from the bathroom to her wheelchair and banged her leg, interrupting the healing process. Days later, she was hospitalized again. This time, she got a blood infection from bacteria entering through an ulcer.

She has since recovered and is now back on the wound care routine at her house.

“I don’t want to live like this forever,” she said. “Sometimes I feel like I have I no identity. I have become my wound.”

Categories: Aging, Cost and Quality

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Dementia Patients Hold On to Love Through Shared Stories

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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

Photo

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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Pursuing the Dream of Healthy Aging

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Credit Paul Rogers

Given their druthers, most people would opt for a long and healthy life. Few relish the idea of spending years, even decades, incapacitated by illness, dependent on caregivers and unable to enjoy the people, places and activities that make life worth living.

In 1980, Dr. James F. Fries, a Stanford University physician who studied chronic disease and aging, proposed that a “compression of morbidity” would enable most people to remain healthy until a certain age, perhaps 85, then die naturally or after only a brief illness.

Now, a prescient group of experts on aging envisions a route to realizing Dr. Fries’s proposal: one or more drugs that can slow the rate of aging and the development of the costly, debilitating chronic ailments that typically accompany it. If successful, not only would their approach make healthy longevity a reality for many more people, but it could also save money. They say that even a 20 percent cut in how fast people age could save more than $7 trillion over the next half-century in the United States alone.

“Aging is by far the best predictor of whether people will develop a chronic disease like atherosclerotic heart disease, stroke, cancer, dementia or osteoarthritis,” Dr. James L. Kirkland, director of the Kogod Center on Aging at the Mayo Clinic, said in an interview. “Aging way outstrips all other risk factors.”

He and fellow researchers, who call themselves “geroscientists,” are hardly hucksters hawking magic elixirs to extend life. Rather, they are university scientists joined together by the American Federation for Aging Research to promote a new approach to healthier aging, which may — or may not — be accompanied by a longer life. They plan to test one or more substances that have already been studied in animals, and which show initial promise in people, in hopes of finding one that will keep more of us healthier longer.

As Dr. Kirkland wrote in a new book, “Aging: The Longevity Dividend”: “By targeting fundamental aging processes, it may be possible to delay, prevent, alleviate or treat the major age-related chronic disorders as a group instead of one at a time.”

His colleague S. Jay Olshansky, a gerontology specialist in the School of Public Health at the University of Illinois in Chicago, said it is often counterproductive to treat one disease at a time. Preventing cardiac death, for example, can leave a person vulnerable to cancer or dementia, he explained.

A better approach, Dr. Kirkland said, would be to target the processes fundamental to aging that underlie all age-related chronic diseases: chronic low-grade inflammation unrelated to infection; cellular degradation; damage to major molecules like DNA, proteins and sugars; and failure of stem cells and other progenitor cells to function properly.

The team, which includes Dr. Nir Barzilai, director of the Institute for Aging Research at Albert Einstein College of Medicine in The Bronx, and Steven N. Austad, who heads the biology department at the University of Alabama at Birmingham, plans to study one promising compound, a generic drug called metformin already widely used in people with Type 2 diabetes. They will test the drug in a placebo-controlled trial involving 3,000 elderly people to see if it will delay the development or progression of a variety of age-related ailments, including heart disease, cancer and dementia. Their job now is to raise the $50 million or so needed to conduct the study for the five years they expect it will take to determine whether the concept has merit.

The project represents a radical departure from ordinary drug studies that test treatments for single diseases. However, the group, spearheaded by Dr. Barzilai, said the Food and Drug Administration has endorsed their idea to test a single substance for effectiveness against a range of ailments.

“If metformin turns out not to work, there are several other substances in the pipeline that could be tried,” Dr. Barzilai said. “Under the auspices of the National Institute on Aging, three research centers have tested 16 substances in different animal models and got incredible results with four of them.”

Green tea, one of those tested, bestowed no health or life span benefits, despite its popularity. But the drug rapamycin, an immune modulator used following organ transplants, was most effective among those tested, Dr. Barzilai said.

The team is starting with metformin because it is a cheap oral drug — costing about two cents a pill — with six decades of safe use in people throughout the world. Among those with Type 2 diabetes who have taken it for years, there is evidence suggesting that, in addition to diabetes, it protects against cardiovascular disease, cancer and possibly cognitive impairment, Dr. Kirkland said, adding that “it targets the fundamental processes of aging, which tend to be linked.”

Dr. Barzilai said, “Our goal is to establish the principle of using a drug, or two in combination, to extend health span. The best we can expect from metformin is two or three additional years of healthy aging. But the next generation of drugs will be much more potent.”

Dr. Barzilai is already conducting a complementary study of centenarians, the results of which could identify more drugs to delay age-related diseases. He and colleagues are isolating genes that appear to keep these long-lived men and women healthy for 20 to 30 years longer than other people and shorten the length of illness at life’s end. Several studies have already found that individuals with exceptional longevity experience a compression of morbidity and spend a smaller percentage of their life being ill, Dr. Barzilai and his colleague Dr. Sofiya Milman wrote in the “Aging” book.

By analyzing the action of genes that extend health span, “it should be possible to devise drugs that mimic the genes’ effects,” he said. Two such gene-based drugs that show early promise against age-related diseases are already being tested.

But until definitive studies are completed and substances are shown to be safe as well as effective in prolonging health, Dr. Olshansky cautioned against dosing oneself prematurely with widely touted substances like resveratrol, the antioxidant found in red grapes and wine, or growth hormone.

Consumers must exercise caution, he warned, because “there’s an entire industry out there trying to market the products we’re testing before they are adequately evaluated.”

He also emphasized that taking a drug found to ward off age-related ills is not a license to abandon a healthy lifestyle. Doing so “could completely negate the benefit of a compound that slows aging,” he said.

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